Advocates are saying that a single payer system man be an answer to solve malpractice woes:

She noted that if health care was guaranteed through government funding there would be no need for malpractice suits and settlements to take into account the future health care costs of plaintiffs. This is particularly important in obstetrical cases given the future medical interventions and life expectancy of these babies.
For physicians to ...

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Fecal DNA tests

As a follow-up to my post on the updated USPSTF guidelines on colon cancer screening, a reader asks me to comment on fecal DNA tests, which along with virtual colonoscopy, was given an "I" recommendation meaning there was not enough data to provide guidance:

I would be very interested to hear your thoughts about their omission of a less well-known new option, stool DNA (SDNA).

The task force ...

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Specialists and zebras

Nicely put:

The dark secret of specialists is that they are trained to see the bizarre. In order to adequately train a specialist in diseases and illnesses that rarely occur, they must train at large, academic medical centers. In such places, where doctors throughout the region send their difficult cases, they do end up seeing quite a few bizarre cases. To deal with the bizarre, they ...

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Having everything done

This anesthesiologist sums up the end-of-life conundrum nicely:

There are families who accept death with peace, dignity, and an unselfish regard for their loved one's wishes.

There are other families who cling to the one they love, and want "everything done" for the person, not because that's what their loved one wants, or would benefit from, but because they, the family, aren't ready to say goodbye.
In the ...

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Residency trains you for the critical or severe cases, leaving the seemingly simplest cases to be the most challenging. Shadowfax reflects on an example where a 1-week old infant presented vomiting blood.

Similarly, when I first started primary care I was comfortable running codes and knowing what to do in an acute MI. It was the rashes that I saw in the office that I found ...

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Celiac disease

Celiac disease is an oft-overlooked diagnosis that can cause a wide constellation of common symptoms, including fatigue, decreased exercise tolerance and a variety of IBS-like gastrointestinal manifestations.

Athletes in particular should suspect this with an unexplained loss in performance or worsening fatigue. It's diagnosed with a simple blood test.

Because there's no known medication for treatment, little has been spent in researching new cures apart from ...

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Medicare is offering bonuses to doctors who adopt e-prescribing. However, the process is convoluted and practices that do everything right still don't receive payment:

Richard McArdle, the CEO of an ophthalmology practice in Portland, Maine, who attended the CMS-sponsored conference, told MedPage Today that his group's experience with PQRI will make it hard to convince his doctors to seek the Medicare bonus for e-prescribing.

"We did everything right ...

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Test post

This is a test post. Please ignore it.

Archives:
September, August, July, June, May, April, March, February.

Internet support groups

They can sometimes give fatal advice, like influencing liver transplant patients to stop taking their immunosuppresive medications. Transplant surgeon Pauline Chen reflects on this tragic case and speculates why some patients do what they do.

When you can't categorize a chief complaint, you're often in for something strange. Or as Shadowfax puts it, a mixture of "curiosity and utter dread."

Internists

Here's what we do, in a nutshell. Multiply that by 20 to 30 patients a day, and you get an idea of the complexity of the profession.

The shaky future of the University of Texas Medical Branch in Galveston:

After sustaining a direct hit by Hurricane Ike, UTMB has been slow to recover and its future is in jeopardy. UTMB suffered over $700 million in damages from Ike with only $100 million covered by insurance, and given their $50 million per month payroll and impaired ability to generate income, this week university officials were warning of ...

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Value of primary care

Dr. Rob comments on the recent preventive medicine piece in the NY Times. To summarize, asserting that screening tests save money is a myth.

The real value of primary care physicians, is that we can prevent unnecessary testing :

For example: if you go to the neurosurgeon with sciatic nerve pain that has gone on for 2 weeks and is excruciatingly painful, what do you think the ...

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The current economic turmoil is resulting in a flood of office visits in some cases:

Doctors say people's financial troubles can, in fact, spread to your body and cause everything from ulcers to heart attacks, often disrupting people's lives and relationships.

Cardiologist Ramin Oskoui says he's seen a 30 to 40 percent jump in the number of patients complaining of chest pains or tightness.
I personally haven't seen it ...

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Arthur Garson talks about unnecessary health care spending in his op-ed. He goes over the common arguments, including practice variation, lack of comparative effectiveness, paying for quantity, and malpractice.

Here's his solution:

The next president, whoever that is, should start by appointing a group made up of those responsible for wasting our dollars "“ as well as members of Congress and the administration "“ to examine ways ...

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Dr. Wes has recently undergone some trying times associated with his blog. He's wondering whether it's worth it to continue the effort:

There is no question that placing one's online self in the world for all to see adds vulnerability and potential liability. When I told a colleague Friday about my recent predicament he responded, "Why the hell would anyone want to blog?"
To this end, he asks some relevant ...

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Elissa Mummolo summarizes Massachusetts' problem of adopting universal coverage before addressing physician access.

Waiving tuition for medical students who choose primary care is a good start.

However, there is a lag time of about 10 to 20 years before these changes take effect. Every medical school has to offer similar incentives, and it will take years for the attitudes of medical students to change. ...

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Primary care and HSAs

A survey of primary care doctors found that less than half felt ready to discuss medical budgets and reported low knowledge of how HSAs work.

If physicians don't understand how high-deductible plans work, how can patients?

One problem is that there is no formal training. I learned pretty much everything I know about the various types of insurance plans and basic health policy issues from reading ...

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This patient was lucky, and avoided a neurosurgical emergency. Others can prevent tragedy from wearing a simple $20 bike helmet.

Pfizer fraud

Big Pharma manipulating studies? Gee, what a surprise. Doug Farrago explains this is a major reason why the public doesn't trust pharmaceutical companies.

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