Fascinating insight over at The Physician Executive:

There are not enough primary care docs to meet the demand and they are not sufficiently well remunerated to provide the level of care it takes to keep people out of ER. They need more resources, but instead, I see resources going to retail clinics and moreover, benefiting large, profitable pharmacy conglomerates at the expense of primary care.

Another EMR fear

With so many vendors out there, there is always the risk of your vendor going out of business.

Dr. Phil and HIPAA

Apparently, the privacy rules don't apply to him as he is no longer licensed:

"If he never bills anybody for counseling services, he very well may not be covered by HIPAA," said Mr. Nahra. "Depending on his licensing, he may not have professional ethical obligations, either."

A pediatrician says doctors do so at their own peril. He claims that when pediatricians ignored them in the 90's, it led to the anti-vaccine movement on the internet:

Would things have been different if we had engaged our patients from the get-go by providing them with alternative Web sites, scrutinizing and rebutting anti-vaccine "science," or posting studies demonstrating vaccine safety in the public domain? I would answer, emphatically, ...

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Patients who cry wolf

Is there any disincentive not to?

And medical providers who don't go "running to the shepherd's aid" every single time he cries for help get their britches handed to them if there is ever a bad outcome.

Diagnosing by smell

When breathing through your mouth is helpful. A case of gas gangrene:

This is what this room smelled like. His foot had an ulcer that was completely black with dark reddish streaks going partially up his shin. Purulence oozed out. When you palpated his shin, it made the sound of rice crispies popping. Not a good sound when it comes from your leg.
(via ...

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Placebo Journal #9

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Thank you Scott Gottlieb for criticizing John Edwards on his exploitation and publicizing what has been oft-repeated here recently:

Research provides little support to Mr. Edward's underlying premise that single-payer health-care systems would do better. On balance, data suggests that in the U.S. transplant patients do quite well compared to their European counterparts, with significantly more opportunities to undergo transplant procedures, survive the surgery, and benefit from new ...

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When they're threatened with physicians dropping out of their network, they simply pass the buck to patients:

St. Joseph Health Services is a Catholic nonprofit that cares for many poor people in Rhode Island. Last year, UnitedHealthcare of New England tried to cut the hospital group from its provider network. The reason? After years of seeing little or no increases in payments for services, St. Joseph had demanded that the ...

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Another article on managing expectations.

Virginia is tackling the physician shortage problem by offering malpractice immunity:


Parties in the debate call it the most significant matter taken up by justices regarding medical malpractice since 1990, when the court upheld the state's limit on malpractice awards.

If successful, tax-exempt physician foundations in Virginia employing about 1,200 doctors and supporting the state's three medical schools could win malpractice immunity.

Angry physicians

And how to deal with them.

The $1,400 physical

Ah, the seductive allure of "more medicine". A clinic that offers $1,400 physicals gets 600 of them last year. For those that are counting, thats approaching a million dollars in revenue.

Was many a HIPAA rule violated when star-struck hospital workers let Dr. Phil walk into Briney Spears' hospital room?

Wondering about the wacky medicine that Hugh Laurie practices on TV? Meet Dr. Lisa Sanders, the medical adviser on House, M.D., and why medicine at times loses out to humor.

There are risks with every medical procedure, and not all adverse outcomes are due to malpractice:

There must be restrictions on malpractice lawsuits so that only the must extreme cases receive settlements. There are risks with every procedure, and everyone should be aware of that. When I got a colonoscopy, I was told that there is a small chance that they puncture my colon. That was a risk I agreed ...

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Plenty of talk about how the US spends much more per person than Canada. Perhaps it's time to re-frame the situation: maybe Canada isn't spending enough.

The 48-year old who doesn't learn:

He's the poster boy for the state's new anti-smoking campaign. But 48- year-old Skip Legault is still smoking"”despite an amputated leg, two heart attacks and a stroke . . .

. . . In the ad, Legault, looking into the camera and supporting himself on crutches, recites a litany of health woes, including a first heart attack at age 28 and another at ...

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One tough day for this OB.

Dropping Medicare

Was the best thing to happen to this primary care physician.

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