June 2009

All Stories

A soccer player collapses, but lives, thanks to his automatic defibrillator

in Patient | no responses

Here's a fascinating, and scary, video of an implanted automatic defibrillator in action.20 year-old Belgian soccer player, Anthony Van Loo, collapsed during a match. Blogging over at MedPage Today, electrophysiologist Dr. Wes analyzes the subsequent video, giving a precise play-by-play, so to speak, of when the defibrillator kicked in, likely restoring the arrhythmia into a normal heart rhythm.As for the cause, Dr. Wes has got you covered: "In ...

KevinMD Live Q&A on health care reform, today at 11:30am Eastern

in Policy | 3 responses

Health reform is rapidly gaining momentum, with details of the proposed plan coming into focus.Yesterday, The New York Times reported on the AMA's supposed opposition to the controversial public plan option, which has been the polarizing issue du jour. The AMA has since clarified their views.I'm opening up a Live Q&A at 11:30am Eastern today to answer your health reform questions. I don't pretend to be a ...

How we spend the most money on futile care

in Policy | 31 responses

A 90-year old man with a pancreatic mass, almost definitely pancreatic cancer, was admitted to a hospital.Surgeon Jeffrey Parks does the initial surgery consult on this terminal case, and recommends hospice care.The next evening, he's shocked by the "astounding amount of medicine [that] had been practiced" during the day:

Consults had gone out to GI, oncology, and nephrology. The GI guy had ordered an MRCP and, based on some mild ...

AMA: Health information technology help for physicians

in Tech | no responses

The following is part of a series of original guest columns by the American Medical Association.by Joseph M. Heyman, M.D.Health information technology (HIT) remains a hot button issue for many physicians, and opinions run the gamut. There are physicians and practice managers who are satisfied long-time users and those who question how HIT will benefit their practice and their patients.My own experience is that of a solo-practitioner using ...

Should doctors be on a salary?

in Policy | no responses

Health policy experts rightly state that the physician payment system, which pays fee-for-service, financially encourages doctors to order more tests.The opposite extreme, as we've heard many times, is the Mayo Clinic, which salaries their doctors.But could there be unintended consequences to placing physicians on fixed pay. For one, you are going to seriously dent productivity. Now, some say that may be a blessing in disguise, since the ...

It’s difficult to treat the morbidly obese

in Patient | 11 responses

There have been plenty of stories detailing how difficult it is to treat the morbidly obese.Most of the time, the stories have centered on simply how difficult it is to transport these patients to the hospital.Once there, however, emergency physician Shadowfax talks about other issues. For instance, obtaining IV access is near impossible, and 500+ pound patients present grave challenges to securing an airway, managing ventilation, or performing ...

Would you be willing to pay more to be seen more quickly in the ER?

in Patient | 7 responses

This ER in Atlanta is betting that you will.Taking advantage of worsening patient wait times in emergency departments, the Emory Adventist Hospital is offering a "Hold my place in line" service.For a fee of $24.99, patients are guaranteed to be see in 15 minutes or less - or the entire visit is free.It seems to me like shrewd business, and the blatant beginning of tiered emergency service. However, WhiteCoat ...

How an EMR destroyed this practice’s medical records

in Tech | 14 responses

A cautionary tale indeed.Chris Rangel details the debacle of his institution's electronic medical record implementation. Apparently, the IT consultants didn't work well in concert with the EMR technical people, with Dr. Rangel noting a circle of blame between the two parties.Indeed, the worst-case scenario happened - a catastrophic loss of patient data:

The backup system was supposed to be saving every EMR database copy but instead it was just backing ...

Executive physicals, and what the Mayo Clinic doesn’t want you to know

in Patient | 31 responses

The Mayo Clinic has been touted by policy wonks as a low-cost, high-quality integrated health system that American physician practices should aspire to.What's somewhat less publicized is that they are also a leader in so-called "executive physicals." (via Schwitzer)These exams, which often exceed thousands of dollars, offer CEOs and other executives a battery of tests that are often not evidenced-based. These can include stress tests, cardiac CT ...

Can patient empowerment be taken too far?

in Patient | 13 responses

Donald Berwick is a physician at the forefront of the patient empowerment movement.In a recent interview, he believes that medical care needs to be more patient-centered, in effect, "transfer[ring] control from doctors to the patients themselves," and, "patient preference occasionally putting evidence-based care “in the back seat."I wonder how, as a pediatrician, he's handling the anti-vaccine movement.In response to a question on patient choices that come in conflict with ...

Should doctors competitively bid for Medicare rates?

in Policy | 8 responses

Frustrated by Medicare's price-fixing tactics?One idea is to introduce a competitive bidding system. It's a well-known fact, and one that strongly influences current health policy decisions, that some areas of the country have more doctors and provide more medical services than others, with no additional, appreciable benefit.In an op-ed in The New York Times, pulmonologist Peter Bach, former senior adviser to the administrator of the Centers for Medicare ...

Maggie Mahar: Removing the hazardous waste from healthcare

in Policy | 7 responses

The following is a reader take by Maggie Mahar.Most of us are now familiar with the estimates that as much as one-third of our health care dollars are squandered on ineffective, often unnecessary, unproven and overpriced products and services. But which third?The fat in our health-care system is not hanging out conveniently on the edges of the steak, waiting to be trimmed. It will take a scalpel, a ...

Losing the anti-vaccine fight, and what we should do next

in Patient | 16 responses

The fight versus anti-vaccine proponents is a losing one.Orac, a general surgeon who blogs over at Respectful Insolence, is on the front lines of the debate. In this post, he writes about how vaccine supporters are facing an uphill battle:

One problem is that vaccines have been so successful that parents rarely see the full, ugly consequences of the diseases against which vaccines defend anymore. The other problem is ...

Poll: Is further reducing resident work hours worth the cost?

in Education | 16 responses

The Institute of Medicine is recommending "rapid implementation" of its proposed plan to further restrict medical residents' work hours. The plan includes a 5-hour nap during extended shifts, a strict 16-hour cap on shifts without naps, reduced workload, and more days off.But at what price?It seems like common sense that better rested doctors make fewer errors and contribute to better patient care, but data from several large-scale studies does not ...

Will comparative effectiveness research really save money?

in Policy | 4 responses

President Obama hopes so.But, as Abraham Verghese writes, we can't be so sure of that. The great cost-cutting hopes proposed by the government, which also include information technology and preventive medicine, all have very little data that show there will be any meaningful cost savings.Are we focusing on the wrong things for cost control? Instead of making the difficult decisions, which includes revamping the physician payment system, ...

Reforming health care using the Massachusetts model won’t relieve ER overcrowding

in Policy | 12 responses

It's looking more and more likely that federal health reform will look very similar to what's going on in Massachusetts.As I've written in the past, expanding coverage is easy, controlling costs is not. And Massachusetts has taken the route of least political resistance and did the former.I've written previously that expanding coverage without re-aligning incentives to produce more primary care doctors will simply increase waiting times and crowed ...

5 top medical comments, June 7th 2009

in Policy | no responses

Here are some of the more interesting comments readers have left recently.1. David Block on the ACP's guest column, A practice model for increasing the appeal of General Internal Medicine: Weinberger talks about the efficiency of Care. Our commentators talk about the efficiency of Consumption. Weinberger assumes the one-on-one of two individuals, known to each other, who together negotiate the terms of personhood. Medicine is “spiritus”; no wonder he became ...

Should medical errors be prosecuted criminally?

in Physician | 13 responses

A pharmacist in Ohio is being criminally prosecuted in a medical mistake that resulted in a death of a two-year old child.Is that going too far?Indeed, if the criminal prosecution of this pharmacist is successful, it may lead to a dangerous precedent. Indeed, "he wasn’t drunk or impaired. He wasn’t even the one who prepared the mixture. He was inattentive and lazy and careless, and now he faces ...

Medical tourism, malpractice, and it’s easier to sue American doctors

in Physician | 12 responses

How are American doctors fighting medical tourism trend?Cardiologist DrRich's latest post details the concern the American College of Surgeons have for the burgeoning medical tourism industry, and how they are using malpractice as a reason not to travel overseas for your procedure."Indeed, the potential difficulty in suing foreign doctors appears to be the chief differentiator, and the primary argument in favor of good-old-American-surgery," DrRich writes. "The surgeons, in essence, are ...

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