Kevin, M.D. - Medical Weblog

Sicko: The other side

Michael Moore points fingers, and doesn't allow the accused to defend themselves.

The Washington Post agrees:

He never interviews actual veterans of the system: doctors, nurses, administrators -- only the victims.

Thus we get a bottom-up, not a top-down or a full-frontal view of the creaking system. The film progresses from anecdote to anecdote along predictable lines: American health coverage = BAD, European health coverage = GOOD. He leaves out the boring parts, forgetting that as far as policy-intense health-care issues are concerned, the only things that matter are the boring parts.

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MedBlog Power 8

6/27/2007-7/04/2007
Next revision: 7/04/2007
(Last week's ranking in parentheses)

1) NHS Blog Doctor (1)
Part-time physicians? Check. Doctors only for the rich? Check. Peeing on jellyfish stings? Check. BritMeds? Check. The Crippen Diaries? Check. Repeat #1 on the Power 8? Check.

2) medinnovationblog (2)
Dr. Reece continues his astute observations on the health care system with his daily entries. This week he wonders about what a "Chief Experience Officer" does, questions the Sermo/AMA deal, talks Sicko, and asks whether the fee-for-service monster can be killed.

3) Respectful Insolence (3)
Resident skeptic Orac continues to destroy woo-based myths. Starchild Abraham Cherrix, The Skeptic's Circle, and continuing Autisum Omnibus trial coverage are hot topics this week.

4) Surgeonsblog (4)
Warning, this blog is rated NC-17. Dr. Schwab devotes some time discussing surgery on that organ we know and love: the spleen.

5) Panda Bear, MD (5)
ER frequent-fliers, people who want Cuban-style health care in America, and drug-seeking behavior are issues that confuse Panda this week. Common sense and the health care system simply don't go hand in hand.

6) GruntDoc (-)
First appearance on the list for this popular blogger. Controversies about nursing home transfers, some interesting (if somewhat depressing) primary care links, and RIP the poor coffee maker. And in a PSA, he recommends not having sex with patients while on duty. Good to know.

7) Dr. Wes (-)
I've been reading cardiologist Dr. Wes for awhile, and frequently link to his finds. Some good ones this week: ordering your own screening tests, what Sicko left out, "lean manufacturing" in health care, and his experience certifying in ACLS.

8) WSJ Health Blog (6)
The WSJ Health Blog is a must-read and should be checked several times per day for those who want to keep up with the latest. I think this is the best mainstream-media health blog today.

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 every Wednesday and will be published every 2-3 days on Kevin, M.D. If you want me to consider your exceptional week of blogging, you can contact me.

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Surgeonsblog turns one

Congrats Dr. Schwab. One of the best on the web.

Posted by Kevin | link | Comments (1) |

iPhone hysteria

A psychiatrist examines the craziness.

Posted by Kevin | link | Comments (2) |

Patients with numerous allergies

Predominantly female?

Are women really more likely to have allergic reactions to medications than men, or are they simply more likely to receive a greater variety of medications over time and thus discover that they are allergic to them? Or are women just more likely to complain about subtle adverse reactions than men?

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Plastic surgery or not?

Take the celebrity quiz. When you're finished that, you can take a look at facelifts for dogs.

Posted by Kevin | link | Comments (1) |

Health care and the military

Panda should know. He compares the health care with the military:

Consider the American military in comparison to the typical European military. The American military is an expensive, technologically sophisticated organization that is twenty or thirty years ahead of anything the Europeans can field . . .

. . . A primary care military with conscripted soldiers who don’t expect to do much is fairly inexpensive and looks pretty good until you have to make it do something. A working war machine isn’t pretty and to make it do something requires the dedication of motivated troops and frightening amounts of money.

Posted by Kevin | link | Comments (0) |

Socialized medicine is inevitable

So says Edwin Leap. Just please don't tell me that health care will be free:

Even health-care in the purest idealized socialist system, in the most European, Marxist based, Castro-modeled, academic leftist dream-scape, won’t be free. Get this: health care can’t be free.

It can be free to the people who receive it, provided they are low enough on the economic scale. But to anyone with money, health care will cost something. It will feel good to have those surgeries and prescriptions handed out without a bill. No question. But it will come at the cost of very high taxes. The money will come from the government, but governments don’t produce…they consume. And what they consume is productivity in the form of taxes.

If care in the US is socialized, look for very high income taxes, in the 50% range for most everyone with a decent income.

Posted by Kevin | link | Comments (2) |

Breast augmentation

The #1 cosmetic procedure. A plastic surgeon explains why:

It's likely that the increasing number of women having breast augmentation is partially due to the strong economy (in everywhere but here in Michigan) and the fact that silicone gel implants were approved by the FDA in November. These implants are so superior to the saline implants in appearance and feel that I am now finding more women opting for these implants over saline implants, which are considerably less expensive and have been the standard in North America for 14 years.

Posted by Kevin | link | Comments (0) |

Newsflash: Office and ER visits surge

A sicker population, and a fee for service reimbursement system are driving factors. Want to solve the problem? Go back to capitati . . . oops, already tried that.

Posted by Kevin | link | Comments (1) |

Why physicians don't adopt electronic medical records

Scott MacStravic clearly identifies the reasons.

Posted by Kevin | link | Comments (20) |

Infectious disease trading cards

I'll trade my Avian Flu for your Hantavirus card. (via Women's Health News and Medgadget)

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Physician salaries: Would the French model work here?

Physicians in France make about $55,000 per year. Can that be realistically applied here?

France reimburses its doctors at a far lower rate than U.S. physicians would accept. However, French doctors don't have to pay back their crushing student loans because medical school is paid for by the state, and malpractice insurance premiums are a tiny fraction of the $55,000 a year and up that many U.S. doctors pay. That $55,000 equals the average yearly net income for French doctors, a third of what their American counterparts earn. Then again, the French government pays two-thirds of the social security tax for most French physicians—a tax that's typically 40% of income . . .

. . . Many French doctors, in fact, earn more by increasing their patient load, or by prescribing more diagnostic tests and procedures—a technique, also popular in the U.S., that inflates health-care costs.

Posted by Kevin | link | Comments (19) |

Beware the dangers of universal health care

Yes, it sounds good. But, be careful what you wish for:

Furthermore, establishing a Health Insurance floor, as any UHC system must inevitably do, will encourage suppliers of Tier 1A care to edge toward Tier 3 care (since Tier 2 will be slowly disappearing.) Since Tier 1 and 1A effectively support the bulk of innovation in Medicine, this movement will further constrict the moneys available for difficult and expensive research. Even those in Tier 1 will suffer by the loss of life saving innovations.

It will all be sold as fulfilling the credo that is almost universally fed to young people in the health care system, that "Health Care is a Right, not a Privilege." Sadly, the only way to make this privilege a right is to offer almost everyone the same level of care, and that way lies disaster.

Posted by Kevin | link | Comments (7) |

Cleveland Clinic bans hiring of smokers

Beginning of a slippery slope? (via Medpundit)

Posted by Kevin | link | Comments (17) |

iPhone

Finance Physician looks at some reasons not to get one.

Posted by Kevin | link | Comments (4) |

Direct admission

Sometimes, it's not so simple.

Posted by Kevin | link | Comments (3) |

JAMA and drug ads

JAMA editor Catherine DeAngelis calls physicians on speakers bureaus prostitutes.

Posted by Kevin | link | Comments (3) |

Physicians and DTC ads

Most physicians want a moratorium. I'll go one step further and say they should be banned.

Posted by Kevin | link | Comments (12) |

Pharma tries victimize physicians

Thankfully, their strategy to shift liability failed:

In a setback for drugmakers, the West Virginia Supreme Court of Appeals ruled that pharma can’t escape liability for harmful prescriptions by blaming problems on the docs. At issue is the notion of ‘learned intermediary,’ which says a doc presumably has enough info to make a prudent prescribing decision, absolving a drugmaker of any subsequent problem with a patient.

Posted by Kevin | link | Comments (2) |

"Is an error-free residency what we really want?"

retired doc on the effects of limiting residents' work hours:

Do we not learn in part by making errors in an environment where we are buffered and protected by our mentors and more senior colleagues? How will this cohort of residents fare when they are truly out on their own and there will be no team to hand off to when they have been up most of the night taking care of patients and fielding phone calls? Will they call their office and tell them they won't be in until noon because they need their protected ten hours post call?

Posted by Kevin | link | Comments (9) |

Doctors as deities

Paul Levy explores this further, and compares physicians to celebrities and sports figures:

All of this suggests a tremendous ambivalence about the profession and those in it. It's really not that surprising. It is inherent in any position of power and influence and prominence and perceived wealth. We admire our political, commercial, and sports heroes but also are quick to call them bums and crooks when they don't meet the standards we have set for them. We should expect some of that reaction in the highly personal field of medicine, especially since our interaction with a doctor is likely to occur when we are most vulnerable.

Posted by Kevin | link | Comments (2) |

Internal medicine versus the ER

ER docs sometimes lament hospitalists asking for a complete workup. Well, The Angry Doctor fires back:

So it's just as easy for me to make disparaging remarks about the ER's complete lack of motivation to diagnose (DISPO DISPO DISPO... the mantra goes, right?) as it is for these ER heads to lament how lazy primary care docs have become. Why all the intellectual; dishonesty? We all know the truth: the REAL reason ER docs didn't do primary care is because they don't want to deal with chronically ill patients and their paperwork!

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Medicine going NASCAR

The Joslin Clinic, Walgreens, and Eli Lilly are all sponsoring a rookie NASCAR driver.

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When hospice care comes too late

Over 10 percent of families say their loved ones entered hospice care too late:

There was a strong association between people who said their loved ones were referred to hospice too late and also reported dissatisfaction with the quality of care.

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Job board

The latest jobs on the Kevin, M.D. Job Board:


Together with The Health Care Blog, your job post will be viewed by readers of two prominent health care blogs, with a targeted audience of physicians, nurses, health IT, and other health professionals.

Post your job listing now.

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MedPage Today

I would like to thank MedPage Today for their continuing sponsorship of Kevin, M.D.

Key to this site is their partnership with the University of Pennsylvania School of Medicine, where faculty review breaking news articles. With their Teaching Briefs, MedPage offers a reliable, physician-reviewed, source where both doctors and patients can digest breaking medical news. For those interested in the "bottom-line", Action Points introduce each article, emphasizing the take-home message.



Physicians and other healthcare professionals can accrue CME simply by reading the news. Articles are accompanied by a CME Post-Test, where AMA PRA Category 1 Credits can be obtained, without a fee. Not a bad deal.



Read more about MedPage Today.

Sponsorship opportunities continue to be available. This can be via a Premium Blogad, Standard Blogad, or a customized package. Please visit the advertising information page for further details.

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The Google Health Advisory Council: Outrage

Controversy continues to engulf Google's announcement of their Health Advisory Council. I wrote that it consisted of old-school, ivory tower-academic types chosen for their titles alone. Safe choices. Boring choices. Hardly befitting the more youthful demographic of the internet.

Frankly, this is a list that I'd expect Microsoft to have thought up, not Google.

Rachel Walden:
"I want to know how a company trying to connect people to health information doesn’t bother to get a few medical librarians on board, given that’s our skillset, profession, and raison d’etre. It’s what we have master’s degrees in. It’s what we do every. single. day. Grrr. Bad Google. If you start a health advisory council and annoy the docs, nurses, and medlibs right away, how good a job have you done?"

Dean Giustini:
"Note to Google: Who do you think provides patient education and materials to consumers? It's nurses. It's health librarians. In the information age, librarians are equal partners in the delivery of health care, in case you haven't noticed. Who do you believe is responsible for delivering information to patients outside of the clinical team? Further, who knows these tools better than health librarians?"

Graham Walker:
"Google announces a new “Health Advisory Council” with a lot of big names, but no medical students or likely anyone in the health care industry (by their faces and descriptions at least) under 35 or 40. (Hint, Google: medical students and residents are your power users and early adopters of medical technology, and are most likely to be open to change in the health care system!) Add some youth to your perspective–we’re the ones who’ve grown up with technology!"

Martha Hardy:
"I'm officially joining the chorus of folks who are justifiably baffled that Google has formed their Google Health Advisory Council without including a single medical librarian. Maybe they think they don't need us because they have Dean Ornish?"

Brian Robinson:
"If Google really is interested in good advice about the medical field then this Council should be broadened substantially, at least to give it the street cred it needs as well as the auspicious glow the current names provide."

Update -
Digital Doorway:
"Google may be very talented at gobbling up major slices of the world without swallowing, but in attempting to create an Advisory Council on healthcare, the good folks at Google seem to have choked on their own hubris. Perhaps the feedback will cause some buyers remorse and compel Google to rethink their strategy. Or perhaps they will steamroll ahead with their Ivory Tower council and continue to spurn those from whom we have the most to learn about healthcare, access to healthcare, and the vicissitudes therein."

PixelRN:
"In the hospital setting, nurses are often the person that the patient interacts with the most, and so they are uniquely positioned to be able to gather information on problems that healthcare consumers face."

John Mack:
"Undoubtedly, Google gets the vast majority of its health ad revenue from the pharmaceutical industry. Just on the basis of that fact, it needs at least one pharma marketing/advertising expert among its advisors.

Google Should Lead New-School Thinking, Not Follow Old-School Advice!

More than that, Google and other online organizations wishing to present responsible drug ads and other pharmaceutical industry communications to consumers need to include experts in pharma eMarketing, especially those experts who want and know how to do it right."

John M. Grohol:
"Unfortunately for Google, their little council of just 21 members leaves out so many components, professions and wide swaths of understanding “health,” it’s almost being seen as either a joke or a naive first step into this field."

Posted by Kevin | link | Comments (5) |

Do we really need brand name amoxicillin?

That's what this drug company is trying to do. It probably would be better to spend their resources trying to find something new, rather than repackaging old drugs (case in point: BiDil).

Posted by Kevin | link | Comments (0) |

Diabetic man mistaken for drunkenness

He was kicked off a train in the middle of a forest:

A 65-year-old St. Louis man is missing after Amtrak personnel, mistaking his diabetic shock for drunk and disorderly behavior, kicked him off a train in the middle of a national forest, according to police in Williams, Ariz.

As an aside, I initially thought someone hijacked my name on the link (www.kpho.com), before I realized it was a TV station in Phoenix. (via a reader tip)

Posted by Kevin | link | Comments (3) |

Ezra Klein thinks he knows medicine . . . but doesn't

Ezra Klein naively wonders why all doctors don't have electronic health records:

To this day, I've never read a compelling explanation of why the nation's doctors and hospitals haven't broadly adopted electronic medical records.

Please educate him. (via Arnold Kling)

Posted by Kevin | link | Comments (12) |

Don't lick fentanyl patches

A friendly PSA from your local ER nurse.

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Defensive medicine in the ER

It doesn't get more blatant than this. And you wonder why health care costs are so high:

18-year old comes in with malaise, mildly elevated fever and body aches. Her head hurt a bit, her belly was a little sore, and her legs were achy along with her back and other muscles. Nothing beyond a couple of days off of work and a little extra sleep.

Work up/treatments:
Head CT to rule out head bleed or tumor
Bilateral venous dopplers to rule out DVT due to sore legs in an 18 year old with no risk factors and no leg swelling
Abdominal CT with PO contrast to rule out...whatever because it was a little sore diffusely
2mg of dilaudid IV push, yes 2 mg (I gave 0.5 only, thanks)
Fluids
Zofran
Full panel of labs
Chest XR
Urine sample

Posted by Kevin | link | Comments (27) |

The Google Health Advisory Council

Google has convened their Advisory Council, presumably to advise them on their health-related initiatives.

Looking at the list, it sounds like a lot of old-school, ivory tower types drafted for their titles. Not a lot of youth nor medical bloggers here, which would have been better choices, considering the demographic of the web.

Update:
Listen to the outrage.

Posted by Kevin | link | Comments (7) |

A convicted killer wants a sex change

Some argue it's a medical necessity. Really?

The question at the center of the case: Should a murderer serving life in prison get a sex-change operation at taxpayer expense?

The case of Michelle -- formerly Robert -- Kosilek is being closely watched across the country by advocates for other inmates who want to undergo a sex change. Transgender inmates in other states have sued prison officials, and not one has succeeded in persuading a judge to order a sex-change operation.

(via a reader tip)

Posted by Kevin | link | Comments (3) |

Your doctor and religious directives

The Well-Timed Period comments:

As long as it's acceptable in this country to debate and set policy based on the premise that, if a patient is female, she may only receive care if, and only if, her life is in danger, you don't have a leg to stand on [chances are, quite literally if you're female and your condition isn't deemed life threating enough to operate and save said leg].

As things stand now, the Drs. Christiansen of the world, your neighbors, politicians, and complete strangers get to decide how close to the brink of death you may be permitted to get, before you're allowed to receive adequate medical care.

Posted by Kevin | link | Comments (4) |

Kobayashi, the world hot dog eating champion, gets injured

I've always wondered when he'd break down. Well, it's finally happened:

This past Monday on his blog the 160-pound Kobayashi wrote, "My jaw refused to fight anymore."

The defending champion currently is being treated for arthritis in his temporomandibular joint, which has left him in such diminished condition that his jaw opening is currently no wider than one fingertip.

He added, "I was continuing my training and bearing with the pain and finally I destroyed my jaw."

Posted by Kevin | link | Comments (1) |

Sicko: Leading us backwards?

Is government-run health care a step backwards?

It's not simply that Mr. Moore is wrong. His grand tour of public health care systems misses the big story: While he prescribes socialism, market-oriented reforms are percolating in cities from Stockholm to Saskatoon . . .

. . . It's compelling material -- I know because, born and raised in Canada, I used to believe in government-run health care. Then I was mugged by reality.

Posted by Kevin | link | Comments (2) |

Giuliani's health care plan

Makes the most sense, says a WSJ op-ed:

"It's your health," Mr. Giuliani said in a June Republican debate. "You should own your insurance."

This is a strikingly different message than the standard political fare of telling people they have a right to health care and someone else has an obligation to pay for it. It will be politically effective, as it addresses the core anxiety most Americans experience with health care -- the insecurity of knowing that we could lose insurance if we changed jobs. Americans don't mind paying for health insurance. We already are. We just want security.

Posted by Kevin | link | Comments (1) |

Job post: Practice Leader, Knowledge Services

Kaiser Permanente, Oakland, CA
Kaiser Permanente's Care Management Institute (CMI) is a unique, pioneering institution with a mandate to drive, fund, and catalyze care management activities throughout our non-profit HMO. CMI strives "to make the right thing easier to do. The Center for Health Care Delivery is creating a new Knowledge Service/Evidence unit. The Practice Leader, Knowledge Services will focus on Knowledge Services and guideline development. In conjunction with the CMI Manager, CMI Evidence Methodologist and Medical Director, Center for Health Care Delivery, this position initiates, coordinates, and facilitates the development, revision and dissemination of national evidence-based guidelines designed to improve member outcomes and organizational performance throughout KP.

Read more.

Together with The Health Care Blog, your job post will be viewed by readers of two prominent health care blogs, with a targeted audience of physicians, nurses, health IT, and other health professionals.

Post your job listing now.

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Not all psychiatrists take drug money

Dinah at Shrink Rap prescribes Seroquel without taking a dime.

Posted by Kevin | link | Comments (0) |

"Pushing patients around" and volunteer work

A college student is looking for "more meaningful" volunteer work. Paul Levy sets him straight.

Posted by Kevin | link | Comments (2) |

Two cardiac patients

Chest pain through the eyes of an EMT.

Posted by Kevin | link | Comments (0) |

High cost generic medications

Dr. Rob looks behind the price gouging.

Posted by Kevin | link | Comments (0) |

I Heart Guts!

Wear your spleen on your sleeve. (via Maria)

Posted by Kevin | link | Comments (1) |

Dr. Charles on hiatus

One of the best writers on the web takes a break. His voice will be missed.

Posted by Kevin | link | Comments (0) |

Needle sticks in resident surgeons

Guess how often it happens? About once every seven months.

Posted by Kevin | link | Comments (1) |

Newsflash: ER wait times are widespread

Nothing new here. Any serious solution to solve this problem has to involve financially enticing more physicians to enter primary care, relieving the burden off the ER.

Posted by Kevin | link | Comments (0) |

MedBlog Power 8

6/27/2007-7/04/2007
Next revision: 7/04/2007
(Last week's ranking in parentheses)

1) NHS Blog Doctor (1)
Part-time physicians? Check. Doctors only for the rich? Check. Peeing on jellyfish stings? Check. BritMeds? Check. The Crippen Diaries? Check. Repeat #1 on the Power 8? Check.

2) medinnovationblog (2)
Dr. Reece continues his astute observations on the health care system with his daily entries. This week he wonders about what a "Chief Experience Officer" does, questions the Sermo/AMA deal, talks Sicko, and asks whether the fee-for-service monster can be killed.

3) Respectful Insolence (3)
Resident skeptic Orac continues to destroy woo-based myths. Starchild Abraham Cherrix, The Skeptic's Circle, and continuing Autisum Omnibus trial coverage are hot topics this week.

4) Surgeonsblog (4)
Warning, this blog is rated NC-17. Dr. Schwab devotes some time discussing surgery on that organ we know and love: the spleen.

5) Panda Bear, MD (5)
ER frequent-fliers, people who want Cuban-style health care in America, and drug-seeking behavior are issues that confuse Panda this week. Common sense and the health care system simply don't go hand in hand.

6) GruntDoc (-)
First appearance on the list for this popular blogger. Controversies about nursing home transfers, some interesting (if somewhat depressing) primary care links, and RIP the poor coffee maker. And in a PSA, he recommends not having sex with patients while on duty. Good to know.

7) Dr. Wes (-)
I've been reading cardiologist Dr. Wes for awhile, and frequently link to his finds. Some good ones this week: ordering your own screening tests, what Sicko left out, "lean manufacturing" in health care, and his experience certifying in ACLS.

8) WSJ Health Blog (6)
The WSJ Health Blog is a must-read and should be checked several times per day for those who want to keep up with the latest. I think this is the best mainstream-media health blog today.

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 every Wednesday and will be published every 2-3 days on Kevin, M.D. If you want me to consider your exceptional week of blogging, you can contact me.

Posted by Kevin | link | Comments (0) |