It may not be long before a hospital will be the least likely place to find a doctor. Pressures are mounting to replace physicians with computers, guidelines, nurse practitioners and even pharmacists. The assault on the patient-doctor relationship continues to mount. Centers for Medicare & Medicaid Services recently made a final ruling that finds the regulation requiring a doctor sit on the governing board of a hospital to be “unnecessary, obsolete, ...

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Top stories in health and medicine, June 27, 2014From MedPage Today:

  1. Shortage of Saline Has Hospitals on Edge. Hospitals across the country are struggling to deal with a shortage of one of their essential medical supplies. Manufacturers are rationing saline -- a product used all over the hospital to clean wounds, mix medications, and treat dehydration. Now drug companies say they won't ...

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This story has become all too familiar. The patient enters the ER with crushing chest pain and their EKG shows an acute MI, (known today in the colloquial as STEMI, for ST-elevation myocardial infarction). The interventional cardiologist is summoned quickly and in less than 90 minutes from the patient's arrival across the ER door threshold, he or she is on a cardiac cath lab table, where a coronary stent is ...

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Top stories in health and medicine, June 24, 2014From MedPage Today:

  1. Mrs. Obama's Lunch Plan: Not So Fast. In the guest blog post, Steven Horvitz, DO, a primary care physician in Moorestown, N.J., responds to MedPage Today's coverage of the Michelle Obama-led White House roundtable criticizing Congressional efforts to reverse nutrition requirements in public schools.
  2. More Than 750 Hospitals Face ...

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“Robert Loeb was the best damned ethicist I ever met.” When I first heard a senior colleague of mine utter these words in the mid-1990s, I was surprised.  Time had not been particularly kind to Loeb, who had been the chairman of medicine at Columbia-Presbyterian Medical Center from 1947 to 1960.  Among other things, critics had chastised Loeb for being imperious and unwilling to listen; former students had even accused him ...

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As a new physician, I find myself besieged by data about how happy patients are with the care we deliver. Press Ganey, HCAPS, Consumer Reports, US News and World Report were merely the beginning. Now, physician reimbursement is tied to how happy patients are after facing and overcoming, at times, life-threatening illnesses in our hospitals. Given the financial incentive, hospitals across the country are seeking the aid of companies like Disney: well-known ...

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We need fewer doctor MBAs and more doctor healers I read an article in the Boston Globe about how doctors are flocking to get Master of Business Administration (MBA) degrees in record numbers. The prestigious program at the Massachusetts Institute of Technology, MIT, apparently now has more students from the health care sector than any other field -- accounting for almost 20 percent of the class. A large number of these ...

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In an effort to save on human resources costs, some hospitals have decided to make locum tenens* doctors and nurses line items in a supply list.  Next to IV tubing, liquid nutritional supplements and anti-bacterial wipes you’ll find slots for nurses, surgeons, and hospitalist positions. This depressing commoditization of professional staffing is a new trend in health care promoted by software companies promising to solve staffing shortages with vendor management systems (VMS). In ...

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If you read my articles, then you likely know about the scam known as pay-for-performance (P4P).  This program not only fails to deliver on its stated mission to improve medical quality, but it actually diminishes it. In short, P4P pays physicians (or hospitals) more if certain benchmarks are met.  More accurately, those who do not achieve these benchmarks are penalized financially. I do not object to this concept.  Folks who perform ...

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After I graduated from medical school, my very first real ward rotation as an internal medicine intern was at the VA.  Therefore, I can say with absolute certainty that all the stuff being said about the VA health system is true.  The place is a mess. Let’s start with the computer system.  The VA medical record system has been held up as an example of an effective EMR system, in which ...

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