Great stuff by Dartmouth's Gilbert Welch. Both Presidential nominees actively flaunt the cost-efficiency of preventive medicine.

In fact, the opposite is true. Prevention costs money:

It boils down to encouraging the well to have themselves tested to make sure they are not sick. And that approach doesn't save money; it costs money.
Dr. Welch likens screening the a car's check engine light:
Early screening is ...

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Treated to death

New York has somewhat restrictive advance directive laws:

Even if friends or relatives were found, New York prohibits the withholding or withdrawing of life-sustaining treatment without a signed health care proxy or "clear and convincing" evidence of a patient's wishes. A "do not resuscitate" order can be put in place by doctors, but only in the absence of identified surrogates and only if resuscitation is considered futile.
This tragically ...

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In yesterday's editorial, The Boston Globe correctly identifies the disturbing trend where hospitals are spending millions on new specialty expansions rather than primary care:

On the North Shore, three capital projects totaling more than $200 million are in the works. In Plymouth, Jordan Hospital in 2006 opened a $40 million pavilion, part of a $57.5 million expansion, only to see admissions drop by about 9 percent this year. Massachusetts ...

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Maggie Mahar expounds on Shadowfax's assertion that health care is a moral obligation, rather than a right.

It's an excellent, detailed piece that you should read in its entirety.

Re-casting the question in terms of "obligations" rather than "rights" is more than just semantics. It lessens the entitlement attitude that patients have towards health services, and that's important.

She also makes this point in ...

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Older patients find "elderspeak" condescending, and worse, research shows it may be associated with shorter lifespans:

Dr. Williams said health care workers often thought that using words like "dear" or "sweetie" conveyed that they cared and made them easier to understand. "But they don't realize the implications," she said, "that it's also giving messages to older adults that they're incompetent."
Some nursing home patients go Tarantino on their medical ...

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I received this email from a physician recruiter, and it provides another perspective on how difficult it is to find primary care doctors. I didn't have much to offer, as she has an accurate read on the grim situation.

I just stumbled across your blog and am very impressed with the information you provided in reference to the physician shortages and IM residents going into almost ...

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The USPSTF updated their colon cancer screening guidelines.

Their reviews are unbiased and evidence-based, and I base my practice decisions mainly on their recommendations. Here are the some high points.

Screening can stop after age 76. From ages 76 to 85 it's a class C recommendation (those with specific risk factors can still be screened), and class D after age 85.

The benefit of colon ...

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A guest post by Val Jones, MD.

On the eve of our second presidential debate, I had the chance to interview Dr. Ken Thorpe, Executive Director of the Partnership to Fight Chronic Disease (PFCD), about America's healthcare crisis. Here's what he had to say (click here to listen to the podcast):

1. I was part of a press conference call with you ...

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Prison doctors

Despite the potentially tough environment, there are some advantages to being a prison physician. Salary for a board-certified physician starts at almost $250,000 a year. Furthermore, there are some other perks that you may not have thought of:

There are no hassles with third-party payers, patients will always show up for their appointments, there is plenty of security, and there's no need for malpractice insurance.
The California Department ...

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While watching the stock market dives 500 points today, Richard Reece gives an interesting take. Maybe the economic turmoil will force another look at rampant health care spending.

There will be an epiphany that no other solution exists except for the re-emergence of primary care. Perhaps it takes a catastrophic economic calamity to force our leaders to take the appropriate measures to save primary care, ...

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Paper charts

Electronic records are a recent theme here. #1 Dinosaur give his take in a Medscape piece (registration required), calling the current crop of EMRs nor ready for widespread use:

The EMRs promise of a "paperless" office is as distant as ever. It's much easier to keep my efficient, time-tested paper charts than lay out thousands of dollars for hardware and software that aren't going to save time or ...

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Bashing Demerol

For good reason. Both Shadowfax and ER Stories write about the addictive potential of this narcotic, and how there is really no positive indication for its use.

It seems like they all get work done, which is no surprise given the media attention.

Joe Biden's probable botox treatment is next to be analyzed by this plastic surgeon.

Dr. Wes alludes to his legal ordeal with anonymous comments. I applaud his stand not to take the offending comment or the post down. It's more than I would have done.

However, he did pay a price in terms of a hefty legal expense and three visits to court.

Comments are moderated here, and because of the legal uncertainty surrounding this issue, I am ...

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Massachusetts' emergency departments are overflowing with newly-insured patients. Don't want to say I told you so but I can't help it:

Doctors and counselors working the front lines of emergency care say a major reason patients still flock to their doors for routine care is that there are too few primary care physicians in Massachusetts. Some newly insured patients are waiting months for their first visits.
...

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Doctors are at odds with administrators in this California hospital. The administrators simply calls the physicians "whiners", and are ignoring the reasons behind the exodus of physicians.

I'm sure this scenario is being played out nationwide:

In our quarterly staff meetings, the number of doctor resignations outnumbers new medical staff. The morale among Memorial Hospital's medical staff is at an all-time low. The patented reply of Santa Rosa ...

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A recent editorial comments on Medicare's never-event policy.

There is no question that hospitals and doctors shouldn't be paid for catastrophic mistakes, like wrong-site surgery. However, the editorial seems to support the widespread expansion of the initiative:

In the long run, as the list of conditions is expanded and more insurers follow Medicare's lead, the savings could be substantial.
Medicare is already proposing partially preventable conditions to ...

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Implementing electronic records

A technologist notes some of the pitfalls obstructing widespread EMR adoption. One important point is that those behind the systems don't know how doctors work, or what makes their lives easier.

Until they do, and can come up with systems that improve physician's lives, resistance will continue:

A large percentage of technology professionals are about the machine. They're about the what and the how. They're not about ...

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A positive experience from this Houston internist.

Tellingly, one of the biggest problems is finding primary care physicians for patients who did not want to follow him into a retainer practice. As we know, those that take Medicare are becoming rare.

Most concierge practices are staffed by doctors fed up with the current system. But more newly graduated doctors are seeing the light, and going ...

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Mister Gasman

Off until Monday. Enjoy the weekend.

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