White House Backtracks on Payment for End-of-Life Counseling
Medical doctors are trained to understand and administer powerful technologies which can prolong life. They get paid to do this. But should they also get paid to inform patients of alternatives if they do not want these technologies? The Obama administration has said no to this question. During the healthcare reform debate the issue of physician reimbursement for end-of-life counseling took a nasty turn when conservatives adopted …Read More
Geriatrics by Legislation: The Trend Continues
In a recent blog post I pointed out some legislative initiatives that essentially make certain principles of geriatric practice required by law. I noted how these laws can be interpreted as an effort to make up for the scarcity of practicing geriatricians, and the lack of geriatrics training for most physicians in America. President Obama has continued this trend by signing a new Medicare regulation …Read More
Brief Reprieve from Congress for Medicare Cuts to Doctors
Earlier this month the Senate voted to postpone for one year the impending Medicare pay cuts to doctors that would have gone into effect January of 2011. This is the latest postponement for a measure that will have deep impact on care of the elderly in America. In a recent blog post I discussed the imminent Medicare pay cut for physicians and the impact on …Read More
Geriatrics: An Endangered Specialty
On December 1, 2010, Medicare payments will be slashed by more than 21%, a cut that will severely impact physicians who practice geriatric medicine. The result will be devastating to the 43 million American seniors who receive Medicare coverage, sharply limiting access to care in an environment that is already facing a deficit in geriatric practitioners. A report published by the Institute of Medicine in …Read More
Geriatrics by Legislation: The Trend of the Future?
Recently Governor Paterson signed a law that mandates New York doctors to offer balanced information on choices for end-of-life care – a step in line with principles of geriatric practice and informed decision making. All nursing homes are already mandated by regulation to perform assessments for such medical problems as delirium, depression, and pressure ulcers – assessments that will become more detailed and comprehensive on …Read More
Geriatrics, Humanistic Medicine, & Art
I recently served as keynote speaker at the American Medical Directors Association annual meeting in Long Beach, California. The reason AMDA picked me was my photos of aging, which you can view on my online portfolio. The title of my talk was Geriatrics, Humanistic Medicine, & Art, and the goal was to weave together themes of art and medicine to draw conclusions as to how …Read More
How Much do Medical Residents Know about Pressure Ulcers?
The Answer: Not as much as nurses!! This past weekend I presented a new study on how much medical residents know about pressure ulcers at the American Geriatrics Society (AGS) Annual Scientific Meeting in Orlando, FL. In our research we tested medical doctors in residency training at a major New York City hospital. For those of us who do wound care on a day-to-day basis, our results …Read More
Memorial Shrine to a Closed Hospital
After servicing the Downtown Manhattan Community for 160 years, St. Vincent’s Hospital is now closed except for some outpatient services. I still go there for my wound care clinic, and passed by the old emergency room where I took the photos posted here. This is the shrine that spontaneously appeared in front of the boarded up ambulance bay doors. An emergency medical technician hangs around manning one …Read More
Pressure Ulcer Prevention Lacking in High Risk Patients
A major study published in The Gerontologist has shown that pressure ulcer prevention measures are lacking in high risk patients. A research group based in the Department of Epidemiology and Preventive Medicine at the University of Maryland School of Medicine studied elderly patients with hip fractures, following them across care settings that included hospitals, rehabilitation facilities, and nursing homes and found inadequate use of pressure-redistributing …Read More
High-Tech Devices for Older Patients: Lots of Money for Questionable Gain
A substantial multi-billion dollar industry in implantable cardiac devices has emerged in recent years. Technologies such as cardiac defibrillators (ICDs) and cardiac resynchronization therapy (CRT) devices are being implanted in many people who may not need them, and one of the biggest markets is the elderly. A recent paper published in the Archives of Internal Medicine underscored the fact that although nearly 20% of the devices …Read More
