Last Word

Is there a case against shared decision making? Print E-mail
Written by Michel Accad, MD | KevinMD   
Tuesday, 24 July 2018 18:09
In a matter of less than a decade, "shared decision-making" (SDM) has emerged as the uncontested principle that must inform doctor-patient relationships everywhere. Consistently lauded by ethicists and medical academics alike, it has attracted the attention of the government which is now threatening to penalize doctors and patients who do not participate in SDM prior to providing certain treatments, even if the legal process of informed consent has been fulfilled - and even if the treatment is widely considered to be clinically justified.
For example, in a recent issue of JAMA, an editorial approvingly reports that the Center for Medicare and Medicaid Services will soon refuse to pay physicians and hospitals for the implantation of cardioverter-defibrillators unless the decision to implant these life-saving devices was "shared" with the patient. Although the announcement is short on details regarding the formal process by which SDM must be documented to have occurred, the new policy certainly testifies to the unquestioned status SDM has rapidly acquired as a general principle of medical ethics.

Last Updated on Tuesday, 28 August 2018 13:53
Come see for yourself why medicine rarely runs on time Print E-mail
Written by Andrea Eisenberg, MD | KevinMD   
Thursday, 12 July 2018 00:00
"Sorry, I'm running late ... sorry, to keep you waiting." How many times a day do I say that? Sometimes it is every time I walk into a patient's room as if it is a normal greeting. Sometimes patients respond with: "Oh, you aren't late" or "I haven't been waiting long." I can be so obsessed with not being late that I don't realize I'm  actually running on time! But I know it is a common complaint that patients "always" have to wait to be seen by their doctor. One of my senior partners at work used to say "waiting for a good doctor is like waiting to be seated at a good restaurant, it is worth the wait," and never worried about time. I admired how thorough he was with his patients - I don't think any of his patients felt rushed or not heard and came to expect waiting for his care.
Come join me for a day and see for yourself why medicine rarely runs on time... 

Last Updated on Friday, 13 July 2018 17:11
Obesity from a Pathologist's Perspective Print E-mail
Written by Jena Martin | KevinMD   
Wednesday, 20 June 2018 00:00
Envision a large, loafy muffin top. Not just a central bulge or even love handles. I'm speaking of an apron of skin and fat that hangs down over many an American's lower torso and groin. Surely you've seen it - you may even have one. Its medical name is the pannus. I had never heard of a pannus in medical school and I still never hear it mentioned outside of the pathology laboratory. In fact, this article is inspired by conversations I've had with friends who know about medicine and who were nevertheless shocked to hear about the pannus.

Last Updated on Friday, 22 June 2018 17:22
The quandary of cost transparency Print E-mail
Written by Ted Matthews, MBA | KevinMD   
Thursday, 07 June 2018 00:00
Why can I get a comprehensive estimate for something like a car repair, but not a hip transplant?
While a cost range or estimate can be provided  regarding what the physician will bill for a specific service, we can - at best - make an educated guess about other surgery costs (hospital bill? anesthesiologist's bill?) and follow-up costs (physical therapy? prescription drugs?). People, unlike cars, are not identical "under the hood," and treatment does not work consistently between people or even at different times for the same person. An expected procedure may need to be changed and additional testing or procedures may be necessary.
This can be a good time to discuss value transparency. Because, like so many things in life, what can look like a "good deal" at the start can end up costing a patient more later on.
Last Updated on Friday, 08 June 2018 17:36
Who Should Get the Liver Transplant? Print E-mail
Written by MD Whistleblower   
Tuesday, 15 May 2018 17:24

People with liver failure and cirrhosis die every year because there are not enough livers available. Who should receive the treasured life-saving organ? There is an organ allocation system in place, which has evolved over time, which ranks patients who need liver  transplants. Without such a system, there would be confusion and chaos. How can we fairly determine who should receive the next available liver? What criteria should move a candidate toward the head of the line? Age? Medical diagnoses? Insurance coverage? Employment status? Worth to society? Criminal record?

Consider the following 6 hypothetical examples of patients who need a liver transplant to survive. How would you rank them? Would those toward the bottom of your list agree with your determination?
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