September 2008

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Staying with the devil you know

in Uncategorized | 2 responses

Someone asks Dr. Rob: "Why do doctors fight universal care so hard when they get a worse deal from the insurance companies than European doctors get from the governments?"

He gives a few good reasons, but this one probably resonates with most doctors:

If I am lazy, I earn less money. If I work hard, I earn more money.
Ah, the American way. Of course, ...

Military care and universal healthcare

in Uncategorized | no responses

Poignant post on the rise and fall of military care. Rationing in the military becomes easer since rank is easy to define.

But what happens in the civilian world?

Where will people be shunted in our new system when we realize it is too expensive or we have too few doctors to provide the care? In short, how will our "rank" be determined? Can we really expect ...

New devices

in Uncategorized | no responses

Shadowfax talks about how doctors are left out of the loop when it comes to new equipment in the hospital or office.

Especially in the hospital setting, there are so many physicians who work on shifts, it is impossible to involve all of them in the decision making for every new device.

One question raised is how long will it take before this leads to ...

Physician-mothers

in Uncategorized | no responses

Using Sarah Palin as an inspiration: "Although Sarah Palin's political views don't overlap much with mine - I don't believe in abstinence-only education, for example - she inspires me to make it all work. I love being both a mother and a doctor, just as Sarah Palin undoubtedly loves her family and her job."

A Parent with Alzheimer’s Disease

in Uncategorized | no responses

A Parent with Alzheimers Disease
If I Had - A Parent with Alzheimer's Disease - Dr. Lon Schneider, MD, University of Southern California Medical School & Keck School of Medicine
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Sliding payment scale

in Uncategorized | one response

A reader writes:

Capitation leads to "creaming" -- selecting healthier/cheaper patients to treat rather than sicker/more expensive patients (where possible). We already know this. Any capitation system has to be tied to a severity index that provides meaningfully more money for meaningfully sicker patients and allows flexibility for patient improvement and deterioration over time. Do you see anything like that happening?

Absolutely. If not, the ...

What if you had a medical home . . .

in Uncategorized | 2 responses

. . . but no physicians to staff it?

Very possible. The idea is that the medical home model would invigorate the primary care profession by improving quality and paying physicians for coordination of care and communicating with patients via e-mail or the telephone. By making primary care more attractive, more medical students will slowly re-enter the field.

But there is a distinct, ...

Emergency care

in Uncategorized | one response

Emergency department overcrowding is nothing new, and is often pointed to as a symbol of healthcare's dysfunction.

In Boston, it has been decreed that emergency departments are no longer able to go on diversion. Apparently when EDs close, it causes more problems than it solves. Makes sense on one level, as patients are shuttled to hospitals who have no records of them.

This is a ...

Retail clinics don’t save money

in Uncategorized | 5 responses

A study in Minnesota compared the cost growth of retail clinics compared to the emergency department, urgent care clinics and physician offices.

Costs are all venues rose, suggesting the more providers in an area doesn't necessarily lower costs. The axiom of competition lowering prices doesn't apply in healthcare.

Physicians make up for lost revenue by simply doing more. There will always a demand ...

Knee surgeries

in Uncategorized | 2 responses

Data is starting to come out showing that knee surgeries may be ineffective:

One finds that surgery is no better than medication and physical therapy for relieving the pain and stiffness of moderate or severe arthritis. The other reveals that tears in knee cartilage -- which often prompt such surgeries -- are very common without causing symptoms.
The medical and patient community has been accepting an "operate first, ask questions ...

Palliative care and cost savings

in Uncategorized | no responses

Drew Rosielle talks about a recent study showing that patients who received palliative care consults were associated with cost savings.

In addition to providing specialized, compassionate, end-of-life care, there is also an economic benefit.

However, I'm not sure how much to tout this. Palliative care already comes at a difficult time for the family, and associating cost savings with this probably isn't the best way to ...

Natural medications

in Uncategorized | 4 responses

Many patients assume just because a medication is "natural" it spares them the side effects associated with prescription medications.

This couldn't be further from the truth. Most natural medications are not regulated, and hence, their side effects are not widely publicized.

In fact, plenty of natural herbs and medications can be harmful. For instance, people taking over the counter liquid potassium for leg cramps without physician ...

Poor P4P implementation

in Uncategorized | no responses

It's well known that configuring a practice to report data is cumbersome and time consuming. All for an inconsequential bonus.

Not only that, practice managers reported it took almost a year and a half to learn the results of their efforts.

Can Medicare do any more to impede the pay for performance movement?

EMRs and EHRs

in Tech | no responses

When it comes to electronic record terminology, I've assumed that electronic medical records (EMR) and electronic health records (EHR) were interchangeable.

A kind reader pointed out that they are not. Here's the subtle difference.

Update:
Link fixed.

Kevin Pho, MD

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