The primary debate in health care reform this past year centered on insurance coverage. The next great debate will focus on the cost of providing health care. For decades, the way we’ve paid doctors and hospitals has driven up health care costs. And while the pace of health care spending has slowed the last four years, it continues to rise faster and more noticeably than improvements in U.S. health care outcomes. The reason is not ...

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shutterstock_36115612 Should joint replacement manufactures provide a warranty for their products?  It seems pretty logical since most consumer products come with some sort of warranty these days.  Basic warranties are almost universally provided and the market for extended warranties is increasingly popular. Take for instance my recent upgrade to the new iPhone 5s.  At the time of purchase, the AT&T store suggested their extended ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 76-year-old woman is evaluated for a 3-month history of left knee pain of moderate intensity that worsens with ambulation. She reports minimal pain at rest and no nocturnal pain. There are no clicking or locking symptoms. She has tried naproxen and ibuprofen but developed dyspepsia; acetaminophen provides mild to moderate relief. ...

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Arthroscopic knee surgery is big business in the United States. Arthroscopic partial meniscectomies alone cost $4 billion per year. Yes, billion. But do they work? I’ve written previously about arthroscopic surgery for a torn meniscus and how it adds nothing above and beyond physical therapy for people with arthritis. We also know that arthroscopic knee surgery for arthritis isn’t effective either. Given the poor performance of these other arthroscopic surgeries, ...

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Everyone is familiar with the acronym HIPAA, which is the 1996 edict called the Health Insurance Portability and Accountability Act.  Isn’t that a smooth and melodious name? These are and regulations that are designed to protect your confidential protected medical information.  I support the mission.  I don’t think that your medical records should be deliberately or inadvertently shared with those who are not lawfully permitted to view them.

The job of a doctor isn’t to diagnose, prescribe, or examine.  It isn’t to be well read, efficient, or punctual.  The job of the modern doctor is to convince. We now have radiological studies whose theoretical discernment limit is subcellular.  We can not only map clear and obvious genetic errors of metabolism, but also minor variations of the normal.  In a few years, the majority of codes in the procedure manual will probably be laboratory ...

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“You are the worst doctor I have ever met.” This was the second patient in a row to explode at me when I explained that further back surgery for his back pain had a low chance of success. I spent a couple of minutes explaining the many successes of our hospital’s pain program. Then he exploded again: “You mean I drove five hours just to hear you tell me that you ...

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Recently, I underwent surgery for what proved to be an extensive tear of my right rotator cuff. I have never had a major operation before. Here is how it went down. Back in July, I felt a sharp pain in my right shoulder while playing tennis. Of course, I continued to play that day and for two more weeks. When the pain finally prevented me from playing, I saw an orthopedist who ...

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On a hot afternoon in July Harold “Junior” Bray walked around his small farmhouse one last time before it was time to leave for the hospital. Everything was in order -- the coffee maker was unplugged, the windows secure and the message on his brand new answering machine informed callers that he would return their call as soon as his health permitted. Every step was deliberate, slow and painful. Whenever he ...

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There is a lot of talk these days about changing our health care system from “pay for volume” to “pay for value.”  The idea is that we currently reimbursement doctors and hospitals according to the number of services delivered rather than how well they make us.  This perverse system of incentives results in runaway health care spending that doesn’t necessarily result in a more healthy citizenry. There is certainly truth in ...

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