For those who haven't been following Michelle Au's Scutmonkey Comics, they are witty and hilarious - I can certainly relate to many of the experiences. A new batch were released today, dealing with her surgery rotation. Check it out!

. . . are now encouraged to use stealth to bring their husbands in for screening tests. In this view from BMJ USA, a general practitioner warns against blindly advocating screening tests. This harkens back to a previous article advocating a balanced view on screening tests.

The "Ignorance Isn't Bliss" campaign—launched this week and run by the Prostate Research Campaign UK with support from AstraZeneca—wants me, ...

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. . . from Finland. It is suggested that the rate of stroke was lowest on Sunday, and highest on Monday. I wonder if the next step would be to see if the same applies to heart attacks.

A new study was released saying that tests are delayed on the weekends versus the weekdays.

In the study, published in the August edition of the American Journal of Medicine, researchers analyzed six procedures commonly used in emergency situations:

Purpose
Many hospital departments tend to have lower staffing levels on weekends. We evaluated the use of selected urgent procedures for emergently hospitalized patients and measured the time ...

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A thoughtful response to my piece on good business vs good medicine. The commenter argues that the fundamental problem is our dependence on the insurance system. Consequently, our health-care system is slanted against good medicine. It is the insurance companies that forces good business on our medical practice, and the physicians are unwitting pawns. Take a read:

The assumption is that somehow good business and good ...

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I regularly receive the Cortlandt Forum and only recently realized they're on the web. It's an eclectic magazine, but has interesting malpractice cases. Here's another one.

Basically, it's a patient who came in with dyspepsia. The PCP ordered an upper GI series and it was read as normal. However months later, the symptoms continued, and an EGD found terminal stomach cancer. The ...

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Here's a case where a physician and pharmacist were sued because they failed to warn about the risk of priapism when Trazodone was prescribed. Looking this up, it occurs in less than 1% of cases. Now, how many of you talk about the risk of priapism when prescribing Trazodone? Note the risk management principle:

Juries have been generally supportive of physicians in this respect and do not ...

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. . . the largest city in the nation thus far to endorse the importation of medications from Canada. Convenient timing of the announcement, one week before the DNC.

A recent comment from my Caduet post stated this:

I'm amazed at how drug reps are taught to sneak in the information about putting patients on an unnecessary drug. I'm also always shocked to see how many free clinic patients at our student clinic are put on Norvasc right away.
This is a sad reality. The reason for this is that drug reps don't leave generic medications. There ...

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. . . on the how Bush and Kerry will approach the various health-care issues. An excerpt:

. . . Kenneth E. Thorpe, an Emory University professor of health policy who has evaluated both plans, estimates that Kerry's would reduce the number of uninsured by nearly 27 million; Bush's would cut it by 2.4 million.

Besides the effect on insurance coverage, the proposals differ in two other ways. ...

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Banging on the drum

The National Coalition on Health Care called Tuesday for a rapid, sweeping reorganization of American health care. Without drastic changes, here are the resulting consequences:

Premiums for family coverage will exceed $14,500 in 2006, more than twice the cost of similar insurance in 2001.

Two million people a year will be priced out of the insurance market, with the number of uninsured growing to more than 51 ...

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. . . between physicians vs. lawyersBlogborygmi,  RangelMD and Galen all chime in with interesting and reflective analysis. 

Here's a cynical letter from an internal medicine physician found on Internal Medicine News:

The headline, "Internal Medicine Seen as Unmanageable Career Choice," hit home.  One of the last sentences, however, demonstrated that someone missed the boat:
"The initial results suggest that students respond to a structured curriculum, which gives them the sense that internal medicine is a manageable career."
 
Ouch.
 

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This case illustrates why a physician needs a true jury of peers in malpractice cases - people who at least have some medical background.  In this case, a cardiologist was sued for giving Retavase (presumably for an ST-elevation myocardial infarction).  Unfortunately, the patient died from cerebral hemorrhage - a well-known complication.  The jury found him liable.  Here's what the independent counsel found:

A four-person state medical malpractice screening panel that met ...

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. . . have been drawn in Florida.  Lawyers vs physicians.  The people will decide in November.

Time is money

Interesting study from Vanderbilt University.  Paying physicians to take more time with patients.  I guess it would make sense if there was a correlation between improved patient outcomes and the length of the visit.  

A small number of physicians at Vanderbilt University Medical Center, Nashville, are taking part in a study to find out if it's more cost effective in the long run to pay doctors to take more ...

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. . . with a Pfizer rep yesterday led to their new medication, Caduet.  This is simply a combination of Pfizer's best-selling medications, Norvasc and Lipitor.  I was commenting on how this medication is convenient for those concurrently taking the two medications separately.  Then, to my surprise the rep suggested that I use this first-line for hypertension, saying that "people with hypertension have high cholesterol anyways". 
 
Pretty ...

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So not everyone's happy about the new NCEP cholesterol guidelines.  Drug companies funding studies is absolutely nothing new.  In this case, the data is sound and peer-reviewed.  True, it's not a completely ideal source of funds, but the money's got to come from somewhere.  

So, I was browsing the headlines and caught this story from Romania.  A bad time and place for your surgeon to lose it.

As health plans trend towards a deductible-type insurance, more patients will have to shoulder the cost. To that end, some health plans in Massachusetts are posting costs of various tests on the web.

Patients being more aware of the cost of care, and being able to talk about cost with doctors, is generally "a good thing and desirable," said James F.X. Kenealy, MD, an otolaryngologist in Framingham, ...

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