Utilization review doctors

In California, these doctors are not required to be licensed within the state, and have the power to veto any diagnostic or treatment plan by a patient’s primary physician.

Worse, they cannot be disciplined:

A huge snag in the system is that utilization review doctors without California licenses cannot be disciplined by the Medical Board of California for unprofessional conduct because they aren’t under board jurisdiction. Neither can they …

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Prostate surgery

The PSA test for prostate cancer screening has come under fire. First of all, it’s not very specific – meaning there is an unacceptable false positive rate (i.e. positive test in the absence of disease) for prostate cancer. This leads to biopsies and surgery that may not be needed.

The implications of this is becoming more widely publicized. Men are starting the realize the downsides of …

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Geriatrics shortage

Niko Karvounis writes on the geriatrician shortage. As baby boomers approach Medicare age, finding doctors to coordinate their care is becoming more challenging. This is due to the same reasons exacerbating the primary care shortage.

Money, as always, is the answer. Not only financial incentives for medical students to choose the field, but the resources for medical schools to institute geriatrics into the curriculum.

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Bernie Mac, pneumonia, and sarcoidosis

Comedian Bernie Mac dies at age 50 from pneumonia. Sad news.

He had been recently hospitalized, and as recently as two days ago, it was reported he was stable and responding well to treatment. What happened?

There is very little medical information to go on. It was known that he had …

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Culture of surgery

Interesting post. Maggie Mahar explores the hierarchical, and sometimes abusive, environment that pervades surgical training. Will it change?

Not likely, as long as payments continue to be tilted towards surgical procedures. Surgeons are the main profit drivers for hospitals, and subsequently, yield positions of significant power.

Especially when financial times are tough, hospitals will continue to appease surgeons, which makes changing their training environment …

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The shift worker mentality

retired doc laments the declining sense of duty in today’s physicians, fostered by work-hour restrictions during residency.

Shift work medicine is here to stay, as hospitalists, part-time physicians and mid-levels make up an increasing amount of the clinician force.

It’s just another sign of how today’s physicians value lifestyle more than their predecessors. And there’s nothing wrong in desiring that kind of work-life balance.

Why would you go into primary care?

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The real heroes of health care

Nurses: “In the ever worsening financial stresses being forced upon our system, one can see why nurses can feel overly burdened by very time consuming and needy patients while also trying to maintain a picture perfect paper trail of documentation that has overwhelmed their profession to much the same degree as physicians.”

Tylenol for $1,089.50 a pop?

Uh, no.

A patient complains about her emergency room bill. Of course after the fact, it looks absurd. But she didn’t know beforehand whether it was something serious or not.

So, the $1,000+ was for a physician’s evaluation, and the exclusion of life-threatening disease. Not just for the Tylenol.

Normally Dubner gets it right, but here the analysis is terribly short-sighted.

The stomach of a competitive speed-eater

This can’t be good for you: “Then they looked at the competitive eater. First, they noticed that his empty stomach showed virtually no peristalsis, the normal squeezing motion that helps the stomach break down food. He started eating hot dogs and his stomach got bigger and bigger. Ten minutes in, he’d eaten 36 dogs. He said he didn’t feel full, but the researchers told him they’d seen enough.”


You get what you pay for: “Does the founder of FreeMD . . . have enough faith in his product to institute it at his own ER as its triage program of choice. Fire his triage nurse. Set up a computer in his lobby and have all prospective patients triage themselves. And if the program says you don’t need to see a doctor NOW, would …

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The entitled

What’s wrong with American healthcare in a nutshell: “How does it reflect upon American culture today when obviously affluent families try to persuade doctors to defraud Medicare? How are we going to cut costs in an era of so-called consumer-driven healthcare which implies that patients and their families are the ones directing care? It is cases such as this one that really make me angry when the public blame …

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Why can’t physicians own hospitals?

It’s only fair: “If it’s OK for individuals to own their own grocery stores, insurance companies, real estate offices, it ought to be OK for the doctors to have an equity interest in the hospitals. You just take care of something better if you have an investment yourself.”

My take: Tim Russert

WSJ Health Blog: “Russert’s doctor Michael Newman said the tough-questioning but congenial host of NBC’s ‘Meet the Press’ had been under treatment for asymptomatic coronary disease, but that it was under control with medication. He was carrying excess weight, Newman observed, but he got regular exercise and he performed well on an exercise stress test in April.”

GruntDoc: “I therefore propose a new sign in …

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