An op-ed in the Boston Globe - "It's too expensive to be a primary care doctor":

Under the current care model, doctors are attracted to better-compensated medical specialties so they can deal with rising medical-school debts, inequities in reimbursement, and increasing malpractice insurance costs. Even though patients receive 95 percent of their healthcare outside of a hospital, it's just too expensive to be a primary-care doctor in America today.

A simple panel used by an ER physician to rule out the diseases that may come back to bite you if you miss them:

I have devised a simple, cheap and quick "reassurance work-up" for these folks which consists of:
an ECG, an i-Stat, a D-dimer, and a troponin. Sometimes I add a chest x-ray if it seems helpful.
PCPs I talk to are ordering more D-dimers as ...

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The right thing was done:

A grand jury Tuesday declined to indict Dr. Anna Pou, the surgeon accused of killing four seriously ill patients in the aftermath of Hurricane Katrina.
Hopefully this saga has come to an end. Read more for extensive debate on the Anna Pou story.

Some blogosphere reactions -

PEU Report:
"The bad news is the grand jury declined to indict the ...

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Dr. Wes writes on hospitalist-run non-teaching services, and how they threaten medical education:

I see many, many more patients shunted to in-hospital hospitalist services that are productivity-driven. These eager inpatient attendants to health care are a formidable challenge to managing inpatient teaching services: patients are seen quickly, decisions expedited, and lengths of stay minimized, making a powerful inducement for hospital systems to employ these services. Teaching services are rarely ...

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Homeopathic surgery

"Amazingly tragic," says Orac.

Accusations continue, suggesting that he rushed through pre-surgery process. The accused physicians are refusing to settle:

But Kaplan had tests to schedule: a psychiatric evaluation was necessary, and Weis needed to meet with a nutritionist. Appointments that usually took two weeks to get were set up in a day or two.

"He was busy with a number of events during that time period that related to the ...

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Wisconsin is a test state for a dramatic reform for health care. And the costs are a whopper:

And, wow, is "free" health care expensive. The plan would cost an estimated $15.2 billion, or $3 billion more than the state currently collects in all income, sales and corporate income taxes. It represents an average of $510 a month in higher taxes for every Wisconsin worker.
And increases entitlements:
The ...

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Lawrence Altman explains why.

Closed hospitals and medical offices are shattering the health care system post-Katrina:

Studies suggest that hundreds of doctors never returned. And some of those who did, especially specialists and young physicians, are leaving, said Dr. Ricardo Febry, president of the Orleans Parish Medical Society, which has lost more than 200 of its 650 members. The exodus has "been a steady trickle," Dr. Febry said.

Overtreating pain

Aggravated DocSurg explores the downside of the "fifth" vital sign:

Couple that issue with the militant attitude of JACHO [sic] ----there shall be no pain!!--- whose guidelines insisted that anyone with a pain score greater than 5 must be reassessed. In the real world, unless a nurse wants to go through the headache of extra paperwork, reassessment means "remedicate." And, of course, there is the all-too-frequent patient who describes ...

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Trusting Medicare

Some are advocating "Medicare for all", partly because of the low-interference such a system will provide. Can this stay true in the future?

As Medicare expenditures rise, this illusion of non-interference will become much harder to maintain and indeed Medicare itself may become less popular. I am always curious to hear -- from single-payer proponents -- which interest groups they think will have a decisive say over ...

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Dr. Rob with some friendly advice that all patients should read.

Dr. RW turns two

Congratulations! Keep up the great blogging.

Sometimes, it's difficult to tell:

Most medical schools don't spend much, if any, time teaching their students how to cope with low-literacy patients, and most doctors aren't particularly adept at detecting reading problems "” or knowing what to do when they identify someone who can't read. And with the specter of "pay for performance," in which doctors' reimbursement will be tied to meeting certain quality goals, there is concern ...

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More feedback on yesterday's study suggesting that older physicians are bemoaning the resident work-hour restrictions. retired doc comments:

This is not a hard data article but a presentation of the impressions of IM resident training program teachers most of whom trained in a era that was very different. One difference is that many faculty likely grew up medically with their limbic cortices branded with the concept that ...

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Think before jumping to conclusions on this recently released study:

The drinking of diet soda, while unlikely to largely contribute to (cause) the development of metabolic syndrome, is a behavioral trait that is associated with others that are negative. So if you DO exercise and otherwise eat a balanced diet, you shouldn't feel awful about drinking a diet soda every now and then: its the behavioral patterns which are reflected ...

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The WSJ Health Blog writes about a recent survey suggesting that older physicians are work-hour restrictions the thumbs-down:

But the faculty docs had mostly bad things to say about the rules, and those who had been teaching for five years or more were more likely than their less-experienced colleagues to be sour on the work limits. Among the overall findings:

* Eighty-seven percent of the doctors thought continuity ...

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Sid Schwab tells all.

Speaking of painful ways to die . . . (via plasticized.com)

No surprise to regular readers here.

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