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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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 point.  He tried to get John Kerry, the senator, ...

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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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I have recently become a card-carrying member of the Association of Health Care Journalists.  Lofty title for a lowly blogger, but I’ll take it.  There are two main advantages to this membership, at least that I can see so far.  The first is access to the full text of online journals, key to actually discussing research intelligently.  The second is the discussion groups, where journalists of all stripes can ask ...

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Doctors have a long and illustrious history of addicting people to narcotics.  In the 1800s this was largely because they didn’t know what else to do, they had no idea what was wrong with anyone, and they didn’t have any drugs that worked.  Apothecaries, pharmacists, and doctors made proprietary concoctions in which opium was always the active ingredient. And it worked, right?  Morphine works for anxiety, works for pain, works for ...

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Anesthesiology used to be a job that was attractive for people who don’t like patients very much.  The drill was: Meet patient 5 minutes before surgery, do case in OR without interruption, drop off in PACU, done.  Minimal need for personal interaction with patient, no need to listen to complaints about back pain and demands for antibiotics for a cold, no risk of getting called in the middle of the ...

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