How to apologize after medical error, and when not to:

An FP in Washington State learned this the hard way when he failed to notice, until a follow-up visit, that a patient's PSA was elevated. "I referred him to a urologist, who successfully treated him for prostate cancer," says the FP, who requested anonymity. "The delay in diagnosis had no negative effect, but I told the patient because I felt ...


How HIPAA is impeding physician-patient email interactions:

As most medicos know, legalities are only as binding as a judge sees fit... especially with the long shadow cast over the health business by the Health Insurance Portability and Accountability Act (HIPAA).

Not only has the Act made it really hard to stay out of a courtroom, but health pros are having more and more trouble keeping up with HIPAA's requirements.
(via ...


GruntDoc is not dead

He is simply a victim of the DOS attack on Hosting Matters. I was affected for a brief time this morning as well - but at least my blog survived (so far). GruntDoc will return soon.

He's back up.

Dr. Crippen probably won't be happy about this:

Nurse practitioners are gaining broader acceptance by health insurers and medical regulators. In Iowa, Oregon and a dozen other states, nurse practitioners can operate without doctors' collaboration or supervision. Most states allow the nurses to prescribe the vast majority of drugs, with the exception of controlled substances such as narcotics.

Medicare, the U.S. insurance program for the elderly ...


During my time off, I read Malcolm Gladwell's fascinating Blink. One chapter deals with Chicago's Cook County Hospital, and it's adherence to Goldman's algorithm for diagnosing chest pain. Gladwell writes:

One of the stories I tell in "Blink" is about the Emergency Room doctors at Cook County Hospital in Chicago. That's the big public hospital in Chicago, and a few years ago they changed the ...


Is this standard of care for a sprained ankle?

James Greco claims Vest failed to provide anticoagulant therapy to his wife on April 30, 2004, failed to warn her of the risk she had for the development of deep vein thrombosis, and failed to consult with a specialist in vascular surgery or disease and/or radiologic expertise to evaluate and treat Tamara.

A podiatrist is sentenced to death.

Orac is skeptical that a medical Wikipedia would work.

The worth of a cure for cancer? $50 trillion.

Much appreciation goes out to Clinical Cases and Images and This Makes Me Sick for keeping the blog fresh in my absence.

Selling sickness: the pharmaceutical industry and disease mongering, BMJ:

"There's a lot of money to be made from telling healthy people they're sick.

Some forms of medicalising ordinary life may now be better described as disease mongering: widening the boundaries of treatable illness in order to expand markets for those who sell and deliver treatments."

How it feels to be the doctor of the ship: The Challenges of Shipboard Medicine in NYTimes.

1) More than a dozen more ear-stapling businesses have been told to shut down by the Mississippi Medical Licensure Board because they aren't licensed. The small, stainless steel staples are supposed to apply pressure to points that control appetite and cravings for nicotine. Do people sue if they keep eating? Read [Clarion Ledger]

2) This happened in Canada, but we couldn't let it go. A hospital had to ...


Nasogastric Intubation is the latest video in the excellent NEJM series Videos in Clinical Medicine.

JAMA is the third journal from the group of "big five" in medical publishing to feature audio summary of content. NEJM and Lancet have their own versions of weekly audio summaries.

You can listen to the MP3 files directly or subscribe via iTunes.

It is a matter of time before almost all major journals feature audio summaries.

In the meantime, you can always use

We thought it was a good a day to thank a few of the many smart minds who have helped bring a personal voice to uncovering"”and overcoming"”the medical liability mess.

Philip Howard and the crew at Common Good are helping bring special health courts to states across the nation. Howard wrote a powerful piece about hospitals' fear of lawsuits helping allow a nurse, Charles Cullen, to kill at least ...


Chinese face-transplant patient is healing well, according to AP.

He was attacked by a bear and had a partial face transplant during a 15-hour operation earlier this month.

Top 5 health concerns of women and men according to WebMD.

Don't check blood pressure when your patient is sitting on the exam table.

In one study, the systolic blood pressure was on average 16 points lower after patients waited in a chair for 5 minutes.

NYTimes writes about some lubricating comments that doctors use and their effect on patients:

"Tell me more about that." "That must have been very difficult for you." "I hear what you are saying." "Your story moves me."

We are getting closer to the 7-minute-Jiffy-Lube-visit every day... The "lubricating comments" will surely help.

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