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july errors

'July Effect' Revisited: Why Experienced Docs May Not Deliver the Best Care

July is when the new interns -- fresh out of medical school -- start work. It's also when the senior trainees, the residents and fellows, graduate to supervisory, self-managed patient care roles. In other words, it's when everyone is most inexperienced. The worry is that this inexperience leads to mistakes.

remote control

Simple Design: What Health Care Can Learn from a TV Remote Control

What can health care learn from Apple and TV remote-control evolution? The first lesson is to consider carefully the user interface before marketing a new product. New ways of delivering health care should be designed in clever ways to make the patient-user or the doctor-user experience smoother. This means a system that streamlines doctors’ interaction with computers and builds in alerts that recognize errors before they happen, without sounding too many false alarms.

doctor naps

Can Better Access to Health Care Really Lower Costs?

Concierge medicine and the patient-centered medical home both offer the promise of better access to care. The former has been around for years, but the medical-home model is just catching on, spurred by provisions of the Affordable Care Act. Figuring out the differences between the way these models work is very confusing, even to people who work in the health-care field.

doctor naps

Should Your Doctor Be Napping on the Job? Studies Find Naps Can Prevent Performance Errors

Sleep scientists have demonstrated that naps can prevent performance error. One 2006 study randomly assigned medical residents to take optional naps and found that on average, they actually did manage to get extra rest. A newer study is currently testing the effect of required naps: residents hand off all duties for short periods of time in the middle of the night.

part time doctors

Can Doctors Have Work-Life Balance? Medical Students Discuss

Are physicians who elect to work part-time violating some sacred aspect of their calling? In this latest column, Dr. Zack Meisel explores Penn medical students' response to an idea promoted in a New York Times op-ed piece by Dr. Karen Silbert. The students disagree with Silbert's opinion that doctors are so "special," they should willingly work more hours than other professions.

medical narrative

Narrative vs Evidence-Based Medicine -- And, Not Or

Recent national debates about childhood vaccinations or cancer screenings demonstrate how the personal stories of junk science gurus routinely drown out physician researchers who make their point with arcane equations and line graphs. In this essay in The Journal of the American Medical Association, Meisel and fellow Penn MD Jason Karlawish call for broader use of storytelling techniques in the health services research field.

secret shopper

The Night-Weekend Effect: Why Medical Outcomes Can Be Worse Depending on What Day You Get Sick

Pennsylvania hospitals have nearly eliminated tge 'night-weekend' effect in their ERs. Changes in staffing and management in the state's trauma centers have made patient outcomes "remarkably similar" day and night, seven days a week. But, keeping a full range of trauma care available 24/7 is an expensive process that continues to challenge health systems across the country.

secret shopper

Why Secret 'Doctor Shopping' Studies Are Necessary

Secret "Doctor Shopping" -- investigations that use phone requests by fake patients to assess how easy it is for certain types of patients to obtain doctor appointments -- is a hot button controversy. Emergency physicians Zachary Meisen and Jesse Pines explain why it is necessary in our rapidly-changing national health care system which has many disparities.


10 Dangerous Places to Vacation: Why Where You Live, Work or Play Matters to Your Health

Advanced hospital trauma care isn't usually on the list of things most families think about when planning their summer travel. But it might interest them to know just how remote some popular U.S. vacation spots are, at least when it comes to access to the kind of care that saves lives in cases of severe injury.


Jane Fibber, M.D.: Why Do Doctors Tell White Lies?

Is it ever acceptable to lie to achieve some emergency room treatment goal? Well-meaning mistruths have always been used to circumvent red tape and at times, can serve the real needs of a patient. But how will the changes of the Affordable Care Act impact an ER doctor's ability -- or motivation -- to use white lies as a tool of the trade?


Post-HMO Health Care: Are ACOs the Answer?

Designed to slow the growth of health care costs without infuriating patients the way HMOs did in the 1990s, Accountable Care Organizations are things of promise and potential problems. Two physicians talk us through the strengths and weaknesses of the concept whose rules and exact practices are still being defined.

county stats

Should Drug Companies Get to See What Your Doctor Is Prescribing?

A Vermont law that prohibits the commercial sale of doctor-prescription records has outraged data mining companies and triggered a legal counterattack that ended up in the U.S. Supreme Court last week. But in oral arguments, the justices appeared highly skeptical of restricting commercial free speech.

county stats

Is My County Healthier Than Yours? Why Rankings Matter

While they may seem like dry and lifeless data printouts to some, the second annual County Health Rankings published by the University of Wisconsin and the Robert Wood Johnson Foundation offer an effective tool for improving local health care.

emergency room

Why the Grey's Anatomy Myth Clouds the Real Value of Emergency Care

Blunt efforts by policymakers and insurers to limit emergency department access by limiting payments need to be reconsidered. They discount the value of emergency departments not only to patients, but also to society.

disaster prep

Persuading Americans to Prepare for Disaster

As the tragedy of the Japan earthquake and tsunami continues to unfold, foreign media have inevitably begun to ask, What are the lessons for disaster preparedness at home?

waiting patients

'Not Mine Yet': The Problem of Patients Under Nobody's Care

A byproduct of high-quality health care is that the needs of patients whose treatment has begun trump those of the faceless "potential" patients in the waiting room.

Medical tests

Why Doctors Order Too Many Tests (It's Not Just to Avoid Lawsuits)

Advanced radiology tests such as CT scans, MRIs and ultrasounds have dramatically changed how patients are diagnosed and treated. But their use has become so routine that their lifesaving benefits are being increasingly overshadowed by the risks of overuse.

drug tests

Why ER Docs Test for Illegal Drugs Without Consent

Do you know that when you walk into an emergency department, your doctor may run a test for illicit drug use without telling you?

CT radiation

Roundtable: Can We Reduce CT Radiation in the ER?

Last week, Medical Insider asked, Why is it so difficult for ER docs to manage patients with belly pain? This week, we sought answers from an expert medical panel.

belly pain

Why Belly Pain Is Such a Headache for Emergency Department Doctors

Abdominal pain is the most common reason Americans visit hospital emergency departments. The difficulty of treating it highlights some major issues facing the health care system at large: the risks and benefits of diagnostic tests, medical malpractice, and patient expectations.

medical care

McDonald's Medicine: Too Impatient to Wait for Care?

Spend time in a busy hospital emergency department and you'll hear a recurrent theme among the harried staff: patients in the U.S. want their health care like they want their food -- served up speedily and made "your way." Is that wrong?

Google medicine

Googling Symptoms Helps Patients and Doctors

With so many patients going online before visiting the doctor, the question now is, How can medical professionals use this phenomenon to offer better health care?

Health IT

The Health IT Paradox: Why More Data Doesn't Always Mean Better Care

There are some insidious factors that come with electronic health information that can be difficult to identify and measure, especially when the human element is removed from health care by technology.

Zachary Meisel, MD, is the Medical Editor of the LDI Health Economist, a columnist for, a Robert Wood Johnson Clinical Scholar, an emergency department physician at the Hospital of the University of Pennsylvania, and a Senior Fellow at the Leonard Davis Institute of Health Economics.

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