Colonoscopies are routinely performed without sedation in Europe and Asia.

With health care costs rising, and staffing become scarce, a study suggests that a no-sedation colonoscopy can help on both fronts. Of 145 patients who elected to undergo a colonoscopy without sedation, 112 completed the procedure.

As a gastroenterologist shortage is looming, a no-sedation colonoscopy may become an option for some patients.

Additionally, patients ...

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Are there too many hospitals?

Should hospitals be run more like fire departments?

"Each neighborhood has its own firehouse," says #1 Dinosaur, adding that "because the training is generally similar from one company to another, you don't have huge, expensive advertising campaigns touting the superiority of the Main Street Fire Company over the one on Church Street."

Calling it "the ultimate in capitation," he envisions hospitals to be funded like police and ...

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The physician shortage is forcing rural ERs to use mid-levels exclusively to staff their emergency departments.

Local doctors are the backup, available by phone and able to go the hospital within minutes for emergencies.

Some hospitals have no choice, since the alternative would be to shut the ER down due to the lack of available physicians.

There is a marked difference in the amount of training an ...

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Should there be preconditions for patients in order for universal care to be enacted?

Chris Rangel weighs the "practical interest in keeping the workforce healthy and reducing the economic burdens from people who become sick and disabled as a result of unhealthy or risky lifestyles" versus the "undue burdens on beneficiaries" that can "lead to decreased participation."

Dr. Rangel points out that under any reform plan that increases ...

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A simple tool can potentially yield huge beneficial results.

As reported by MedPage Today, Atul Gawande led a team that studied whether surgical teams who completed one-page procedural checklist in the operating room affected patient care.

The results, published in the NEJM, were stark. In eight hospitals in eight different countries, both 30-day death rates from non-cardiac surgery and inpatient complications were significantly lowered.


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Ever schedule an appointment with a physician only to see a mid-level provider instead?

Patients better get used to it, as the doctor shortage, especially in primary care, is leading hospitals and practices to staff mid-level providers like nurse practitioners and physician assistants instead.

A retired doctor reminisces about the old days, and notes that "it is really all about economics," and that the doctors patients really ...

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Here's what an emergency physician would recommend.

In addition to everyday things like gauze, alcohol wipes, bandages, and select over the counter medications, some of the non-traditional items include hemostats and trauma shears (both available online), as well as Krazy Glue.

Why Krazy Glue? Dermabond, liquid bandage that's often used in the emergency department, has the same active ingredient that's found in Krazy Glue.

I've written in the past that the routine physical exam does not have data to back up its efficacy.

Family physician Ben Brewer (via the WSJ Health Blog) has a different take, saying that it provides time to build relationships, which can have "a beneficial impact on health quality, costs and outcomes that goes way beyond disease detection and health screening."

There are some variables that ...

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California doctors are going to lose a lot of money.

Emergency physician Shadowfax analyzes the recent California decision that bans balance billing. Calling it "a disaster in the making," he writes that removing the option to directly bills patients removes the leverage physicians have when negotiating with insurance companies. Namely, the option to stop accepting insurance.

Without this option, doctors "have to accept whatever pittance ...

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The traditional method of learning medical procedures may need to be revamped.

Procedures, like inserting a central line, can be technically difficult and fraught with complications. The traditional way of teaching was to do one, have a medical resident watch, and then supervise the physician-in-training's first attempt. Today's focus on patient safety doesn't lend itself to medical trainees practicing on live patients.

Indeed, the teaching ...

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