The Surgical Care Improvement Project (SCIP) and its antecedent, the Surgical Infection Prevention project, have been around for several years. In short, these consist of several rules issued by various self-appointed agencies with important-sounding names and the Centers for Medicare and Medicaid Services (CMS), a federal agency. The main rules are 1) administer the correct prophylactic antibiotic before surgery, 2) give the antibiotic within one hour before the skin is incised ...

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Physician/poets such as William Carlos Williams are an honorable tradition in the history of medicine, following in the footsteps of Keats, Schiller, and Oliver Wendell Holmes (of “Chambered Nautilus” fame). Physicians have also been writers, painters, musicians, philosophers, and – at least in more recent times –photographers. Yet in 1980 the historian G.S. Rousseau expressed concern that modern physicians no longer embodied the humanist tradition of their predecessors. Now that medicine ...

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The primary care-specialist pay gap is a popular target for those eager for reform. The gap is hailed independently as an example of and a cause of the lack of focus on primary care and prevention in the United States. There is no doubt that the United States treats primary care, preventative care and triage much differently than most of the rest of the developed world. The distribution of primary care ...

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I am a medical doctor.  I am also called an allopath, someone who practices “Western medicine.” We allopaths like data, proof, science, randomized, double-blind, placebo-controlled trials.  We want to know the “mechanism of action.”  We want someone to prove that yoga or medication or some procedure actually helps your depression or blood pressure or back pain and that these treatments are safe before we prescribe them.  We feel more confident about ...

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Being a hospitalist, I often see patients sitting in the hospital for days at length for no reason other than poor planning. Sometimes I feel that physicians who are involved in patient care are oblivious of each other. Everyone is in their own domain rather than working as a team. An increased length of stay in the hospital not only increases the cost of health care but also adds to the ...

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by Dennis Grace So, you have to go to the hospital. You’ve had an accident and the doctor wants to keep an eye on you for a few days. Maybe you need major surgery. Whatever the reason for the stay, a lot a people think you should have an advocate with you. Why? In my life, I’ve had lots of hospital stays. Why is this suddenly a big ...

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Recently, I had the opportunity to decamp from the the friendly confines of GlassHospital and trek a few miles to the north. GlassHospital has brokered a teaching and patient-sharing agreement with a nearby religiously-affiliated community hospital I’ll call Our Lady of Blessed Proximity. Our Lady has a residency training program, just like ours, with the major difference being that nearly all of the doctors come from foreign lands. Something you should know about medicine in ...

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Concierge care is often discussed as a way for primary care to survive in the United States. Pauline Chen talks about the concept in her recent New York Times column, discussing the well-known issues involving "two-tiered" care that boutique practices inevitably bring. But what I found fascinating was how Tufts University utilized the concept. Here's how it works:

Since 2004, the primary care physicians at Tufts Medical Center have offered patients the option ...

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In response to a recent article on the topic of economic motivation theory, Michael Kirsch sent me information about a very interesting study (May 2010 issue of the British Medical Journal) done to evaluate the effects of monetary incentives on clinic, physician, and staff work performance. From 1999 to 2007,  35 medical facilities of Kaiser Permanente in NorthernCalifornia, were given financial incentives  for ensuring that their patients got regular screening for ...

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Health care is changing at lighting speed. If you don’t know this, or worse, don’t accept it you’re doomed. No. Really. It’s change or close shop. Whether you like it or not, health care reform is going to change the way we practice from now on. Many physicians are choosing to work for large group practices to buffer themselves from directly dealing with change. Mental health providers could do the same, ...

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