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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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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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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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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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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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.
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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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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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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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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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