Medicine is obsessed with numbers.  Or rather, journalists and medical administrators are.  Here are two related examples of how large a grain of salt one must put on numbers. Cardiac surgical procedures, like everything else in medicine, have quality indicators.  One of these is what we doctors call “30-day mortality.”  What this term means is that surgeons are evaluated in part on how many of the patients they operated on died ...

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I was talking to a colleague of mine yesterday. (At least I flatter myself that I am a colleague.  He has a writing job at a prestigious magazine while I, well, don’t.)  We were talking about the doctor-patient relationship, as is our wont, and he said something that stood out to me as the quintessential statement of patients’ expectations about doctors. It goes something like this: "I expect that when I ...

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In order to interpret the world, we tell ourselves stories.  All day long.  About everything.  That guy in the grocery store who clipped your heels with his cart?  A jerk.  The car that cut you off at that intersection? A jerk.  A little old lady stopping in the middle of the aisle at the grocery store?  Senile. It is automatic, it takes no effort, and it is completely egocentric.  It is ...

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shutterstock_178434308 Recently I wrote about the problems with maintenance of certification requirements.  One of the phrases I repeatedly read when I was researching the piece was “the patient as customer.”  Here’s a quote from the online journal produced by Accenture, the management consulting company:

Patients are less forgiving of poor service than they once were, and the bar keeps being raised higher because ...

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Last week, my best friend took the recertification exam in anesthesia, the so-called MOCA exam.  Like a good doobie, she paid her $2,100, paid her nanny extra so she could study, took a day off in which she missed the funeral of a friend’s husband, and took the test.  Wow, she must be the most awesome, most well-read, most skilled, most enthusiastic anesthesiologist ever now!  Well, she always was, but ...

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0121_davidson-620x411 When we perceive any object of a familiar kind, much of what appears subjectively to be immediately given is really derived from past experience. - Bertrand Russell, The Analysis of Mind I’ve learned a few more things about Stephen Pasceri, the man who murdered a cardiovascular surgeon in Boston recently.  He had money troubles involving credit card debt.   He declared bankruptcy at one ...

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michael davidson This week the local and national attention has been riveted on accusations that Bill Belichick and the Patriots football team deliberately deflated the footballs used in the division championship game.  Football, remember, is a multi-billion dollar industry in which the commodity being sold is grown men throwing brown, oblong balls at each other and knocking each other down.  Boston.com, a ...

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When I was in nursing school there was always a lot of eye-rolling when it came time to discuss nursing diagnoses.  This was mostly because nursing diagnoses were followed by book-length nursing care plans that we had to produce for various imaginary patients. There was also a faction, including myself, who thought a medical diagnosis was just fine, thank you, no need to reinvent the proverbial wheel. For example, for a ...

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A front page entry in a recent issue of Anesthesiology News: "Physicians Versus CRNAs: Redefining Roles in the Changing Landscape of Health Care."  Sounds like a prize fight or a gang war: Crips vs. Bloods.  I immediately got my boxing gloves on, readying myself for another bout of vitriol and dislike thinly disguised as concerns for patient safety.  But the author, Michael DeCicca, a second-year anesthesia resident, surprised me. He writes: “Logically the ...

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Medicaid is a federal program for the very poor implemented by grants to states, which do the administration.  Medicaid typically pays doctors about 60 percent of what Medicare pays.  In Florida, a typical primary care visit might pay the doctor $32.  In Alabama, doctors who agree to be the primary care physicians of record for Medicaid patients get a whopping $2.60 per beneficiary per month, a fee with which the ...

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