Chris Rangel, MD

Chris Rangel is an internal medicine physician.

Are Cadillac plans responsible for rising health costs?

Policy

July 23, 2013

If there’s anything that liberals hate it’s inequality – unless it’s the Federal tax code – and health care is a prime offender. The liberal mantra is that everyone should have the same access to basic health care. But this doesn’t just involve improving health care access and affordability for millions of uninsured Americans. It also involves limiting or impairing (through taxes) those health care plans liberals have decided are …

Should drug testing be considered screening tests?

Chris Rangel, MD

Conditions

July 12, 2013

cropped-clean_urine

Tests like cholesterol levels are considered screening tests because they are cost effective, have high sensitivities (a low rate of false negatives), and have been proven to be beneficial in the identification of conditions that may require treatment before symptoms occur. The vast majority of medical tests are not considered to be “screening” because they violate one or more of these principles, …

Are hospitals really soaking the poor with high prices?

Chris Rangel, MD

Policy

June 16, 2013

The Centers for Medicare and Medicaid recently released its compiled data on what over 3,000 hospitals across the country charge for 100 of the most common discharge diagnostic codes under the diagnosis related group (DRG) system, and boy did the DRG really hit the fan. Liberals, economists, and band wagoners got all upset about the enormous pricing differentials between hospitals for the same services.

For example, Twin Cities Community Hospital in …

How doctors will use Google Glass

Chris Rangel, MD

Tech

June 3, 2013

google-glass-modular

Google Glass will be like the Segway. It’s really cool but it will have only a few practical uses and won’t be a paradigm shifter. Segway never won widespread acceptance in a culture dominated by cars and Google Glass is unlikely to win over people who prefer to wear their smart phones on the waist instead of on their face.

Still, …

Read more…

How doctors will use Google Glass

Why it’s important to place limits on liability by association

Chris Rangel, MD

Physician

November 12, 2012

In June of 2006 Mary Ann Ambrogio went to see her gastroenterologist Dr. Frank Troncale in Connecticut for a follow up of her history of liver cirrhosis and associated hepatic encephalopathy.

Reportedly following this visit Mrs. Ambrogio was driving home when she passed out and hit a pedestrian John Jarmie causing “severe and permanent” injuries. The injured pedestrian sued Dr. Troncale claiming malpractice under Connecticut law in that the doctor did …

ER utilization shouldn’t be a measuring stick for health care reform

Chris Rangel, MD

Policy

November 1, 2012

Mitt Romney’s “let them eat cake” comments on 60 Minutes serves to illustrate how badly both sides of a political debate can confuse an issue. In 2010 he criticized emergency room care as a potential loophole used by people to get “entirely free care” while avoiding having to pay for health insurance and in his book No Apology, the Governor outlined the idea behind Massachusetts health care …

The hunger-obesity paradox: Why it’s a modern problem

Chris Rangel, MD

Policy

October 4, 2012

It’s a uniquely modern problem. We have the most obese impoverished population in the history of the planet and its been called the “hunger-obesity paradox.” Even the homeless are now more than likely to be overweight with over 32% being officially obese. Think about that.

Then think about every single picture you have ever seen from the Great Depression when 1 of every 4 Americans were out of work …

Don’t blame the patients for long wait times

Chris Rangel, MD

Physician

September 14, 2012

Dr. Anthony Youn, a plastic surgeon practicing in Detroit places most of the blame for long office waiting times at the feet of the patients themselves. He comes up with three general categories; patients who arrive late for their appointments, emergencies that require the physician to leave the office, and “oh by-the-way” scenarios:

“Here is a typical scenario: It’s the end of a 10-minute office visit, scheduled as a …

Why Facebook should be a template for electronic medical records

Chris Rangel, MD

Tech

April 5, 2012

The Internet beta 0.5 version was nothing like it is today. Back in the ’80s and the early ’90s the most common way to access the outside world was to use a phone modem to dial the number of a remote computer. These primitive servers usually ran DOS based software called a Bulletin Board System (BBS) which allowed users to post messages to each other. For the most part, these …

Why the civil litigation system is unfair to physicians

Chris Rangel, MD

Physician

February 24, 2012

It’s unclear how many non-legal persons actually understand how different civil trials are from criminal proceedings. Most people have heard that juries in criminal trials are told that they can only find a defendant guilty if their belief that the defendant is guilty is beyond a reasonable doubt. Federal courts define this term further as, “proof of such a convincing character that a reasonable person would not hesitate to act …

Should teenagers be screened to prevent sudden cardiac death?

Chris Rangel, MD

Conditions

September 6, 2011

It seems as if teenage student athletes have been dying by the month in often spectacular and dramatic fashion. Last September Texas high school senior Reggie Garrett died suddenly just after throwing a touchdown pass . Last week a 16-year-old Michigan basketball player died dramatically just after becoming a hero by scoring the winning basket to preserve an undefeated season. Then just a week later another 16 …

Medication reconciliation brings the ER back to 1960

Chris Rangel, MD

Meds

June 14, 2011

What a blessing and a curse it must have been to practice medicine fifty years ago.

Most internists had only about twenty or so medications that they used regularly. It was a curse not to have effective medications to treat many common ailments but somewhat of a blessing not to have the modern medical nightmare of having patients on 15-20 chronic medications with all the logistical problems of keeping track of …

Why some EMR programmers think physicians are stupid

Chris Rangel, MD

Tech

March 29, 2011

Every major industry is now computerized with one glaring exception; health care delivery. Thirty years after Steve Jobs began selling personal computers out of his garage, far less than 50% of physician practices and hospitals have converted to any form of electronic medical record.

The vast majority of medical documentation is still done via paper and writing utensil just as it …

Nicotine vaccine to treat tobacco abuse and nicotine addiction

Chris Rangel, MD

Meds

January 25, 2011

Antibodies are complex proteins created by immune cells that are targeted to very specific parts of other large and complex molecules called antigens.

Much smaller molecules like nicotine, called haptens, do not normally induce any significant immunologic response so researchers chemically bound several nicotine molecules to a large protein to form an adduct. This combined molecule does induce an immune response, i.e, causes immune cells to produce antibodies targeted to the …

Concerns about long term acid suppressive therapy

Chris Rangel, MD

Meds

November 26, 2010

Physicians hate acid. But, hey, who doesn’t hate acid? It burns things. It corrodes. It’s that after-pizza punishment.

We prescribe antacid medications by the ton in this country, not because people’s stomachs have developed increased acidity, but because people in our modern society are generally overweight, like to eat large meals, and prefer fatty foods and things like alcohol, chocolate, and tobacco, all of which tend to worsen acid reflux.

Physicians like …

Medical malpractice and how legal waste increases overall costs

Chris Rangel, MD

Physician

October 7, 2010

Dr. Kirsch at MD Whistleblower has written about his recent unpleasant experience with malpractice litigation. Despite having full access to the patient’s chart and medical records, the plaintiffs attorney chose to include Dr. Kirsch in the suit … apparently … just because … he had seen the patient.

In Ohio – where this case was filed – a plaintiff in a medical malpractice case is required to obtain an …

Why pay for performance does not work and may impair patient care

Chris Rangel, MD

Physician

September 1, 2010

In response to a recent article on the topic of economic motivation theory, Michael Kirsch sent me information about a very interesting study (May 2010 issue of the British Medical Journal) done to evaluate the effects of monetary incentives on clinic, physician, and staff work performance.

From 1999 to 2007, 35 medical facilities of Kaiser Permanente in NorthernCalifornia, were given financial incentives for ensuring that their patients got regular screening for …

Greed is not good when it comes to doctors, patients and medicine

Chris Rangel, MD

Policy

July 31, 2010

Gordon Gekko is wrong. Greed is not good. Not when it comes to health care providers.

The socioeconomic study of what motivates people is a fascinating field of study, not the least of which is because of how counter-intuitive it is. For example, it seems normal to assume that the more someone is rewarded for their efforts, the more effort they will put forth toward those rewards.

These rewards (increasing salary, bonuses, …

Why patients don’t value primary care doctors

Chris Rangel, MD

Physician

June 30, 2010

“Hey doc, all I need is this referral.”

I’ve been encountering more of this lately. A patient who has not been seen in the office for months to years (well beyond when they were supposed to come back for a follow up visit) walks in and requests a “referral” for a specialist visit but they can’t be bothered with actually being seen and evaluated in the office or to be compliant …

MRI abuse can be dangerous and expensive for patients

Chris Rangel, MD

Conditions

June 7, 2010

What is “MRI Abuse”? This is when the health care provider orders MRIs (Magnetic Resonance Imaging) in excess or for the wrong reasons. There are many causes of MRI abusive behavior but most evolve out of a significant misunderstanding of how to properly utilize this diagnostic tool. MRI imaging has a high sensitivity to detect anatomic abnormalities, does not expose the patient to high doses of radiation like a CAT …

Chris Rangel, MD

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