Holiday break



I will be away from the blog until the New Year. Please welcome back Josh Umbehr, M.D., an editor at Medgadget, who will guest blog in my absence.

I wish everyone a safe and happy holiday season. Thank you for your continued readership and support.

Paying for hearing aids

John Ford explains why health insurers don't.

Shadowfax with more on the lack of business acumen from today's medical graduates. Anyone who thinks otherwise, well, is pretty naive and is ripe for manipulation when they reach the real world:

Med school is about more than preparing you for internship. There's 30+ years of practice to follow, and you need to be prepared for that, also. It's not too hard to teach students some universal concepts ...

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As indicated by this recent survey. Well, don't complain when you get what you pay for:

Unfortunately, only 50% felt that a primary care physician should make at least $180,000. This pales in comparison to most other specialties and is the reason for the death of primary care.

1/3 believed that the primary care physician was only worth $140,000 a year. Again, an unreasonable expectation when specialties ...

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The story has hit national media - that surgeon's career is in serious jeopardy. However, TBTAM wonders if the anonymous whistleblower made the more egregious error:

In fact, I'd argue that the "whistle blower" to the media committed an even bigger violation of the patient's rights than did the resident who snapped the photo. What could have been a private matter between the patient and the Mayo Clinic ...

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The university has hit it big in royalties with Pfizer's drug.

Too much medicine

Any discussion of overtesting needs to be accompanied with the reasons why: the malpractice environment promoting defensive medicine and the flawed reimbursement system.

Any discussion of "doctors ordering too many tests" without mention of the aforementioned causes isn't worth listening to.

A recent NEJM study support their use:

"Even though the differences in length of stay we observed may on first blush appear as small, if you multiply those by the many thousands of admissions to hospitalist care each year, the effect can really be quite large," lead author Dr. Peter Lindenauer of Baystate Medical Center in Springfield said in an interview. "This benefit did not come at the expense of ...

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Moneyball medicine

Arnold Kling on EBM and the role of guidelines in today's clinical decision making:

It is absurd to think that a baseball statistician, operating at a distance in time and space from a player being scouted, is able to make a better decision about the player's likelihood of major league success than a local scout. Except that it happens.

It is absurd to think that credit scoring models ...

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Woefully unprepared

Medical schools are doing a miserable job teaching the business side of medicine. In my opinion, this is equally as important as the medicine itself.

I think an MBA should be a pre-requisite prior to entering medical school. New physicians would be better prepared to face what's coming to them in the real world.

So, Congress comes through with a 6-month reprieve:

Lawmakers have crafted a six-month reprieve for physicians facing a 10 percent rate cut when treating Medicare patients, two senators announced Tuesday.

The pay cut for doctors had been scheduled to take effect Jan. 1. Doctors had warned that a cut in reimbursement rates would lead to physicians taking on fewer new Medicare patients.
Yay, we get to do this ...

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I guess there's enough of these cases to go around in Thailand:

Thai Surgeons are gaining a reputation as specialist in the delicate art of reattaching severed penises.

They've become experts in this field due to the increasing number of penises chopped off each year by angry Thai women. Seems that the women see this as an acceptable way of taking revenge on their cheating lovers and husbands.

And how third-party payers and drug companies have corrupted the concept.

Despite what some patients and lawyers say, the only guarantee in medicine is that nothing is guaranteed. Nothing is ever 100%, and this is not communicated clearly enough by many physicians.

The Independent Urologist concludes that dropping Medicare would be tantamount to suicide.

Snowblower vs hand

Guess what won.

What happened at this recent code in an ER. (via WhiteCoat Rants)

Just what we need, the 19th approved beta-blocker. Why would any physician in his/her right mind prescribe Bystolic when several generics are available for pennies a day?

Doctors will figure out the best way to financially optimize any reimbursement system. So when you're talking about "over" coding, blame the system, not the players:

The CPT coding system was devised to distribute resources according to the effort required. Somebody underestimated the effort required by primary care and most especially the degree of risk assumed in primary care. But fraud is not worth it at our compensation ...

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The WSJ on Scott Morrison of Polite Dissent. His reviews of House, M.D. has opened up opportunities as a medical drama consultant:

Morrison says happy with his career in medicine, but he doesn't mind a little impromptu consulting for medical dramas. "I've had some screenwriters ask for my opinion on various medical things when they're submitting review copies for other shows," he says. "I don't know if they ...

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