Can improved communication lead to a decrease in defensive medicine?

"There is just this lack of communication between the patient and the physician, and because of this communication gap, we have physicians practicing defensive medicine -- ordering those extra tests out of fear they might miss something. This has paralyzed medicine. When something bad happens, no one talks."

Which physician would get the credit?

As Medicare moves to develop a national physician P4P program, two assumptions underpin successful implementation: that claims data can be used to retrospectively assign patients to physicians or practices with primary responsibility for their care, and that physicians can be held responsible for a meaningful percentage of the patients they treat and the visits they bill for.

The reality, however, is that many ...

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She had to be transported by ambulance, but she unfortunately died. The family is suing:

The EMS rule of not transporting patients who weigh more than an estimated 300 pounds is arbitrary and not required by any regulatory agency, Hanlon said.

"I was shocked when I learned of the 300-pound limit. It doesn't make sense," she said. "I can't find any state or national standard for that (rule)."

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The NEJM speculates in an editorial:

Ultimately, the payment of primary care physicians might be a blend of fee for service, monthly fees for practices serving as patient-centered medical homes, and additional bonuses for meeting quality and efficiency performance goals. Primary care physicians could instead be paid a monthly fee per patient (adjusted for the case mix), along with a bonus for performance. Such payment methods are more likely ...

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The latest case image from the NEJM. Dye from an angiogram persisted in the blood of this patient due to acute renal failure.

This report would suggest so, as it looks at evening newcasts in 2006:

The Business & Media Institute (BMI) has found a recurring network news bias against the pharmaceutical industry, treating drugs as an entitlement rather than an expensive-to create product, refusing to credit and often ignoring entirely the companies that made the medicine. Even when one new drug was hailed as a "major advance in combating breast cancer" and ...

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The lung cancer screening debate continues. An internist writes in the WSJ about the benefits of early diagnosis, even with no difference in mortality:

By the time a lung cancer is seen on an X-ray it is almost always too widespread to be operated on. Hence, the only chance for a cure is finding it before it has spread via a screening CT scan.

It is true ...

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Courtesy of Trench Doc.

Scapel takes us through the lumbar puncture to make the diagnosis. Good job.

What does it mean to you?

The Cheerful Oncologist with his take:

Yes, I have job security and I'm grateful for the chance to serve those living with this vile disease. Wouldn't it be something, though if I was put out of business before being put out to pasture? Now that's a dream worthing staying awake for. Let us hope scores of budding physicians agree.

A recent NEJM study sheds some light on weekend hospital care:

Although the increased risk of death is small, roughly 5 percent higher in the month after an attack occurs, it can mean potentially thousands more deaths in the United States annually. The study indicated that weekend patients waited longer for angioplasty and other procedures, probably because of reduced staffing.

A new type of concierge care is emerging in urban, affluent areas:

The doctor is cruising downtown on Eighth Avenue in his black BMW when he gets the first in a string of text messages from his patient. "No one here?" reads the last one. The doctor is late.

The doctor texts back, one thumb flying over his Verizon Pocket PC, the other hand on the wheel. Natan ...

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A bizarre finding from this interesting study:

Although both men and women look at the image of George Brett when directed to find out information about his sport and position, men tend to focus on private anatomy as well as the face. For the women, the face is the only place they viewed.

This image of George Brett was part of a larger page with his biographical ...

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Fingers And Tubes In Every Orifice has to be the most entertaining medical blog out there. The stories read like action movies. Here's two of the latest cases, with a little x-ray teaser:

Clear Blogging



I recently received a copy of this book. Yours truly, as well as several other medical bloggers, is interviewed within its pages.

Clear Blogging takes a comprehensive look at the blogging world, with tips on getting started, building an audience, and monetizing your blog. Interviews with bloggers from a variety of fields are included for added ...

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Sorry, I can't take credit for the headline:

Except Goulet, who has been treating patients at six clinics in five counties for sexual dysfunction, is not a doctor, authorities said.

On Monday, undercover detectives from the Broward Sheriff's Office arrested Goulet, 60, at his Pompano Beach office and charged him with practicing medicine without a license, a third-degree felony.

Lost, or stolen, data containing patient information.

A significant shortfall is predicted by 2020.

A series of articles discussing the issues of patient privacy and medical blogging.

Is Dr. Blogger telling too much?
"Hundreds of doctors across the country are writing Internet diaries that sometimes include harsh judgments of patients, coarse observations and distinct details of some cases.

Critics say the blogs cross into an ethical gray area and threaten patient privacy while posing liability risks for health workers and their employers."

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