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Latest Posts

Price Variations In Healthcare Are Not Related to Quality

The Massachusetts health reform law, Part II – enacted in 2008 – laid the groundwork for cost control and quality improvement, as a follow-on to the initial legislation’s emphasis on achieving near-universal coverage.  The legislation authorized several studies — including a report published a few months back on global payment strategies — and set the stage for hearings on health care cost containment to be held before the state Division of Health Care Finance and Policy (DHCFP), which are scheduled to begin March 16, 2010.

Update 2/18/10: Paul Levy posted a series of questions DHCFP would like hospitals to answer at the hearings at Running a Hospital. Read more »

*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*

Healthcare Reform And The Death of Dartmouth Atlas

An important article appeared in the NYT recently, describing a new paper by Peter Bach, which is in today’s NEJM. Peter’s paper (“A Map to Bad Policy“) debunks the Dartmouth Atlas and cautions against its use. As I said in the Wash Post in September, the Dartmouth Atlas is the ”Wrong Map for Health Care Reform.”

More damning even than Peter’s analysis was Elliott Fisher’s reply: “Dr. Fisher agreed that the current Atlas measures should not be used to set hospital payment rates, and that looking at the care of patients at the end of life provides only limited insight into the quality of care provided to those patients. He said he and his colleagues should not be held responsible for the misinterpretation of their data.” Really? It was someone else’s interpretation? OK, Elliott, you’re not responsible. Just stand in the corner. Read more »

*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*

Takayasu’s Arteritis: Breathtaking Images

A young adult (mid thirties), a known case of non-specific aortoarteritis (Takayasu’s arteritis) was referred for a CT scan of the Abdomen including a CT Aortogram to rule out mesenteric ischemia.

The inital plain (no IV or oral contrast) CT scan did not show any evidence of abdominal pathology. So a CT Aortogram was done.

The following is the best CT image of thoracic and abdominal wall arterial collaterals that I have seen in a decade of being a radiologist: Read more »

*This blog post was originally published at scan man's notes*

Blue Jeans May Offer Protection From Rattlesnake Bites

When I was a medical student, I served a summer externship in 1975 with the Indian Health Service at Fort Belknap in Harlem, Montana. On some hot summer evenings, I went fishing at a place the locals called “Snake Lake,” which was loaded with cutthroat trout, and surrounded by rocky outcroppings that were home to scores of rattlesnakes. I was advised to stay away from the rocks, and to always wear long pants.

In the December, 2009 issue of the Annals of Emergency Medicine (Ann Emerg Med 2009;54:830-836), there appeared an article reporting a study by Shelton Herbert, PhD and William Hayes, PhD entitled “Denim Clothing Reduces Venom Expenditure by Rattlesnakes Striking Defensively at Model Human Limbs.” The purpose of the study was to determine whether ordinary clothing (denim material from blue jeans) interferes with the kinematics of venom delivery, thereby reducing the amount of venom injected by a typical snake into a (model) human limb. Read more »

This post, Blue Jeans May Offer Protection From Rattlesnake Bites, was originally published on by Paul Auerbach, M.D..

Nursing Survival Tips For Snow Days At The Hospital

These young ladies are prancing back to their nursing dormitory after a snowstorm. They look really happy to finally make their exit from the hospital. I identify with these girls because I got snowed in at my hospital for eight days last week. It was tedious, but I used my time constructively. I studied human nature.

People go through three phases when a snowstorm starts bearing down. The first phase is giddiness. I saw at lot of people become gleeful when the first snowflakes started hitting the sidewalk. They became delusional and said things like, “Look at the snow. It’s so beautiful!” People, snow is NOT beautiful. It is wet and cold. No one enjoys digging their car out from a five-foot snowdrift.

The next phase of a snowstorm involves a strange survival instinct that compels people to rush to their local grocery store and buy copious amounts of milk, toilet paper, and comfort food like corn chips. I’ve never been about to understand this phenomenon, but I’m sure that grocery store chains love it. Panic in the air indicates that people are entering into the final phase of their snowstorm response. The snowstorm is in full gear and everyone wants to leave work and go home. The walls start closing in, and those with a lesser constitution make a break for the door. I understand that some people can’t deal with their claustrophobia, but please don’t yell, “You can reach me on my Blackberry,” as you run out the door. That just makes you look pathetic. Read more »

*This blog post was originally published at Nurse Ratched's Place*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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