Physician

10 Reader Takes you may have missed

With entries dating back to 2004, here are 10 classic Reader Takes:

1. The Happy Hospitalist: All for one and none for all

2. Robin S.: A marriage made in heaven

3. Edwin Leap: The strength of our sameness

4. Dr. Rob: Good humor

5. WhiteCoat: Never say never

6. Sid Schwab: No more and no less a …

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Getting used to torture, and what surgery has to do with it

Can you get desensitized to grisly procedures?

In last week’s NY Times column, Pauline Chen looks at the declassified torture memos and thinks about the first time a doctor-in-training cuts through skin during an operation.

“Most people “” actually anyone who has experienced even a paper cut “” are hesitant to slice through flesh,” writes Dr. Chen. “Aspiring surgeons are no different. Their first efforts are tentative …

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Are East Coast doctors different from their West Coast counterparts?

Maria, a psychiatry fellow who’s practiced medicine on both coasts, notes some differences between the two breeds of physicians.

For instance, regarding hierarchy, on the East, “Physicians wear one color of scrubs. Nurses wear yet another color of scrubs. Medical technicians wear a different color of scrubs from doctors and nurses. It’s very clear who is who”¦ unlike the uniformly scrubbed people on the West Coast.”

And although, …

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Does telemedicine reduce malpractice risk?

The conventional wisdom is that practicing medicine over the telephone exposes doctors to potentially more malpractice lawsuits.

But, is that really the case?

Blogging over at Better Health, physician Alan Dappen, who created an innovative primary care model, suggests not.

His practice, which is based on 24/7 physician availability by phone, solves most patients’ concerns half of the time. He was recently audited by his malpractice …

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Patients do not want their doctors paid on salary

One question that occasionally comes up is whether doctors should be paid a flat salary or not.

Currently, the majority of physicians are paid fee-for-service, meaning that the more procedures or office visits they do, the better they are reimbursed. This, of course, gives a financial incentive to do more, without regard to quality or patient outcomes.

One proposed solution is simply to pay doctors a flat …

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Should specialists be re-trained as primary care physicians?

It appears the forces are aligned to bolster the number of primary care physicians.

Increasing pay has been discussed as one solution, however, any effect from such a move won’t be seen for years to come.

Joe Paduda says we need more immediate results. Training more mid-level providers, like nurse practitioners and physician assistants, or enticing more foreign-trained doctors isn’tt the answer because they too will be …

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Should health care providers be forced to work through a flu pandemic?

With swine flu in the news, some are wondering what the responsibilities of health care providers are in case of a full-blown pandemic.

Shadowfax has unearthed an article citing little-known laws in some states, “that authorize government officials to order health care professionals to work during declared public health emergencies, even when doing so would pose life-threatening risks.”

And it’s no joke, as those “who violate these …

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Are emergency physicians best served to staff urgent care centers?

Long wait times in emergency departments have led to a resurgence of urgent care centers.

The LA Times has a piece on the phenomenon, and notes that many of these facilities have opened up in suburbs, where patients with insurance tend to live.

By skimming off the profitable and straight-forward cases, emergency departments have generally taken a disparaging view of their urgent care brethren. Sandra Schneider, vice president …

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Retired physicians are going back to work, but are there jobs waiting for them?

The recession and stock market downturn are forcing previously retired doctors to go back to work.

But, after being away from medicine for so long, some are finding that hospitals and clinics aren’t willing to take them back with open arms.

Malpractice coverage will be higher for these physicians, and indeed, a cited gastroenterologist commented that “he couldn’t get liability coverage because he hadn’t done an endoscopy …

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How the primary care doctor shortage threatens Obama’s health reform plan

Top story in The New York Times.

Excellent.

There’s hope that maybe, just maybe, we’re getting through to the decision makers in Washington.

The article itself is old news to regular readers of this blog, and regurgitates many of the arguments impeding health reform, as well as the problems in solving them.

“Obama administration officials, alarmed at doctor shortages, are looking for ways to increase …

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Should hospitalists or intensivists manage ICU patients?

Many hospitals prefer so-called “closed” intensive care units solely managed by intensive care specialists.

The reason being that specialists can supposedly better adhere to quality measures, and hence lower costs, which are goals that hospital administrators pine for.

The problem is, there aren’t enough intensivists to staff closed-ICUs for many medical centers across the country.

So, hospitalsts are stepping in as a “stop-gap” measure, and …

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Do some doctors take on more risk than others?

A neurosurgeon has higher malpractice premiums than an internal medicine physician, but do they really take on more risk?

The Happy Hospitalist says no.

That’s a counter-intuitive take, as surgeons and proceduralists are perceived to take on more risk, and thus, pay higher malpractice rates.

“I don’t think any physician, who is trained in their scope of practice, takes on anymore risk than any other physician, …

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ER visits and health care costs rise in Massachusetts due to lack of primary care access

Color me unsurprised.

A Boston Globe article today confirmed what has been discussed on this blog during the past year. Universal care without primary care access is a recipe to increase both emergency department crowding and health care spending.

We now have more data to back up this expected conclusion.

Despite an individual mandate covering almost everyone in Massachusetts, the cost of emergency care …

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After a doctor is convicted, is telemedicine dead?

A doctor is sentenced to 9-months in jail after prescribing Prozac to a teen who later committed suicide.

The contract physician, who had a restricted license in Colorado, prescribed generic Prozac for the patient after reading his questionnaire online. It’s one of the first criminal convictions for a doctor practicing medicine over the phone or internet.

This is one of the dangers of prescribing drugs, sight …

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The dynamics between the surgeon and anesthesiologist in the operating room

A surgical procedure is truly a team effort.

Along with support staff, the patient outcome depends on how well the surgeon and the anesthesiologist work together.

Dr. T provides a fascinating account of the issues that she faces when behind the screen, and indeed, there is a spectrum of surgical personalities she has to deal with.

Although noting that some surgeons have the patient’s best interests …

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10 primary care posts you may have missed

With entries dating back to 2004, here are 10 classic blog posts on primary care:

1. Why not a down payment for primary care, and problems with the medical home?

2. How connected are you to a primary care doctor?

3. Mid-levels for primary care, but not for surgery?

4. Half of primary care doctors want to quit

5. Read more…

Are quality measures doing more harm than good?

With a second poignant op-ed in the Wall Street Journal within the span of a month, Drs. Jerone Groopman and Pamela Hartzband take on quality measures.

It’s no secret that I’ve been a proponent of increased standardization in medical care, adhering the evidence-based practice guidelines.

That assumes, however, that the recommendations themselves are rigorous and have been shown to help patients.

And that assumption, as the …

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How building your brand can improve your medical practice

Some basic public relations skills can come in handy when building your practice.

I’m cited in a recent piece from the American Medical News, which talks about how consciously creating a “brand” can help shape your practice, and perhaps, make your medical work more rewarding.

With more patients having high-deductible health plans, “patients are going to be more picky about where and with whom they spend their money.” …

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Health courts, and how they can save our health care system

Common Good’s Philip K. Howard made it into the NY Times with an op-ed promoting health courts.

It’s a good piece, and covers familiar ground to regular readers of the blog.

He also cites the landmark 2006 NEJM study by David Studdert that I routinely refer to when talking about the current, flawed, state of the malpractice system (it’s like the gift study that keeps on …

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What would happen if every doctor chose to specialize?

Only 2 percent of medical students said they planned to enter primary care internal medicine.

Hospitalist Chris Rangel offers an interesting analogy for that grim statistic, applying the specialization phenomenon to other fields.

“Imagine if only 2% of police academy graduates took jobs as beat cops while the rest became detectives, forensic specialists, or SWAT members,” writes Dr. Rangel. “Imagine if only 2% of nursing graduates became floor …

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