It seems as if teenage student athletes have been dying by the month in often spectacular and dramatic fashion. Last September Texas high school senior Reggie Garrett died suddenly just after throwing a touchdown pass . Last week a 16-year-old Michigan basketball player died dramatically just after becoming a hero by scoring the winning basket to preserve an undefeated season. Then just a week later another 16 ...
Chris Rangel, MD
Medication reconciliation brings the ER back to 1960
What a blessing and a curse it must have been to practice medicine fifty years ago.Most internists had only about twenty or so medications that they used regularly. It was a curse not to have effective medications to treat many common ailments but somewhat of a blessing not to have the modern medical nightmare of having patients on 15-20 chronic medications with all the logistical problems of keeping track of ...
Why some EMR programmers think physicians are stupid
Every major industry is now computerized with one glaring exception; health care delivery. Thirty years after Steve Jobs began selling personal computers out of his garage, far less than 50% of physician practices and hospitals have converted to any form of electronic medical record.The vast majority of medical documentation is still done via paper and writing utensil just as it ...
Nicotine vaccine to treat tobacco abuse and nicotine addiction
Antibodies are complex proteins created by immune cells that are targeted to very specific parts of other large and complex molecules called antigens.Much smaller molecules like nicotine, called haptens, do not normally induce any significant immunologic response so researchers chemically bound several nicotine molecules to a large protein to form an adduct. This combined molecule does induce an immune response, i.e, causes immune cells to produce antibodies targeted to the ...
Concerns about long term acid suppressive therapy
Physicians hate acid. But, hey, who doesn’t hate acid? It burns things. It corrodes. It’s that after-pizza punishment.We prescribe antacid medications by the ton in this country, not because people’s stomachs have developed increased acidity, but because people in our modern society are generally overweight, like to eat large meals, and prefer fatty foods and things like alcohol, chocolate, and tobacco, all of which tend to worsen acid reflux.Physicians like ...
Medical malpractice and how legal waste increases overall costs
Dr. Kirsch at MD Whistleblower has written about his recent unpleasant experience with malpractice litigation. Despite having full access to the patient’s chart and medical records, the plaintiffs attorney chose to include Dr. Kirsch in the suit ... apparently ... just because ... he had seen the patient.In Ohio – where this case was filed – a plaintiff in a medical malpractice case is required to obtain an ...
Why pay for performance does not work and may impair patient care
In response to a recent article on the topic of economic motivation theory, Michael Kirsch sent me information about a very interesting study (May 2010 issue of the British Medical Journal) done to evaluate the effects of monetary incentives on clinic, physician, and staff work performance.From 1999 to 2007, 35 medical facilities of Kaiser Permanente in NorthernCalifornia, were given financial incentives for ensuring that their patients got regular ...
Greed is not good when it comes to doctors, patients and medicine
Gordon Gekko is wrong. Greed is not good. Not when it comes to health care providers.The socioeconomic study of what motivates people is a fascinating field of study, not the least of which is because of how counter-intuitive it is. For example, it seems normal to assume that the more someone is rewarded for their efforts, the more effort they will put forth toward those rewards.These rewards (increasing salary, bonuses, ...
Why patients don’t value primary care doctors
“Hey doc, all I need is this referral.”I’ve been encountering more of this lately. A patient who has not been seen in the office for months to years (well beyond when they were supposed to come back for a follow up visit) walks in and requests a “referral” for a specialist visit but they can’t be bothered with actually being seen and evaluated in the office or to be compliant ...
MRI abuse can be dangerous and expensive for patients
What is “MRI Abuse”? This is when the health care provider orders MRIs (Magnetic Resonance Imaging) in excess or for the wrong reasons. There are many causes of MRI abusive behavior but most evolve out of a significant misunderstanding of how to properly utilize this diagnostic tool. MRI imaging has a high sensitivity to detect anatomic abnormalities, does not expose the patient to high doses of radiation like a CAT ...
Doctors may be forced to accept Medicare rates to stay licensed
Massachusetts has a problem.In April 2007, they became the first state to require residents to have health insurance. Reportedly this has resulted in 300,000 newly insured patients and lowered the uninsured population to 5%. But of course, given the relatively poor reimbursement rates for primary care providers, especially when it comes to government insurance, the state is facing a growing shortage of primary care providers.Without an adequate supply of primary ...
Health reform won’t help the ER
Contrary to popular belief, those without health insurance are not flooding emergency rooms as a consequence of being cut off from routine and preventive care. Actually, frequent visitors to the local ER are far more likely to have insurance according to a new review of 25 studies on ER use published since 1990.
Frequent users account for about 8% of ED patients but 28% of ...
