Wednesday, May 14, 2008
MedBlog Power 8
5/13/2008 - 5/20/2008Next revision: 5/20/2008
(Key: Rank, Blog name, Last week's rank, Post of note)
1) Health Beat (3), Health Care Reform Via Focus Group
2) WSJ Health Blog (2), Doctor Shortage is ‘Coming On Like A Freight Train’
3) The Happy Hospitalist (1), Doctoring From The Back Seat
4) Musings of a Dinosaur (7), Managing Risk
5) DB's Medical Rants (4), Reasons to become a doctor
6) Dr. Wes (5), MacGyver Moments in Medicine
7) Buckeye Surgeon (-), Surgeon Tryouts
8) Not Totally Rad (-), The Radiologic Appearance of Acute Kindle-itis
The MedBlog Power 8 is a list of medical blogs that have had an exceptional week of blogging, based purely on my subjective measures. Factors I consider are how provocative the posts are, the amount of discussion it generates, and posting frequency.
The list is revised mid-week and will be published every 1-2 days on Kevin, M.D. If you want me to consider your exceptional week of blogging, you can contact me.
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"Isn't it time we had a health system run by doctors?"
Ezra Klein makes some sense in analyzing a potentially politically feasible approach to reform.
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The bias against physicians leading health IT
Health Care Renewal: "I believe this and related stereotypes about physicians are a driver and an enabler (either through genuine belief or through disingenuous opportunism) of much that ails medicine today through the interference of non-medical outsiders. The fundamental message is that physicians are children who cannot do anything more than medicine, and require 'a village' of paternalistic non-medical outsiders to manage their affairs."
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The public's confusion
This makes some sense as to why reform is so difficult in America:Lake is not interested in explaining reform; her goal is to market reform. And how do you market a product? By appealing to prejudices, and playing on the ignorance of your audience. If they think a yellow box make it a friendlier product, then put it in a yellow box.
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Amazon Kindle and radiology
How's the screen for viewing plain films?The results? Not too shabby. Although it wouldn't fly for diagnostic purposes, the lace-like pattern of sarcoid in the distal phalanx can still be seen well enough for educational purposes. Of the two dithering modes, I think I prefer the Atkinson algorithm. Also, I have found that an image looks a lot better when it is sized large enough to completely fill the Kindle screen.
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The ACP launches a blog
It's about time. (via Clinical Cases)
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Will P4P kill off public hospitals?
Another possible unintended consequence:In an analysis of three years' worth of key performance measures, these hospitals fared worse at baseline than hospitals with fewer Medicaid patients, and they had significantly smaller improvements thereafter, suggesting a grim reimbursement fate if the model becomes more widespread.
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iMedExchange
I would like to thank iMedExchange for their continuing Premium Sponsorship at Kevin M.D.
If physicians want it, iMedExchange is building it...
It's rare when a company actually listens to their customers. Even more rare when a company has enough insight into their market that they can anticipate their customer needs.
iMedExchange is accomplishing both. A seasoned team of Web 2.0/social networking gurus, along with a team of several hundred physician advisers, is quietly building a new model for physician social networking.
Not satisfied to merely provide clinical information and resources, the iMedExchange model takes into account the additional pressures and challenges facing today's physician. Not only are they providing the forums and clinical information physicians want, word on the street is that they are using Web 2.0 technology to help physicians in their business -- like help with finances and healthcare technology -- and even for leisure, like sharing great wine tips.
Most recently, they built a tool that lets its members create their own groups, giving physicians the opportunity to have private conversations with other physicians who share their specific interests and issues.
iMedExchange technically hasn't launched yet, but physicians can still join the site as they build it. Almost every time you log in there is a new tool or feature. Log in at www.imedexchange.com (they verify that you are a physician before you can enter the site) and start using their forums and groups.
Sponsorship opportunities continue to be available. This can be via a Standard Blogad or a customized package. Please visit the advertising information page for further details.
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Tuesday, May 13, 2008
Business and medicine
I have long contended that some sort of business education or degree should be mandatory for every practicing physician.Skills like running a business and the art of negotiation are just as important as clinical aptitude. The medical profession's lack of business skills is a major reason why physicians have lost control of their profession, and why doctors have so little influence in the health care debate.
Those who don't think so are sorely naive and will be in for a harsh wake-up call when faced with post-graduation reality.
I'm happy to see that others agree:
A common fallacy shared by many medical students and pre-meds is that doctors are isolated from business practices such as marketing, management, and finance. A rude awakening is applied to anyone upon graduating residency when he discovers that the laws of economics apply to medicine just as easily as they apply to any other employment field. Many doctors are woefully unprepared for running a hospital or clinic.
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The inhaler switch
Matthew Mintz blogs about the impending switch to HFA Albuterol inhalers.
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Maybe we should throw money at the doctor shortage problem
Bingo:"Until we make it financially advantageous to do that kind of [general] practice, then you’re going to see a continued growth of the shortage. Just throwing money at it won’t solve it completely, but it would sure go a long way toward making a huge difference."
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Emergency call, post-EMTALA
Image this scenario happening on a daily basis, in thousands of EDs nationwide.
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The unintended consequences of P4P
Like any attempt to regulate physician behavior, the unintended consequences often worsen the situation:[P4P] also led to unintended effects, such as . . . potential deskilling of doctors as a result of the enhanced role for nurses in managing long-term conditions, a decline in personal/relational continuity of care between doctors and patients, resentment by team members not benefiting financially from payments, and concerns about an ongoing culture of performance monitoring.
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Negotiating
Hospital CEO Paul Levy, TBTAM and GruntDoc talk about the relationship physicians have with administration. All sparked by an offhand comment Levy made on last week's Dr. Anonymous Show.
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How some hospital CEOs deal with bad news
Roy Poses: "When bad news appears, the first impulse many health care executives now have is to ignore it, their second, to censor it, but not to deal with its cause."
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Grand rounds is up
Health Business Blog hosts the weekly best of the medical blogosphere.
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Hypothalamic hamartoma
Fascinating case report from the NY Times:The source of her suffering is a hypothalamic hamartoma, or H.H., a tumor on the hypothalamus that strikes only a few thousand people in the world. And while the tumor is not malignant, until five years ago it was considered incurable, even when baffled doctors could diagnose it. Surgery was risky and largely ineffective. Medication seldom helped. Many children were institutionalized.
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Want my take?
This is a periodic open thread to solicit issues people want me to blog about. Suggest topics and links in the comments of this post, or you can e-mail me.I'll choose a few to put into my regular "My take" feature.
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Vaccines in the news
Antivaccinationists are getting their moment in the mainstream media sun.Orac continues to lead the charge against them.
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Insidermedicine: If I Had - A Changing Mole
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| If I Had - A Changing Mole - Dr. Nanette Liegeois, MD, Ph.D |
Thanks to Insidermedicine for their continuing sponsorship at Kevin, M.D.
Insidermedicine (www.insidermedicine.com) is a physician-led news organization that brings daily evidence-based updates to patients, doctors and medical students. Also available in Chinese and Spanish.
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Monday, May 12, 2008
Testing surgeons' skills
Buckeye Surgeon: "Moving a bunch of rubber balls from one cup to another or being able to tie a knot in a piece of styrofoam does not necessarily translate into real life excellence. It's like drafting a quarterback based on how fast they can run the 40 yard dash and how many footballs they throw through a tire in a 60 second period. Surely we can do better than rubber balls and styrofoam bowels."
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Loan repayment
Want more primary care physicians? Repay their student loans, no strings attached. It seems to be working in Boston.
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A physician-congressman goes without health insurance
A stunt to be sure, and it doesn't hurt that he's a millionaire.
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Generalists get no respect
The Physician Executive: "Many of US doctors feel that primary care is the choice of students with no other choice. Even Canada's social conscience cannot mask the prejudice entirely. I was once recruited by a cardiovascular surgeon who said I was too good to settle for family practice. It is a nearly universal phenomenon in a world where progressively greater expertise gets more respect than being a generalist."
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MedBlog Power 8
5/07/2008 - 5/13/2008Next revision: 5/13/2008
(Key: Rank, Blog name, Last week's rank, Post of note)
1) The Happy Hospitalist (2), This Deserves The Middle Finger
2) WSJ Health Blog (3), Doctors Shun Less Lucrative Specialities
3) Health Beat (5), Health Care Reformers Debate the Road to Universal Coverage, Part II
4) DB's Medical Rants (6), The waning art of history taking
5) Dr. Wes (7), Subspecialist Shortages and the EMR
6) Notes from Dr. RW (-), Unhealthy pressure to implement electronic medical records
7) Musings of a Dinosaur (-), Just (Don't) Do It
8) Street Anatomy (-), Christopher Huet: Retouching into Beauty
The MedBlog Power 8 is a list of medical blogs that have had an exceptional week of blogging, based purely on my subjective measures. Factors I consider are how provocative the posts are, the amount of discussion it generates, and posting frequency.
The list is revised mid-week and will be published every 1-2 days on Kevin, M.D. If you want me to consider your exceptional week of blogging, you can contact me.
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Medical relatives
The Happy Hospitalist: "Sometimes I'm surprised, incredibly surprised, even by doctor families that are so blinded of the reality, they can't see the forest from the trees. The patients who are clearly so ill, that aggressive intervention is the worst possible course of action."
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When pandering to patient satisfaction can harm
Unintended consequences, indeed: "A few years ago, as we tried to improve patient satisfaction, we changed the way that patients order their hospital food. The program was called “At Your Request" and let patients call up to order their meals from a menu of options – at essentially anytime they wanted to eat. (From a practical standpoint, this works a lot like room service: you call and order your meal, and it shows up half an hour later.)However, this turned out to be another way that patients who were at high risk for aspiration (see above) could get food that was unsafe for them to eat."
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Pharmacist ranting
#1 Dinosaur launches a verbal assault on pharmacists.I'm waiting for The Angry Pharamcist to retort.
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Reputation and narcotics
When words gets out that a physician doesn't give out unnecessary pain medications: "My honest reaction was to swell with pride!"
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When too much is too little
How palliative care is not emphasized during medical education nor is valued by Medicare:"When a three-person palliative care team made up of a doctor, a nurse and a psychologist spends 90 minutes in a meeting with a family, Medicare would probably pay $130 to $140—for all three people . . though it would be hard to say that one of us is practicing more sophisticated medicine."
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The Medicare cuts are looming
The chilling effect is well stated here:The practice of medicine is a calling and as such, my colleagues and I have endured more unfair revenue cuts than most businesses would have endured. Yet, a medical practice is also a small business, and there are limits to how much we can endure. We are now at the point where further cuts are not survivable. Just like any small business, our revenue has to exceed costs in order to survive. Despite everything that I have been able to do to cut costs, the margin of profit is now thin, and the proposed greater than 10 percent cut will put us out of business. The only option will be to downsize the practice and stop seeing all Medicare patients. I would hate this, but it will be the only option I have if Congress does not reverse the proposed cuts.
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Electronic records by 2014?
There's a reason why universal electronic records are nothing but a pipe dream:The high cost of EMRs, combined with a small return on investment, is a main reason why physicians have been slow to adopt systems . . . While some EMR functions, such as billing and transcribing notes, financially benefit physicians, most of the return on investment accrues to health plans.
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Reader Takes
Reader Takes is a regular feature where selected op-ed style pieces from the audience at Kevin, M.D. will be published on the blog.Posts are between 500 and 600 words in length, and can argue any opinion related to medicine and health care.
Original articles that are provocative, well-written, free of grammatical or spelling errors, and generally follow these guidelines are preferred.
Once a reader take is published, it will remain at the top of the blog above the fold for one day. A link to the author's book, blog, or website will be included.
Kevin, M.D. receives in excess of 10,000 visits daily, and is regularly read by major media outlets.
The piece will remain exclusive to Kevin, M.D. and may not be republished elsewhere.
If you are interested in submitting a take for consideration, please contact me.
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MedPage Today
I would like to thank MedPage Today for their continuing sponsorship at Kevin, M.D.
MedPage Today is the only medical news service for physicians that links consumer medical news and the professional medical analysis needed by clinicians. Through their daily coverage of breaking medical stories and topics widely reported in the consumer media, they provide clinicians with the real-time information they need to address their patients' questions and to find out how new developments might impact their clinical practice.
Co-developed by MedPage Today and The University of Pennsylvania School of Medicine, Office of Continuing Medical Education, each article alerts clinicians to breaking medical news. Physicians and other healthcare professionals may also receive Continuing Medical Education (CME) credits at no cost by completing these educational programs. CME is required of physicians in approximately 30 states and utilization of electronic CME is growing at an estimated 80% annual rate. MedPage Today meets this growing need in a unique and valuable way.
Sponsorship opportunities continue to be available. This can be via a Standard Blogad or a customized package. Please visit the advertising information page for further details.
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Saturday, May 10, 2008
Reader take: Ganging up on primary care
The following is a reader take by an anonymous primary care physician.I am a primary care physician who is less than a decade removed from residency, and at a recent medical staff meeting, I witnessed the beginning of the end of primary care in this rural Midwestern town.
I work in a town of about 50,000 people roughly an hour outside of a major Midwestern city. There is one hospital in the entire county of over 100,000 people, which employs the vast majority of physicians in the area. Being a Healthcare Provider Shortage Area, they are able to offer some student loan forgiveness, but the warm fuzzies end there.
Physician retention has been a chronic problem. A malignant administration reveals itself almost before the ink is dry on signed contracts. They have recently forced increased unassigned call duties upon primary care doctors with no additional compensation. To our faces, administration promised us hospitalist coverage for not only our own patients, but also for the admissions for patients without physicians (a substantial percentage of the population).
The city itself has none of the charms of a small town and all the disadvantages of one. Having practiced in many parts of the state and country, the sense of entitlement, payor mix, tobacco abuse, sedentary lifestyles and obesity rates of our current patient population are nothing less than breathtaking. At best, it is a painful population to care for.
Not surprisingly, the recruitment and retention problem hit the hospitalist program simultaneously. Three hospitalists are now expected to manage 24-hour coverage with no relief in sight. And instead of offering the degree of compensation necessary to bring more physicians on board, the administration exploited the sense of crisis to convince the medical staff to consider opening the doors to Advanced Practice Nurses. This was the only solution, we were told, to the hospitalist shortage. The only way to stop taking extra call for free.
At this meeting, 100% of the subspecialists voted for allowing APNs to practice in the hospital. 75% of the primary care physicians dissented. The vote was overwhelmingly in favor of the measure. This happened in a system where some primary care doctors are making less than they would if they took a new position in a major city, and more than a couple subspecialists make seven figures. The abandonment of the greater medical good by our specialist friends eager to expand their already-overflowing coffers has filled me with renewed vitriol.
After weathering repeated attempts to renegotiate our contracts in a blatantly deceptive fashion, our administration has dealt yet another demoralizing blow to the community's primary care physicians. Subspecialists have an enormous return on the investment of "physician extenders" and do not surrender any of their autonomy. As a result of the awesome greed and narrow-mindedness of the proceduralists, primary care physicians will now have little recourse when the hospital offers insulting compensation packages.
What will motivate the system to improve the lives of doctors who have mortgages, children in school, and contractual "gotchas" when they can threaten to replace us all on the cheap?
Submit a reader take for consideration.
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Mississippi: What happened after tort reform
WSJ: "Almost overnight, the flow of lawsuits began to dry up and businesses started to trickle in. Federal Express invested $1 billion in a new facility in the state. Toyota chose Mississippi over about a dozen other states for a new $1.2 billion, 2,000-worker auto plant. The auto maker has stipulated that the company would pull up stakes if the tort reforms were overturned by the legislature or activist judges.That hasn't happened. About 60,000 new jobs have arrived in four years – not a small number in a workforce of about 1.3 million – and a sharp improvement from the 30,000 jobs lost in the four years before Mr. Barbour took office. Since the law took effect, the number of medical malpractice lawsuits has fallen by nearly 90%, which in turn has cut malpractice insurance costs by 30% to 45%, depending on the county."
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Friday, May 09, 2008
MedBlog Power 8
5/07/2008 - 5/13/2008Next revision: 5/13/2008
(Key: Rank, Blog name, Last week's rank, Post of note)
1) The Happy Hospitalist (2), This Deserves The Middle Finger
2) WSJ Health Blog (3), Doctors Shun Less Lucrative Specialities
3) Health Beat (5), Health Care Reformers Debate the Road to Universal Coverage, Part II
4) DB's Medical Rants (6), The waning art of history taking
5) Dr. Wes (7), Subspecialist Shortages and the EMR
6) Notes from Dr. RW (-), Unhealthy pressure to implement electronic medical records
7) Musings of a Dinosaur (-), Just (Don't) Do It
8) Street Anatomy (-), Christopher Huet: Retouching into Beauty
The MedBlog Power 8 is a list of medical blogs that have had an exceptional week of blogging, based purely on my subjective measures. Factors I consider are how provocative the posts are, the amount of discussion it generates, and posting frequency.
The list is revised mid-week and will be published every 1-2 days on Kevin, M.D. If you want me to consider your exceptional week of blogging, you can contact me.
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Withholding antibiotics and public perception
Ten out of Ten: "But the problem with too many people is if they’re not ignorant, then they just can’t see past the boundaries of their own skin to the greater good."
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Malpractice reform, a bad idea?
DrRich takes a contrarian view:The threat of malpractice litigation, as wasteful and counterproductive as it is, provides at least some degree of balance in the doctor-patient encounter, and gives doctors (even those whose professional pride has been successfully eroded by all the many efforts aimed at doing just that) a good reason to always ask themselves, “Is this action I’m about to take the action that THIS patient really needs me to take?”
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How trial lawyers will solve the specialist shortage in the ED
"Increasing requirements for doctors to take call as a condition of practice."Yeah, that's going to go over real well.
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Failing to provide futile care
It sometimes means accepting the risk of being sued. #1 Dinosaur says to deal with it.
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