Palliative care specialist Christian Sinclair explains some misconceptions:

There are times when extubating a patient can cause more distress - an obstructed airway, a high risk for hemorrhagic bleed, inability to control tachypnea with medications, feel free to add others. But in my palliative care reading and experience, leaving a patient intubated is the exception, and not the rule.


#1 Dinosaur: "Right now the idea of a cash only practice -- be it fee-for-service or prepaid; so-called retainer medicine -- is just beginning to take hold. I think it is a good idea, and I do believe I will move to it sooner or later. I also believe that many other physicians will come to the same conclusion and take the same action. I see the insurance companies' ...


For those rare cases when you have to do a neurological exam in a bubble.

Discussing why young adults don't need health insurance. Jay also touches on how universal coverage is useless without primary care access.

Mandibular dislocation in a nursing home setting.

Accepting Medicare

When you've been doing cash-only, trying to add Medicare is an eye-opener.

Half "Medical equipment can be produced at a cheap cost. The current system does nothing to reward us for developing innovative, cost-effective devices. Instead, we continue to throw away money on machines that can be produced by hobbyists for 1/100 of the cost."

As lymph node biopsies become more sensitive and sophisticated, how to interpret the results is not always clear-cut.

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(via MedPage Today)

Doc Gurley analyzes the myriad of options.

Leech clinic

For real, $20 per leech.


Marianas Eye: "Why we doctors continue to attend industry sponsored CME luncheons just to listen to these medical whores is unknown. Oh, wait, it actually is known. We're such a cheap lot, we'll do anything for a free lunch, as long as the salad has nice crisp croûtons."

It is no secret that to solve ED overcrowding, primary care access needs to be addressed:

I am speaking specifically of those 4 in 5 New Yorkers who are using ERs for non-emergencies and who receive a far greater continuity and quality of care in a primary care setting with their everyday doctor than they do in an emergency room with a doctor the patient has never met before.


He appreciates the concern about his well-being and will be back blogging soon.


Nothing strengthens the bond between physicians and support staff like food.

Richard Reece: "The hidden reason may be that generalists want to become specialists and the road to that ambition goes through hospitals."

That's old hat to regular readers here, but it's a point that needs to be repeatedly emphasized to patients.

Aggravated DocSurg: "Woe to the physician who doesn't complete, sign, date, and thumbprint with blood The Form in exactly the mandated manner. He is met with a response reminiscent of the way a Communist party apparatchik in the USSR viewed any form placed in front of his imperious nostrils -- to be sneered at unless it is filled out 'correctly,' with the definition of 'correct' ...


Simply having had a C-section in the past can deny one from obtaining individual health insurance:

She was turned down because she had given birth by Caesarean section. Having the operation once increases the odds that it will be performed again, and if she became pregnant and needed another Caesarean, Golden Rule did not want to pay for it. A letter from the company explained that if she had ...


The medical home

Support and dissent of the emerging concept continues.

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