There has been much discussion on the recent NY Times piece on "Malpractice Myths", seen here at Medrants. Now comes some more criticism from the law world, highlighting the obvious ignorance of the article (via Medpundit).

The switch to EMR

So the big deal in my practice is the transition to an EMR in the upcoming months. Finally. Our administration has chosen the HealthMatics EMR by A4 Health Systems.

The plan will be to carry these laptops into the exam room, and in an ideal situation, directly enter notes into templates while doing the history.

Anyone have any experience with this system? ...

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Stories are coming out regarding the recent JAMA article concluding that the USPSTF recommendations on PAP smears are being ignored:

Twenty-two million US women 18 years and older have undergone hysterectomy, representing 21% of the population. The proportion of these women who reported a current Pap smear did not change during the 10-year study period. In 1992 (before the US Preventive Services Task Force recommendations), 68.5% of women ...

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Billing for sex

Lest I be accused of taking a continual pro-physician bias, comes a story that brings shame to our profession:

An Oregon doctor, who had sex with a patient and then charged the state about $5,000 for his "treatments," has been jailed for 60 days and stripped of his license, officials said on Friday.

Dr. Randall J. Smith, 50, told the woman that massaging her "trigger points" would ease ...

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On mammograms

The mainstream press has gotten hold of the recent MGH study detailing that only 6% of women obtain a screening mammogram yearly during a 10-year period. With the barriers today to mammogram access, I'm not sure that improvement is on the horizon.

Medpundit writes an insightful piece on how recent lawsuits have equated risk with harm.

Money talks

Paying patients to lose weight. It's the American way:

One doctor paid $1,044 to 150 of his patients who lost weight . . . The patient with the greatest weight loss, a 51-year old woman, took off 35 pounds and will get a vacation to Las Vegas, a bonus prize Dr. Chemplavil threw in as an added enticement.

We have concierge practices, now people can pay extra for "priority access" at emergency rooms:

The 95-year-old financially ailing Southampton Hospital - the only serious medical emergency center on the South Fork - is offering a plan aimed at wealthy summer visitors whose primary doctors are back in Manhattan and out of reach, presumably along with the hospital's sense of propriety. For $6,000 per family, or $3,800 for individuals, ...

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This week is Bike Week in New Hampshire. It amazes me as I drive home how many helmet-less motorcyclists there are around here, zooming along at 70+ mph. As you may know, there is no helmet-law here.

Consider the following from the BMJ:

Deaths on motorcycles have increased 54% since 1997. As soon as helmet laws are reversed or weakened in a state, ...

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The Atlanta Journal-Constitution editorializes on how capitalism is one of the driving forces behind our broken health care system:

We now have a health-care system whose primary mission is not delivering health care. Instead, insurance companies, pharmaceutical companies, medical device manufacturers and, in fact, many hospitals exist to make money. That's their first priority, and also their second and third priority. The product they sell happens to be improved ...

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For those who have been following the incidents at the South Shore ER, written here earlier this month, the Boston Globe writes about the status of the investigation. As an aside - an 82-bed ER is bigger than some of the hospitals that I round at.

Medpundit has commented on the ER (mis)use piece written earlier this week, emphasizing the convenience ("In fact, you don't even have to walk to your tests. You get rolled to them in a wheelchair or gurney." - how true). Perhaps people are willing to wait the 5-6 hours in exchange for a second opinion, or in some cases a specialist evaluation. Beats waiting months. ...

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Today's Boston Globe contains an interesting piece on malpractice reform from a professor of law at Columbia University. One nice analogy:

Current practices make no more sense than asking airline pilots to guarantee safety for the entire aviation industry, and forcing those who fly the most dangerous routes to compensate injured passengers from their personal paychecks.

What a quote from the president of the Academy of Florida Trial Lawyers in response to the increasing number of physicians going without malpractice insurance (i.e. "going bare"):

'You can't hide all of your assets and you can't hide all of your wages forever. One way or another, we'll find a way to represent these medical malpractice victims because they deserve it,'' said Alexander Clem, president of the ...

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Medical Economics discusses the use of clinical guidelines in malpractice litigation. One interesting point is raised regarding whether new guidelines are being affected by the current malpractice atmosphere:

. . . as trial lawyers are using guidelines more in court, the organizations writing them are changing their motives. The American College of Obstetricians and Gynecologists, for example, has recently come under fire from plaintiffs' lawyers . . . ...

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Our second winning entry is a story from a paramedic:

A late-fifties male gets up in the morning [wife's still sleeping] to go to the bathroom. He's overweight, smokes like a chimney, and is now grunting away - trying to push out the pound of steak he ate for dinner last night. While he's doing that, the pressure he places on his bowels produces a sudden drop in his ...

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Our first winning entry is a story from a grizzled resident:

A lot is on my mind these days. I am thirty years old, I have a one year girl who is turning into an Olsen Twin with melodrama substituted for'acting'. I just had a new baby boy 7 days ago who has decided to make me relive my intern year all over again; sleepless nights and ...

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Gmail invite status



It seems like Google is giving away Gmail invites like candy. I now have 7 (!) to give away. Instead of posting the top three stories, I'll be giving away the invites on a rolling basis. Again, I'll accept anything medically-related that's interesting or entertaining - just email me your submission.

This will go on until I run out of invitations. ...

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Despite the current controversy on importing medications, it seems a recent report has observed that Canadian pharmacies are pretty safe. In fact, some have stricter standards than US-based pharmacies:

Despite safety concerns voiced by opponents of prescription drug imports, congressional investigators said they encountered few problems with medicines purchased from Canadian Web sites.

In some instances, Canadian online pharmacies had stricter standards than those in the ...

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As a follow-up to what I wrote last week on the ER stories near Boston comes this report. Most of it we know already, but it's nice to see some concrete data:

One-fifth of patients coming to the ED did not have conditions requiring emergency care, and another one-fifth had urgent conditions that could have been treated in a primary care setting, the report shows.

Uninsured ...

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