July 2009

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Does cutting health care costs mean spending less on the elderly?

in Policy | 13 responses

Reducing health spending, as Congress is finding out, is difficult.Some health economists have pointed to medicalization of common complaints, like erectile dysfunction and attention deficit hyperactivity disorder, as one reason. Indeed, Dartmouth researchers, who are cited as favorites of the current administration, feel that an "epidemic of diagnoses" is what's making us sick.But, Darshak Sanghavi writes in Slate that this may be a red herring, and clouds what's ...

Who speaks for the doctors who spend time with patients?

in Policy | 15 responses

Among physicians, there's tremendous contention as to who represents the "true" voice of doctors.There are indeed various lobbying groups, but as Stanford's Abraham Verghese writes in a recent WSJ column, "Our esteemed medical societies and academies aren't speaking for medicine; they are lobbyists, defending their financial self-interests, lining up for or against the latest bill being proposed," and that, "our great academic institutions and our esteemed medical schools have ...

Are drive-thru ERs the future?

in Physician | 14 responses

Finding a way to decompress crowded emergency departments is imperative.Over at Stanford Hospital, doctors there have come up with one novel tool: the so-called "drive-thru ER." Patients literally don't have to get out of their cars to receive medical care.This is especially relevant in the current era of pandemic flu, since patients can use their own cars to reduce the risk of contaminating others.So, how does ...

Controlling health care costs will require patient sacrifice, that how that will affect the status quo

in Policy | 31 responses

One of the hurdles impeding health insurance reform is convincing those already with insurance that the changes will benefit them.Indeed, according to most polls, more than 3 in 4 are satisfied with their own care, and according to The New York Times' David Leonhardt, "Americans say they want change, but they also want to preserve their own status quo."But, the status quo cannot be preserved if we're serious about ...

ACP: Putting effectiveness into the health care equation: Rational or rationing?

in Policy | 17 responses

The following is part of a series of original guest columns by the American College of Physicians. by Steven Weinberger, MD, FACP“Effectiveness” has become a buzzword these days in discussions about healthcare reform. It is often accompanied by different preceding modifiers, such as “cost” or “comparative,” each conjuring up different images in the minds of physicians, patients, insurers, and the pharmaceutical industry. Some say that cost effectiveness and comparative ...

Why it’s difficult to put doctors on a salary

in Policy | 32 responses

One of the reasons why large, integrated health systems are able to hold down costs is because they put their doctors on a salary.This divorces payment from volume of care, which is one of the major criticisms of a fee for service system. The pros and cons of such a system can certainly be debated, but the point is that it will be difficult to make such wholesale ...

Are patients refusing doctors who no longer do hospital work?

in Physician | 17 responses

As the numbers of hospitalists increase, more primary care doctors are no longer doing hospital rounds.Communication problems can arise from this, as discharge summaries and other hospital notes often are not transferred back to the outpatient physician in a timely manner, if at all. And indeed, some patients are unhappy with this trend, and prefer to choose doctors who both have an outpatient clinic and perform hospital duties.As ...

Are female surgeons happier than their male counterparts?

in Physician | 4 responses

The answer appears to be yes.MedPage Today reports a study suggesting that, "Most women surgeons would make the same career choice again if given the option," and, "women were somewhat more likely than men to say they would choose the surgical profession again."What's notable is the general high satisfaction rate among surgeons, as "most surgeons of both sexes would recommend their profession to others, indirectly suggesting a high rate ...

Explaining soaring health care costs in easy to understand language

in Policy | 6 responses

Hospitalist Bob Wachter comes up with a nice analogy explaining why health spending is soaring.Apologies for the block quote, but this should be read in its entirety:

You’ve just moved to a new town and stroll into a restaurant on the main drag for lunch. None of the large tables are empty, so you sit down at a table nearly filled with other customers. The menu is nice and varied. ...

Did Michael Jackson’s doctor give propofol, a possible cause of death for the King of Pop?

in Meds | 7 responses

Things are looking increasingly bleak for Dr. Conrad Murray, Michael Jackson's personal physician.Did Michael Jacksons doctor give propofol, a possible cause of death for the King of Pop? Reports are circulating that the powerful anesthetic propofol, also known by its trade name Diprivan, was found in the singer's body. According to ABCNews, "the autopsy of Michael Jackson found the powerful anesthetic propofol, as well as several prescription drugs, in his system, and law enforcement sources ...

Should heart disease screening tests be covered by insurance?

in Conditions | 5 responses

Tremendous controversy surrounds the screening for cardiac disease.The USPSTF does not recommend heart screening tests for the general population, like a routine EKG or exercise stress test. Texas, however, takes the opposite approach. They recently passed the Texas Heart Attack Prevention Bill (via Schwitzer), "mandating health-benefit plans to provide coverage for certain screening tests for early coronary artery disease."Indeed, some of the wording of the bill ...

We should not care about Regina Benjamin’s weight

in Patient | 22 responses

Regina Benjamin has impressive qualifications to become our next Surgeon General. She's a primary care physician in Alabama who has spent considerable time treating the poor. Certainly a better choice than celebrity neurosurgeon Sanjay Gupta.We should not care about Regina Benjamins weight But it's unfortunate that there has been so much controversy about her weight.Rob Lamberts has the best take I've read on the issue, and he ...

Why rationing is a dirty word, and can we ever limit care in America?

in Policy | 12 responses

Peter Singer confronts rationing of medical care head-on two weekends ago in a piece in The New York Times.It's gained plenty of traction within the blogosphere, but none better than hospitalist Bob Wachter's opinion on the issue. In his take, he channels Joseph Stalin, saying, "A single death is a tragedy, a million deaths is a statistic.”And that's really the driving force behind the mindset against rationing ...

Should health care come with a warranty?

in Policy | 19 responses

It's no secret that one of the keys to cutting health care costs is changing the way doctors are paid.One proposal that has been used in some integrated health systems, like the Geisinger Health System in Pennsylvania which uses a similar model, is to not pay for complications. Known as the Prometheus model, the system proposes that "half of the costs from avoidable complications must be paid for by ...

Cursing can kill pain, I swear

in Patient | 2 responses

Maybe those who scream obscenities while in pain are onto something.MedPage Today writes about a study showing that those who swore had an increased pain tolerance, along with an increased heart rate. This is similar to the proverbial "fight or flight" response that can help mitigate actual pain.Researchers asked a group of undergraduate college students submerge one of their hands in freezing cold water. One group was ...

Are doctors pressured to prescribe opiate drugs?

in Meds | 26 responses

When it comes to opiate drugs, like morphine, there is a bitter debate between patients who are in chronic pain, and the doctors who are vilified for under or over-prescribing these medications.But there are some other subtle influences that push doctors to prescribe these drugs, in some cases inappropriately. An ER physician talks about the issue, saying, "when dealing with a patient who is in pain, or appears ...

E-cigarettes are not safe, and here’s why

in Conditions | 27 responses

E-cigarettes, or electronic cigarettes, have been largely unregulated, and there have been many doctors questioning its safety.MedPage Today recently reported on the FDA's analysis of such products, and now we have some guidance as to how dangerous they can be.E-cigarettes are battery operated, and contain nicotine and other flavors that the user can inhale. Advertisements claim they are safer since they don't burn tobacco.But according to the FDA, ...

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