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Check Out Me & My Doctor
A decade or two ago, health care was strictly between patients and their doctors. Patients and their doctors had candid and open conversations and were in charge. That’s not the case today. Instead, the government, insurance companies, and politicians are making the decisions. Health care has become too bureaucratic, too confusing, and too complicated.

Plus, with all the rhetoric surrounding health care – everyone is confused.

We want to help patients and doctors find a new and better way to talk to each other. The purpose of TMA's new Me & My Doctor blog is to create a dialogue between patients and doctors where they can discuss important health care issues, such as the new health law, government health insurance programs (Medicare, Medicaid and TRICARE), health insurance, and hundreds of other topics. We invite you to join to the discussion. Please feel free to ask questions, share your concerns and insights.
Physician-Written Blogs for Your Consideration

From Texas Physicians:

NEW DocbookMD, by Tracey Haas, DO, MPH, Austin

Dr.Winsett.com, by Owen Winsett, MD, Austin

Hot Shots, by Melanie E. Mouzoon, MD, Houston

American Health Scare, by Richard Young, MD, Fort Worth

Austin Dermatology and Vein Treatments, Steven E. Zimmet, MD, Austin

organicgreendoctor, by family physician DeWayne Nash, MD, Cedar Park

Residency Notes, by neurosurgery resident Colin Son, MD, San Antonio

Dr. B. Culp: Scrubbing In to Explore Life, by surgery resident Brittney Culp, MD, Dallas

TrendsMD, from the physicians, attorneys, and insurance experts at Texas Medical Liability Trust

Ben's Blog, by Ben Raimer, MD, Galveston

Echos for the Future: Reflections on the State of Healthcare, by Rob Tenery, MD, Dallas

33 Charts, by Bryan Vartabadian, MD, The Woodlands

Grunt Doc, Ramblings of an Emergency Physician in Texas

docdano, by Dan McCoy, MD, Dallas

Digitized Medicine, by Matt Murray, MD, Fort Worth

From Other U.S. Physicians

KevinMD, by Kevin Pho, MD, a primary care physician in Nashua, NH

Musings of a Distractible Mind, by Dr. Rob, a primary care physician from the Southeastern United States

Dr. Anonymous, by a family physician in Ohio

Better Health, by Val Jones, MD, formerly of WebMD and Revolution Health

Have some suggestions of good doctor-written blogs to add to our list? Let us know.
33 Charts

► Should Doctors be Paid to Use Social Media?

The question of physicians and renumeration for social participation makes great cocktail party, or Twitter, conversation. If you cornered me around a plate of hors d’ouvres, here’s what I might say: I think we have a responsibility to be part of the conversation. All of us should be participating in some way. Optimally we should [...]

► Creating Content Beyond Patients

When we think about doctors using tools of communication, we assume that the only thing they are capable of is creating for patients. When people look at my blog they say, ‘why would a mother of a child with intestinal problems care about that?‘ I never said that they would. And who said that a [...]

► Doctors, Social Media and Shiny Objects

Most presentations to physicians on social media don’t do the job that they should be doing. They focus on the medium rather than what the medium can bring. They focus on tools rather than the value offered by tools. The audience only sees the shiny object. Presentations that tell doctors about social media rarely motivate. [...]

► Medical Microcelebrity

I like to look beyond the confines of medicine in order to understand medicine. And I happen to follow a handful of sociologists who bring me things that get me there. Today I stumbled upon “Not This One”: Social Movements, the Attention Economy, and Microcelebrity Networked Activism by Zeynep Turfekci. The paper explores a new [...]

► Permanence and the Public Physician

The idea of permanence is an important concept for the public physician. It’s important because it’s a new concept. Since the dawn of civilization medical students and doctors have had opinions, ideas, beliefs and complaints. Anger and frustration were around long before the digital medium for sharing. Traditionally remarks went no further than earshot of [...]
Echos for the Future: Reflections on the State of Healthcare

► The Intangibles— Why Paying Paying for Performance Won’t Work

The new buzz phrase in health care delivery is paying for performance, which is the method of tying reimbursements to outcomes. What this formula doesn’t adequately take into account are the intangibles: The efforts, skills and devotion of the providers, the unpredictability of the science and the patients’ comfort level during the process. Provider efforts [...]

► The Money Has to Come from Somewhere

Federal entitlement programs dominate the public debate. Social security, Medicare, Medicaid, and the social welfare programs of food stamps, disability and unemployment insurance are the most widely discussed. As a share of the federal budget, entitlement spending accounts for over 60% (up from 25% in 1960). They can be divided into the programs that are [...]

► Is Doing the Right Thing Passé?

Visiting with associates and even a few of my family members, I wonder why we seem to be divided into two almost opposing positions on the critical issues that affect this country. We come from similar backgrounds or have devoted much of our lives to the medical profession and seem to share the same values. [...]

► What Would Hippocrates Do?

There was a time when physicians in this country spoke with one voice. Beginning in 1847, the American Medical Association was that voice. No more! In the early 1950s, the American Medical Association’s membership penetration was over 75% of physicians. Since then, the percentage has fallen into the mid-teens for a variety of reasons. Although [...]

► The Physicians’ Vanishing Covenant

The patient/doctor relationship began as an act of beneficence— the process of sharing one’s knowledge with another in need. There was no formal contract. Instead of a handshake, the offer was a helping hand. The ultimate goal was one of good, and not for any reward that might come out of the encounter. The relationship [...]
GruntDoc

► I turned 50 today

Some reflections on the first third of my life. I’ve been blessed with people in all stages of my life who supported me, and even when situations didn’t warrant it, they kept believing. My parents are alive and healthy, three terrific kids, two grand kids, a most excellent and accomplished son-in-law (and another in the [...]
Related posts:

I have some OCD; also, my wife gets me. Just went to the kitchen to get a drink. Went...

So long, pencil sharpener I bought some school supplies when I started med school...

Our unrealistic attitudes about death, through a doctor’s eyes We all die. Here’s just a snippet from this doctors’...

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► Our unrealistic attitudes about death, through a doctor’s eyes

We all die. Here’s just a snippet from this doctors’ experience: …Sometimes an estranged family member is “flying in next week to get all this straightened out.” This is usually the person who knows the least about her struggling parent’s health; she’ll have problems bringing her white horse as carry-on luggage. This person may think [...]
Related posts:

Your eyes do not deceive you, it’s different The first new theme for this blog in years. It...

How Doctors Die | The Saturday Evening Post Well written, and I think correct. It’s not a frequent...

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► Zachary Quinto vs. Leonard Nimoy

It’s been a while since I posted something fun:
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► Is farting in the OR transmitting germs?

From the BMJ: “It all started with an enquiry from a nurse,” Dr Karl Kruszelnicki told listeners to his science phone-in show on the Triple J radio station in Brisbane. “She wanted to know whether she was contaminating the operating theatre she worked in by quietly farting in the sterile environment during operations, and I [...]
Related posts:

Health Officials: No Need To Call 911 For Mosquito Bites « CBS Dallas / Fort Worth Unbelievable. FORT WORTH CBSDFW.COM – With hundreds of human cases...

iowahawk: You Didn’t Build That You Didn’t Build That Readings from the Book of Barack...

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► All health-care systems have ‘death panels’ of one sort or another | Full Comment | National Post

Via @medskep on twitter: Many scoff at the term “death panel” — Sarah Palin’s morbid, if misleading description of the powers contained in U.S. government health-care legislation back in 2009. Yet there was a grain of truth in that infamous noun phrase. The fact of the matter is that all health-care systems have “death panels” [...]
Related posts:

How Doctors Die | The Saturday Evening Post Well written, and I think correct. It’s not a frequent...

Class Act: Usain Bolt Drops Everything to Honor U.S. National Anthem | Video | TheBlaze.com Jamaican sprinter and four-time Olympic gold medalist Usain St. Leo...

Health-Care Costs: A State-by-State Comparison – WSJ.com Nice graphs of spending by state, then another breakdown of...

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Digitized Medicine

► AMA Fails To Do Homework on ICD-11 Cost Analysis

The American Medical Association (AMA) failed to complete their homework assignment before concluding in a report that skipping ICD-10 to move directly to ICD-11 is not a feasible option. Just like CMS (see CMS prematurely dismisses the alternative option to...

► EHR Interoperability is a Nervous System

In this scenario the imaginary national health IT nervous system is analogous to the real-life health IT infrastructure being developed at the national and state levels through National Health Information Network (NHIN) Direct project and the State Health Information Exchange (HIE) Cooperative Program. The charged impulses represent each patient’s electronic health information. The axons represent each physician’s cable to the Internet. The gap or synapse represents the present-day constraints on our ability to send and receive electronic health information to one another.

► Vendors Can Raise EHR Safety, Lower Business Risks Through Patient Safety Organizations

Physicians are disturbed when patient care is put at risk due to a problem caused by their use of an electronic health record (EHR). Although they will generally tolerate the situation when their reported problem is effectively managed in a...

► Dangerous Precedent Set To Financially Penalize Doctors Who Fail to Influence Patient Behavior

I strongly oppose use of quality measures that incentivize or penalize physicians based on their ability to influence patient actions when those actions are beyond reasonable control of physicians or if there is no evidence linking such actions to improvements...

► CMS Decision on ICD-10 Spurns Optional Path to ICD-11 Without Comparing Value

"The decision to mandate ICD-10 for covered entities has already been made." This response in the ICD-10 final rule published last Friday by the Department of Health and Human Services (HHS) bluntly spurns the option of foregoing ICD-10 to implement...
TrendsMD (from TMLT)

► Survey shows physicians’ feelings about the changes to health care

by Brian Dittmar A grand experiment is in progress. As a society, we are trying to determine if access to health care can be expanded while simultaneously curtailing costs and maintaining quality of care. Physicians are at the epicenter of this experiment and almost all agree that it is a challenging and uncertain time to [...]

► Failure to follow up with patient

by Louise Walling and Laura Hale Brockway, ELS Presentation A 52-year-old man had been treated for chronic hepatitis C and cirrhosis starting in 1998. Since he had an increased risk of liver cancer, the patient’s gastroenterologist (Gastroenterologist A) recommended monitoring, including semi-annual alpha fetoprotein (AFP) testing and annual liver ultrasounds. The patient did not follow [...]

► Closed Claim Study — Failure to prescribe appropriate antibiotic

by Louise Walling and Laura Hale Brockway, ELS Presentation On September 23, a 39-year-old man came to his family physician with complaints of a skin lesion on the right side of his head. The patient reported redness, pain, and puss discharge from the lesion for four days. Physician action The patient was seen by the [...]

► A new tool to earn CME

A new tool to earn CME; tmlt.inreachce.com… please share this link!

► The Value of Empathy

By Wendy Kaliszewski Empathy is defined as the direct identification with, understanding of, and vicarious experience of another person’s situation, feelings, and motives. Patients and their families want physicians who can not only properly treat and diagnose, but can also show empathy when difficult medical situations arise. Besides patient satisfaction and better patient outcomes, empathy [...]
Residency Notes

► Biological Calculators

Biological computers are not new. There is continual work on creating circuits from cells. Now work out of MIT on an analog computational system. Big enough for MIT to issue a press release. To create an analog adding or multiplying circuit that can calculate the total quantity of two or more compounds in a cell, [...]

► Your Next Prescription Will Come From A Computer

Vinod Khlosa has already made it clear Silicon Valley will be at the forefront of automating health care. He made waves last year by saying that 80% of what physicians do can be done as well or better by a computer. I can’t fault the premise that diagnoses and interpretation of studies and prescription of [...]

► Like All Insurance, Medicaid’s Role In Health Debated

Last week you could watch liberals scramble in response to a New England Journal of Medicine published study. In 2008 Oregon found resources within the state budget to expand Medicaid. There were far more eligible for the expansion than funds available. Oregon held a lottery to enroll 10,000 new people onto the Medicaid rolls. Harvard, [...]

► Post Spinal Tap Headaches Can Be A Real Problem

As a result of the spinal tap I suffered the worst headache I’ve ever experienced and been the weakest I’ve ever felt. — Luol Deng (@LuolDeng9) May 3, 2013 You can imagine that if the pressure inside of your head is high you might, amongst other things, have a headache. Your skull is a closed [...]

► Facing The Truth On Cancer

You need to read this piece in Salon by Mary Elizabeth Williams who is living with widely metastatic melanoma. [T]he fate of people with metastatic cancer is the same as everybody else’s – to go on living until life ends It raises important issues, and links to posts from others on the same subject, about [...]
Austin Dermatology and Vein Treatments

► How to Choose a Sunscreen (& How to Apply it)

Sunscreen is a hugely important tool in the fight against the adverse effects of the sun. It even protects against melanoma, the deadliest form of skin cancer. But not all sunscreens are created equal. You probably already know that expired sunscreen will do you no good, but you might not be sure how to choose [...]
The post How to Choose a Sunscreen (& How to Apply it) appeared first on Austin Dermatology and Vein Treatments.

► Non-Melanoma Skin Cancers You Should Know About

Although it is the most life-threatening form of skin cancer, melanoma is not the only kind of skin cancer that is currently affecting millions in the U.S. and worldwide. To further raise awareness during Skin Cancer Detection and Prevention Month, we’d like to give you a quick rundown of the two most common forms of [...]
The post Non-Melanoma Skin Cancers You Should Know About appeared first on Austin Dermatology and Vein Treatments.

► “What Should I Expect at a Professional Skin Exam?”

This month is Skin Cancer Awareness Month, so if you have been waiting for some added motivation to get your skin examined by a physician, let that fact be it. Health organizations all over the country are stepping up efforts to raise the public’s awareness of skin cancer. A large part of the effort is [...]
The post “What Should I Expect at a Professional Skin Exam?” appeared first on Austin Dermatology and Vein Treatments.

► How to Perform a Self-Exam for Melanoma

Unlike some forms of cancer, melanoma is preventable and highly treatable when caught early. Signs of the cancer are visible on the surface of skin, so the first line of defense against melanoma progression is you. Protect yourself by conducting monthly self-exams to inspect moles and other marks on your body for abnormalities or changes. [...]
The post How to Perform a Self-Exam for Melanoma appeared first on Austin Dermatology and Vein Treatments.

► May is Skin Cancer Awareness Month

May is Skin Cancer Detection and Prevention Month, and to kick it off, the American Academy of Dermatology has designated the first Monday in May “Melanoma Monday”. The Academy is asking people to wear the color orange on that day to raise awareness as well as to motivate the public to get skin cancer detected [...]
The post May is Skin Cancer Awareness Month appeared first on Austin Dermatology and Vein Treatments.
American Health Scare

► The Cost-Effectiveness of Family Physicians

Something has just come up. I’ll get back to complaining about Dr. Oz in a few weeks. In the mean time: I just had a paper published in the journal Family Medicine that took a long time to get here, but the wait was worth it. It has great stories explaining why family physicians deliver better healthcare at a lower cost. If you want to be efficient, read the Results, Table 3, and Figure 1. Here is the link to the paper http://stfm.org/fmhub/fm2013/May/Richard311.pdf For the next few posts, I will take some of the concepts in the paper and expand just a little. For today, I provide an overview. Me and my fellow researchers uncovered lots of themes backed up with great stories about the ways family physicians deliver better care at a lower cost. We arranged these themes into an explanatory model, Figure 1, that transition from some abstract concepts to the practical behaviors that explain the outcomes. We found that the two foundational themes of this model were that 1) family physicians had different personal characteristics, attitudes, and behaviors than other physicians, and 2) this skill set on their part was combined with a deep knowledge of their [...]

► The Wacky Ignorant Dr. Oz, Part I

Dr. Oz is back at it again, spreading ignorance across our fine land. But before I get to the most recent example …. A story about the good doctor that appeared earlier this year in the New Yorker included some fine quotes about his medical statements that have little to no evidence to back them up. From a surgeon professor colleague in New York: “Sometimes Mehmet will entertain wacky ideas—particularly if they are wacky and have entertainment value.” From Eric Topol, MD, who is a very evidence-based cardiologist: “When he tells people the number of sexual encounters they need each year to improve their lives in a specific way, or how to lose weight in three days—this is simply lunacy. The problem is that he is eloquent and talented, and some of what he says clearly provides a service we need. But how are consumers to know what is real and what is magic? Because Mehmet offers both as if they were one.” And finally, his comment that prompted this post was from a YouDocs column on April 29. He said: When you get an annual physical, if you can find out you have high cholesterol and start taking a [...]

► Scare Tactics and Exaggerations of Cancer Centers

A recent report from Reuters talked about the tactics of Cancer Treatment Centers of America. The piece started with a story of a woman who called for help, but was denied after the Center realized she had cancer spread throughout her body. I’m sure this for-profit company is not the only entity who advertises that their centers have spectacular results, then tells the sickest to not pass through their doors. Reuters asked nine cancer experts to review the claims on the Center’s website of survival rates. These experts noticed that the results were skewed in several ways: few elderly patients, almost no insured patients, and almost no Medicaid patients. Results were further skewed by the Center’s acknowledgment that the statistics were only for patients who “received treatment at [the center] for the duration of their illness. This means the more active and wealthier patients who could afford the time away from their hometowns were preferentially included in the survival numbers. The biggest single predictor of health outcomes, across many diseases and conditions, is socio-economic status. If you have a more attractive insurer and personal income, the Center will pick you up in a limo when you fly to one of [...]

► Payers Who Cooperate to Purchase High-Value Healthcare

Two weeks ago, I wrote about the actual lack of success Kaiser has had in reducing healthcare costs very much more than the rest of the U.S. healthcare system. This is a story about a group having a little more success. This is a post originally written by Brian Klepper, PhD on his Care and Cost blog. He is a health economist who is one of the leaders of efforts to lead the non-healthcare industries to push back against the excesses of the healthcare industry. It’s the 83% of the GDP standing up to the 17% of the GDP. Last week I visited with Gary Rost, an unassumingly knowledgeable man and the Executive Director of the Savannah Business Group (SBG), arguably one of the most effective health care coalitions in the country. Their offices are only a couple hours away from my home on the Northeast Florida coast, so it was a quick trip up. SBG was founded in 1982 as a way of mobilizing employer buying power for better care at lower cost. Its reach now extends beyond Savannah about an hour south, north into South Carolina and west from the coast. The vision described on its site is straightforward [...]

► Loss of Professional Joy

Larry Bauer, who is a leader in family medicine education in the northeast U.S., sent out a link to a piece written by teacher who complained about the over-emphasis on standardized tests in secondary education. He felt so bad about it, he quit teaching. Here is the link: http://www.washingtonpost.com/blogs/answer-sheet/wp/2013/04/06/teachers-resignation-letter-my-profession-no-longer-exists/ Larry asked a group of family physicians what they thought about this, and if they felt this way in family medicine. Here is how I responded: We are going through this silly meaningful use hoop-jumping now. This journey is made worse with the limitations of EMRs. Here are some of my frustrations: The bureaucrats want us to measure processes that have been proven to be essentially ineffective, i.e. weight loss counseling in the primary care center. Similarly, we will have to check boxes that we provided tobacco cessation counseling, which everyone knows will mostly be delivered as a quick statement, probably by an MA, that will have no impact on cessation rates (and even if it worked, it doesn’t lower healthcare costs). The diabetes quality measures can’t be directly tied to the diagnosis of diabetes in our EMR (one of the big company’s products), but must be entered separately so reports [...]
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