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Panda Bear answers your reader questions, addressing what it takes to get into medical school and patients who annoy him.

Extravasation injury

Suture for a Living talks about this complication from chemotherapy.

Opting out of Medicare

DrRich looks at how feasible that would be.

The fact that many physicians are piss-poor at business and have learned to bend over and keep taking it during medical school and residency places doctors at a disadvantage during any difficult negotiation. We need to toughen up as a profession.

A sense of the bizarre complexity of coding that is the lifeblood of every physician. Most residencies don't spend enough time on this aspect, which are doing new physicians a severe disservice.

Rapid response teams

What seems good in theory is proving difficult, and expensive, to implement.

Anyone who couldn't see this coming is blind:

"Pay for performance," one of the great health-care buzzwords of the moment, is often described as paying hospitals more if they take better care of patients. In a 104-page proposal unveiled today, Medicare offers a twist: Pay hospitals less if they aren't among the top performers.
There is no doubt that many would want this extended to all physicians.

There is no question that the use CT scanning is exploding. Which is not good on many levels. Especially if you're pregnant:

The notion that pregnant women are also being scanned at an increasing rate is even more troubling, given that exposure to excess radiation can severely damage a developing fetus. Some of the rise is due to the fact that better technology is now available to ...

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A hospital does a wrong-side neurosurgery. Not once, but twice. What's going on at this Rhode Island hospital?

I'm happy to see mainstream media starting to publicize the death of primary care:

"Why do we pay somebody $1,000 for a half-hour of surgery and pay someone $100 for a half-hour of thinking?" he asked. "I do a preventative test on someone that keeps them from getting cancer - a pap smear, a colonoscopy, whatever - and I get my $50," he said. "But if I cut off ...

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A PA misdiagnoses sinusitis, which leads to a brain abscess. Although this happened in a physician's office, it could have just as easily occurred in Minute Clinic staffed by mid-levels.

A few high-profile cases like these against them will no doubt kill them off, which I think will be inevitable.

A bizarre case of trichophagia.

Maybe this patient should realize that only office visits gets reimbursed - not telephone calls - explaining the need to come in. Blame the system, not the doctor:

For those of you who know of my legendary patience, you'll find the next bit surprising.

I ripped that doctor a brand new number two.

I let him know that I hate how I was left wondering if there ...

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Now we can point to the evidence:

The study found people who had a family physician were less likely to use their local emergency room and, in general, benefited from a better quality of care than someone who was seen in a walk-in or specialty clinic where the treating physician did not know them or their medical history as well.

They were also less likely to suffer a medical emergency ...

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Thank you for pointing that out.

The hard sell of PHRs

The availability of PHRs is not translating into sales:

Vendors have had a hard time selling the idea of a personal medical diary to healthy consumers who see their doctors maybe once or twice a year. In addition to privacy and security concerns, patients are staying away because the PHRs on the market aren't doing much to entice them, analysts say. The industry also has failed to come up with ...

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This is life in the pseudo single-payer VA. Imagine a whole country subjected to this standard of care.

SWAT docs

Meet a physician on the SWAT team:

There is a growing trend among the country's SWAT teams -- not just in Dallas -- to add doctors to provide immediate lifesaving treatment on the scene. Far from the controlled environment of hospitals, these doctors learn to work on trauma victims even as they take fire.

The insight of mortality

Walking out after a shift in the ER causes this physician to reflect:

Leaving my shift yesterday, I walked past a family grieving the unexpected death of an elderly loved one. There they were, gathered in the conference room, making phone calls, comforting one another. I was in my jacket, a drink in my hand (tea, mind you), my backpack over my shoulder. I was headed ...

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Ridiculous, says Dr. Wes:

As though our patients can go down to the corner store and pick one of these up for their heart. I guess J&J feels patients can discern when a drug-eluting stent is preferred over a bare metal stent, or better yet: when a stent is appropriate and when it is not.

ER nurses and childbirth

An "Oh Sh**!" moment:

I may have mentioned before, ER nurses DO NOT like childbirth. There is blood from places you can't put direct pressure on and wet, slippery infants involved.

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