Physicians writing on KevinMD about hospital practice: employment by health systems and corporate owners, hospital closures after debt-financed acquisition, productivity quotas, the electronic record as hospitalists live with it, from alert fatigue to copy-and-paste, the errors hospitals count and physicians remember, and the nurses physicians work beside. Four maintained records draw on this archive: Private equity and corporate medicine: what physicians say, in their own words, The electronic health record: what physicians say, in their own words, Medical errors: what physicians say, in their own words, and Nursing: what nurses and physicians say, in their own words.

Steve Jobs received a new liver, and the ethics surrounding his transplant

Conditions and Diseases
June 22, 2009

Orac, a general surgeon who blogs at Respectful Insolence, writes the most comprehensive entry I’ve seen thus far on Apple’s Steve Jobs’ liver transplant.

For those interested in the medicine behind the transplant, go and read his post in its entirety. I’d like to highlight some of the potentially questionable ethics surrounding the case.

For one, there is the question why Mr. …

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Steve Jobs received a new liver, and the ethics surrounding his transplant

My reaction to President Obama’s speech to the AMA

Health Policy
June 15, 2009

I was seeing patients during the actual speech, so I had to rely on the transcript.

The points that interested me the most were any language pertaining to malpractice, addressing the AMA’s recent concerns about the public plan option, and reforming the physician payment system.

I think he did pretty well.

Regarding the physician payment system, he again addressed McAllen, Texas, which is fast becoming the symbol of what’s wrong with American …

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My reaction to President Obama’s speech to the AMA

Maggie Mahar: Removing the hazardous waste from healthcare

Health Policy
June 8, 2009

Most of us are now familiar with the estimates that as much as one-third of our health care dollars are squandered on ineffective, often unnecessary, unproven and overpriced products and services. But which third?

The fat in our health-care system is not hanging out conveniently on the edges of the steak, waiting to be trimmed. It will take a scalpel, a keen eye, and a steady hand to remove at least …

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Maggie Mahar: Removing the hazardous waste from healthcare

5 top medical comments, June 7th 2009

Health Policy
June 7, 2009

Here are some of the more interesting comments readers have left recently.

1. David Block on the ACP’s guest column, A practice model for increasing the appeal of General Internal Medicine:
Weinberger talks about the efficiency of Care. Our commentators talk about the efficiency of Consumption. Weinberger assumes the one-on-one of two individuals, known to each other, who together negotiate the terms of personhood. Medicine is “spiritus”; no wonder he became …

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5 top medical comments, June 7th 2009

Physician payment reform is the key to fixing the health care system

Health Policy
June 1, 2009

Changing the way doctors are paid is more important than the debate over the public insurance option, or the arguments over whether we should adopt a single-payer system or not.

Atul Gawande’s recent New Yorker article is a tour de force, and gets down to the core of why American health care is so expensive. I won’t bother summarizing it here – it deserves to be read in its …

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Physician payment reform is the key to fixing the health care system

ACP: A practice model for increasing the appeal of General Internal Medicine

Physician
June 1, 2009

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

by Steven Weinberger, MD, FACP

Much is written and discussed these days about the importance of care coordination by a primary care physician, not only to facilitate patient-centered quality of care, but also to curb the unsustainable growth in the nation’s health care tab. Yet, we hear that the current shortage of …

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ACP: A practice model for increasing the appeal of General Internal Medicine

6 top medical comments, May 3rd, 2009

Medications
May 3, 2009

Here are some of the more interesting comments readers have left recently.

1. Carla Kakutani on the lack of primary care access in Massachusetts:
So we have a chicken and egg problem. Do we wait health care reform until we have revived US primary care, or is that even possible without health care reform to create the disruption needed to change our entrenched fee-for-service, procedure-happy payment …

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6 top medical comments, May 3rd, 2009

Reader take: Patients should be allowed to access their entire medical record

Health Technology
April 28, 2009

The following is a reader take, in response to a post on whether patients should own their medical records, by an anonymous nurse.

Dear Dr. Pho,

I wish to respond to your position on patient access to their medical records both as a patient and a nurse.

If a doctor or other health professional believes their documentation would be inappropriate or too sensitive for …

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Reader take: Patients should be allowed to access their entire medical record

HealthHarbor: Health IT stimulus leads to more questions than answers

Health Technology
April 25, 2009

The following is a reader take from the staff at HealthHarbor.

We had a chance to attend the HIMSS conference two weeks ago. HIMSS is healthcare’s premier annual tech expo, and was in Chicago this year. The undeniable theme of this year’s conference was the anticipated expansion of Health Information Technology (HIT) via the Economic Recovery Act. …

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HealthHarbor: Health IT stimulus leads to more questions than answers

6 top medical comments, April 19th 2009

Uncategorized
April 19, 2009

Here are some of the more interesting comments readers have left recently.

1. Manalive on quality measures:
It is almost always a leap of faith to apply evidence-based guidelines to the frail elderly, to patients with many medical problems, to alcoholics, to the poorly insured — in short, to a large percentage of my practice. Accordingly, I have been on the wrong end of too many …

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6 top medical comments, April 19th 2009

5 top medical comments, April 12th 2009

Uncategorized
April 12, 2009

Here are some of the more interesting comments readers have left recently.

1. Dr. Gwenn on limited health literacy:
For us to do a better job with patients and teach them to be better advocates for themselves, we need more time – plain and simple. At the same time, patients need more community supports to understand the complex health world and build the skills they need …

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5 top medical comments, April 12th 2009

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

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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

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?

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

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