Doctors are often encouraged to discuss advance directives with their patients. But sometimes, when it comes to act on a "Do not resuscitate" (DNR) order, the situation can be far from clear. In a provocative essay from the Washington Post, emergency physician Boris Veysman discusses a case where he successfully revived a man who, unbeknown to Dr. Veysman, had a DNR order. Despite the temporary nature of the illness, the family honored ...

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Ten years after the release of the IOM report To Err is Human, which documented the toll taken by medical errors in this country, the question remains: What can be done to reverse the trend of ever-increasing morbidity and mortality due to medical errors? Last December, a look back over the decade since the release of To Err is Human -- and a steady medical error death rate of about ...

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ER overuse may be a myth

Overuse of the emergency department is commonly discussed during the health care conversation. Especially with the lack of primary care access shunting patients with seemingly routine symptoms to the ER. But is this a myth? That's what two emergency physicians contend in a piece from Slate. The emergency department is functioning just fine, they say: "Just 12 percent of ER visits are not urgent. People also tend to think ER visits ...

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Thanks to AOL News for publishing my latest opinion piece, Reform's Great, But We Need More Doctors. I discuss how health reform's ultimate success or failure is largely dependent on whether our primary care system can accommodate the millions of newly insured patients:

... having health insurance doesn't necessarily mean it will be easy to find a doctor. Even before reform, ...

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Medicare's sustainable growth rate, or SGR, has been the bane of doctors for years now. To encapsulate, this is the reason for Medicare's annual threat to cut doctors' fees by 20% or more, only to be staved off at the last minute. Emergency physician Shadowfax has a nice take on it, explaining why it has devastated primary care:

Primary care has many fixed expenses in addition to those we bear: they pay ...

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One of my interns was “running the list” with me last week (giving me a thumbnail update on the plans for each of our inpatients). It was standard stuff until he got to Ms. X, a 80ish-year-old woman admitted with urosepsis who was now ready for discharge. “I stopped her antibiotics, advanced her diet, called her daughter, and YoJo’ed her.” Say whaa? I’m pretty sure that the most valuable thing I’ve done ...

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In America, too many people die in the hospital. I don’t mean that they die due to medical error or incompetence, though that’s always a hot topic of discussion amongst doctors, researchers, administrators, and regulators. What I mean is that if you ask most people, they say they’d rather die at home, surrounded by their loved ones, drifting off to sleep painlessly after having had last rites administered (feel free to plug ...

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An excellent article appeared recently in the Washington Post, entitled, "Having health insurance doesn't ensure it will be easy to find a doctor," where a young, otherwise healthy and insured woman discusses her extreme difficulty in finding a doctor in Washington, DC who will see her. "I was just 23, basically healthy and, most important, insured. So I pulled out my computer, looked up the UnitedHealthcare list of pre-approved doctors ...

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Doctors don't garner much sympathy when they rail against the perpetual threat of Medicare reimbursement cuts. In a story from CNNMoney.com, a primary care physician provides some stark reality. In an independent solo primary care practice, employing an office staff and two nurse practitioners for instance, fixed costs add up to $60,000 per month. A 21% cut in Medicare reimbursement, assuming an average sized Medicare panel, can take away ...

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When nurses sign out during the end of shift, it's done so in a quiet setting. Contrast that to medical residents -- at least when I was a resident 8 years ago -- where pager interruptions during sign out were the norm. PookieMD compares the situation to the "sterile cockpit" that airline pilots enjoy: "Pilots have the sterile cockpit–a situation in which, if the plane is below 10,000 feet, only conversation ...

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