February 2009

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Poll: Should doctors apologize after a medical error?

in Physician | 14 responses

Despite the fact that almost 100,000 patients die from medical mistakes each year, only 30 percent of those errors are ever disclosed to patients. Saying "I'm sorry" is morally and ethically proper. It re-establishes trust and empathy between doctor and patient, and makes it easier for everyone involved to learn from the incident. Hospitals that have instituted full disclosure programs have seen a decrease in the number of ...

The privilege of being at a patient’s bedside

in Patient | 2 responses

The bedside exam has become increasingly irrelevant, as technology and tests have largely supplanted physical diagnosis skills.

Pauline Chen interviews Stanford's Abraham Verghese, who also wrote last year's excellent NEJM piece on the demise of the physical exam, and he provides some provocative insight.

Dr. Verghese calls the physical exam "an important ritual" that still matters to patients. "If as a doctor you shortchange the ritual, ...

How to survive heart disease requiring quintuple bypass surgery, did continuity of care care help?

in Patient | 2 responses

Author Jay Neugeboren presented with shortness of breath after exertion, and eventually was diagnosed with coronary artery disease requiring an emergent quintuple-bypass.

How did two doctors, including a cardiologist, miss the urgency of his symptoms? It probably was because they didn't know the author, whereas his lifelong friend, who turned out to also be a doctor, was able to "place [his] new symptoms in the context of [his] ...

Routine screening test recommendations, and how newspapers often get it wrong

in Social media | one response

As a primary care physician, I generally follow the guidelines of the USPSTF, an entity that uses rigorous standards of evidence as the basis for their recommendations.

Sadly, however, major media publications fall short of such standards whenever they delve into "which screening tests should I get"-type of articles.

The latest example is this piece from the Washington Post, discussing recommended tests men should ask for.

California’s balance billing ban, are hospitals about to give patients refunds?

in Physician | 2 responses

The fallout from California's balance billing ban is about to get much, much worse.

A patient is suing an emergency physician group for the $57 he spent last year on the balance bill he had to pay for services his insurance didn't cover.

If successful, the results for already near-bankrupt hospitals are chilling, as "hospitals and ER doctors could be on the hook for hundreds of millions ...

Why implant more than one embryo per in vitro fertilization cycle?

in Conditions | 3 responses

The answer is cost.

Because the costly treatment isn't often covered by insurance, doctors are sometimes pressured by patients to implant more than one embryo per cycle.

Since a single cycle can cost as much as $12,000, and those who aren't successful often keep on trying, the cost of having a baby can reach into the hundreds of thousands of dollars.

As this reproductive endocrinologist recounts, ...

Walter Reed Army Medical Center to close, was lazy staff a factor in the decision?

in Physician | 9 responses

Washington DC's infamous Walter Reed Army Medical Center is set to close in 2010.

In an effort to subsidize the city's subway system, the medical center purposely limited the number of parking spots, forcing staff to use public transportation.

Combined with the fact that buildings are subject to a height restriction in DC, the campus became increasingly sprawled as it expanded, forcing staff to walk longer distances.

A note to e-mail subscribers

in Uncategorized | no responses

I recently migrated the site's RSS feed from Feedburner to Google.

After the transition, it seems that I lost subscribers who had received a daily e-mail update from Feedburner.

If you were someone who received a daily update, please re-subscribe, by entering your e-mail address at the top of the middle column, to the right of this post.

Instead of a daily update, you ...

Are the days of the independent physician coming to an end?

in Physician | 4 responses

I think so.

The NEJM has a perspective piece on the declining percentage of doctors who practice independently. Depending on the source, the number ranges from 29 to 61 percent.

It is becoming increasingly difficult for doctors not to be supported by a hospital or large integrated health system. With reimbursements declining, many doctors are opting for the relative security of a salary.

Furthermore, ...

Is Daschle’s Federal Health Board an idea from Hitler’s Nazi Germany?

in Policy | 5 responses

Perhaps it was satire.

But the right-leaning Washington Times (via Matthew Holt) sounds the alarm about the proposed National Coordinator of Health Information Technology, a post that has gained significant publicity since the economic stimulus bill was signed.

Bluntly put, yes, health care needs to be rationed in order to have any hope in controlling health care spending. Ideally, an entity free of political and industry ...

Can we rely on IMGs to help with the primary care shortage?

in Physician | 7 responses

Studies show that international medical graduates (IMGs) see a disproportionally high number of Medicaid patients when compared to their American counterparts.

Like most doctors, if they had a choice, the incentives are such that they too would choose to practice in cities rather than in rural areas.

Less-restrictive visa requirements are making it harder to recruit IMGs to rural areas, and compounded by the fact that American ...

How to drive a doctor out of primary care

in Physician | 2 responses

A family physician chronicles his journey from an HMO to urgent care to practicing outside of the insurance system.

Steve Simmons notes that doctors out of residency rarely have any training in the business of medicine, including the all-important skill of coding.

"I needed to learn this'skill' on the fly," observes Dr. Simmons, "using a code book to translate each medical diagnosis into a five digit number, ...

PNHP can threaten health reform

in Policy | 11 responses

PNHP is a fringe physician group that advocates for a single-payer health system.The Massachusetts branch came out recently and railed against the state's health reform plan, which incidentally, is similar to what President Obama is likely to propose.According to its leadership, "nothing less than single-payer national health reform will work."I've always thought they should compromise their stance on a single-payer system, which has next to zero chance of being passed. ...

Health IT in the economic stimulus bill, should we be frightened?

in Tech | 9 responses

Much has been made of Betsy McCaughey's analysis of how the economic stimulus package will affect health care.

Although she takes a partisan swipe at the National Coordinator of Health Information Technology, perhaps what's more frightening is that billions of dollars may potentially be poured into an inadequate health IT infrastructure.

Blogging over at Health Care Renewal, MedInformaticsMD asks whether government can succeed as the primary ...

Is fibromyalgia real, and if so, are drug companies profiting from the uncertainty of the disease?

in Meds | 10 responses

Fibromyalgia is a condition that has no clear cause, and there's no definitive diagnostic test.

However, there is no doubt that the symptoms are real, and many patients are suffering from the disease. Two brand-name medications, Lyrica and Cymbalta, represent several billion dollars in revenue.

The Washington Post points out that both Pfizer and Eli Lilly donated more than $6 million in education funding in 2008 to ...

Should some doctors be restricted from prescribing narcotic pain medications?

in Meds | 7 responses

The FDA is about to get serious on inappropriate prescribing of narcotic pain medications.

What exactly they're going to do is unclear, but as reported in the NY Times, it "will result in further restrictions on the prescribing, dispensing and distribution of extended-release opioids like OxyContin, fentanyl patches, methadone tablets and some morphine tablets."

Part of the problem is that some patients who present with musculoskeletal injuries ...

We need comparative effectiveness research, or, I agree with Paul Krugman for the first time ever

in Policy | 10 responses

I usually disagree with pretty much everything that liberal rock star Paul Krugman writes from his pedestal at the New York Times.

However, when it comes to comparative effectiveness research, I'm with him 100 percent. Physicians need an authoritative source of unbiased data, untainted by the influence of drug companies and device manufacturers.

With treatments and medications announced daily, having an entity definitively compare these newer, ...

Ways you can die from having sex

in Potpourri | 4 responses

Cosmo Magazine, that bastion of reliable medical advice, declares, "An orgasm almost killed her."

Intrigued, gynecologist Amy Tuteur reads further, and finds its about case where a woman developed stroke-like symptoms after intercourse, and was diagnosed with an embolic stroke.

The patient was taking the birth control pill, which can raise the risk of blood clots. In this case, it was also combined with the presence ...

When should you keep your sick child away from school?

in Patient | one response

It's an age-old question that many parents still ask.

Pediatrician Perri Klass gives her take in a NY Times column. In general, you can't prevent every child who's shedding virus from going to school, as "that's everybody all winter long."

The only confirmed way to prevent the transmission of infection is hand-washing, a habit that should be regularly taught and enforced.

Dr. Klass' bottom ...

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