Choosing Wisely: 5 Questions to ask your doctor

choosing wisely 5 questionsCutting the waste

I’ve posted several times about the Choosing Wisely campaign.

Developed by Consumer Reports and the American Board of Internal Medicine, Choosing Wisely hopes to educate both physicians and patients, and cut back or eliminate unnecessary medical tests, procedures and treatments.

Over-testing and over-treatment are estimated to cost about $200 billion every year. I think that’s a conservative figure, as the financial—not to mention emotional—consequences of too much medicine can be difficult to quantify.

Bringing about change in our behemoth, for-profit healthcare system is a daunting task, and I’m always happy to see signs that it’s catching Continue reading

Rudeness and patient safety

How rudeness affects your healthcare

I just read an article in the New York Times by Perri Klass, MD: Rude Doctors, Rude Nurses, Rude Patients.

Rudeness all around!

Dr. Klass, a pediatrician, refers to a recent study published in a pediatric medical journal. The study looked at how rude or disparaging comments (by an actor playing the part of an infant’s mother) affect the performance of doctors and nurses.

The study’s conclusion?

Rudeness has robust, deleterious effects on the performance of medical teams. Moreover, exposure to rudeness debilitated the very collaborative mechanisms recognized as essential for patient care and

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Tips to save money at the hospital

save money at the hospital“An American Sickness”

I love Elisabeth Rosenthal’s work.

She’s a medical journalist (an MD, but no longer practicing) who wrote a brilliant series of articles on the high cost of healthcare for the New York Times a few years ago.

Now she has a book on the same topic. Because, of course, our healthcare system with its punishing costs for services, drugs and insurance has not improved. If anything, it’s worse.

As a physician, Dr. Rosenthal has experienced first hand the perverse incentives—illness being more profitable than health, after all—and lack of price transparency in our healthcare system. Her book … Continue reading

Healthcare’s perverse financial incentives

A hospital puts profits over patient safety

First do no harm.

That’s part of every medical school graduate’s oath. It should be the motto of anyone working in healthcare.

But I just read a disheartening piece of investigative journalism in my local newspaper, the Seattle Times, about a hospital where I trained, worked, and received care. The story highlights how the perverse financial incentives in healthcare (do more, get paid more) undermine patient care and safety.

…the aggressive pursuit of more patients, more surgeries and more dollars has undermined Providence’s values — rooted in the nonprofit’s founding as a

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“Brain on Fire” – A diagnostic odyssey

brain-on-fireI just finished reading a really gripping and emotional story—Brain on Fire: My Month of Madness by journalist Susannah Cahalan. (Soon to be a movie!)

As a twenty-something cub reporter in New York, Ms. Cahalan began experiencing strange, seemingly unconnected symptoms, such as forgetfulness, paranoia and the sensation that bugs were crawling on one side of her body.

The details of her weeks’ long medical journey—which she had to piece together from medical records, her parents’ journals, and the recollections of friends, doctors and nurses because she couldn’t remember most of it—are a pretty frightening look at today’s fragmented … Continue reading

EHR – Electronic Hell Records

Healthcare Not Fair is a satirical YouTube video series created by a real-life physician, Dr. Waqas Khan, to highlight problems within our broken healthcare system.

Their latest video takes a stab at electronic health records, EHR—or, as they call it, Electronic Hell Records!

Other videos by Healthcare Not Fair:

I just saw my primary care physician a few weeks ago, and I can relate to the fictional patient’s experience in the video. Receptionists really do keep their eyes glued to their computer screens!

My physician isn’t that bad, … Continue reading

Always ask for your medical test results

An error of omission

A few weeks ago there was a lot of news about how medical mistakes are the third leading cause of death in the US, behind heart disease and cancer.

A medical error is defined as “an unintended act (either of omission or commission) or one that does not achieve its intended outcome.”

And now a Philadelphia paper is highlighting one very common mistake: when you and/or your doctor are not informed about a serious finding on a medical test.

The article explains that a well-known local musician (which is why this story is popular on … Continue reading

Hospital safety tips

hospital safetyHospital safety and medical mistakes

A friend forwarded an email to me. It was from a retirement blog he subscribes to, and this particular post was about what the writer, a doctor as well as a blogger, considers “The deadliest place you’re likely to visit this year…”

He’s talking about hospitals. And he’s not being overly dramatic, either.

He knows what many of us in health care know: hospitals can be dangerous to your health. One of my best friends is a physician. We have a pact that if either one of us has to go into the hospital, the … Continue reading

Electronic health records and medical mistakes

I just read a funny-not-funny post on the health care blog KevinMD: This doctor orders pregnancy tests on men. You’re probably doing it too

The author, a physician, laments that his hospital’s electronic health records system (EHR or EMR) makes it way too easy to make mistakes, such as ordering pregnancy tests on male patients.

Now this may sound funny to you, and I know the nurses love to read me the riot act when I do it, but truthfully this is no laughing matter.

As easy as it is to order a pregnancy test on a man, it is

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Save money – When to call an ambulance

I recently read an article about a man who was taken to the ER in an ambulance for a sprained wrist.

And then he was astounded when the ambulance company charged him $250!

“If I wanted to go to the emergency room, I could have taken a cab costing less than $10,” he said.

Or Uber. Or a friend. He learned the expensive way that ambulances are costly—$250 is actually on the cheap end—and should not be used without good cause.

Ambulance costs can range anywhere from a couple hundred dollars to well over $2,000, depending on the length … Continue reading

The “financial toxicity” of cancer

We’ve all heard the phrase “cancer kills.”

But guess what? So can the high cost of treatment.

I just read about a study that came out of the Fred Hutchison Cancer Research Center here in Seattle.

The results won’t surprise anyone familiar with how much cancer treatment costs (a lot!), but researchers found:

…cancer patients who go bankrupt are nearly 80 percent more likely to die than patients who don’t, and some cancers had significantly higher mortality rates. Prostate cancer patients who filed for bankruptcy were almost twice as likely to die; bankrupt colorectal cancer patients were 2.5 times more

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Overuse of CT scans is dangerous and expensive

I read two articles yesterday that complemented each other:

In Kaiser Health News (KHN) Heavy Use Of CT Scans Raises Concerns About Patients’ Exposure To Radiation

And on KevinMD two radiologists posted The financial costs of treating CT-induced cancer

Each underscores the fact that CT scans are significantly overused in American healthcare.

Although CT scans are an essential diagnostic tool, the Food and Drug Administration reports that an estimated 30 to 50 percent of imaging tests are believed to be medically unnecessary.

Considering we spend tens of billions of dollars every year on diagnostic imaging, that’s a lot of wasted … Continue reading

Be informed – “The Patient’s Playbook”

the patient's playbookI’ve spent most of the holiday weekend happily engaged in reading through a pile of health care books.

And the one I absolutely have to recommend to everyone is The Patient’s Playbook: How to Save Your Life and the Lives of Those You Love by Leslie D. Michelson.

Michelson is not a physician, but has worked in the health management field for more than 30 years, helping individuals and companies navigate our crazy health care system.

Based on his experience, he has organized his book into three sections. Each chapter ends with a helpful “Quick Guide” of the most crucial … Continue reading

Heads up about Medicare changes

This post if for any of my readers who are Medicare age or about to be Medicare age.

I think it’s important to understand what changes are in the pipeline that will affect your doctors and their ability to be able to treat you.

Some doctors already refuse to see Medicare patients because of government red tape and poor reimbursement.

But starting in 2017 it’s going to get worse, and many physicians are wondering if they should follow their colleagues and drop out of the Medicare game altogether.

I recently read two posts by physicians on the health care blog … Continue reading

Sad but true – CYA medicine works

A few months ago I posted about CYA—Cover Your Ass—medicine being one reason why too many diagnostic tests are ordered and health care costs are high.

CYA medicine is when the doctor or doctors are pretty sure what your problem is, but they order extra scans and x-rays and blood tests anyway because “failure to diagnose” is one of the leading causes of medical malpractice suits. They aren’t going to take any chances, and who can blame them?

Related story from KevinMD: This is why doctors practice cover your ass medicine

Besides, they don’t pay your resulting medical bill, so … Continue reading