A medical student resents having to make smart choices. Here’s why.
The human experience is an exercise in connection. Nothing is seen, heard, or felt in isolation. This is what can make womanhood in a large urban city so challenging. A catcall is not a single comment, heard on a single morning about the tightness of your jeans or the way your hair falls; but instead carries with it every unsolicited thing you’ve ever heard about your body, a shadow of every time someone has touched or cornered you without permission, every time you’ve ever felt unsafe.
This is not something the fourth-year medical student leading my clinical experience team likely thought about when he selected me, al...
Source: Kevin, M.D. - Medical Weblog - December 3, 2015 Category: Journals (General) Authors: Anonymous Tags: Education Emergency Medical school Source Type: blogs
Telehealth under alternative payment models
The post below originally ran on Milliman, Inc. on November 23.
Telehealth, as a modality of delivering healthcare services, is growing in terms of acceptance and adoption. There are a few key drivers for this dynamic: (1) consumer demand for convenient access to care; (2) availability of lower-cost telehealth technologies; (3) clinician comfort and willingness to provide certain services remotely; and (4) evolving payment models that seek to incentivize value and better population health.
Evolving payment models reflect the need to mitigate perverse incentives for the unnecessary healthcare utilization, waste, and ineffic...
Source: Disruptive Women in Health Care - November 25, 2015 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Innovation Technology Source Type: blogs
Pharmaceutical Pricing – A Reminder of the Value Equation
We previously wrote about the actions Congress is taking to "combat rising prescription drug prices," and the rhetoric politicians of all stripes are using in an attempt to force public opinion on their side. HHS has announced a pharmaceutical pricing forum set for November 20, Congress has committees on both sides working toward a "solution," and Hillary Clinton has said that if she is elected president, she would "demand a stop to excessive profiteering and marketing" by the drug industry.
Often left out those discussions includes the value of medications, PhRMA has recently released a forty-deck slideshow that addresse...
Source: Policy and Medicine - November 25, 2015 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs
Pleural effusion in heart failure – on which side is it more common?
Brief Review
Conventionally it is considered that pleural effusion in heart failure is more common on the right side. If it is bilateral, it is likely to be more severe on the right side. In fact if it is more on the left side, the conventional teaching is that a cause other than heart failure is to be looked for. There have been several discussions on the sidedness of pleural effusion in heart failure one view is that the larger surface area of right lung permits more transudation into the right pleural cavity. Another technical aspect is that an enlarged heart on the left side may prevent the detection of minimal effusio...
Source: Cardiophile MD - November 14, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology heart failure pleural effusion pleural effusion in heart failure Source Type: blogs
Prosthetic valve associated hemolysis
Brief Review
Prosthetic valve associated hemolysis is more with paravalvular leak, endocarditis and structural failure in bioprosthetic valve. Prosthetic valve dehiscence is an important cause for prosthetic valve associated hemolysis [1].
Control of hypertension with beta blockers can reduce hemolysis as the shear stress reduced. One of the earlier studies used propranolol to reduce hemolysis in patients with aortic prosthetic valve [2]. Three of the five patients given propranolol in their study had a clear decrease in hemolysis. One of their patients developed congestive heart failure with propranolol therapy at 6 mont...
Source: Cardiophile MD - November 10, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac Surgery paravalvar leak Prosthetic valve dehiscence Source Type: blogs
The discovery period regarding the existence of life
What do I need to know as I age? While scientists ponder the questions of water existing on Mars and if it can essentially sustain life, my duty it to assess if there is life left in Oliver — a nursing home patient transferred to the ER. Oliver was not oxygenating well but appeared to be resting comfortably. Reportedly, Oliver had fallen that day and EMS discovered a sizeable bruise on his chest. Did Oliver have a collapsed lung or did his underlying congestive heart failure worsen? With age, my need to know about other planets and disease processes in patients approaching the end of life has become more select...
Source: Kevin, M.D. - Medical Weblog - October 29, 2015 Category: Journals (General) Authors: Kevin Haselhorst, MD Tags: Physician Emergency Palliative care Source Type: blogs
The High Cost of High Cost
By ROB LAMBERTS
“You don’t charge enough.”
I’ve heard this from a lot of folks. I’ve heard it from my accountant (of course), other doctors, consultants, and even some of my patients. I’ve had some patients who are especially complex offer to pay me more because of the difficulty of their care. I think they feel guilty and worry I’m upset that they are being “too demanding” for what they are paying. I don’t ever take extra money.
When I recently told an elderly patient’s family that I was willing to do house calls if/when the woman needed it, their qu...
Source: The Health Care Blog - October 16, 2015 Category: Consumer Health News Authors: Simon Nath Tags: THCB Rob Lamberts Source Type: blogs
What Cardiologists Can Teach Economists
By MICHEL ACCAD, MD
I had the great fortune and pleasure of studying under the late Kanu Chatterjee during my cardiology fellowship at the University of California San Francisco.
In the early 1970’s, Dr. Chatterjee was among the first to understand the benefits of “afterload reduction” for the treatment of congestive heart failure:
Prior to that time, giving medications that could lower the blood pressure was often seen as heretical. In fact, during the 1950’s and 1960’s, the treatment of heart failure sometimes consisted in applying measures to raise the blood pressure and increase the work of the heart.
The...
Source: The Health Care Blog - October 14, 2015 Category: Consumer Health News Authors: Simon Nath Tags: THCB MICHEL ACCAD Source Type: blogs
A patient turns down hypertension treatment. What happens next is tragic.
I have previously written about a patient on this site: “How elderly patients can be stubborn to their own detriment.” In that post, I discussed how the patient repeatedly turned down appropriate therapy for her hypertension, saying she didn’t need the help. Now I’m writing an update.
Due to the patient’s refusal to accept treatment for her hypertension, despite counseling on the part of her cardiologist and primary care physician that she needed to be on a daily medication for it, she has now found herself in an unenviable place. Fifteen years later, she is now dealing with the following medical conditions...
Source: Kevin, M.D. - Medical Weblog - October 8, 2015 Category: Journals (General) Authors: Sharon Bahrych, PA-C, MPH Tags: Physician Geriatrics Heart Primary care Source Type: blogs
Narrative Matters: Poems On The Patient Experience And The Practice Of Medicine
Editor’s note: This spring, Health Affairs held its first ever poetry contest. Three winning poems were published in the journal. We’re also featuring some of our other favorites on the Blog throughout the month of October.
Operating Room Report (or: Uses of the Passive Voice)
I. What Dr. X Wrote
The patient
was consented, told
the complications,
risks, benefits, alternatives.
The patient
was brought to the room,
prepped and draped
in sterile fashion.
Upon entering the cavity,
a large amount of blood
was noted
the patient
at that moment, became
unstable.
No distal pulses detected.
II. What the Patient Remembers
...
Source: Health Affairs Blog - October 8, 2015 Category: Health Management Authors: Jessica Bylander Tags: Elsewhere@ Health Affairs Narrative Matters Cindy Potts medicine Micaela Mascialino Narrative Matters poetry patients Source Type: blogs
Using EHR Data to Manage Hypertension More Aggressively
By JOSH GRAY
The NIH (National Institutes of Health) recently released initial results from its SPRINT (Systolic Blood Pressure Intervention Trial) study, suggesting more aggressive treatment for hypertension may reduce risk for cardiovascular events by 30 percent and the risk of death by 25 percent.
The SPRINT group recruited over 9,000 non-diabetic subjects aged 50 or older with systolic blood pressure (SBP) over 130. Individuals were then randomly assigned to either a standard treatment goal of lowering SBP below 140 or a more intensive treatment goal of lowering SBP below 120. The findings were sufficiently compellin...
Source: The Health Care Blog - October 6, 2015 Category: Consumer Health News Authors: Simon Nath Tags: Uncategorized Source Type: blogs
Bundled payments means the death of quality medical care
A recent CMS proposal to bundle payments for doctors and hospitals for hip and knee replacements in 800 model centers has hit a roadblock. The five-year program would have begun January 1, 2016, and nearly 300 comments were received by CMS earlier this month. Apparently most of the comments were not, shall we say, favorable. Even the Federation of American Hospitals protested
For those who are unaware, “bundled payments” means that CMS gives a lump sum of money to pay the doctor and hospital bills for a given procedure. In some ways, this is similar to the diagnostic related group concept, or DRG, from years ag...
Source: Kevin, M.D. - Medical Weblog - September 30, 2015 Category: Journals (General) Authors: David Mokotoff, MD Tags: Policy Medicare Source Type: blogs
The Phonemic Path: A Way to Measure Health That Can Lead to Health Improvement
By ANDY ORAM
We know what improves health–but we’re simply years away from having the tools to achieve it. We know that we can reduce the chronic conditions plaguing the world’s populations by a subtle combination of:
Closely monitoring the behavior of individuals
Linking health goals to treatments and behavior changes
Upgrading the problems in communities that contribute to disease
Such activities call for supple and sophisticated ways to link together disparate types and sources of information–the subject of this article. Doing such linking requires a new way of approaching data that is lacking ...
Source: The Health Care Blog - September 3, 2015 Category: Consumer Health News Authors: Simon Nath Tags: THCB Andy Oram Phenomic path Source Type: blogs
This story will show you how doctors are like sidewalk jugglers
The job of being a doctor can sometimes be like that of your favorite sidewalk juggler. It used to be that a good family doctor would have to show up in the clinic for a couple of hours, make a few house calls, and be available if anyone needed him while he played a round of golf in the afternoon. (Really, this is quite an exaggeration but it sets the tone.)
In reality, most doctors today must compartmentalize their day, prioritize the patients from most sick to least sick, and then organize a plan of attack that then needs to be carried out with sniper-like precision. (Also a bit of an exaggeration for most doctors. But i...
Source: Kevin, M.D. - Medical Weblog - August 30, 2015 Category: Journals (General) Authors: David Jones, MD Tags: Physician Primary care Source Type: blogs
August Men of the Month: Dr. Timothy Harlan & Chef Bill Barum
Today begins our Culinary Nutrition Series, through next Wednesday we will be running posts from experts who will explore the relationship between food and health. Bon appetit! In August we have the pleasure of naming two Men of the Month, the first Dr. Harlan (post below) and the second Chef Bill Barum (see his post here).
With an August theme of The Link Between Food and Health, Dr. Timothy Harlan was the natural choice as one of the two Disruptive Women in Health Care’s Man of the Month. While many physicians have developed an interest in food, Dr. Harlan was a chef and restauranteur first, and then developed an in...
Source: Disruptive Women in Health Care - August 24, 2015 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Food Man of the Month Nutrition Source Type: blogs
