Health reform should make conservatives very happy

Health Policy
March 24, 2010

Let’s get one thing out of the way.

The health care reform bill that passed the House this past Sunday, and will be fixed via reconciliation in the Senate, is a moderate, relatively incremental approach to fixing our health care system.

Conservatives are up in arms, as they have been during the entire process, and are lining up lawsuits and trying to gather momentum to repeal the bill.

And I’m asking myself, …

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Health reform should make conservatives very happy

ED can predict heart death

Physician
March 24, 2010

Originally published in MedPage Today

by Joyce Frieden, MedPage Today News Editor

Patients with erectile dysfunction (ED) who were treated with telmisartan, ramipril, or both were at greater risk for cardiovascular events than other patients on the same medications, researchers found.

In men who reported ED at baseline, all-cause mortality during a median follow-up of four years was double that seen …

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ED can predict heart death

Archeology skills work in medicine

Patient
March 23, 2010

I’m becoming an amateur archeologist. The hilltop where we live is strewn with arrowheads and bits of Native American pottery shards. I have slowly, surely, trained my eye to find them. There is little flint here; so most of the pieces I find were made of quartz. (Hard to work with, but remarkably beautiful and almost always a brilliant white.)

My kids and I walk the red-clay paths and look down …

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Archeology skills work in medicine

Tax credits and new patient care models in health reform

Health Policy
March 23, 2010

by Robin Tang

Sunday, March 22, 2010, marked the passage of the Health Care and Education Affordability Reconciliation Act (H.R. 4872) by the House by a narrow 219-212 margin, with no Republicans voting in favor. Whether you think the bill is good, bad, sustainable, or even constitutional, we can agree this was a historic day.

Putting politics aside, I want to highlight two parts of the bill that aren’t getting enough …

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Tax credits and new patient care models in health reform

Palliative care shows the importance of language

Physician
March 23, 2010

by Patrice Villars

The best learning experiences for me have been times when I come away questioning core assumptions about the work I/we do. As palliative care folks, we try to help people understand where they are in relation to their disease and what their hopes and goals are for care. We offer treatments and resources to match those needs through, in part, supportive communication.

What if, in our kind, well-meaning …

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Palliative care shows the importance of language

Healthcare reform will be challenged in states

Health Policy
March 23, 2010

Originally published in MedPage Today

by Joyce Frieden, MedPage Today News Editor

With the House and Senate now in basic agreement on healthcare reform and President Barack Obama about to sign the underlying bill into law, opponents are gearing up to challenge the legislation on a variety of fronts.

This effort was beginning even before Sunday’s House vote sent the Senate …

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Healthcare reform will be challenged in states

Patient input in their treatment should be valued by doctors

Patient
March 23, 2010

Thanks all who responded to my recent USA Today piece, Patient-satisfaction surveys have drawbacks.

But in a letter published in the paper yesterday, a reader from Oklahoma City was quite unhappy with my take.

Mark R. Heaton writes, somewhat angrily:

Dr. Kevin Pho’s recent opinion piece was not only arrogant but also grossly naive.

His basic premise was twofold:

• Doctors know best and should therefore ignore patient feedback regarding possible tests and treatments.

• …

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Patient input in their treatment should be valued by doctors

ACP: To whom are physicians accountable?

Medical Education
March 22, 2010

The following is part of a series of original guest columns by the American College of Physicians.

by Steven Weinberger, MD, FACP

The New England Journal of Medicine‘s March 11 issue included an interesting “Clinical Decisions” article. Looking at a hypothetical case of an endocrinologist with time-unlimited board certification, the editors posed the question of whether he should voluntarily …

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ACP: To whom are physicians accountable?

Futile care has human and financial costs

Physician
March 22, 2010

I haven’t ever saved a life. No doctor has. We may prolong the inevitable, but we don’t save anyone. We aren’t immortal, and weren’t meant to be. We die. All things do. Plants, animals, even stars. Death is as much a part of life as birth. And yet, at times people chase medical science as if we have immortality in all our gadgets and pills.

Why am I writing this?

A few …

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Futile care has human and financial costs

Health care reform passes the House in a historic vote

Health Policy
March 22, 2010

Originally published in MedPage Today

After a year-long struggle and often-raucous partisan debate, the House of Representatives passed an historic health care reform package late Sunday night.

The vote on the last of the two bills in the package was 220-211. All 178 Republicans, along with 33 Democrats, voted against the measure. The margin was similar on the other measure; both …

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Health care reform passes the House in a historic vote

Industry relationships with physicians are coming under fire

Medications
March 21, 2010

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

Earlier this year, Harvard’s Partners Healthcare put a cap on payments its physicians can receive for serving on corporate boards at $5,000 a day.

Although the cap primarily affects top researchers and executives, it is by far the stiffest limit imposed by any academic medical center, and drives deeper the …

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Industry relationships with physicians are coming under fire

Healthcare reform is an achievement but isn’t perfect

Health Policy
March 21, 2010

Heading into the final weekend of Mr. Toad’s Wild Ride, who could have guessed that in a year that brought us Death Panels, Pickup Trucks, “You Lie”, The Cornhusker Compromise, Bart Stupak (boy, that must have been a tough name to grow up with), and the Senate Parliamentarian-as-Rock-Star, we would be on the cusp of passing a perfectly …

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Healthcare reform is an achievement but isn’t perfect

Flood insurance by the government, but no public option

Health Policy
March 20, 2010

Originally published in MedPage Today

by John Gever

This meditation was evoked by the prospect that my basement could be filled with E. coli-laden mud next week.

I live within a few yards of Wheeling Creek, a tributary of the Ohio River that drains about 250 square miles of northern West Virginia and southwestern Pennsylvania. This week has brought temperatures near 70 degrees, …

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Flood insurance by the government, but no public option

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Atrial fibrillation as experienced by an electrophysiologist

Conditions and Diseases
March 20, 2010

Middle age introduces itself in many ways; one is atrial fibrillation. Youth, vigor and a medically-problem free life was seemingly right there in the recent past. A rhythm doctor often hears this suddenness of onset described as “Doc, yesterday, I was fine.” As is always the case for a first episode of an arrhythmia, yesterday, you were fine, but today is indeed a new day.

It happened during a bike ride. …

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Atrial fibrillation as experienced by an electrophysiologist

Professionalism matters in correctional health care

Physician
March 19, 2010

As correctional health care professionals, there may be times when we are tempted to conduct ourselves in a less than professional manner simply because we can.

We may be able to get away with speaking to our patients rudely, using profanity profusely, or wearing inappropriate clothing. After all, we work in jails and prisons. This culture is far from prim and proper. And, our patients are inmates. Many may tolerate misbehavior …

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Professionalism matters in correctional health care

Medicare rates and capping payments to hospitals

Health Policy
March 19, 2010

If there is anything about economics that has been proven over and over, it is that price controls do not work. The unintended consequences are usually worse than the problem that led to the solution in the first place.

Massachusetts legislators, feeling the frustration of higher insurance premiums, are now considering a bill to limit doctor and hospital reimbursement payments to 110% of Medicare rates, or perhaps some other percentage …

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Medicare rates and capping payments to hospitals

Coronary angiography is being overused

Conditions and Diseases
March 19, 2010

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

For patients without known heart disease, the diagnostic yield of coronary angiography appears to be low, researchers found.

Only about 38% of those referred to the cath lab for the elective procedure had obstructive coronary artery disease, Manesh R. Patel, MD, of Duke University, and colleagues reported online in the New England …

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Coronary angiography is being overused

Business model woes traps doctors and impedes health care

Health Policy
March 18, 2010

If you are a physician, therapist or any other helping professional whose business model relies on third party manged care reimbursement you are engaged in the world’s worst business model.

Let me start with a story to set the stage.

Imagine you are a bright, idealistic college student. You’re good at academics, want to make a difference in the world and have hundreds of career options in front of you.

After lots of …

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Business model woes traps doctors and impedes health care

Dance healed this physician and helped with burnout

Physician
March 18, 2010

Ten years ago, I was an Emergency Medicine Resident and wanted to die. Today, I’m a general practitioner in part-time practice and am in love with life. What made the difference? I signed up for a dance class.

Reports on physician burnout list the personality traits that set us up for trouble: we’re excessively conscientious, feel overly responsible, want to please everyone, and function on an extremely high level – even …

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Dance healed this physician and helped with burnout

Medicare and how a grandmother worries about its costs

Health Policy
March 18, 2010

Originally published in MedPage Today

by Liz O’Brien

My grandmother and her hospital roommate — aged, tiny, frail, and sporting matching bright pink hairnets.

They looked like twins — two thin shrubs in winter that had each sprouted an improbable, big pink rose.

Although sick and scared, my grandmother had admired the pink hairnet on the lady in the next bed, so my mother …

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Medicare and how a grandmother worries about its costs

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