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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

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. ...

Read more...

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 blogs. ...

Read more...

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.

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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

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 ...

Read more...

Most Popular

Join 150,000+ subscribers

Get the best of KevinMD in your inbox

Sign me up! It's free. 
close-link
✓ Join 150,000+ subscribers 
✓ Get KevinMD's 5 most popular stories
Subscribe. It's free.