Half MD talks about his internal medicine rotation:

One of the frequent complaints about the internal medicine clerkship is that rounds take entirely too long. My own team would routinely spend about three hours going through a census of only 20 patients. Some of my classmates got thrown into groups which would take five hours every day to run through the list"”and that's after all of the pre-rounding has ...

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Wrong focus

Charlie Baker: "If 70% of all physicians are specialists and only 30% are in primary care "” and some 40% of what goes on in an ER belongs in the office a primary care provider, something's wrong."

Some of the major players are learning that buffing up the country's primary care physician numbers can go a long way to solving many of our health care delivery problems.


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Injury from doctoring

Rural Doc talks about the physical toll her body takes from being a hospitalist:

Over the last few years I have come to realize that the physical toll of doctoring will eventually limit my participation in clinical medicine. I just can't believe I'll be able to do long stretches of hospitalist shifts in ten years, and I'm almost certain I won't want to be catching babies if it means the ...

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A commenter at Maggie Mahar's blog recounts a story about how nurses were hesitant to speak up after a sponge count. The surgeons were civil, but the observer noted a climate of fear.

Change needs to start at the academic medical centers, where the majority of surgeons are trained. In these institutions, top surgeons are generally revered, and this fosters a hierarchical climate.

Residents ...

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Never events redux

Buckeye Surgeon points to a naively written column supporting not paying for hospital "never" events.

There is plenty of nuance that is missing from article, and I'd like to refer you to WhiteCoat's excellent Reader Take on the issue a few months ago.

Weightlifting trauma

Horrific elbow dislocation from the Olympics.

Outrage over an insurance plan offering assisted suicide as an option to a patient:

In July, the Oregon Health Plan injudiciously sent a letter to lung-cancer patient Barbara Wagner denying coverage for the expensive chemotherapy her doctor had recommended, and offering instead to cover palliative care "including doctor-assisted suicide."
If health insurers were serious about embracing assisted suicide, DrRich has some tongue-in-cheek tips for them.

The last suggestion is ...

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Medical translators

You'd be surprised at what they're actually translating:

Alterations were common, in over 50% of translated statements. Most were editorializations (which they defined as an interpreted passage which combined at least two of either an omission, addition, or substitution) or omissions. 77% of these were judged to be 'potentially significant' alterations (which could affect the goals of the conference such as sharing accurate medical information, building rapport, eliciting patient ...

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Being a good patient

Dr. Rob posts his rules on what patients can do to get along with their medical providers:

One more point: we aren't that much different from you. We have good days and bad days. My staff cry sometimes when they are mistreated by patients. I get discouraged and emotionally drained. It really helps to hear thanks. I don't expect it all the time, but when ...

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This reason is particularly galling: "Nursing home patients who are DNR getting sent in to die. So the home's in patient death rate stays low."

Olympic doctors

A fascinating behind-the-scenes look at practicing medicine in the Olympics:

Canada's Olympic physicians have all been granted temporary medical licences in China so they can order tests and prescriptions while they are there; the logistics of simply ensuring patients get appropriate medical care can be difficult. None of the Canadian physicians have been given hospital privileges. That means that although Beijing has hospitals and medical staff ready to help ...

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Worrisome exam

Emergency physician Edwin Leap asks the following: "Sick patient, worrisome exam, negative studies. So, what do we do?"

Should they impose on already overburdened specialists to come in for another opinion?

From the ED perspective, I believe the answer is yes. Especially when it's their name on the chart, the specter of a failure to diagnose lawsuit is too much of a risk to ignore.


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Changing health care

Entrepreneurs are finding that it's easier said than done. Revolution Health is becoming a textbook example.

Primary care access

Having health insurance without primary care access is "like having a car without the key to run it: you're not going to get anywhere you really need to go."

Also today is another article from the Baltimore Sun that summarizes the mindset of today's medical student:

Rich Bryson is a third-year medical student at the University of Maryland. Although he hasn't finished his clinical rotations, he is already leaning ...

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If I Had - The Worst Headache of My Life - Dr. Steven Chang, MD
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Sick or not

One of the most important skills for a doctor is knowing when a patient is truly sick or not. Also known as the eyeball sign or "hair on the back of the neck" sign, it's the ability to determine within seconds whether a patient needs immediate attention or not.

Rural Doc writes about a case where this skill came in handy:

As I walked into her ...

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It's impossible and Democrats should know better.

Rather than focusing on universal coverage, it's much wiser to guarantee physician access first. Being insured is useless if you can't see a primary care physician in a timely fashion.

Shannon Brownlee thinks that the recently passed Medicare bill should have been vetoed, since some Medicare Advantage plans are doing a good job:

Taking money away from Medicare Advantage is the wrong thing to do, but not because it reduces "choice" for Medicare recipients. Medicare Advantage, which pays a premium to health maintenance organizations, preferred provider organizations, and so-called private fee-for-service plans, was originally enacted 25 years ago to ...

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Geriatrics shortage

Niko Karvounis writes on the geriatrician shortage. As baby boomers approach Medicare age, finding doctors to coordinate their care is becoming more challenging. This is due to the same reasons exacerbating the primary care shortage.

Money, as always, is the answer. Not only financial incentives for medical students to choose the field, but the resources for medical schools to institute geriatrics into the curriculum.


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Kudos to Tara Parker-Pope, who writes a must-read article in today's NY Times. It touches upon the misconceptions of screening, including false positives, lead-time bias, and harm of potential treatments.

The USPSTF was instrumental last week in casting a more skeptical eye towards prostate cancer screening.

Mainstream media outlets are following suit, and now are writing more critical articles on early cancer screening.

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