tag:blogger.com,1999:blog-211246732012-02-02T21:49:07.070-05:00Amy Tuteur, MDnoreply@blogger.comBlogger391100tag:blogger.com,1999:blog-21124673.post-12587110966997206912009-04-06T10:59:00.001-04:002009-04-06T10:59:40.040-04:00

if (WIDGETBOX) WIDGETBOX.renderWidget('9ae28d33-5e06-45d1-970c-7fefdee42cf9');Get the The Skeptical OB widget and many other great free widgets at Widgetbox!

Amy Tuteur, MDnoreply@blogger.com0tag:blogger.com,1999:blog-21124673.post-1148474286631272042006-05-24T08:30:00.000-04:002006-05-24T08:38:57.936-04:00

At least one hospital appears to have gotten the message about noise:The sound echoed throughout Montefiore Medical Center, like somebody pounding dozens of nails around the clock.Wham! Wham! Wham!The source was actually a pill banger, used to crush medications for geriatric patients who can't swallow whole pills.The process occurred repeatedly each shift, disrupting sleeping patients and

Amy Tuteur, MDnoreply@blogger.com24tag:blogger.com,1999:blog-21124673.post-1148300922061189772006-05-22T07:42:00.000-04:002006-05-22T08:28:42.133-04:00

No one should conclude from my continuous ranting against the disrespectful behavior of doctors that I consider myself above such behavior. Far from it. I know how very easy it is to be disrespectful to patients, how the forces of contemporary medicine promote disrespectful behavior, and how there is very little condemnation of it within the profession.Were I ever inclined to forget, I could just

Amy Tuteur, MDnoreply@blogger.com4tag:blogger.com,1999:blog-21124673.post-1148179894203566582006-05-20T22:30:00.000-04:002006-05-20T22:51:34.226-04:00

The problem of medical staff failing to treat patients respectfully is a very old one. Eventually, I think, many doctors and nurses just get used to seeing it. However, the first time you see it, it can make a big impression on you. I can still remember the first such incident that I observed. It has stayed with me for more than 20 years.I was in the first weeks of my general surgery rotation at

Amy Tuteur, MDnoreply@blogger.com8tag:blogger.com,1999:blog-21124673.post-1148093382760586592006-05-19T22:43:00.000-04:002006-05-19T22:49:42.773-04:00

Cancer Doc has a written a poignant description of the doctor patient relationship:When you see someone continuously for three years, they become more than your patient. Not really a friend or family but something very distinct. Not the impersonal feeling of a brand new patient, but something akin to a comrade in arms. A fellow soldier. Someone you've humped through the bush, the desert, the

Amy Tuteur, MDnoreply@blogger.com0tag:blogger.com,1999:blog-21124673.post-1147729219597241862006-05-15T17:28:00.000-04:002006-05-15T18:19:43.443-04:00

I am very happy to learn that BigMamaDoc, of the fabulous blog Fat Doctor, is recovering from the strokes she recently suffered. I was saddened, but not surprised, by some of what she had to endure during her treatment:...Do you need to go to a hospital?" I agreed to go if Coworker, who took care of me during my last hospitalization, felt it was appropriate.An hour later, we were at the ER, where

Amy Tuteur, MDnoreply@blogger.com0tag:blogger.com,1999:blog-21124673.post-1147397168422447932006-05-11T21:19:00.000-04:002006-05-11T21:26:08.466-04:00

Press Ganey Associates Inc., which measures healthcare satisfaction across thousands of healthcare delivery organizations has issued this press release about the widening gap in hospital patient satisfaction.The American Consumer Satisfaction Index (ACSI) from the University of Michigan has shown that consumers' satisfaction with healthcare has decreased significantly over the past several years,

Amy Tuteur, MDnoreply@blogger.com2tag:blogger.com,1999:blog-21124673.post-1146597849954456282006-05-02T15:19:00.000-04:002006-05-02T15:24:09.970-04:00

Kevin MD mentioned the new profession of patient advocate. It is an indication (as if we needed more indications) that the healthcare system is falling apart.Most doctors might not recognize the term “patient advocate”, but they’ve probably already fulfilled its function many times for relatives and friends. If you’ve ever informally evaluated a relative’s care, called the doctor of a friend for

Amy Tuteur, MDnoreply@blogger.com9tag:blogger.com,1999:blog-21124673.post-1145964943623359742006-04-25T07:32:00.000-04:002006-04-25T07:35:43.656-04:00

This week's edition of Grand Rounds, the best of the medical blogosphere, is up at Health Business Blog!

Amy Tuteur, MDnoreply@blogger.com0tag:blogger.com,1999:blog-21124673.post-1145718879771766282006-04-22T10:27:00.000-04:002006-04-22T11:14:42.246-04:00

Point/Counterpoint on Pay-for-Performance is a fascinating look at the latest buzzword, P4P, pay for perfomance. Dr.Robert Centor of DB's Medical Rants faced off against Dr. Michael Barr.On the face of it, who could object to P4P? A doctor will be paid based on his performance. The better the quality of medicine he practices, the more patients he saves and improves, the more he will be paid. Oh,

Amy Tuteur, MDnoreply@blogger.com6tag:blogger.com,1999:blog-21124673.post-1145408333428605192006-04-18T20:41:00.000-04:002006-04-18T20:58:53.850-04:00

A recent report from the Commonwealth Fund offers statistical evidence that patients feel they are not getting treated with respect.Key findings from the Commonwealth Fund report "Mirror, Mirror on the Wall: An Update on the Quality of American Health Care Through the Patient's Lens" include:"Patient safety: Among sicker adults, Americans had the highest rate of receiving wrong medications or

Amy Tuteur, MDnoreply@blogger.com0tag:blogger.com,1999:blog-21124673.post-1145041159650163812006-04-14T14:56:00.000-04:002006-04-14T14:59:19.666-04:00

Head on over to The Health Care Blog to check out this comment thread. I have been spending a lot of time there lately, debating the issue of healthcare financing with administrators and others. Fascinating discussion!

Amy Tuteur, MDnoreply@blogger.com0tag:blogger.com,1999:blog-21124673.post-1144851031370773992006-04-12T09:59:00.000-04:002006-04-12T10:10:32.190-04:00

Everyone is talking about administrative decisions to save money on health care. What upsets and frightens me is that I see precious little discussion about patients and how the administrative decisions affect them.The fact is that heathcare "administration" has made healthcare worse for patients. I'm not just talking about the administrative nightmare that is healthcare, although that is

Amy Tuteur, MDnoreply@blogger.com4tag:blogger.com,1999:blog-21124673.post-1144599203804122332006-04-09T11:30:00.000-04:002006-04-09T12:13:23.826-04:00

The recent debacle in drug testing, which nearly killed the 6 participants, has been attributed in large part to the greed of the drug company. They were so intent on developing a profitable new product that they ignored the possible devastating impact on the study participants. Such unconcern is not limited to researchers motivated by profit. There is always a tremendous danger that research

Amy Tuteur, MDnoreply@blogger.com0tag:blogger.com,1999:blog-21124673.post-1144352704746068632006-04-06T15:20:00.000-04:002006-04-06T15:45:04.840-04:00

Practicing medicine is extremely demanding and sometimes it seems that it is almost impossible to manage the medical needs of extremely ill patients, let alone the psychological needs. It feels like there is no time to delve into side effects that are not mentioned or to address questions that are not voiced. Rebecca Peterson's experience of her husband's illness and death remind us that

Amy Tuteur, MDnoreply@blogger.com1tag:blogger.com,1999:blog-21124673.post-1144180387683343682006-04-04T15:40:00.000-04:002006-04-04T15:53:07.710-04:00

The purpose of this blog is to draw attention to ways that physicians can improve the care of their patients. While roaming the blogosphere to find topics for discussions, I am repeatedly drawn into arguments with health care administrators. I suspect that this is because so much of what is wrong with medicine today is in part the fault of healthcare administrators.For example, Matt Holt on The

Amy Tuteur, MDnoreply@blogger.com0tag:blogger.com,1999:blog-21124673.post-1143840545468977742006-03-31T16:16:00.000-05:002006-03-31T16:29:05.520-05:00

In the realm of medical practice, it's a small thing, but I suspect it's emblematic of what's wrong with the doctor patient relationship. I'm talking about hospital rounds. It varies from specialty to specialty of course, but most doctors make rounds at dawn.I understand that this is because it's convenient for us as doctors. We see our hospitalized patients before the operating room opens, or

Amy Tuteur, MDnoreply@blogger.com8tag:blogger.com,1999:blog-21124673.post-1143640642015746022006-03-29T08:42:00.000-05:002006-03-29T08:57:26.520-05:00

There have been several insightful comments posted in response to my rants. One thread in particular has generated a lot of back and forth, and I'd like to bring it out from hiding under the comments heading of the C-section post.The discussion is about the role of lifestyle in promoting health and you can read the beginning of it below. I'd like to respond specifically to the comments of Marcus

Amy Tuteur, MDnoreply@blogger.com0tag:blogger.com,1999:blog-21124673.post-1143490279353270642006-03-27T15:08:00.000-05:002006-03-27T15:11:19.396-05:00

I am alternately amused and irritated by the hullabaloo surrounding the supposed obesity epidemic. First of all, people are not dropping like flies from obesity. Anyone who spends a fair amount of time in hospitals can attest to that. There are many people in the hospital because they smoke or they drink, but there are very few people in the hospital solely because they are overweight.That’s not

Amy Tuteur, MDnoreply@blogger.com4tag:blogger.com,1999:blog-21124673.post-1143407141870359952006-03-26T15:55:00.000-05:002006-03-26T16:09:51.306-05:00

From Fixin' Healthcare:For example, what is going on with care during pregnancy and delivery? This is a biological process that in the absence of complications cannot be improved upon with technology... Yet, beginning in the 1970s the incidence of C-sections rapidly increased.As an obstetrician, there is very little that makes me angrier than attempts to blame the outrageous C-section rates on

Amy Tuteur, MDnoreply@blogger.com13tag:blogger.com,1999:blog-21124673.post-1143311497486425972006-03-25T13:13:00.000-05:002006-03-25T13:31:39.266-05:00

I think that this op-ed really bothered me because Bilston is the nightmare of every compassionate doctor. You take the time to explain your recommendation, your reasoning behind it, the evidence that may or may not support it, trying to give the patient all the tools she needs to be an informed "consumer" of health care. Nonethless, Bilston insists that the doctor somehow forced her to go on

Amy Tuteur, MDnoreply@blogger.com0tag:blogger.com,1999:blog-21124673.post-1143206949774925712006-03-24T08:24:00.000-05:002006-03-24T08:29:09.790-05:00

What is going on over at the NYTimes? There is an article on today’s op-ed page about bed rest for obstetrical complications. I can only hope that it was published because the author is related to someone at the Times, because it certainly doesn’t belong there. It isn’t news and it is a hit below the belt to obstetricians who try their best to help patients make decisions.Bilston whines that her

Amy Tuteur, MDnoreply@blogger.com2tag:blogger.com,1999:blog-21124673.post-1143121515443195372006-03-23T08:35:00.000-05:002006-03-23T08:45:15.456-05:00

On Asymmetrical Information, Jane Galt has started a discussion about controlling health care costs. Comments have included the usual arguments about "socialized medicine" vs. "free markets", but as the commenter Jessica points out:"The twin elephants in the room that no one wants to discuss are 1) rationing and 2) end of life care."These issues are probably the most important issues in cost

Amy Tuteur, MDnoreply@blogger.com0tag:blogger.com,1999:blog-21124673.post-1143029419787806602006-03-22T07:06:00.000-05:002006-03-22T07:10:19.820-05:00

In today's NYTimes, The Doctor Will See You Now for Exactly Seven Minutes.You may think that this is exaggeration, but I was briefly a part of a practice that literally had a 7 minute limit on patient visits. If I did not leave a patient room after 7 minutes, the office staff was instructed to page me out. Needless to say, I could not tolerate the practice for long and left after a few months.

Amy Tuteur, MDnoreply@blogger.com0tag:blogger.com,1999:blog-21124673.post-1142980274739639652006-03-21T17:30:00.000-05:002006-03-21T17:31:14.753-05:00

Ever notice how the opponents of single payer health care all have health insurance? Not just any health insurance, either. Most of them have excellent health insurance, the $5 co-pay for your brain surgery health insurance. I suspect that this renders their opposition more than a bit cynical. After all, if your personal situation is not going to be improved by a change in health care financing,

Amy Tuteur, MDnoreply@blogger.com2tag:blogger.com,1999:blog-21124673.post-1142977827236088132006-03-21T16:46:00.000-05:002006-03-21T16:50:27.270-05:00

Adventures in Applied Math offers a mathematical perspective on the conflicting goals of health care financing in an article about Pareto-Optimal Healthcare.

Amy Tuteur, MDnoreply@blogger.com0tag:blogger.com,1999:blog-21124673.post-1142976046073517602006-03-21T16:17:00.000-05:002006-03-21T16:20:46.083-05:00

Grand Rounds, the best of this week's medical blogging is on Healthy Concerns.

Amy Tuteur, MDnoreply@blogger.com0tag:blogger.com,1999:blog-21124673.post-1142799022318394072006-03-19T15:07:00.000-05:002006-03-19T15:11:15.673-05:00

From an outstanding post on Cancerdoc's website:I think one thing that must be emphasized more than anything in medical education is the singular importance of the powerful, almost sacred relationship between doctor and patient. Like any relationship, it is trust that is the most critical, not all the bells and whistles.

Amy Tuteur, MDnoreply@blogger.com0tag:blogger.com,1999:blog-21124673.post-1142545553008874202006-03-16T16:37:00.000-05:002006-03-16T21:49:17.736-05:00

I don't know what the solution to our healthcare crisis is, but I know that banning concierge medical practices is not part of the answer.Frank Pasquale on Concurring Opinions comes down heavily against practices that charge patients a retainer for what essentially amounts to better healthcare than that tolerated and encouraged by managed care. My response:The rise of concierge medical practices

Amy Tuteur, MDnoreply@blogger.com2tag:blogger.com,1999:blog-21124673.post-1142435856816978402006-03-15T10:10:00.000-05:002006-03-15T10:23:09.963-05:00

Fat Doctor writes about a medical mistake:His first push of the PCA pump button delivered a lethal dose of narcotic. Thankfully, he was resuscitated and after a long sleep in the ICU he is recovering well. [His wife] wrote, "We don't want to sue or anything, but we wish we knew what happened…"… This family's surgeon immediately told Friend about the PCA problem and she easily accepted it as an

Amy Tuteur, MDnoreply@blogger.com0tag:blogger.com,1999:blog-21124673.post-1142303390851395652006-03-13T21:27:00.000-05:002006-03-13T21:29:50.876-05:00

Doctors witness a lot of unavoidable pain. Whether it’s from trauma, from surgery or from labor, we become sensitized to it. We couldn’t be good doctors if we were not. Yet sometimes we become so used to the pain of others that we do not take the easy steps that would reduce avoidable pain.When my son teenage son broke his arm in a snowboarding accident, I knew what to expect in the emergency

Amy Tuteur, MDnoreply@blogger.com2tag:blogger.com,1999:blog-21124673.post-1142098020562034162006-03-11T12:25:00.000-05:002006-03-12T11:14:32.113-05:00

Over on Mad About Medicine, Dr. Kirschenbaum responds to writer complaints about office scheduling:The reality is that dependent upon the day I can schedule an office day with all intentions of being on time and the first patient comes to me with cancer in the pelvis and I have to discuss complete removal of half of the pelvis. This is not a 15 minute visit and can even be a 1 hour discussion.The

Amy Tuteur, MDnoreply@blogger.com3tag:blogger.com,1999:blog-21124673.post-1142090902074443872006-03-11T10:24:00.000-05:002006-03-11T10:31:37.506-05:00

Many times the problem is not that healthcare providers individually treat patients poorly. It is that healthcare providers routinely tolerate a culture that is harmful to patients, without ever considering how this is impacting the patients.Take hospital noise, for example.When my son was hospitalized, my husband and I took turns staying each night for the 8 nights he was hospitalized. It’s not

Amy Tuteur, MDnoreply@blogger.com1tag:blogger.com,1999:blog-21124673.post-1141939437485435072006-03-09T16:20:00.000-05:002006-03-09T16:26:57.810-05:00

More nasty comments over on Kevin MD.Here's my reply:Judging by the vehement response, I have clearly touched a nerve. It is precisely this defense of the indefensible that is responsible for a great deal of the misery in the current health care system.Time management experts agree that hospitals (including ERs) are run in a grossly ineffiecient manner. Quoting from The Boston Globe:"Boston

Amy Tuteur, MDnoreply@blogger.com1tag:blogger.com,1999:blog-21124673.post-1141882076999506052006-03-09T00:06:00.000-05:002006-03-09T00:30:44.080-05:00

I posted a comment on Kevin MD about practicing defensive medicine and included a link to this blog. In case I had any doubts about the existence of arrogant doctors who don't care how long patients wait, I got this is response:OMG, you're right! Tuteur's entire Blog rails against ER's. She wouldn't even have gotten in from the waiting room at my hospital in the 7 hours it took for her sons' care

Amy Tuteur, MDnoreply@blogger.com0tag:blogger.com,1999:blog-21124673.post-1141828827621603092006-03-08T09:38:00.000-05:002006-03-08T09:40:27.653-05:00

What never ceases to amaze me is how much of the inconvenience that doctors perpetrate on patients is purely gratuitous. The patient isn’t kept waiting because the doctor has an emergency or the office schedule is over booked. The doctor keeps the patient waiting simply because he can.I have seen many examples of this, but the most egregious happened to my husband several years ago. My husband

Amy Tuteur, MDnoreply@blogger.com1tag:blogger.com,1999:blog-21124673.post-1141768941236768812006-03-07T17:01:00.000-05:002006-03-07T17:02:21.246-05:00

Following up on the previous post, what do you think would happen if patients began demanding some accountability from the emergency room staff? Suppose patients came in with a form that the triage staff would fill out. It would begin something like this:I am visiting the ER because of: (chief complaint)The reasonable amount of time I can expect to wait to see a doctor is:The name of the doctor I

Amy Tuteur, MDnoreply@blogger.com1tag:blogger.com,1999:blog-21124673.post-1141590879577565712006-03-05T15:34:00.000-05:002006-03-07T08:51:59.490-05:00

One day last year I spent 7 hours waiting with my son in the emergency room of the premier children’s hospital. It wait was medically irresponsible and administratively unnecessary. It was emblematic of the lack of respect shown by doctors to patients.My son had badly fractured his humerus 10 days earlier. He had had surgery and was left with two K wires protruding from his arm. The previous day

Amy Tuteur, MDnoreply@blogger.com1tag:blogger.com,1999:blog-21124673.post-1141582894793777082006-03-05T13:20:00.000-05:002006-03-07T08:50:56.400-05:00

The medical system in this country is broken. There is not a doctor in the United States today who does not believe that this is so. Beset on all sides with increasing demands and decreasing resources, the practice of medicine has become grim indeed. Pressured by increasing paperwork and productivity requirements, decreasing reimbursements and a fixed number of hours in the day, doctors are

Amy Tuteur, MDnoreply@blogger.com3