"If you want government to pay for it, you have to accept no as an answer"

Well said. Only if people are willing to accept “no” will single-payer or any other radical health reform be a reality. I just don’t see that happening anytime soon in this age of entitlement.

Primary care vs the engineer

Guess who comes out ahead when it’s all said and done? And it’s not even close.


Atul Gawande on the power of a simple checklist in medical care. (via Wachter)

Want to fix health care?

You have to start listening to The Happy Hospitalist. Here’s his first suggestion:

1. Remove failure to diagnose as a legal basis for a lawsuit.

To spend billions on testing “just to make sure” when your medical training says you already know the answer. The testing that is the result of that 0.5% chance you are wrong. No matter how much we try, we will never get it right …

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University of Pittsburgh Medical Center

Flush with cash? Bob Wachter speculates.

Bob Wachter on his Imus interview

The blogging hospitalist talks about a somewhat surreal appearance in 2004.

Medicare and single-payer

I am consistently baffled at why single-payer pundits want to put our health care in the hands of the government. People like Ezra Klein and Paul Krugman simply don’t know what they are asking for, and have zero insight into how restrictive Medicare really is for a practicing physician.

Their ridiculous reimbursement decisions, rules and restrictions are far, far worse than any private insurer. Roy Poses …

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CT scans and cancer

Will patients care and start to decline scans? Probably not:

My guess is that a few patients will say no, but most will shrug and sign, favoring current certainty in their anxious moment-of-truth over a tiny risk somewhere beyond a distant horizon.

Coding complexity redux

Sometimes you need a math degree to analyze RVU values.

Penalized for appropriate coding

EMRs are causing physicians to code appropriately, and resulting in higher payments. So why are doctors being penalized?


How the patient is excluded from the reasons why we document:

We doctors, in order to make our living, have been turned into Medicare lemmings and I believe it brings incredible loss of productivity by deferring time, money and resources from patient care to patient documentation:

To appease the lawyers. It didn’t happen. You’re at fault
To appease the insurance companies. It didn’t happen. You …

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The game of Medicare coding

A sense of the bizarre complexity of coding that is the lifeblood of every physician. Most residencies don’t spend enough time on this aspect, which are doing new physicians a severe disservice.

Rapid response teams

What seems good in theory is proving difficult, and expensive, to implement.

"Sit down when you round on your patients"

One of many tips from a new hospitalist. This one is especially poignant in this litigious day and age:

Call in consultants. It bothers me to call in the GI folks for every case of diverticulitis and the endocrinologists for all uncontrolled diabetics, but that’s what I do now. As one of my partners told me, “Just because you can take care of a patient’s problem doesn’t …

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"There are no losers in a well run hospitalist program"

A day in the life of a Happy Hospitalist.

Even the ivory tower gets it

An editorial in JAMA suggests that the RVU system is killing primary care. Something that has been repeated every day in the medical blogosphere:

The ending commentary was a shot across the bow of the single payer fanatics.

You can’t have primary care for all if you don’t have primary care docs for all. It is an impossible feat.

The same government that gives us the ridiculous …

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Yes, it takes that long

Those who advocate having mid-levels replace primary care should read this.

VIPs, Dennis Quaid’s children, and medical errors

Did their celebrity play a part in the ensuing medical error?

There is no evidence that Dennis Quaid’s kids were harmed because they hail from a VIP bloodline, but it wouldn’t surprise me if it was a causative factor. Everybody just tries a bit too hard, and in doing so, they throw off their natural rhythm. In any case, when we get a VIP admission at UCSF and the residents …

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The surgical hospitalist

Hospitalist medicine is already exploding. Surgery and OBs are also exploring this model. Robert Wachter talks about surgical hospitalists:

The surgical hospitalist model extends my original concept of a hospital-based generalist who offers full-time availability, the ability to personally handle a wide variety of problems and coordinate the care of others, and a focus on improving both the care of individual patients and hospital systems. Like all medical …

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The academic hospitalist

Further fracturing the internal medicine specialty?


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