From the monthly archives:

October 2008

Wyeth v. Levine

October 31, 2008

I don’t have much to add to the medical blogopshere’s discussion on the upcoming, landmark Supreme Court decision, so instead I’ll point to two reasoned posts, arguing the case from opposite sides.

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That’s how you cut emergency department use

October 31, 2008

More community health centers:
Family Health Center cuts its ER visits by 15 percent from 2006 to 2007 after creating a nurse triage system and adopting appointments for its urgent care department. Overall, ER visits dropped by 2 percent at the 21 health centers participating in a state initiative.
Finding physicians to staff community clinics is another [...]

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Prescribing narcotics in the Middle East

October 31, 2008

If you think the consequences are tough here, you haven’t seen this case in Saudi Arabia:
Egyptian Raouf Amin languishes in a Saudi jail and is punished with 70 lashes once a week. Cut off from his family in Egypt, the 52-year-old doctor was convicted for prescribing painkillers to a Saudi princess that led to her [...]

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Patients waiting for hospital beds

October 31, 2008

It is common to find patients waiting for admission sitting in the hallways of emergency departments.
A new study suggests there is no harm in transferring them upstairs to the floor, where they can wait in the hallways there.
The sight of waiting patients on a medical floor would put pressure on the administration to open up [...]

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Is concierge care really too expensive?

October 31, 2008

Say a concierge doctor charges you a $2500 annual retainer fee. Sounds expensive, right?
But not after you break it down where the cost can be mere dollars per day, after savings from reduced wait times and improved access are considered:
Or is it just that giving up the daily Jamba juice or Pinkberry yogurt in [...]

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Placebos in the emergency department

October 31, 2008

When one thinks about placebos, sugar pills come to mind.
As Shadowfax illustrates, it’s can be so much more than that, ranging from IV fluids for flu-like symptoms to plain x-ray films for musculoskeletal pain.
A placebo can certainly be more vague than initially thought:
In the end, I don’t really know what a placebo is. There’s a [...]

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Remove jewelery before working with power equipment

October 31, 2008

Here’s why.

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Soft tissue finger injury

October 31, 2008

These are very common injuries that present to the emergency department. Who better than plastic surgeon Ramona Bates to talk about treatment and suturing techniques?

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Health care and statistics

October 31, 2008

Here are some responses to last week’s NY Times op-ed suggesting that a comparative effectiveness institute be considered.
Most of the resistance comes from the fact that medicine is infinitely more complex and variable than the current tools of empirical data can resolve:
The number of variables in medical care (patient and treatment variability, co-morbid conditions) and [...]

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Why primary care doctors shouldn’t be pain specialists

October 31, 2008

Managing chronic pain is becoming increasingly difficult. As Dr. Rob observes, many primary care doctors simply don’t prescribe narcotic medications.
Worse, pain specialists often won’t either, preferring to focus on procedures and non-narcotic management:
What happens when, despite my best efforts, the person is still in significant pain? Most of the time I get to [...]

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When government solves problems

October 31, 2008

When government gets involved, unintended consequences often ensue. One example is the so-called “moral hazard,” where people are insulated from the consequences of risk:
The person may behave differently from the way the person would behave if fully exposed to that risk. Here’s a familiar example: If you insulate people from the consequences of [...]

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Should doctors want their children to become physicians?

October 30, 2008

Studies have suggested that more doctors than ever do not recommend the profession to their children. With all the interference from insurance companies and government, doctors are frustrated and the future of the profession does not bode well.
Brian Carty recounts an encounter with a prospective medical student, and emphasizes that those considering this career [...]

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Should doctors talk politics with patients?

October 30, 2008

Manoj Jain asks whether politics belong in the exam room in his recent Washington Post piece (via the WSJ Health Blog):
I have strong political opinions, but I am edgy about disclosing them to my patients for several reasons. For one, I’m in an authoritative position: When I talk about antibiotics, my patients listen and usually [...]

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ER waits, how long is too long?

October 30, 2008

3 1/2 hours, according to a study. After that, patient satisfaction scores plummet. I’m surprised the scores didn’t drop sooner than that.
To help with patient satisfaction, hospitals are resorting to a time-tested marketing tactic. Underpromise and overdeliver:
Basically, the docs calculated the mean time it took to get through the ER for a [...]

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Rewarding the most needed doctors the least

October 30, 2008

Another general internist leaves The Happy Hospitalist’s area, and there is difficulty finding a replacement. It’s not news that this scenario is mirrored throughout the country.
He goes on to say that half of the health care dollars is spent by 5 percent of the population.
Generalists are needed to coordinate care, which will help rein [...]

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