Most hospitalists are good, but some, like these ones, aren’t

Physician
April 1, 2009

It’s a well known phenomenon that hospitalists are taking over inpatient medicine.

And no wonder, the payment system strongly discourages newly minted doctors to practice outpatient medicine, and the demand that hospitals have for inpatient physicians is surging at an unprecedented rate.

It’s a good time to be a hospitalist, but, as this reader writes to me, that may lead to an increasingly variability in the quality …

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Most hospitalists are good, but some, like these ones, aren’t

Half MD: How to fix the scramble before Match Day

Medical Education
March 31, 2009

The following is reader take by Half MD.

The third Thursday of March each year is Match Day for fourth-year medical students. There are many smiles and frowns made on this day when soon-to-be doctors discover where they will obtain their first job to continue their medical training. While Match Day is the most famous day of the week, Monday and Tuesday are the …

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Half MD: How to fix the scramble before Match Day

Nighthawks, dayhawks, and the demise of the American radiologist

Physician
March 29, 2009

More hospitals are resorting to so-called “dayhawk” radiology services to read their x-rays.

It’s modeled after the “nighthawk” model, where radiologists (via Shadowfax), in some cases as far away as India, remotely read films in the middle of the night.

Now, the phenomenon is happening during business hours as well, which according to radiologist Giles W. L. Boland, means that “some radiologists can no longer assume long-term …

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Nighthawks, dayhawks, and the demise of the American radiologist

Op-ed: Unbiased research for doctors is good medicine

Health Policy
March 26, 2009

The following op-ed was published on March 26th, 2009 in the USA Today.

As a primary care doctor, I am frequently faced with decisions where the choice is not always clear. Do the latest, more expensive drugs work better than the less costly, older medications? Will ordering an MRI help me treat a patient’s lower back pain? Often, the answer to these questions is, “I’m not sure.”

Because …

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Op-ed: Unbiased research for doctors is good medicine

Should the MCAT grant extra time for students with learning disabilities?

Medical Education
March 22, 2009

A recent California court denied extra time for aspiring medical students with dyslexia and attention deficit disorder when taking the MCAT.

The body that administers the test has to straddle a delicate line, in granting extra time to a broadening definition of the disabled student versus maintaining the overall fairness and integrity of the high stakes test.

Despite the ruling, three of the four plaintiffs have gone …

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Should the MCAT grant extra time for students with learning disabilities?

Did the Canadian health system fail Natasha Richardson?

Physician
March 20, 2009

Would Natasha Richardson be alive today if she had gone skiing in the United States instead?

I don’t think it would have made a difference.

To recap the tragedy, Ms. Richardson died from an epidural bleed, after she fell while skiing. Her presentation was somewhat classic, with the well-described “lucid” period before she deteriorated.

According to Canada’s Globe and Mail, “ambulance workers were not …

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Did the Canadian health system fail Natasha Richardson?

Is Natasha Richardson brain dead? Was an epidural bleed, or “talk and die” syndrome, to blame after her ski accident?

Physician
March 18, 2009

Tragic news this morning regarding actress Natasha Richardson, who reportedly, suffered a head injury during a ski lesson in Canada.

According to reports, she fell on a beginner’s ski hill, and did not hit anyone or anything during the fall. There was no obvious sign of injury, and in fact, she was “was walking around and feeling fine for an hour after her accident.”

Things then …

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Is Natasha Richardson brain dead? Was an epidural bleed, or “talk and die” syndrome, to blame after her ski accident?

Will reforming the malpractice system be a deal breaker for health reform?

Physician
March 17, 2009

In a surprise, President Obama has signaled a willingness to discuss medical liability as part of the health reform process.

Good for him for standing up to the trial lawyers, a core constituency of the left.

That’s a good sign, as the costs of defensive medicine brought on by the broken malpractice system, should be addressed if there is any hope of reducing health care spending.
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Will reforming the malpractice system be a deal breaker for health reform?

Will patients or doctors be the biggest obstacle impeding health care reform?

Health Policy
March 10, 2009

If both patients and doctors don’t accept the changes required of their behavior, no amount of comparative effectiveness studies will cut health care spending.

Two prominent medical journalists write as much in their respective blogs.

First, the NY Times’ Tara Parker-Pope notes that patients have to realize that, yes, they should demand the best care possible. However, that means, “we will have to accept that ‘best’ …

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Will patients or doctors be the biggest obstacle impeding health care reform?

Why do I need a rectal exam, and what can doctors find with the gloved finger?

Conditions and Diseases
March 6, 2009

Have you ever wondered why doctors have to perform a digital rectal exam?

Well, look no further, as primary care doctor Rob Lamberts gives us the answers discerning readers demand.

Simply by looking at the rectum, which by the way, indeed “takes some getting used to,” can lead to significant diagnostic findings. Furthermore, does tight sphincter tone matter? And should you be worried about the large hands …

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Why do I need a rectal exam, and what can doctors find with the gloved finger?

Relative value units, and how the RVU payment system doesn’t allow doctors to practice good medicine

Health Policy
March 5, 2009

For those who don’t know, every piece of work that a doctor performs is quantified and measured.

The base unit of physician work is known as the relative value unit (RVU). Most physician salaries are determined by the amount of RVUs a doctor produces in a given year, and in most cases, can range between$35 and $45 per RVU in primary care, depending on geographic location and …

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Relative value units, and how the RVU payment system doesn’t allow doctors to practice good medicine

Op-ed: Pads, pens, prescriptions

Medications
February 26, 2009

The following op-ed was published on February 26, 2009 in the USA Today.

Have you ever noticed the pens, coffee mugs and prescription pads at your doctor’s office? Chances are, they were prominently adorned with the brand name of the prescription drug its company is touting.

The pharmaceutical industry has been giving these types of small gifts to doctors for years, in hopes of raising physician awareness of …

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Op-ed: Pads, pens, prescriptions

Op-ed: More coverage requires more doctors

Health Policy
February 25, 2009

The following op-ed was published on February 25th, 2009 in The New York Times’ Room for Debate blog.

With the number of the uninsured having risen to 48 million Americans, clearly the need for reform is dire. But President Obama made no mention of who exactly will take care of these patients, even if they get insurance under a successful health reform initiative.

As a primary care physician in southern New …

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Op-ed: More coverage requires more doctors

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Ways you can die from having sex

Potpourri
February 17, 2009

Cosmo Magazine, that bastion of reliable medical advice, declares, “An orgasm almost killed her.”

Intrigued, gynecologist Amy Tuteur reads further, and finds its about case where a woman developed stroke-like symptoms after intercourse, and was diagnosed with an embolic stroke.

The patient was taking the birth control pill, which can raise the risk of blood clots. In this case, it was also combined with the presence of …

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Ways you can die from having sex

Tom Daschle withdraws, and how that will impact health care reform

Uncategorized
February 4, 2009

There’s no shortage of informed opinions on the Tom Daschle debacle, and how this will affect the chances of successful health care reform.

I don’t pretend to be a political pundit, so instead, here is a collection of selected insights from news sites and health policy blogs that I regularly read.

First off, the NY Times says it will likely halt the momentum for health reform, and …

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Tom Daschle withdraws, and how that will impact health care reform

Her hands and feet amputated, a Brazilian model dies from Pseudomonas aeruginosa sepsis. What happened?

Uncategorized
January 25, 2009

Mariana Bridi da Costa, a 20-year old Brazilian model, tragically died early Saturday morning from Pseudomonas aeruginosa urosepsis.

How can this happen?

Miss Bridi da Costa initially presented on December 30th, and was diagnosed with kidney stones. An ultrasound, plain film, or CT scan likely would have been done to confirm the diagnosis. I assume that a urinalysis was also performed, and if …

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Her hands and feet amputated, a Brazilian model dies from Pseudomonas aeruginosa sepsis. What happened?

Op-ed: Medicare’s mistake

Health Policy
January 14, 2009

The following op-ed was published on January 14th, 2009 in the USA Today.

Every patient’s worst nightmare is going to the hospital for a procedure only to have a surgical instrument left in his body, the wrong limb or organ operated on or, worse, dying from a medical mistake. These types of mistakes should never happen.

So when Medicare recently instituted a plan to deny hospital payments for …

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Op-ed: Medicare’s mistake

Jett Travolta’s seizure and death, was Scientology a factor?

Uncategorized
January 3, 2009

Jett Travolta tragically passed away yesterday, after being found unconscious in his hotel room by his caretaker. There is speculation that he had a seizure and hit his head on a bathtub.

Travolta apparently had a long history of medical problems, including Kawasaki disease, which is a vasculitis that primarily affects children. It is one of the most common causes of acquired heart disease in children, and …

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Jett Travolta’s seizure and death, was Scientology a factor?

Why too many CT and MRI scans can be dangerous for patients

Uncategorized
December 9, 2008

This is an important article to read.

Many of the incentives today encourage doctors to order more advanced imaging scans, like CTs and MRIs. This expensive practice is invariably caused by this common scenario, as “patients who are in pain often demand scans hoping to find out what is wrong, doctors are tempted to offer scans to those patients, and then, once a scan is done, it …

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Why too many CT and MRI scans can be dangerous for patients

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