My favorite blog posts of the past week or so, organized loosely by topic/theme. Enjoy!
Kids Dying From Vaccine-Preventable Illnesses:
Dr. Rob: These parents probably thought “what’s the harm? Why can’t we just wait to do the immunizations until the risk is less?” A 7-month-old infant died from this logic.
Dr. Whitecoat: Should parents who fail to take steps to prevent a largely preventable illness be held accountable if their children suffer a bad outcome?
Rules Meant To Be Broken
Dr. Scalpel: Protocol-driven medical decision-making is always going to be inferior to expert clinical judgment. This is also one of the reasons you should be suspicious of the current fad of the various “accreditation” merit badges hospitals proudly display. They are equally worthless.
Increased Costs Without Increased Value
Paul Levy: Now, let’s acknowledge that MGH and the Brigham are powerful brands. To the extent patients are influenced by that reputation or other factors to migrate to the PHS facility from Norwood Hospital, the overall health care bill for the state will rise for no documented additional value to those patients or society.
Dr. Wes: According to the Illinois Fair Patient Billing Act, hospitals can charge 35% above cost for services provided to the uninsured. The natural question we should ask, then, is why the insured should have to pay “full price” if a profit margin is already built into the price offered to the uninsured.
The reason, of course, is simple: someone has to pay for the insurer’s offices and staff salaries, don’t they?
10 out of 10: The cost of confirming the obvious: The scan came back showing “likely early appendicitis.” I examined her yet again and she now had clear localization to the right lower quadrant. Lucky for me it was positive I thought, at least now I won’t get dinged for overtesting.
Rural Doctoring: Noo’s chart missing most of the pathology reports from her recent procedures, despite the 25 phone calls made to various providers offices to release this information. However, I am an excellent historian and fill in the blanks.
The Best Sarcastic Blog Post Of The Week
Edwin Leap: The Leap non-severity score.
Dr. Dinosaur: If the next Surgeon General were to adopt the elimination of Quackery — whether known as “alternative,” “natural,” “complementary” or “integrative” medicine — as his or her major issue, that bully pulpit might help generate enough of a popular political groundswell to overcome the few credulous members of Congress who pushed the whole thing onto us in the first place.
Somehow, I don’t think Sanjay Gupta is up for that, so I hope President Obama picks someone else.
Science Based Medicine: NCCAM not only funds studies of dubious “alternative” therapies, such as reiki and homeopathy, that estimates of prior probability alone would argue to be so close to impossible as to be not worth spending millions, much less thousands, of dollars upon, but it also promotes quackery by funding “fellowships” at various institutions to teach “complementary and alterantive medicine” (CAM) sometimes also called “integrative medicine” (IM). Given that it spends over $120 million a year on mostly dubious studies and CAM promotion, we all have called for NCCAM to be defunded and disbanded.
ACP Internist: Brown recluse spiders only bite when you press against them.
KevinMD: Although most infectious disease specialists acknowledge that contracting a Pseudomonas infection outside the hospital is not common, this is a sobering reminder that drug-resistant infections are not only possible, and may be on the rise.