Physician

ER crowding and your risk of dying from a heart attack

It’s not a secret that emergency departments are becoming more crowded by the day.

Especially if universal health coverage is enacted without appropriate primary care doctors to see the newly-insured, expect the problem only to worsen.

So, it comes as no surprise that those who wait longer, especially for symptoms that could be cardiac in nature, potentially can have worse outcomes.

As reported in MedPage Today, a study shows that, “emergency …

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Poll: Should a doctor blog his medical malpractice trial?

Emergency physician WhiteCoat has been blogging a detailed account of his recently concluded malpractice trial at Emergency Physicians Monthly.

In 2007, pediatrician known as Flea live-blogged his malpractice trial. He shared his thoughts on the defense strategy and frank, unflattering opinions of the opponent’s legal counsel. The plaintiff’s attorney discovered the blog, confronted him during cross examination, and the case was settled the next day.

In these litigious times, there’s been …

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Physician malpractice deposition observations

Emergency physician WhiteCoat continues the chronicles of his concluded malpractice trial.

A recent episode focused on the deposition at the plaintiff attorney’s office. Along the way, there are observations on whether doctors with thick foreign accents make good witnesses (according to WhiteCoat’s lawyer, “juries are not very forgiving of foreign doctors”), or if the bathrooms were bugged. Cloak and dagger stuff.

But importantly, with the deposition focused on whether WhiteCoat …

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The worst medical malpractice cases you can possibly imagine

Read it to believe it.

It’s not often that this blog links to Cracked, but here it is, The 6 Most Terrifying Medical Malpractice Cases Ever. (via WhiteCoat)

Among them is a psychiatric case where the doctor gave a patient, who unfortunately eventually committed suicide, “several thousand pages of sadomasochistic fantasies [in] an extensive effort to brainwash him into believing he was a child and that the doctor was his mother.”

But …

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Should medical errors be prosecuted criminally?

A pharmacist in Ohio is being criminally prosecuted in a medical mistake that resulted in a death of a two-year old child.

Is that going too far?

Indeed, if the criminal prosecution of this pharmacist is successful, it may lead to a dangerous precedent. Indeed, “he wasn’t drunk or impaired. He wasn’t even the one who prepared the mixture. He was inattentive and lazy and careless, and now he faces the …

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Medical tourism, malpractice, and it’s easier to sue American doctors

How are American doctors fighting medical tourism trend?

Cardiologist DrRich’s latest post details the concern the American College of Surgeons have for the burgeoning medical tourism industry, and how they are using malpractice as a reason not to travel overseas for your procedure.

“Indeed, the potential difficulty in suing foreign doctors appears to be the chief differentiator, and the primary argument in favor of good-old-American-surgery,” DrRich writes. “The surgeons, in essence, are …

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Why doesn’t medical peer review work?

Reporting bad doctors seems like a pretty simple task.

Why then, is physician peer review seemingly inept?

Bob Wachter comes up with some theories, including the fear of litigation. Although doctors who perform peer review are supposed to be legally immune, many hospitals have little faith in these protections. As Dr. Wachter concludes from an analysis of the National Practitioner Data Bank, “these protections must be unambiguously robust,” but in …

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A surgeon dumps post-op patients to hospitalists

Is it ever ok for a hospitalist to be the primary physician in post-op cases?

The answer is no, but as The Happy Hospitalist reports, it’s happening in some cases.

He details an instance where a hospitalist program is being asked by an orthopedic surgeon to provide care for his post-op cases, with the surgeon only coming in for a visit on the day of discharge.

As Dr. Happy correctly states, it’s “one …

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A doctor is sued, and blogs his malpractice trial

An emergency physician recently concluded his malpractice trial, and is blogging about it.

Sound familiar? Well, this isn’t the first time it happened. In 2007, pediatrician Flea live-blogged his malpractice trial, which wasn’t a good idea for him, and indeed, became a media circus.

Prominent emergency physician blogger WhiteCoat is diving into the same waters, albeit with a disclaimer saying that the trial has already ended, and also, …

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Physician apologies, and does saying you’re sorry mean it’s your fault?

There’s a movement afoot to make physician apologies inadmissible in court for cases of adverse patient outcomes.

Hospitalist Chris Rangel notes the absurdity of the situation, and says that expressing sympathy shouldn’t always imply causation in the first place. After all, saying sorry and expressing sympathy is the right thing to do in these difficult circumstances.

But not everyone supports such a move. For instance, Massachusetts is considering such a …

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A referral to a specialist turns patients into currency

Most insurance plans require primary care doctors to refer patients to specialists, like surgeons, cardiologists, and dermatologists.

Without a primary care source of patients, specialists will be without patients, and like any business, their practice will suffer as a result.

In a recent essay, cardiologist Sandeep Jauhar talks about this system. He writes of an ironic paradox where primary care doctors yield a rare display of power: “Specialists are better …

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What is the occupational risk of being a health care worker?

Turns out, we don’t know for sure.

“Despite the very real risk that exists for all health care workers,” writes surgeon Pauline Chen in her recent column, “the actual number of deaths from occupational injuries or infections is unknown. Unlike policemen and firefighters and other high-risk occupations, health care workers have no national registry to track deaths caused by infections or injuries acquired on the job.”

We can only extrapolate from …

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ACP: A practice model for increasing the appeal of General Internal Medicine

The following is the first in a series of original guest columns by the American College of Physicians.

by Steven Weinberger, MD, FACP

Much is written and discussed these days about the importance of care coordination by a primary care physician, not only to facilitate patient-centered quality of care, but also to curb the unsustainable growth in the nation’s health care tab. Yet, we hear that the current shortage of …

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Do female doctors hurt physician productivity?

It’s a sensitive subject, previously broached by a Canadian magazine last year.

Now, to pour fuel onto the fire, a recent report finds that, in Canada at least, the growth of female physicians will cause a doctor shortage equivalent to 1,600 physicians over the next decade.

It’s a fact that female doctors work less clinical hours than their male counterparts. According to this article, “women, on average, provided 30 hours a …

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How much time do doctors spend on paperwork?

A common complaint is that doctors these days are spending more time doing clerical tasks.

Examples include filling out pre-authorization forms, talking to health plans for pre-certifications on imaging studies, and spending time jumping through bureaucratic hoops. Generally, you do not need a medical degree to do these tasks.

Bob Doherty points to a study that gives some numbers to back up the claims. Primary care doctors spend about 3.5 …

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How doctors should deal with physician rating sites

Stuff the ballot box.

The value of these sites, previously exposed as pretty useless in this Slate piece, is mainly due to the anonymous nature of the comments.

Indeed, even if a doctor wanted to genuinely improve from this form of patient feedback, “posting anonymously on the Web (on sites a doctor does not regularly monitor) is probably the least effective way to accomplish that goal.”

So, physicians are fighting back by …

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Should primary care doctors embrace retail clinics?

Yes, they should.

Whether retail clinics will be a viable venue for the majority of minor medical conditions is in question, but in many cases, doctors seem to be taking an antagonistic front.

As this piece in the NY Times writes, “Many primary-care doctors still denigrate the retail clinics as cheap, unworthy competitors.” That’s precisely the wrong strategy to take.

Witness hospitals who do more to partner, rather than oppose, retail …

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How is concierge medicine doing in the recession?

Surprisingly well.

Although there are plenty of reports where people are splitting their pills, and delaying elective procedures and preventive care, those who are able to afford concierge medicine aren’t cutting back.

In these cases, health is showing resiliency during these tough economic times, and, “With jobs scarce and stress at a peak, many may see a link between continued health and continued employment. And with savings depleted, they recognize that …

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Do we really need fancier, more expensive hospital gowns?

The hospital gown has been much-maligned.

So, in response, textile companies are coming up with innovative replacements that are more functional and stylish, as well as offering better access for medical personnel.

Of course, the biggest obstacle is cost, and with many hospitals financially floundering, spending double the money on hospital gowns is pretty low on the priority list.

Some, like patient Duncan Cross, doesn’t feel …

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Hospitals lose money by preventing patient re-admissions

Preventing re-admissions, or so-called “bounce backs,” is one way for Medicare to cut costs.

Too bad there’s zero economic incentive for most hospitals to do so.

It’s obvious that keeping patients out of the hospital will save money in the long run. Many factors play a role in this, including, appropriate primary care follow-up. But, when hospitals diligently spend money to ensure good post-hospital care, they’re …

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