Medicaid is a federal program for the very poor implemented by grants to states, which do the administration. Medicaid typically pays doctors about 60 percent of what Medicare pays. In Florida, a typical primary care visit might pay the doctor $32. In Alabama, doctors who agree to be the primary care physicians of record for Medicaid patients get a whopping $2.60 per beneficiary per month, a fee with which the …
I have recently become a card-carrying member of the Association of Health Care Journalists. Lofty title for a lowly blogger, but I’ll take it. There are two main advantages to this membership, at least that I can see so far. The first is access to the full text of online journals, key to actually discussing research intelligently. The second is the …
Doctors have a long and illustrious history of addicting people to narcotics. In the 1800s this was largely because they didn’t know what else to do, they had no idea what was wrong with anyone, and they didn’t have any drugs that worked. Apothecaries, pharmacists, and doctors made proprietary concoctions in which opium was always the active ingredient.
And it worked, right? Morphine works for anxiety, works for pain, works for …
Anesthesiology used to be a job that was attractive for people who don’t like patients very much. The drill was: Meet patient 5 minutes before surgery, do case in OR without interruption, drop off in PACU, done. Minimal need for personal interaction with patient, no need to listen to complaints about back pain and demands for antibiotics for a cold, no risk of getting called in the middle of the …
Having been both a nurse and a doctor, most of the questions I get from readers have to do with making the decision between nursing and medicine. Let’s lay aside for a moment the reality that the fields are totally different and that direct comparisons are useless.
But people ask me all the time, so, as a little experiment, I …
In another entry for the communication category, here’s a little play I wrote:
Scene: Pre-op area. Patient arrives for surgery exactly at the scheduled start time, that is, 90-minutes late.
Anesthesiologist (me): Good morning Mrs. Jones. I’m Dr. so-and-so. How are you this morning?
Patient: Oh, doctor, I have the most terrible headache. They told me my surgery was at 11 so here I am at 11, and now they tell me I’m late.
Me: …
Imagine this: You are sick. You are the sickest you’ve ever been. You want to die. You almost did die. You want to bury your head in your cozy bed for the next two years.
But you’re not in your bed. This bed has plastic for covers and sandpaper for sheets. You need to throw up every thirty minutes but you have to share a bathroom with someone you don’t know, …
We all want the advantage. We put our kids in special preschools so they have the advantage. We work 100 hours a week so our kids can do 8 activities and get the advantage. Tall people have an advantage, we’re told. Poor people are “disadvantaged.” Well folks, there are a whole bunch of senior citizens in Massachusetts who are about to get disadvantaged starting September 1.
UnitedHealthcare (UHC) will be Read more…
After I graduated from medical school, my very first real ward rotation as an internal medicine intern was at the VA. Therefore, I can say with absolute certainty that all the stuff being said about the VA health system is true. The place is a mess.
Let’s start with the computer system. The VA medical record system has been held up as an example of an effective EMR system, in which …
Apparently all doctors must practice medicine until the day the die. Or so says Gordon Marino in a New York Times piece called “A Life Beyond Do What You Love.” This article caught my eye, since I am currently trying to do “what I love,” having already lived a couple of lives doing “what I think I should love.” I didn’t …
A small case with big implications almost escaped my notice recently The Boston Globe reported a case in which a family sued after a 23-year-old man died after being diagnosed with a lung infection.
According to the Globe, the young man went to one of the Boston emergency rooms complaining of cough, fever, and chest pains. OK, stop right there all …
A few months ago while I was working in the interventional gastrointestinal unit I noticed something because it was driving me nuts. One of the monitors in the holding area that slaved to one of the procedure rooms was beeping. Just a low, constant blip blip blip blip. The screen read, “no data.”
So I asked one of the nurses “can we turn that monitor off? No one is using procedure …
Let’s talk for a moment about medical education. I went to a work-related party recently and rode in the elevator with a dear friend who is my contemporary, and a more senior and highly regarded faculty member known for her work in medical education. Both were afraid for the future of medical education in different ways.
My contemporary was concerned that the emphasis on the use of advanced technologies like ultrasound …
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I have written a good amount about automation, the good, the bad and the ugly. I have written about doctors and ancillary providers and physician extenders, also good, bad and ugly. A recent comment on Karen Sibert’s excellent blog A Penned Point caught my eye as an amalgamation of these subjects.
This person wrote, and I hope he doesn’t mind my quoting him:
American anesthesiologists should focus much more on …
I hate being told what to do. I will scratch and claw when ordered around. It takes a conscious act of will to smile and say, “sure, I’ll get going on that right now.”
This is a problem since, as an anesthesiologist, I get told what to do all the time. My kids order me around all the time. When I was a nurse I used to bristle at the term …
Over the last month I have received several comments from readers who have or who are trying to make the choice between nursing and medicine. And may I just say what a great problem we have now, to be able to choose. I’ve been thinking about this and I submit there are three considerations: philosophical, practical, and logistical.
1. Philosophical. Many of you have heard of the “medical model,” the idea …
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The Institute of Medicine (IOM) recently released a report on the state of cancer care in the United States. The IOM generally knows what it’s talking about. It’s a non-profit, non-governmental advisory group essentially. To get on one of their advisory boards you have to be a national, if not international, expert in whatever field is being studied. According to the cancer advisory board, the state of cancer care in …
Good old Earl Blumenauer. A bespectacled and bowtied Congressman from Oregon. He of the “death panel” proposal. Thank God he’s still here. Presuming that the crazy talk over the provision in the Affordable Care Act that would have paid doctors to discuss end-of-life issues with patients is over, he has introduced a separate bill with this provision and hopes to get it passed in the next couple of …
With immigration reform under hot debate, it’s important to remember that all of us except the Native Americans are foreigners. It’s what has made our culture so diverse. People from foreign countries ideally bring the best of their cultures to the US and enrich us all with the diversity of life. This advantage lessens considerably when those visitors want to enter fields in which understanding of endemic American culture is …
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The Mayo Clinic Proceedings came out with a study that shows that many of the treatments that doctors once swore by are useless or worse.
The New York Times did a piece on it and the commentary contained a great deal of doctor-bashing. So of course I opened my big mouth and pointed this doctor hatred out. The comment I got back was this: “It’s not hatred, it’s fear.”
Wow. If people …
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