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Heard Around The Blogosphere: 2.22.09

greysharkI thought I’d highlight some interesting posts written by my peers this week. Keep up the great blogging, everyone!

Healthcare Policy

This is what happens when you begin the process of bailing out key stakeholders in our economy:  h/t Happy Hospitalist

Britain’s NHS has hired teams of bureaucrats whose sole purpose is to enforce health coverage denials. Dr. Crippen also notes that the NHS will cover sex change operations, but not ear repair from piercings.

The number of Americans without health insurance is increasing by 14,000/day. H/t Shadow Fax.

Just Plain Gross

Thanks to Medgadget for featuring a story on grey nurse sharks. Apparently their young, while still in the womb, cannibalize each other until only one is left in the uterus. They even linked to a video of fetal sharks devouring one another. Eww!

Bad Science Of The Week

Thanks to Mark Hoofnagle for deconstructing the laughable PLoS article suggesting that cell phone exposure increases migraine risk but decreases Alzheimer’s and epilepsy risk. The study was a statistical fishing expedition that proposes random cause and effect.

Good Doctor

Dr. Theresa Chan coaxed a 90 year old man out of somnolent delirium by singing to him.

“Bad Doctor”

By not caving in to a 16 year old’s request for a medical excuse from school or admitting a patient to the hospital for walker training and observation, this doctor won no brownie points with his patients.

Funny Patient

Nurse Gina witnesses a post-op patient give a doctor a math lesson.

Tragedy

A physician mother struggles with the immanent death of her 4-year-old with brain cancer.

Heard Around The Blogosphere, 12.15.08

I hope you enjoy this week’s round up of quotable quotes from the medical blogosphere…

Scalpel or Sword quotes Taiwanese hospital administrator who chose “Hello Kitty” as a new design theme for their maternity ward: “I wish that everyone who comes here, mothers who suffer while giving birth and children who suffer from an illness, can get medical care while seeing these kitties and bring a smile to their faces, helping forget about discomfort and recover faster.”

Charlie Baker on hospital financing: Calculating hospital operating margins actually draws a starker picture.  Hospitals collectively lose $30 billion on Medicare and Medicaid and earn $66 billion on commercial business, thereby generating a $36 billion gain overall on their insured patients.  They lose another $13 billion on their uninsured patients, netting out to a $24 billion – or 3.6% – operating margin.

This means private sector employers and their employees and families are paying as much as 10-11% more than they would otherwise pay for health insurance – to fund the provider operating deficit created by Medicare and Medicaid.

Paul Levy: There are two types of hospitals, the kind that have had a wrong-side surgery and the kind that will have one.

Edwin Leap: Over the past few years, I’ve observed some curious phenomena.  For instance, the raging debate over pharmaceutical companies.  Sure, bad data is bad data.  And of course, we shouldn’t have our prescribing practices ‘purchased’ by gifts, trips or cute reps.

But, what I find fascinating is the collective anger against those companies for trying to ‘profit.’  Ghastly!  Companies, publicly traded ones, in America,trying to make a profit?  What are they thinking?  I mean, considering doctors and nurses work for free, with no thought to financial benefit…right?

Let’s face it, like it or not, those huge companies make life better.  They create and market substances that keep us healthier; and of course, in some instances they offer very vanity driven products that keep us having sex longer or getting fewer wrinkles.  But on the balance, we wouldn’t want them to go away, any more than we really want oil companies to disappear.

Respectful Insolence: given the utter lack of scientific support for the vast majority of CAM modalities and the weak support for the remainder, what’s left if you’re a CAM advocate trying to prosletyize about how great CAM is?

Argumentum ad populum, of course. Otherwise known as the bandwagon fallacy or appeal to popularity, it is one of the most favorite logical fallacies of all.

Terra Sigilata: Readers often ask me and other sci/med bloggers why revered academic medical centers are increasingly offering these questionable approaches. The truth is that there is a market for them. A good market. And one that will gladly pay out-of-pocket for such things.

Never mind if the approaches are effective. Or safe. Or can delay treatment with science-based approaches known to be effective.

Smoking, abusing alcohol, using CAM: Just because a lot of kids do it, does that mean it is right for yours to do so as well?

DB’s Medical Rants: Because prices are increasing, Medicare has tried classic bureaucratic techniques to minimize expenses.  Our billing system requires extensive documentation.  If we do not document well, then we are not paid appropriately.

In an effort to pay physicians more appropriately, Medicare adopted RBRVS.  But then they made a huge mistake.  They let the AMA develop the RUC – The primary care reimbursement mess.  The members of that secret society include very few primary care physicians and many proceduralists.

Movin’ Meat: Wondering why it is that my placing a stethoscope on a patient’s chest is universally interpreted as a signal for the patient (or a family member) to begin talking.

PixelRN: The other day I was talking to a veteran CCU nurse. She told me that she worked at the hospital where the first defibrillations were studied and performed. Like many health care studies, the testing was done on animals – dogs in this case.

She then went on to tell me that one of the requirements for working in her CCU (back in the 1970’s) was that you actually had to defibrillate a dog to show that you were competent in that skill! Yes, the dogs were sedated before hand, but still.

Nurses see (and do) the craziest things.

Heard Around The Blogosphere: Top 10 Quotes Of The Week

Forgive me for not keeping up with my own weekly feature: “heard around the blogosphere.” I’ve been very selfish lately, reading and chuckling to myself without sharing. Let me try to remedy that… Here are my top 10 amusing/noteworthy quotes from around the blogosphere:

1. Dr. Rob: “Santa: I suppose if a guy like me can deliver presents to all of the children of the world without developing a significant budget shortfall, perhaps Obama can deliver quality care for all Americans and save money.  I would suggest he talk to me before he tries, however, because it isn’t as easy as it looks.”

2. Terra Sigillata: “My hiking boots are old enough to go to college.”

3. Edwin Leap: “Disability is not a career choice.”

4. Ten Out of Ten: “At the interdepartmental meeting the surgeon was irritated at all the hospital cafeteria food being fried and suggested offering some healthy entrees.  Turns out they tried that once before but could never sell the healthy stuff.”

5. Respectful Insolence:  And then Carol Alt had to come along. Move over, Jenny and Suzanne, there’s a new model woo-meister in town, and she’s looking to out do you both with her vegan raw food woo after having been totally convinced by–you guessed it!–an anecdote.

6. Scalpel or Sword: “Sometimes, [in the ER] what looks like a quickie really isn’t, so one has to be careful.
PATIENT 1
Chief Complaint: sprained ankle (Great, send them
back!)

Nurses note: pt c/o twisted ankle and vaginal discharge for one week. (Never mind.)

7. Scanman: “Soon, specialists will uniformly be comprised of American medical graduates, while the majority of generalists will be composed of mid-levels and foreign-trained physicians. It’s an interesting demographic glimpse of the future American medical workforce… A new kind of caste/class system where the financially less desirable, menial jobs are relegated to second class citizens.”

8. KevinMD: “Primary care is associated with negative connotations such as bureaucracy, paperwork, and being perceived as the lowest physician on the totem pole. Or as this doctor puts it, “‘PCP’ now seems to be synonymous with overworked, underpaid ‘loser’ who at least by some people’s opinions aren’t carrying their weight.” Taking a tip from marketers, how about re-branding the profession?… “

9. GruntDoc: “C=M.D.  C=75% and that means I know 3 out of 4 diseases, and that ain’t bad.”

10. PearSoup: To pregnant mommy: “Mommy, If there was a fat person contest you would win! Yay!”


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