Don't try this at home.
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(via The Happy Hospitalist and Bad Medicine, Good Solutions)
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What if restaurants were paid like doctors?
Imagine if food was a universal right in America, and citizens can forward the bill to the national government.
Wendy Lynch does so, and hypothetically describes a system which assigns an "RVU" value to weigh the cost of different meals. Examples include "basic oatmeal and fruit served at a diner in Omaha is assigned a RVU of 1 . . . for consumers needing special meals, a ...
Treating chronic pain with narcotics and avoiding the risk of addiction
Management of chronic pain and anxiety is a significant challenge in primary care.
Rob Lamberts provides an excellent overview of how he manages pain requiring narcotic medications, and touches on other controlled substances like benzodiazepines.
Physician prescribing patterns can be quite variable, ranging from those who won't prescribe controlled substances under any circumstances, to others who take a "candy-man" approach, giving short-term narcotics liberally.
I agree with ...
Sanjay Gupta for Surgeon General, is he qualified?
Is this a case of style over substance?
Val Jones, who has interviewed three recent Surgeon Generals, calls it a "shock," and says, "I don't think he has the gravitas or appropriate experience for the role of Surgeon General of the United States."
She cites a source that is concerned about his lack of experience, and notes that it may cause tension within the Pentagon. "It ...
Why health IT and electronic medical records are so misguided
Is it the technology or the people behind the computers?
This piece from Health Care Renewal suggests it's the latter, or the so-called sociotechnical issues. In other words, the problem is not with the technology itself, but "inadequate planning, insufficient testing or training, failing to include front-line clinicians in the planning process, failure to consider best practices for HIT operationalization, failure to ...
Tufts Medical Center plays the Partners HealthCare card and drops Blue Cross Blue Shield
The stakes cannot be higher for Boston's Tufts Medical Center.
Over the past few weeks, we've been reading how rival Partners HealthCare, comprised of powerhouse hospitals Massachusetts General and Brigham and Women's Hospitals, have bullied health insurers into disproportionally higher payments.
I have argued it is because patients demand their services.
Now, Tufts Medical Center is attempting to play the same game, announcing they are ...
Prescribing insulin for diabetes, do endocrinologists have a financial incentive to do so?
Recent guidelines ignore newer oral diabetes agents like Avandia and Januvia.
Matthew Mintz criticizes this move, saying that this will lower the threshold for diabetes to begin insulin therapy.
He wonders if the endocrinologists, who authored the guidelines, have a financial motive to do so. Due to time constraints, primary care physicians do not have the inclination to manage insulin regimens, which can ...
Apple’s Steve Jobs, and how his hormonal imbalance and pancreas is making him sick
Endocrinologists are puzzled over the Apple chief executive's medical condition.
Steve Jobs disclosed a cryptic letter today detailing his health condition. It reads, "As many of you know, I have been losing weight throughout 2008. The reason has been a mystery to me and my doctors. A few weeks ago, I decided that getting to the root cause of this and reversing it needed to become my ...
Are all for-profit health care companies evil?
For-profit health care organizations are vilified in the media and those wanting to reform health care
But are the attacks justified or not? Val Jones points to several instances were non-profit academic institutions engaged in less than ethical behavior, while pointing out examples of for-profit companies who "who cultivate a culture of environmental responsibility and charity."
Judgments should not be made on
How to convince doctors to accept health reform
Stuff their mouths with gold.
Or so says Britain's health minister when asked how he got doctors to buy into the UK's National Health Service.
One way to overcome dissent is to buy off the opposition, and this is what Jacob Hacker is alluding to in his piece promoting an influx of dollars to push health reform forward (via Maggie Mahar) at all costs. He ...
Doctors are finding leprosy in the heartland
A man presents with a fever of 109 degrees, swollen lymph nodes, and hepatosplenomegaly.
MedPage Today reports that many doctors are unaccustomed to diagnosing and treating leprosy.
Approximately 150 cases are diagnosed annually, mainly in port cities. As immigrants are moving middle America, where the jobs are, medical providers are finding more cases.
The big clue is "a reduction or absence of sensation around the ...
Why doctors need to embrace retail clinics
A nice op-ed in Forbes.com outlines some basic strategies to revamp our generalist system.
Two suggestions, increasing payment and addressing defensive medicine, are not new and I certainly agree they need to be part of the answer. They have been discussed comprehensively in my past posts.
One idea, allying with retail clinics, is something that many physician groups foolishly oppose. But as the opinion piece ...
Should doctors form a union or join the SEIU?
There's no question that health reform needs to rebuild around primary care medicine.
Doctors give their own suggestions, including aligning generalist salaries comparable to how the UK pays GPs in their nationalized health system, which is approximately "$230,000 a year plus 25% performance bonuses."
Some other more aggressive tactics involve forming a physician union, or joining the Service Employment International Union (SEIU). One doctor has initiated ...
Jett Travolta’s seizure and death, was Scientology a factor?
Jett Travolta tragically passed away yesterday, after being found unconscious in his hotel room by his caretaker. There is speculation that he had a seizure and hit his head on a bathtub.
Travolta apparently had a long history of medical problems, including Kawasaki disease, which is a vasculitis that primarily affects children. It is one of the most common causes of acquired heart disease in children, and ...
What should a doctor do when he discovers another doctor’s mistake?
An interesting question.
Amy Tuteur asks this question at a dinner party, and it elicits a whole host of responses. If a patient asks directly, the answer is easy. But what if the patient doesn't ask? Is there an ethical requirement to disclose another physician's error?
My first reaction, along with Dr. Tuteur's, would be full disclosure, meaning that the patient should know everything ...
Local television news may be using pre-packaged health stories
Budget cutbacks are forcing some local television stations to use canned health segments that can be tailored to a specific local market.
The result can give "viewers the false impression that the stories were locally produced and the patients and doctors quoted in the stories could be their neighbors," and one nationally syndicated physician is ...
The economy, plastic surgery, and how it’s affecting cash only medicine
It's no secret that difficult economic times have forced many patients to put off cosmetic surgery.
No where is that more apparent than in South Korea, the Asian "mecca" of plastic surgery. Thirty percent of Korean women had cosmetic procedures done last year, and now, scores of luxury clinics either are empty or have gone out of business.
Doctors are always drawn to cosmetic procedures, since ...
How old is too old to continue breast feeding?
A woman continues to breast feed her 6-year old son.
Many find that shocking, but when you consider that "the average age of weaning around the world is 4 years old and there are no studies saying it is harmful," is it really?
While psychologists wonder whether it will impede the ability to "develop the capacity to soothe oneself, the capacity to tolerate frustration," mothers claim a ...
Is health care prohibition in our future?
One scenario envisioned by health reformists is to prohibit doctors from practicing outside a government-run system.
This is the situation in Canada, leading to single-tier health care. Opting out of Medicare and other health insurers remains the last trump card doctors have in negotiations. Removing that option would enslave physicians to the whims of government control. Most health policy wonks would like nothing more than to ...
Are doctors finding the physical exam useless and obsolete?
Many are bemoaning the deterioration of physical exam skills that the current generation of doctors are displaying.
Bob Wachter says it may not be that big a deal. "Even if we could create a new generation of expert physical examiners," he writes, "would it be worth the time and trouble?" He doubts it, saying the time spent to learn and perform a comprehensive physical has to be ...
