More on good business vs good medicine

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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Why physicians need a true jury of peers

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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The battle lines . . .

. . . 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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A recent conversation . . .

. . . 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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Folks, this is nothing new . . .

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.  

Surgeon goes crazy and amputates penis

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

Posting health care costs on the web

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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Changes at Medlogs and new Blogger editor

As many may know, Medlogs is an indispensible aggregator of medical blogs. Lately, there was concern about how many non-medical blogs were included in the physician section. Let me say that I completely agree and applaud the recent editorial changes at the site. Thanks Nick for saying what has been on everyone’s minds. Medlogs is now much cleaner and more medically relevant.

As …

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Innocent

Everyone was acquitted in the local case against TAP Pharmaceuticals, charging that the drug reps were bribing physicians to prescribe their drugs (Lupron and Prevacid). Although certainly in a moral gray zone, tough to say that it was criminal.

An interesting story . . .

. . . on a fertility case gone wrong due to a medical mix-up.

Thinking about my schedule

Some big changes in the coming months. First we’re switching to an EMR. After that, there’s the increasing pressure by management to see more patients – not to mention having our compensation structure more directly correlate with our productivity RVUs. I’m thinking of changing my schedule structure – currently it’s the standard 15-minute blocks with 30-minute physicals. Many advocate the modified-wave structure. Looks good …

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New cholesterol guidelines

As you may have heard, the new NCEP cholesterol guidelines were released yesterday. The biggest change is a goal LDL of < 70 in the very high risk group. Now, what classifies as very high risk? They are the following: Established CAD plus:
i) multiple major risk factors (esp. diabetes)

ii) severe and poorly controlled risk factors (i.e. continued smoking)

iii) multiple risk factors of …

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On sudden wealth syndrome

As you may heard, in Lowell, MA this lady recently won the $294 million MegaMillions jackpot. Some psychologists say that the so-called sudden wealth syndrome often leads to impulse buying and social isolation.

Two views . . .

. . . on medical malpractice. One from the insurers’ perspective, the other from the lawyers. These articles are from the state of Wyoming, where 1 of the 3 medical malpractice insurers withdraws from the state later this year.

The option of binding arbitration . . .

. . . as a solution to alleviate the malpractice crisis. Some practices claim up to 80% of patients agree to the terms – namely waiving their right to a jury trial. Read more about it in Medical Economics.

Response to recent articles

Medrants and RangelMD have chimed in with their opinions on the piece regarding the patient who demanded ovarian-cancer screening. Each makes fantastic points.

Also, in response to BMC hiring a managment consultant, symtym supports the idea, while Blogborygmi takes a more cautious take.

A balanced view on screening

Medpundit links to an excellent article detailing how more cancer screening isn’t necessarily better. There certainly should be further public education on taking a more balanced, evidence-influenced view – or else more physicians would be subjected to this.

Lawsuit against Massachusetts General Hospital

This story is getting a lot of play here. Here are the basics:

In short, the unsupervised pharmacy technician, in her second week on the job, wrongly added insulin to an undisclosed number of intravenous nutrient bags prescribed to sick infants.

The feeding bags contained no indication of insulin on their labels. They apparently were not checked by the pharmacist before delivery to the neonatal intensive …

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Good business vs good medicine

Medrants has recently ranted about going to back to basics:

We need to return to first principles. The reason we became physicians was to care for people, not patients! By that I mean, caring for the patient, rather than the disease.

We need a revolution in our thinking. This revolution actually is occuring in retainer practices and cash only practices. Patients will, I believe, be willing to pay …

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