A recent study suggests that a single IM dose of steroid is equivalent as an 8-day tapering course of oral steroid in the setting of relapse rates from acute asthma attacks:

Objective: To compare the efficacy of long-acting IM methylprednisolone to tapering oral methylprednisolone in adult asthmatic patients discharged from the emergency department (ED).

Methods: Randomized, double-blind, placebo-controlled trial of a single IM dose of 160 mg depot ...

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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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Time is money

Interesting study from Vanderbilt University.  Paying physicians to take more time with patients.  I guess it would make sense if there was a correlation between improved patient outcomes and the length of the visit.  

A small number of physicians at Vanderbilt University Medical Center, Nashville, are taking part in a study to find out if it's more cost effective in the long run to pay doctors to take more ...

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Refraining from testing and evidence-based testing is nice, but difficult in today's practice environment:

In one study in which Dr. Kroenke said he examined 500 patients with physical symptoms, 70% of all subjects improved two weeks after seeing a primary care physician. While symptoms persisted in about 25% of patents, follow-up studies showed that serious diseases not suspected during initial evaluations rarely emerged after one year.

The lesson, ...

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A sign of things to come?

We have concierge practices, now people can pay extra for "priority access" at emergency rooms:

The 95-year-old financially ailing Southampton Hospital - the only serious medical emergency center on the South Fork - is offering a plan aimed at wealthy summer visitors whose primary doctors are back in Manhattan and out of reach, presumably along with the hospital's sense of propriety. For $6,000 per family, or $3,800 for individuals, ...

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The Atlanta Journal-Constitution editorializes on how capitalism is one of the driving forces behind our broken health care system:

We now have a health-care system whose primary mission is not delivering health care. Instead, insurance companies, pharmaceutical companies, medical device manufacturers and, in fact, many hospitals exist to make money. That's their first priority, and also their second and third priority. The product they sell happens to be improved ...

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Medpundit has commented on the ER (mis)use piece written earlier this week, emphasizing the convenience ("In fact, you don't even have to walk to your tests. You get rolled to them in a wheelchair or gurney." - how true). Perhaps people are willing to wait the 5-6 hours in exchange for a second opinion, or in some cases a specialist evaluation. Beats waiting months. ...

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As a follow-up to what I wrote last week on the ER stories near Boston comes this report. Most of it we know already, but it's nice to see some concrete data:

One-fifth of patients coming to the ED did not have conditions requiring emergency care, and another one-fifth had urgent conditions that could have been treated in a primary care setting, the report shows.

Uninsured ...

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More on ER waits . . .

The story where the woman had to dial 911 from the ER to receive care seems to be getting a lot of play here. The ensuing forum is bringing out more "complaints" against this hospital - it seems that people do not understand that the reason why ERs are so overcrowded is beyond the physicians' control. There are many reasons for this (too many uninsured, poor access to ...

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