A family medicine director is scared for the future:

Medicine is again overspecializing, fueled by a market-driven health-care system that promotes the expansion of procedural medicine and specialty practices that create large profit margins. Primary-care physicians are increasingly employed by health-care corporations that judge and pay them mainly on the basis of productivity. Our reimbursement system is not designed to reward spending time with patients to counsel, educate and to ...


Essentially, almost every day in April, all the doctors in the hospital had to give a hand to the ER:

On every day but one in April, crowding prompted ER staff to declare a "code orange," which sets other departments scrambling to accommodate emergency patients.

Ducharme says code orange is only declared when ER doctors don't believe they can treat patients adequately.

Being a doctor trained her well for her shift:

On that Monday, she arrived at Steamer's at 3 p.m. to don her chef's jacket for the big night. There were no major mishaps during the seven-hour shift, only a couple of anxious moments when she had to be especially quick on her feet. But as she noted, when you're a doctor, you're more than used to that.

So says the "father" of Quebec's modern health-care system.

This exposes the turf wars that are present in every hospital:

According to the suit filed in the Philadelphia Court of Common Pleas, Feldman's e-mail stated:

"I have been informed now on multiple occasions by our house staff at Methodist, as well as by one of our cardiology fellows who moonlights there, that the ED attendings (at the instigation of the ED director) are urging and pushing ...


For being a "Blog of Note" on Blogger's home page. Keep up the great medblogging.

Everyone should be asking their physician for these easy ways to stay healthy:

Five of the best solutions are used by fewer than half of the people who need them, according to the report. Besides counseling on aspirin and tobacco, the measures include screening for colorectal cancer and the sexually transmitted disease Chlamydia, and vaccinating older adults against bacterial pneumonia, researchers said.

Dr. Crippen thinks this could have been avoided if this was at a hospital.

Clinical Cases summarizes her recent stroke. I wish her all the best.

From the "obvious study results" department:

When a drug company or device-maker is funding a clinical trial for a new cardiovascular treatment, the reported outcome is likely to reveal good news for the new treatment, according to researchers here.

Likewise when funding comes from non-profit sources, the outcomes are less likely to favor the new treatments and when for-profit and not-for-profit funders split the tab, the results are, in ...


Human leather

They don't make books like they used to:

The best libraries then belonged to private collectors. Some were doctors who had access to skin from amputated parts and patients whose bodies were not claimed. They found human leather to be relatively cheap, durable and waterproof . . .
More on Medgadget.

Kim talks about the perspectives of a patient encounter:

Perception is everything.

Having had recent experience as the nurse, the patient and the family member, I am in the unique position of seeing all three sides.

Let us examine how the perception of time, place and situation differ depending on which "chair" you occupy.

"I'm a crack whore . . ." Life in the ER from Charity Doc.

The FDA will be closely watched to ensure morality doesn't play a role in its decision regarding Merck's cervical cancer vaccine.

Speaking in Canada: "In the U.S., administrative costs mean the financial tail is wagging the health-care dog."

When less is more

The researchers from Dartmouth are at it again:

"We must reward, rather than penalize provider organizations that successfully reduce excessive care and develop broader strategies for managing patients with chronic illness." . . .

. . . The researchers concluded that the federal government could save tens of billions of dollars a year, plus improve care, if it took steps to prevent the overuse of health care.
One easy way ...


Some insights from PointofLaw.com:

But today's system cannot work well for close calls, at least not when the stakes are in the billions or tens or hundreds of billions of dollars. Analysts expect tens of thousands of cases roughly similar to Mr. McDarby's. Juries will continue to guess at the central issues, getting it wrong as often as right but charging Merck $10 million or $20 million or $40 million ...


From the CMAJ:

Although there is no guarantee that Canadians who have the surgeries performed out of country will be reimbursed by provincial health insurance plans, that is not a major obstacle for MedSolution's clients, says Knox.

"Waiting lists are so out of control in this country, many patients are willing to pay anything to obtain swift access to the services they need," he says. "It's our job ...


More from Health Care Renewal:

Another doctor said the company's behavior "demonstrates the unrestrained greed and arrogance of an organization that has systematically undermined the very health care system that provides the basis for its wealth."
UnitedHealth is clearly the worst payer here in the Northeast.

You can bet that many ERs won't be happy with this study:

The end result, Dr. Todd said, was that as many as 40% of patients who go to the ER for pain relief are still in pain when they are discharged.

"The results of these studies show that persistent pain is common and substantial after emergency department discharge," said Dr. Todd. "We, as emergency room doctors, do ...


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