Friday, February 29, 2008

You're fired

When doctors fire patients. Most commonly happens during sustained non-compliance or appointment no-shows.

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"Can't I get an American doctor?"

Dealing with the prejudiced patient.

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MedBlog Power 8

02/29/2008 - 03/05/2008
Next revision: 03/05/2008



(Key: Rank, Blog name, Last week's rank, Post of note)

1) Panda Bear, MD (2), Death at 30,000 Feet and Other Random Notes

2) WhiteCoat Rants (3), Can Medicine Learn A Lesson From Sprint?

3) EM Physician - Backstage Pass (-), A groove...and time *not* being a doctor

4) ER Stories (1), Whining Rich Doctors

5) over my med body! (-), Being Out on Residency Applications

6) Surgeonsblog (-), You Are So Beautiful

7) Dr. Wes (-), Mine's Bigger

8) DB's Medical Rants (-), Fixing health care - focus on payment, Redux

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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World's first eyeball tattoo

Freaky.

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"We ought to have evidence-based tort reform"

The AMA analyzes tort reform:
Recent research -- consistent with earlier studies -- revealed that noneconomic damage caps continue to reduce insurers' claims payouts, which translates to lower rates for doctors.

The AMA analysis also concluded that reforms can help alleviate physician shortages. And some research showed that medical liability risk contributed to higher health care spending, the report said.

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Annuale

I missed this last weekend, but it's pretty damn funny.



(via John Mack)

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Residency applications and blogging

See what Graham thinks about it.

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Code blue in the air

Scalpel: "I'm sure a lawsuit will be brought against American Airlines in this case, but the sad truth is that if you have a cardiac arrest when you're 30,000 feet over the ocean, then you are likely going to die whether the oxygen tanks are working or not."

Panda: "No doubt the family of the lady are going to sue the airline. And they’ll probably win because in our death-averse society, there is no place under Heaven were we expect to be at the mercy of nature, not as long as there is someone around with a uniform and deep pockets. Someone has to pay? Don’t they? John Ritter taught us that. Even a major aortic dissection, a killer so fearsome that even when discovered there is often nothing to be done but hope the sucker doesn’t dissect over something vital before the patient can be rushed into the operating room for a highly dangerous, do-or-die, vascular procedure that is usually too late anyways, even a major act of nature like that has got to be blamed on someone."

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Physician "consulting" agreements

How medical device companies are bribing doctors:
Wine-tasting outings to California's Napa Valley. Ski trips to Colorado. Tickets to sporting events. Gourmet meals at swanky restaurants. Forays to "adult entertainment" clubs.
Paying doctors to go to strip clubs? Bizarre. (via Schwitzer)

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What happened here?



(via Street Anatomy)

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Google interviews Joshua Schwimmer

He talks about Google Book Search.

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Neurosurgeon shortage

Expect more of this to happen:
As a group, specialists are getting older and less willing to work on call. Many specialists say they fear they are more likely to get sued by emergency patients than by their regular patients, who know and trust them. Even when hospitals pay doctors for working on call, specialists often make less money working emergencies than they do caring for regular patients.

And, as fewer specialists work on call, the burden falls heavier on those who remain.

"You have to understand the risk that these people are taking, and the life balance issues they are facing," Eixenberger said. "There comes a time when everybody in their life has to say, 'Why am I doing this?'"

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Beautiful inside?

Sid Schwab: "Operating, as is our aim, on sick people, more often than not things aren't so pretty inside. Diabetic, or old, or overweight, or with concomitant diseases affecting various organs, typical surgical patients rarely retain the born-in beauty and peach-fuzz perfection with which they came into the world."

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Costs

The Happy Hospitalist: "It does not surprise me that health care costs are out of control in this country. It does not surprise me that health care costs are out of control in any country that does not run its business practices based on capitalistic principles of supply and demand. Resources are not infinite. Without demand control, you will eventually ration."

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Stylish scrubs

Who cares what you look like when you're in the hospital? Apparently, plenty of people do.

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Operating on a Jehovah's Witness

Dr. Bruce Campbell writes about his experience in JAMA.

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10 out of 10 pain

Read how differently people describe "the worst pain you can imagine".

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Kids and obscenities

Dr. WhiteCoat: "Some kids think it's business as usual spewing toxic waste out of their mouths and don't bat an eye about it. People around them seem to accept it as an 'exacerbation' of their ADHD. This type of stuff didn't happen 20 years ago. It isn't potty mouth any more, it's 'potty brain.'"

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HemCon Medical Technologies



I would like to thank HemCon Medical Technologies for their sponsorship at Kevin M.D.

HemCon Medical Technologies Inc., develops, manufactures, and markets innovative technologies to control bleeding and infection resulting from trauma or surgery. HemCon products are designed for use by military and civilian first responders as well as medical professionals in hospital, dental and clinical settings where rapid control of bleeding is of critical importance. The HemCon® Bandage was developed in collaboration with the Oregon Medical Laser Center and Providence St. Vincent’s Hospital.

HemCon Medical Technologies, Inc. has shipped over 1 million of our HemCon Bandages and ChitoFlex since 2003. There have been no adverse reactions reported to date. But no news is not as strong as good news. We are proud of the stories that are shared with us on a daily basis on how our products save lives, make medical professionals' jobs easier and how we have made patient care stronger.

For more information, please visit www.hemcon.com.

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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Thursday, February 28, 2008

Transplant surgeon on trial

Goran Klintmalm: "If you think a malpractice lawsuit is scaring surgeons off, wait to see what happens when people see a surgeon being charged criminally and going to jail."

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Jon Arbuckle . . .

. . . minus Garfield: "Who would have guessed that when you remove Garfield from the Garfield comic strips, the result is an even better comic about schizophrenia, bipolor disorder, and the empty desperation of modern life?"

(via Movin' Meat)

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Grand rounds is up

ScienceRoll hosts this week. Come get the weekly best of the medical blogosphere.

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Irrational health IT exuberance

MedInformaticsMD: "There must come a time when medicine's professionals stand up for their profession and stop permitting politicians, business interlopers and other parasites from attaching themselves to medicine's back and sucking the blood and sweat of its practitioners, and siphoning off capital better used to improve health."

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Raising OBs malpractice premiums

That's the stupidest decision I've read today. It's a bad time to be a patient.

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Plastic surgeons

ER Stories: "It may be a surprise to many of the lay public but the reality is that plastic surgeons RARELY want to come in a fix a laceration. The only ones that generally are enthusiastic are those that are just out of training and need money to get their cosmetic practices going. That is why they often take call from the more senior guys. That being said, NO doctor is psyched about coming in to see a clinic patient or self pay (young plastic surgeon or not). And it is near impossible to get a plastics guy (or gal) to come in and suture a minor facial cut in an uninsured patient - even if the patient demands it for cosmetic reasons (they sometimes ask the patient right then and there if will pay for the repair)."

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Answering the call

At 30,000 feet.

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Balance

Welcome to the new generation of work-life balanced doctors. Get used to it.

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Choosing a specialty

Often the most important decision a physician can make. Read what goes into it.

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Pit bulls

Edwin Leap talks about a close call on a recent ER shift.

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Prevention to save money?

Recent studies have suggested the opposite. Dr. Wes elaborates.

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Needle size

And what does your doctor have to do with it?

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Robert Centor fixes health care

Fixing how physicians are paid is a good starting point.

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Doctor Zhivago and Alien

What do they have in common? They're two of Aggravated DocSurg's Top 10 doctor movies.

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Gum and post-op care

Can it speed up recovery?
Chewing five sticks of gum a day after cystectomy and urinary diversion speeds post-operative return of normal bowel function.

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Insidermedicine: If I Had - A Child With Seizures Who Needs Medical Imaging

If I Had - A Child With Seizures Who Needs Medical Imaging - Dr. Raymond Sze, MD

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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MD Job Exchange



I would like to thank MD Job Exchange for their continuing sponsorship at Kevin, M.D.

The goal of MD Job Exchange (mdjobexchange.com) is to create a free, independent site which will make it easier for physicians to find great jobs and get real answers to important issues related to the practice of medicine.

The site is designed to be free in price for job seekers and free from requirements to "log-in."

Surf the site, see what real docs in your specialty have to say. Participate in the discussion forum, and take a look at the jobs.

Knowledge truly is power. Arm yourself with the right knowledge and you will be able to ask practices and hospitals the right questions to find that perfect job.

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, February 23, 2008

Winter break



I'll be away until the end of the week. In the meantime, here are some things to keep you occupied.

Read other blogs on the Feeds page.

Check out the latest MedBlog Power 8.

Catch up on recurring discussions: primary care, defensive medicine, malpractice, and single-payer.

Say "health care is not a right" and see what happens.

Remember Dr. Terry Bennett?

Find out why cutting Medicare payments will limit physician access.

Who's made it into my "Gone Wild" series?

Re-live past controversies like the Big Fat Blog saga, Dr. Anna Pou and Black Wednesday.

Ever eat ice? You're not alone.

Listen to me talk on the CBS Evening News, Dr. Anonymous Show, and Reach MD.

Still not enough? Here are my takes on recent events:

Social networks, Obama, mandates, Super Bowl, military malpractice

Mandate wars, reimbursement, ignoring physicians

Mid-levels, PCP summit

Heath Ledger, contracts, disease prevention

Physician salaries, the Massachusetts trap

Telephone care, dumb mandates

GE and radiology, health reform, MacBook Air

Carrot > stick, the pandering NEJM, retail clinics

MA and the Titanic, second opinions, airplane banter, cheap primary care

Dwindling primary care, spinal care, ratting out patients

Preventive medicine, Rhode Island, C-sections

Incentives, hospitalists, probabilities

Tort reform, Curt Schilling, e-mails

Mid-levels, cost-shifting, IMGs

Enjoy!

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The Clinical Documentation Specialist

And how they contribute to the nursing shortage.

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Medical advice and a financial stake

Can it ever be objective?

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When homeopathy takes hold

It's often due to the failure to adequately resource conventional medicine. Orac explains.

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MedBlog Power 8

02/20/2008 - 03/05/2008
Next revision: 03/05/2008 (no update next week)



(Key: Rank, Blog name, Last week's rank, Post of note)

1) ER Stories (3), The Consulter

2) Panda Bear, MD (5), Overdoctored

3) WhiteCoat Rants (2), What Did You Expect?

4) Health Beat (1), The Cholesterol Con--Where Were the Doctors? Part I

5) intueri (-), Questions.

6) Respectful Insolence (-), Media reporting on pseudoscience: When should a newspaper abandon the "report both sides" mantra?

7) Schwitzer health news blog (-), Promoting obsession with health test scores

8) Movin' Meat (-), Get ready for that 10% cut

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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"My lips are chapped"

Find out what happens next.

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Dumping babies

ER Stories: "Every now and again, we all are treated to some horrific story of a baby being abandoned by a young teen-aged mother. Sometimes it appears that the girl is in total denial about even being pregnant - hence the apparent “justification” for doing such a terrible thing. Well, one night last year, we had one of these patients."

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Canadian doctor shortage

If Medicare continues to tighten the payment screws, look for the primary care shortage to worsen. And it could look like this.

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When government has you by the balls, redux

Our brethren in the UK is at war with the government. Dr. Crippen chronicles the good fight.

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Computer vs doctor

The machines are winning:
A computer does better than a doctor at diagnosing certain brain diseases, research has suggested.

Experts taught a standard computer how to diagnose Alzheimer's from brain scans, and got a 96% success rate.

The accuracy of diagnosis from standard scans, blood tests and interviews carried out by a clinician is 85%.

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Free doctors, save Medicare

John Goodman: "We should be willing to reward doctors and other health-care providers who raise quality and lower costs -- including improving patient communication and access to care, and teaching patients how to be better managers of their own care.

Accordingly, providers should be able to propose and obtain a different reimbursement arrangement, provided that (1) the total cost to government does not increase, (2) patient quality of care does not decrease, and (3) there is a mechanism for accountability, and a method of measuring and assuring that (1) and (2) have been satisfied."

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Did Facebook lead to health insurance denial?

Law.com: "Litigation over an insurer's refusal to pay health benefits for anorexia or bulimia may turn on what is revealed from the alleged sufferers' e-mails and postings on the social networking sites MySpace and Facebook.

The plaintiffs are suing in federal court in Newark, N.J., on behalf of their minor children, who have been denied benefits by Horizon Blue Cross Blue Shield of New Jersey.

Horizon claims that the children's online writings, as well as journal and diary entries, could shed light on the causes of the disorders, which determines the insurer's responsibility for payment. New Jersey law requires coverage of mental illness only if it is biologically based."

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Sponsored post: National Cord Blood Stem Cell Council



The following is a sponsored post by Family Cord Blood Services.

Dr. Charles Sim, MD, co-founder and medical director of Family Cord Blood Services, has been recently appointed to Department of Health and Human Services’ (HHS) Health Resources and Services Administration (HRSA) Advisory Council on Blood Stem Cell Transplantation (ACBSCT).

As representative of the family cord blood banking industry, Dr. Sims says his appointment will help “further educate expectant parents and physicians about the medical advancements and life saving benefits of umbilical cord blood stem cells.”

Many expectant parents, realizing the benefits of cord blood stem cells, are investing in the once in a lifetime opportunity to collect their baby’s cord blood at birth. Parents who choose private cord blood banking have a lot of choices in where to store their baby’s cord blood. Accreditation and licensing are important factors for parents to review while deciding on a cord blood bank. See how Family Cord Blood Services compares to the competition.

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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Friday, February 22, 2008

My take: Pete Stark, residents

1) Pete Stark continues his attack on the medical profession, calling specialty hospitals places for "back rubs and silk robes".

My take: Specialty hospitals deliver higher quality care with a lower complication rate and at a lower cost.

Mr. Stark's profound ignorance of medical issues is stunning and dangerous. It is frightening that a politician of his stature is so openly biased and antagonistic against physicians.

His personal ill-will against the medical profession will harm the public he represents. His goals of driving down physician reimbursement and closing specialty hospitals will do nothing more than deprive patients of physician access and the option of specialty hospital care.

Doctors will survive Mr. Stark's assault. I'm not so sure about the patients.

2) Two resident physicians are featured prominently endorsing weight loss products.

My take: I'm not going to take issue with DOs specifically, since plenty of MDs also hawk questionable products.

More striking is that residents are targeted. Graduating medical school with a $150,000 debt and making around $50,000 for the first few years out certainly puts some financial pressure on the newly-minted doctor. Like Drs. Marshall and Swanson, there are plenty who will feel the need to sell their name and degree for quick cash.

One thing to keep in mind. In addition to the hit their reputation takes, their good name will be forever linked on search engines to Hydroxycut and Rapid Slim SX. Not the biggest marker of confidence for prospective patients who will undoubtedly Google their physician.

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Pete Stark on specialty hospitals

Our favorite physician-friendly politician is at it again:
Stark, who 20 years ago helped write the laws that regulate what businesses physicians can invest in, has been trying to ban doctor-owned specialty hospitals since the 1970s. "These doctors are not entrepreneurs. They're getting a kickback from referring patients," says Stark. "They make enough money." Of the patients who prefer smaller facilities: "If that's what they want, back rubs and silk robes, go to India."

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