Hospitalists

Medpundit writes about giving in to the hospitalist temptation. Let me say, hospital medicine is a completely different world from primary-care medicine. If you stay away from it, that knowledge will slowly dissipate. It's like not exercising a muscle - after awhile, it will atrophy and weaken. That's partly why I enjoy the occasional hospital and ER shifts - keeping these skills sharp is important ...

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The Concord Monitor . . .

. . . with a pair of editorials: one detailing some of the issues plaguing our health-care system, including "shell-game" of re-distributing health-care costs:

Costs are shifted "from the payer to the patient, from the health plan to the hospital, from the hospital to the physician, from the insured to the uninsured and so on.

Passing costs from one player to another, like a hot potato, creates no net ...

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The FDA recently approved a purse-sized defibrillator (AED - automatic external defibrillator) for home use at $2000 each. The company "is already selling the product on its Web site and hopes to have it on stores shelves by Christmas . . . [they] hope the device will become as common as a fire extinguisher or a smoke detector . . . ", and is being advertised as the "
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In reading this morning's headlines, several caught my eye: "Medicare will pay for Alzheimer's scan" and "US to pay for brain scans to diagnose Alzheimer's". The funny thing is, the diagnosis of Alzheimer's dementia is not based on any imaging nor laboratory tests. 87 percent of cases can be detected clinically in the absence of blood tests or scans. So, what is the role of imaging in Alzheimer's dementia?

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The hidden cost of medications

From the Archives of Internal Medicine, comes this story:

About one-third of chronically ill adults who underuse medications because of the costs associated with buying the drugs, never tell their health care practitioners . . .

The underuse of essential medications, including cholesterol-lowering medications, heart medications, asthma medications and antipsychotics, has been associated with increased emergency department visits, nursing home admissions, acute psychiatric hospitalizations, and a decrease in self-reported ...

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Active euthanasia

What an incredible story today from Medpundit:

An elderly, "comfort care only" patient was transferred from her nursing home to the ER in the middle of the night because the nursing home didn't know what to do when she developed abdominal pain. She was much too frail to withstand surgery, and since she was "comfort care only," that wasn't an option anyways. The emergency room doctor who drew her ...

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With focus on the former president's successful heart surgery, there is more interest than ever in screening for heart disease. Lots of business for hospitals:

"I'd imagine that the phones are ringing off the hook at every cardiology practice in the city," said Dr. Peter Buttrick, cardiology chief at the University of Illinois Medical Center. "There certainly is more public awareness of heart disease this week than there was ...

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I just completed another shift in the emergency room (which I do about once per month), and it continually amazes me the amount of non-emergent cases that comes through - but that's for another rant.

So I'm reading that the family of John Ritter is suing the hospital for misdiagnosing his ascending aortic aneurysm. Galen certainly has some tough words for this. I'll reserve opinion since I'm ...

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Hostages in the ER

In a reminder that an emergency room can be dangerous place, this story reveals how desperate some patients are to continue their prescription drug abuse:

A man apparently distraught at not being able to see a doctor immediately held two hostages for 20 minutes at Frisbie Memorial Hospital Wednesday. . .

"They were able to get a doctor to respond to the emergency room," Officer Mike Allen said. ...

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With former President Clinton's successful CABG, this NY Times article cites the higher than normal mortality rate for this procedure at Columbia-Presbyterian:

The hospital where former President Bill Clinton awaits bypass surgery has the highest death rate for the operation in New York State, according to the state's Health Department. While the death rate is quite low - fewer than 4 percent of all bypass operations - it is ...

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The final word on South Shore ER

Today the Massachusetts Department of Public Health came down with its decision on South Shore hospital, just south of Boston. I have written about the situation previously and followed up here.

The Department of Public Health report, released yesterday, ends review of a dozen complaints about the pace of care in South Shore's emergency room since last year. It found that emergency room staff at the ...

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The future of primary care

The New England Journal published a sounding board piece on the future of primary care in the United States. The authors suggest that one paradoxical reason is the increased exposure to primary care in residency training:

But an additional possibility, albeit an apparently paradoxical one, is that the decline is due in part to the successful efforts by medical schools to increase students' exposure to primary care practice. ...

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Winning Gmail entry #4

It's been awhile since I've received any submissions for my remaining Gmail invites. I still have 3 more left. Send me any entertaining, medically-related story or article, and I'll give a Gmail invite to what I find interesting. I give preference to entries that are well-written.

This morning, I received this story from someone who works with the developmentally disabled. An eye-opener to say the ...

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A trio of articles . . .

. . . from Medpundit on Overlawyered. The first, discussing a lawsuit based on a 1 in 1.09 quintillian chance. The second on the benefits of non-economic damage caps. The last on the effects of lawsuits going out-of-control: obstetricians are leaving Pennsylvania, and some hospitals are closing their OB departments entirely.

Our surgical colleague on A Chance to Cut . . . responds to the piece on delayed weekend testing. He disagrees with my hypothesis that the savings from shortened length of stay would offset the increased staffing costs of treating a weekend like a weekday. Perhaps this should be studied next.

Given the current nursing shortage and the premium that would have to be paid to ...

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John Stossel did a fantastic piece on 20/20's "Give me a break" segment regarding John Edwards and personal injury lawyers (found via Galen's Log). Some excerpts:

In hospitals, the lawyers have bred so much fear that patients now suffer more pain, and may be less safe because doctors are concerned about being sued.

"That fear is always there," said obstetrics professor Dr. Edgar Mandeville. "Everybody walks in mortal ...

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A new study was released saying that tests are delayed on the weekends versus the weekdays.

In the study, published in the August edition of the American Journal of Medicine, researchers analyzed six procedures commonly used in emergency situations:

Purpose
Many hospital departments tend to have lower staffing levels on weekends. We evaluated the use of selected urgent procedures for emergently hospitalized patients and measured the time ...

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I regularly receive the Cortlandt Forum and only recently realized they're on the web. It's an eclectic magazine, but has interesting malpractice cases. Here's another one.

Basically, it's a patient who came in with dyspepsia. The PCP ordered an upper GI series and it was read as normal. However months later, the symptoms continued, and an EGD found terminal stomach cancer. The ...

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Here's a cynical letter from an internal medicine physician found on Internal Medicine News:

The headline, "Internal Medicine Seen as Unmanageable Career Choice," hit home.  One of the last sentences, however, demonstrated that someone missed the boat:
"The initial results suggest that students respond to a structured curriculum, which gives them the sense that internal medicine is a manageable career."
 
Ouch.
 

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This case illustrates why a physician needs a true jury of peers in malpractice cases - people who at least have some medical background.  In this case, a cardiologist was sued for giving Retavase (presumably for an ST-elevation myocardial infarction).  Unfortunately, the patient died from cerebral hemorrhage - a well-known complication.  The jury found him liable.  Here's what the independent counsel found:

A four-person state medical malpractice screening panel that met ...

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