Physicians are becoming alarmed:

Dr. Frank Madda of the DuPage County Medical Society said chain clinics "will certainly drive many family-practice physicians, pediatricians and internists out of business. This will result in a decrease in the availability of physicians for all patients."
I don't think that physicians will go out of business because of this, but it does highlight an important consumer priority. Simply stated, patients want access ...

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This is what you get when you reimburse for quantity. Remember, more healthcare isn't always better.

An uncommon case of jimson weed poisoning.

This patient was in the ICU for pneumonia. It took about a year to fully recover.

There is concern about unnecessary exposure to radiation. As stated previously, these tests are useless.

Typically only 10 units is given, along with glucose. Predictably, this did not end well for the patient.

Dr. Hebert takes exception:

Ms. Freeman's death was a very famous event. You know her, even if you do not think you know her. Pictures of her body, slumped in a wheelchair and draped with a blanket, made the lead news story on every continent a year ago. She will remain one of the enduring images of Hurricane Katrina in the minds of everyone in the city, and for ...

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Chris Rangel wonders why he's ordering a CT scan on this 95-year old:

Physicians are trained to do react to symptoms with tests and treatments and to proceed in this direction until a cure is achieved, the problem resolves, comfort is attained, or a terminal/incurable condition is found. But this 95 year old had dementia, diabetes, hypertension, and unexplained anemia. I was in a gray zone here. Was being 95 ...

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May 2005 - One of many posts lamenting what the death of primary care means:

No one wants to wait two weeks to see a doctor. In fact, no one wants to wait an hour in my waiting room. People are much more concerned about getting things done on demand, and they have difficulty finding a primary care doctor who will see them promptly.

May 2005 - A frivolous lawsuit is filed against a physician:

A frivolous lawsuit is filed after a physician suggested hospice care, but the patient lived. Although the majority of lawsuits that do go to trial are won by the physician, the mere act of being involved in a frivolous lawsuit is quite disruptive. Lawyers are paid to be in the courtroom - physicians are not. Every minute spent ...

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May 2005 - The AMA starts charging for access to American Medical News. The medical blogosphere takes exception to this short-sighted act.

March 2005 - A case where a little defensive medicine would have saved this physician:

The physician tried to rely his clinical acumen to make the diagnosis: "Doctors are not magicians or wizards. They can only base their result on what they hear."

This got him into trouble by missing the gallbladder disease. It would have possibly saved the patient, and kept the physician out of the courtroom, ...

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March 2005 - Speculation on President Clinton's complication from heart surgery:

Pleural effusions are common after cardiac surgery, occurring in up to 90 percent of patients following CABG (bypass surgery). Causes range can include congestive heart failure, postcardiac injury syndrome, pericarditis, surgical tissue trauma, or atelectasis. Effusions can occur early (less than 30 days) or late (greater than 30 days). Up to 60 percent of patients have effusions at ...

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March 2005 - Speculation on how a young actress died of pneumonia:

From what I gather, she was rushed to the hospital on February 12th, and sent home - probably with a diagnosis of bronchitis to be treated conservatively.

The next day, she was worse. This time, she was given antibiotics and sent home. Two days later, she was again rushed to the hospital and tragically died the ...

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May 2005 - Forbes with another "top 10" list. There are some non-evidence based tests that were recommended, including the C-reactive protein and the CYP450 test.

April 2005 - An ER nurse with a tirade for the ages:

The fear of liability is why we send so many people to the ED. But don't take it out on the advice nurses, they are simply doing what the docs are instructing. And that means sending everyone in question to the ER to be evaluated as a cya measure. You can see the pressures of defensive medicine ...

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March 2005 - A great ad promoting sunscreen use.

March 2005 - Some frank talk with the ACP on the future of primary care:

Small steps indeed, but we still have a long ways to go. It is encouraging that the ACP is listening, and our continued vigilance in providing real-life feedback to our leaders will be essential in primary care's future.

February 2005 - A man sues because a biopsy was not performed prior to testicle removal due to cancer. Frivolous, because standard of care was followed to the letter:

Put yourself in the doctor's shoes. You have a case of a suspicious testicular mass. You don't know if it's cancer or not. Biopsying the mass may lead to a worse outcome if it is cancer. However, there is ...

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November 2004 - Why DTC drug advertising sucks:

If the majority of DTC marketing were based on sound evidence-based medical principles, I would be in strong favor of it. After all, the more information patients have at their disposal, the better.

However, this is simply not the case, as the evidence seems to always interfere with profits. All we see are countless ads for erectile dysfunction, Singulair for ...

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