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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ED can predict heart death

Originally published in MedPage Today by Joyce Frieden, MedPage Today News Editor Patients with erectile dysfunction (ED) who were treated with telmisartan, ramipril, or both were at greater risk for cardiovascular events than other patients on the same medications, researchers found. In men who reported ED at baseline, all-cause mortality during a median follow-up of four years was double that seen ...

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by Patrice Villars The best learning experiences for me have been times when I come away questioning core assumptions about the work I/we do. As palliative care folks, we try to help people understand where they are in relation to their disease and what their hopes and goals are for care. We offer treatments and resources to match those needs through, in part, supportive communication. What if, in our kind, well-meaning ...

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I haven't ever saved a life. No doctor has. We may prolong the inevitable, but we don't save anyone. We aren't immortal, and weren't meant to be. We die. All things do. Plants, animals, even stars. Death is as much a part of life as birth. And yet, at times people chase medical science as if we have immortality in all our gadgets and pills. Why am I writing this? A few ...

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As correctional health care professionals, there may be times when we are tempted to conduct ourselves in a less than professional manner simply because we can. We may be able to get away with speaking to our patients rudely, using profanity profusely, or wearing inappropriate clothing. After all, we work in jails and prisons. This culture is far from prim and proper. And, our patients are inmates. Many may tolerate misbehavior ...

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