Physician

Are more patients leaving the hospital against medical advice?

by Michael Smith, North American Correspondent, MedPage Today

The number of people who check out of hospitals against medical advice has grown dramatically, according to the Agency for Healthcare Research and Quality.

medpage-today In 2007, the agency said, inpatient care ended that way 368,000 times, accounting for 1.2% of all hospital stays, compared with only 264,000 such discharges a decade earlier.

That …

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Would you rather have an older or younger trauma surgeon?

Turns out, it may not matter.

According to a recent study from the Archives of Surgery, when it comes to trauma surgery, the mortality rate of trauma causes handled by “novice” surgeons – those just out of residency – did not differ appreciably from those handled by more experienced doctors.

As reported by ABC News (under the somewhat melodramatic headline, “In the ER, Baby-Faced Doc Is No Death Sentence”), whether the hospital …

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Situs inversus, and the difficulty of operating on patients with reversed anatomy

Operating is difficult enough, but imagine doing on someone’s organs that were transposed on the other side.

1 in 10,000 patients have a condition known as situs inversus, where, despite the non-traditional placement of organs, patients function without clinical symptoms.

In this interesting piece from MedPage Today, several surgeons are interviewed about their experiences performing procedures on such patients. For instance, when talking to a heart surgeon who knew …

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Will nurses solve the primary care crisis?

by Derek Mazique

Between “death panels,” a NICE-style cost effective analysis board, and Obama’s slowly graying hair, one conspicuously absent part of reform are reimbursement rates. Medicare and private insurance typically reimburse for expensive procedures, which ultimately rewards procedure-heavy specialists while discourage those cognitive-heavy services like primary care docs.

The result? As a recent Baltimore Sun op-ed and this very blog pointed out, a combination of pay and burn-out are encouraging …

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CNN op-ed: What good is having health insurance if you can’t find a doctor to see you?

My latest opinion piece was published on CNN this morning.

cnn Entitled, Why the doctor won’t see you now, it should be familiar to regular readers of KevinMD. Here’s an excerpt:

Although it is a moral imperative for every American to have access to health insurance, alleviating the shortage of primary care providers is of equal importance. The prospect of …

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A doctor in Cuba becomes a nurse in the United States

When physicians in other countries come to the United States, they often become nurses or lab technicians, rather than re-taking rigorous board exams to remain doctors.

One example includes doctors from Cuba. According to this story in The New York Times, “6,000 medical professionals, many of them physicians, have left Cuba in the last six years.” Cuban doctors, who often earn $25 per month, find it significantly more …

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Is reducing medical errors similar to improving transportation safety?

According to a recent op-ed, Jim Hall, former chairman of the National Transportation Safety Board, says, “Because American medicine accepts error as an inevitable consequence of treatment, our hospitals, insurers and government do little to respond to unnecessary deaths. If we are to address the problem in a serious manner, we must first change this culture.”

But a simple solution to reduce medical errors may be elusive, says emergency physician …

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Poll: Should doctors be compensated for responding to in-flight medical emergencies?

When an airline passenger has a medical emergency mid-flight, a call normally goes out asking for a doctor among the passengers to help. One study has estimated 350 such emergencies in the air every day, worldwide.

Airlines appeal to a doctor’s sense of duty when asking for their help, and generally don’t provide anything more than a token gesture of appreciation. But should physicians who respond to the call be financially …

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A borderline admission from the ER, or not

A woman on Medicaid is newly diagnosed with lung cancer in the emergency department. Although medically stable, should she be admitted to facilitate the coordination of the care she will require?

That’s a question emergency physician Jesse Pines asks in a recent WSJ op-ed. In the end, despite the resistance of the admitting hospitalist, he admitted the patient. Dr. Pines writes that, “Without expert help, arranging a …

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What do primary care physicians and cardiac surgeons have in common?

They’re both going to be scarce.

Along with primary care, cardiothoracic surgeons are projected to be in short supply, according to a report in MedPage Today. A study found in Circulation suggested that fewer medical students are pursuing the field, leading to a “shortage of at least 1,500 surgeons or 25% of the likely projected need.”

Lifestyle issues are cited, as it takes over 8 years of post-graduate training …

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Should advance directives be stored online on Google Health?

It was recently announced that Google Health, a popular personal health record, will allow patients to store their advance directives.

Emergency physician Graham Walker calls the initiative an “epic fail,” and illustrates some real-life problems of the idea.

While it is generally thought that making one’s health information available electronically to medical personnel is a reasonable idea, doing so with advance directives may not be. Especially in the emergency department where …

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Robert Ricketson and the surgical screwdriver medical malpractice case: The medical records revisited

Robert Ricketson is a spine surgeon who was involved in a high profile 2003 medical malpractice case in Hawaii where a surgical screwdriver was implanted into a patient’s back. This is his account of the ordeal.

by Robert Ricketson

I am writing today out of frustration and anger, as I am frankly quite tired of passively going along as my name appears year after year in malicious “medical blogs” and …

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Joe Jurevicius sues the Cleveland Browns’ team doctors, would an apology have helped?

Maybe.

Joe Jurevicius is a former Cleveland Browns wide receiver who contracted an MRSA infection while playing for the team. He has had multiple procedures to clean out the infection, and this past March, the Browns terminated his contract.

Jeffrey Parks, also known as Buckeye Surgeon, has been keeping a close eye on the case. He writes that the case isn’t necessarily about negligence, but instead, “what it represents …

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How many radiologists cheat or take short-cuts in their interpretations?

If you aren’t following emergency physician WhiteCoat’s account of his malpractice trial, you should.

During one exchange with an expert witness, here’s how he described what a radiologist routinely did at his hospital:

The radiologist that read the film had a habit of going to the surgeons the following day and asking them what they had found. He would open up a blank report so that it looked as if it was …

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Doctors suffer too when they make medical mistakes

Much of the attention, rightly so, is on patients whenever a medical mistake is made.

But the toll it takes on doctors can be significant. I’ve often referred to the statistic, for instance, that 10 percent of doctors who are sued for medical malpractice contemplate suicide.

In a recent column in The New York Times, Pauline Chen examines how doctors fare after making a mistake. And the answer is, not …

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Should ER doctors be immune from medical malpractice?

Emergency physicians are forced by EMTALA  to treat everyone who comes through the ER doors.

Should these cases be exempt from medical malpractice? The Happy Hospitalist argues that the standard of care within the community sets an unreasonable bar. Consider this situation, for instance:

The [problem] I see in today’s malpractice environment is the irrational standard of care that has been established, not by science, but rather by the fear …

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