Remove the financial incentive, and you get what's happening in Canada - perceived doctor shortages:

Now, we have a situation where the great doctor can only bill a maximum of $450,000 per year (minus overhead and taxes). When, prior to the cap, he was happy to work for "services rendered" and billed accordingly.

However, now his $1.3 million practice is cropped at $450,000 per year. So he has two ...

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Coughing fit

An uncontrollable episode of coughing causes a girl to get kicked off a plane, even though a physician on board said she'd be ok to make the flight.

Carrot or the stick?

An economist suggests demerit awards instead of performance bonuses. With all due respect to guys like Matthew and Ezra, the problem with health policy wonks is that they base their opinions with zero clinical experience in medicine. Because of this, it is difficult for physicians put any weight into anything they say.

An op-ed in the Boston Globe:

And yet Elizabeth Edwards said at a news conference, "I don't expect my life to be significantly different." She calls herself "incredibly optimistic." About his press secretary Tony Snow, President Bush said, "He is not going to let this whip him, and he's upbeat."

Of course all people need hope: hope for a good day today, hope for a normal life, and ...

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Power of placebo

Or, an IV flush for pancreatitis pain.

A physician is about to go through a malpractice trial. His wife goes off on a tirade:

My physician husband is going to court next week, being sued by a woman whose husband died of esophagus cancer. She thinks she deserves money because someone died. SOMEONE must pay. Win or lose, the taxpayer pays and health care costs go up for everyone. Win, and tens of thousands ...

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A Texas senator wants to pay women $500 if they change their mind about an abortion after showing up at the clinic. Steven Levitt thinks about this:

Honestly, though, is it really such a bad idea? What if he left out the part about visiting an abortion clinic? Does it make sense to subsidize women who were going to give up babies for adoption? I think maybe it ...

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Panda Bear is on a roll with a follow-up missive against single-payer health care. He tries to explain it as simply as possible for those blindly support such an ill-conceived measure:

In the quasi-single payer system of Medicaid and Medicare we have today, the goverment fixes the price at such a low level that those who decide to let the dog into their practice have to run a high ...

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Bard-Parker with the revealing CT scan. Wow.

CRNA salaries

CRNAs (Certified Registered Nurse Anesthetists) make almost as much, if not more, than primary care physicians - with 2 years of college education. This post from a forum wonders how:

CRNAs make 224% as much as RNs and 156% as much as advance practice nurses (NP). According to the allnurses.com website, 58% of nurses are certificate nurses only, ie. have no advanced degree beyond a RN. It is not ...

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Isn't that the point?

That is the plan some are considering:

Democrats in the Minnesota state Senate want to give publicly insured patients $20 gift cards to stores such as Target as an incentive to follow their doctor's orders.

Sen. Linda Berglin, who leads the health budget panel, is betting that it will pay off for the state to sink $1 million into incentives for diabetics who control their blood sugar and smokers ...

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The once-promising pill for obesity is facing challenges in the FDA due to its psychiatric side-effects.

"When faced with the opportunity to read a book by someone who isn't by profession a writer, I always go for the doctor." (via DB)

Orac and The Cheerful Oncologist comment further.

Physicians take Dr. Siegel to task for his baseless, emotional support of CT scans for lung cancer screening. Apparently, he doesn't believe in evidence-based medicine. Money quote: "the plural of anecdote is not data."

If physicians don't believe in the evidence, how can we convince the public?

Most importantly, he also neglects to take the downside risks of screening into account: False-positives are indeed common, and ...

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A pediatrician's take on the breast cancer screening issue, responding to yesterday's post and today's breast screening MRI news:

As a physician, I know testing is not the be all end all, even for women. And I don't think every woman should get an MRI.

But, as a women, I can't imagine waiting 4-6 months for a retest - I'd rather the biopsy or MRI. I know ...

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One disgruntled Pfizer rep thinks so.

This is being suggested as a way to decrease the incidence of bile duct injuries - as this is one of the largest reasons for malpractice lawsuits within general surgery. I wonder if any of the surgeons who read this blog can comment:

Cholangiograms have a lot of potential, but "they have not been adopted as a routine part of most surgeons' practices," says Lawrence Way, a surgeon at ...

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The WSJ Health Blog was there, talking about the carnival-like atmosphere of the exhibit hall. Probably like Pri-Med, taken to the extreme.

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