In the rush for quality, measures that harm patients will be inevitable:

Is Dr. Government willing to purchase malpractice insurance, to open itself up to lawsuits by the millions when one of their quality indicators show more harm than good. It will happen. Give it time. I guarantee you that. Will they shield themselves under the cloak of national interest. Of course they will. The fall out will be ...


Time to cognate

A way to save primary care?

Chief complaint: "Uh."

The importance of context in the chief complaint.

A noted infectious disease specialist gets arrested, and says he was doing it for his research:

A doctor specializing in infectious diseases at UMass Memorial Medical Center said he was just "gathering information" when he was arrested by police this weekend for allegedly offering to pay for sex from an undercover officer posing as a prostitute.

It's a ridiculous idea, but hey, it may help take the liability burden off the physicians:

Finally, let's make sure the trial lawyers are safe. After all, they have easy pickings with primary care physicians and drug companies when things go wrong. By shifting the responsibility to patients and pharmacists (whose liability coverage is not as rich as physicians), trial lawyers could find themselves out of a significant contingency ...


Click the image to find out.

Earning his money

WhiteCoat with one of the more unsung therapeutic procedures of the night, in elaborate detail.

In medical school, it is emphasizes that the chief complaint be phrased in the patients own words. Here are some of the dangers of using patient quotations without context.

It's going to be one lucrative exit strategy hypothesizes DrRich:

But before they drive them into oblivion, the Democrats promise to create for them one last, massive windfall - namely, the government-paid insurance premiums for many of the 47 million uninsured Americans. (Joseph Paduda at Managed Care Matters thoughtfully estimates for us that windfall as $150 billion per annum - not exactly chicken feed.)

So, for at least a while, ...


Paul Levy talks about being a patient at his own hospital:

I am really lucky to have a primary care doctor who knows how to protect me, as president of our hospital, from our well meaning doctors. Why do I need protection? Well, because the specialists are really proud of their work and want to use any malady that I have to show me their stuff. My doctor knows ...


Howard Brody on a free-for-all over at CafePharma:

. . . the discussion thread had to do with some reps sharing stories of how they had deliberately contaminated the food they brought into physicians' offices to "get even" with various people who gave them a hard time or who did not value their services. Others took issue with such behavior.
(via Health Care Renewal)

Taking apart drug ads

Great new series from Consumer Reports, where ridiculous DTC drug ads are critically analyzed. (via Dr. Wes)

Cardiac electrophysiologist Dr. Wes talks about a 30% reduction in physician revenue next year: "You have now walked a day in primary cares shoes."

Too many colonoscopies?

The NY Times points to a study suggesting that colonoscopies are performed too often - not surprising since they are well-reimbursed by insurers.

Guidelines state that in the asymptomatic population, normal colonoscopies need to be repeated every 10 years.

IVF and the obese

Should the obese be banned from IVF?

Whether they are seeking treatment on the NHS or privately, professionals are being urged to deny treatment to women with a Body Mass Index of more than 35.

Where possible, the British Fertility Society says IVF should be offered only when her BMI has dropped below 30 - a figure based on both height and weight.

Cockroaches in the OR

And that wasn't even the worst of it:

A former senior doctor at Sydney's Royal North Shore Hospital says complaints that he had to kill cockroaches on operating theatre tables during surgery were ignored by management.

It has also been confirmed that an anaesthetist at the hospital was forced to catch an unconscious patient after an operating table broke in half.

Now, the current number of physicians is being overestimated.

Canada is bracing for universal healthcare Stateside:

With all the presidential candidates vowing to extend health insurance coverage to the about 47 million Americans without it, Canada's doctor supply will be raided, said Brian Day of the Canadian Medical Association.

There's no doubt the promise will be kept and have a dramatic effect on Canada's supply of doctors, Vancouver-based Day said in London.

Diseases and insults in the Netherlands:

The worse the disease, the more insulting the curse, and the Dutch use a whole clutch of them: pleurisy, tuberculosis, the plague, smallpox, cancer... recently even Aids has been added to the list. To call someone an 'Aids sufferer', for instance, is a grave insult, so the system evolves continually.

Ok to hug your patients?

Maurice Bernstein looks at the ethics:

Is hugging a patient professional? Does it exceed boundaries of professional behavior? Does it invade the patient's privacy? Should doctors first ask the patient "may I hug you?" and wait for permission? When you are upset and in distress and need the attention and compassion of someone who shows that he or she cares about your feeling, should you or would you accept ...


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