Richard Baron is a primary care physician the Philadelphia area. He published a paper in the New England Journal of Medicine entitled “What’s Keeping Us So Busy in Primary Care? A Snapshot from One Practice," and discussed recently on KevinMD.com.  Dr. Baron conclusively demonstrates that there is a deluge of uncompensated work performed by physicians in the outpatient arena. This comes as no surprise to those of us in ...

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Health care in the United States is struggling to redefine itself. We have been spending twice what other countries spend on health care, yet our citizens are less healthy. We now have legislation to create more or less universal insurance coverage, and we are about to embark on a technology-driven quest for quality and uniformity. At the same time, Americans are increasingly turning to alternative health care practitioners, mostly at ...

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Until about 8 years ago, inspections by the Joint Commission (TJC) were predictable and fairly silly. Hospitals were given a couple of years' notice of the week that “The Joint” would be visiting. Everybody scurried around preparing – waxing the floors, locking up all the medications, that sort of thing. (It always struck me as the most dangerous day to be in the hospital, since nobody could find any of the ...

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The bioethics community has been working on defining the concept of medically futile care for more than a quarter of a century, yet the debate continues. The way in which the current notion of medical futility becomes folded into the proposed healthcare reform bills is at a critical point. Sophisticated medical technology that is at once life-saving, life-prolonging as well as death-prolonging has created populations which, in the past, would have ...

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How fast should an ambulance go? The stereotypical speeding ambulance with sirens blaring is the image that most conjure up. But recent data suggests that transport speed may be overstated. In a fascinating piece from Slate, emergency physicians Zachary F. Meisel and Jesse M. Pines examine that very question. They cite a recent study from the Annals of Emergency Medicine, which concluded that a fast transport speed didn't necessarily save lives:

The ...

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Patient handoffs increases the risk of medical errors. It's a phenomenon during residency, as doctors are mandated to leave the hospital after a defined number of hours.  But it's also prevalent outside of an academic setting, as more institutions use hospitalists for their inpatients. This increases malpractice risk. Perhaps the biggest problem with hospitalists is the transition during discharge, when the patient is handed back to the primary care physician's care. Various questions ...

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Part of a resident’s job is to learn the ropes in preparing for independent practice. While you’re a resident, you get the benefit of having someone looking over your shoulder to critique you as you determine how you are going to manage patients. I frequently tell residents that different attending physicians practice medicine in different ways. Some practice defensive medicine more than others, some prescribe antibiotics more than others and some ...

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The daVinci surgical robot is a multi-million dollar device that more hospitals are using for urologic and gynecological surgery. I wrote previously on the topic, saying that robotic surgery is, in part, driven by patient demand. The Wall Street Journal had a scathing piece on the robot a few weeks ago, exposing the relatively high complication rates at a small New Hampshire hospital. The issue comes down the training, or lack thereof, ...

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What if some physicians actually like the way primary care is currently practiced? It's hard to believe, considering the majority of studies suggest marked dissatisfaction among primary care doctors, and an increasing prevalence of physician burnout. The ACP's Bob Doherty recently summarized an epic Health Affairs article devoted to fixing primary care. The bottom line was that better paying primary care doctors isn't enough. The whole field needs to ...

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I’ve just finished a month “on-service” as a teaching attending for a general medicine team here at GlassHospital. This means I served as the physician of record for every patient admitted to the team. You might find it interesting to know that patients admitted to the hospital’s general medicine service get assigned to their teams by random assortment. Since there are five teams, one team takes call every fifth day. ...

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