Co-management agreements are growing in popularity as health care shifts to outcomes-based reimbursement models.  Physicians and hospitals contract with one another in quality-oriented pay-for-performance arrangements, in which physicians oversee and manage service lines (most commonly orthopedics, oncology, and cardiology). The overarching goal of these agreements is quality improvement, which benefits all parties involved -- especially the patient.  The hospital benefits financially in part from reducing costs and physicians receive a base ...

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shutterstock_173620244 This is one of those columns that will risk the respect and friendship of some of my closest colleagues in the health care world.  In addition to disagreeing with me, they may argue that I am giving aid and ammunition to "the enemy," where the enemy might be viewed as those forces in the health care world who really don't want ...

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Recently a neighbor of mine was in our local hospital for several weeks undergoing treatment for MRSA and dehydration. Polly is a woman in her late seventies who is completely alert and oriented. She lives an active and independent lifestyle and is fully capable of understanding and communicating clearly with others. I asked her adult daughter how her mother’s experience had been so far. Given that this is a hospital that ...

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“Dr. Vashist, I’m sorry to bother but you really need to look at this medication being taken by our patient.” My hospital pharmacist gently prodded me as he handed over the patient’s medication list along with cost information and side-effects of the offending medication. The issue with the list was a subcutaneous injectable form of calcitonin, Miacalcin, costing approximately $11,300 per day of treatment. The patient had been admitted about 11 days back ...

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shutterstock_48561808 The medical world has made terrific scientific and technological progress over the last century. Previously incurable diseases can now be treated as day cases, and patients no longer have to accept a paternalistic, one-sided relationship with their doctors. Hospitals too, have a come a long way if you look at pictures of what they used to look like in those old ...

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shutterstock_178086407 He sat there holding his wife’s hands and hugging her as tightly as he possibly could.  Tears were streaming down her face, and she was vulnerable to the diagnosis I had just bestowed upon her. Cancer, the “C” letter word nobody wanted to hear, suddenly invaded the lives of this newly married couple. Multiple thoughts were running through my mind before bestowing ...

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shutterstock_212693173 I work in a place where nobody calls me by my name. They all address me by a moniker of their choosing that I have asked them not to use.  I have asked them to use my name.  Aside from a few who respect my wish, most of my co-workers just call me by the impersonal-sounding phrase they’ve selected instead.  It creates ...

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Dr. Atul Gawande is an American surgeon and public health extraordinaire. He is one of the most successful physician authors of this century, and he writes routinely for the New Yorker. His most recent article discussing unnecessary health care is, as expected, a good read. I applaud Dr. Gawande’s passion towards advancing medicine. And, yes, there is universal agreement that we need to be better in America at providing high-quality low-cost health care. ...

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Before I got into medical school, while I was still in my first year of graduate school, I learned what hell was like. The hospital was a rabbit warren. Walking down the long empty beige halls fueled my hatred for hospitals.  And, of the color beige. When I had volunteered during college, I would press myself up against the wall whenever a gaggle of doctors passed by. They ruled the hospital: powerful, ...

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shutterstock_141076960 As someone who has practiced hospital medicine up and down the East Coast for the last several years, I’ve had the fortune of working with some absolutely terrific colleagues. The hospital environment is by its very nature a busy and hectic one -- where we all put our heads down and work tirelessly at the coalface for hours on end. Doctors ...

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