Pressure to order tests

Almost a third of physicians surveyed will bow to patients' wishes if an MRI is demanded. With patient satisfaction and physician ratings becoming more important, expect this number to rise:

"There's a lot of pressure on physicians to keep their patients happy," Blumenthal says. "Part of the problem with the American health care system has been that there is no throttle on test-ordering."

Pay physicians peanuts, they will stop accepting insurance. Watch what's happening in California.

Stand up and applaud these physicians who have taken a stand and dropped insurance plans. Doctors are tired of being extorted by third-party payers and won't take it anymore:

It's hard to say exactly how many local doctors have stopped accepting insurance because it's a private business transaction that isn't tracked by government agencies. About ...

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Dr. Wes in the news

Cardiologist Dr. Wes makes the Chicago Tribune, with a story on medical blogs. Thanks for the shout out!

Personal DNA tests

A "waste of money". I completely agree. The supporting data isn't there yet.

The next ADHD

It's called sensory processing disorder (SPD), something that physicians haven't heard of, but I'm sure the drug companies will be correcting that soon:

Never heard of it? You're in good company. Neither have many pediatricians, neurologists, psychologists and teachers. But in the parallel universe of occupational therapy, which focuses on the more primal "occupations" of life--dressing, eating, working, playing--SPD is commonly treated.

John McCain so gets it

Senator McCain just received the Union Leader's endorsement, and he's on a roll with his straight-talk on the need for tort reform. Bravo:

"In every other industry when technological advances are implemented costs to the consumer decreases. This is not the case in healthcare."

"Because of the need for health care reform, medical malpractice reform is at least my second highest priority."

"Every time there is ...

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And winning a few of them:

Three Ohio courts in six months sanctioned plaintiff lawyers for pursuing unsupported claims against three doctors. Judges awarded the physicians their legal expenses. In New Orleans, the 5th U.S. Circuit Court of Appeals upheld a similar award to a Mississippi doctor Nov. 13.

The courts chastised the attorneys for wanton behavior including: suing the wrong doctor; refiling a claim against a physician even ...

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Double trauma

In one room. Must have been tough to concentrate.

"Felt like I'd done 5000 benchpresses. My damn chest hair hurt for 3 days!"

Completely unethical:

These nurses, however well intentioned, should not perform unproven therapies "” if these are unproven; opinions differ passionately "” on unwitting patients. To do so is to tell a kind of lie to patients, who reasonably assume that their care meets hospital standards. And while the placebo effect can be beneficial, that is insufficient reason to routinely deprive patients of pertinent facts. Patients cannot give informed consent ...

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Medical centers often pay local TV stations to air "breakthrough news".

An uncommon but serious complication from this diagnostic test using methylene blue.

Why would physicians start chemotherapy in this patient?

Why would cancer specialists agree to give induction chemotherapy for acute myelogenous leukemia to a patient whom they knew could not survive the treatment? Such a decision, to proceed with intensive chemotherapy in a patient who is likely to die due to his refusal to accept blood transfusions, seems to me to be a splendid example of medical myopia, if not pretentiousness.

CT scans and cancer

Will patients care and start to decline scans? Probably not:

My guess is that a few patients will say no, but most will shrug and sign, favoring current certainty in their anxious moment-of-truth over a tiny risk somewhere beyond a distant horizon.

"Bring a few good books," says Dr. WhiteCoat:

. . . some Georgia patients with psychiatric problems are waiting in the emergency department for up to three days before they can be transferred to receive appropriate care. The psychiatric patients get "housed" in the emergency department until a psychiatric facility is able to take them. In other words, the patients are forced to lay in an ED bed for ...

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Discussing DNR

A difficult, but necessary, topic:

For families facing the impending death of a loved one, few topics trigger more anguish than the Do Not Resuscitate order. The subject can be so painful that relatives and doctors wait too long, until the patient's mental capacity wanes and the tough decision is left to family members. There is little ambiguity in a DNR order: Emergency medical staff must withhold CPR and ...

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What happens when you have government officials who know nothing about medicine trying to regulate physicians:

The Stark laws, along with an older anti-kickback law that bans paying for patients, have had a huge impact on how medical business models are structured. Yet in an interview today the Congressman lamented that he had ever made his legislative intrusion into medical practices. The unintended consequences of trying to legislate good behavior, ...

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When a physician gets sued, their effect strikes a physician to the core:

Those physicians who have not yet been sued may be surprised to learn what a web of conflicting emotions it elicits. One moment I felt shame and self-pity, while the next moment I felt sadness and sympathy for those who had sued me because something bad did happen, regardless of culpability. Moments later, the compassion turned to ...

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Not necessarily, but some sort of medical background would be helpful.

Too many CT scans?

Taking issue with the recent NEJM study, and wondering whether radiologists have any credibility:

The article cites a "straw poll" of pediatric radiologists (which appears to be a panel discussion in which the audience was apparently able to vote on questions posed by the panel discussants) who opined that 30% of the CT scans ordered were unnecessary. Let me translate that into non-medical lingo:

"We are a group ...

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