In their most recent piece at Slate, emergency physicians Zachary F. Meisel and Jesse M. Pines tackle the issue of bouncebacks.  That is, the re-admission of recently discharged hospitalized patients. They bring up good some good points, and point out that, until recently, hospitals really didn't have any incentive to reduce bouncebacks:

... hospitals have never had a compelling reason to try to prevent bouncebacks. Hospitals are typically paid a flat sum ...

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by John Gever Surgery for torn knee ligaments and meniscal cartilage may have improved patients' short-term outcomes, but it did not seem to prevent the eventual development of osteoarthritis, researchers said. A study that followed 326 patients for a mean of 10 years found that radiographic findings shortly after the initial knee injury strongly predicted the long-term clinical course, with no significant difference seen between those who did and did not have ...

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Year: 1994 Setting: Port Moresby General Hospital, Papua New Guinea Position: Chief medical officer for Chevron Oil Co. The wife of an expatriate employee has injured her arm and, suspecting that she has fractured her left elbow, I accompany her to the Port Moresby hospital for further evaluation. The building looks good and new. In fact, it was recently donated to Papua New Guinea by the Japanese government. While waiting for the X-rays, I ...

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What is the purpose of the note in the patient chart? Depends who you’re asking. The best guidance I ever received on how to write a good note came from my residency program director, who told us that a note needn’t be encyclopedic to be excellent; in fact, he urged us to get away from the “second-year medical student” style, which typically includes absolutely everything. Instead, he urged us to write, as concisely ...

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For at least the last 20 years, graduates of U.S. medical schools have resisted pleas from organized and disorganized medicine to become primary care physicians (PCPs). Since there is already a severe shortage of PCPs, pundits are wondering who is going to take care of the hordes of newly insured by 2014. Many have speculated about the possible reasons for this dilemma such as the relatively paltry earning potential of ...

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Death is not the enemy. We all die. The enemies of patients and physicians are premature death, disease, disability, pain, human suffering. I believe that all people deserve a death with dignity and without pain. Palliative care is the right mode for as many as 80% of all Americans who will die of chronic progressive incurable diseases. Eighty percent of those state that they do not want to die in a hospital ...

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Some physicians and physician groups are quite upset about insurers' recent moves to offer employer customers tight, small networks of providers based on quality and cost criteria. In an effort to block these new plans, the AMA and other groups are focusing on the few problems with ratings and avoiding the larger issue - some physicians are just bad actors. What they should be doing is working closely with health plans ...

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What are entry-level non-clinical physician job salaries? Let me clarify what I mean by "entry-level" here: I'm referring to non-clinical jobs that physicians may find if they leave clinical medicine to pursue a non-clinical job in a company (such as a medical communications company, a health IT company, pharmaceutical, biotechnology, or a consulting company). So, let's look at several examples: * A primary care physician who's making $120k/year leaves clinical medicine and begins ...

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Three years ago, the Department of Justice took stock of the orthopedic medical device industry--represented by the five big makers of orthopedic implants--and concluded that it was rampantly violating federal anti-kickback laws with the bribes and favors it was offering to surgeons. Such bribes often came in the form of training grants for those just starting out in the profession, or as lucrative consulting contracts for influential academic orthopedists. The ...

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Say the words, "Patient-centered medical home," and you're bound to get a variety of opinions. On this blog alone, there are a variety of guest pieces critical of the effort, saying it does not increase patient satisfaction, nor does it save money. And that's not good news for its advocates, who are pinning primary care's last hopes on the model. Medical homes hit the mainstream media recently, ...

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