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Why Is There So Much Less Paperwork In Canadian Health Care?

If you ask internists and their patients what makes them bonkers about the U.S. health care system, paperwork will top the list. Many will point to the federal government as the culprit, citing the many forms, RAC audits, pre-and post-payment reviews, documentation and coding guidelines, HIPAA privacy rules, quality measurement and reporting, Part D drug formularies, and HIT meaningful use requirements imposed by Medicare and other federal programs. (Some put more of the blame on private insurers and pharmacy benefit managers.)

But if paperwork is associated with the degree of government involvement in health care, then Canada–a single payer system–should have more of it than the United States, right? Think again.

A new Health Affairs survey of U.S. physicians and practice administrators found that U.S. physicians spend Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

Physician Discusses The Confusing Aspects Of Medicare Part D

I have discussed Medicare Part B and Part F in recent blogs. A reader asked about Medicare Part D:

Dr. Feld

“Please discuss Medicare Part D, the drug benefit plan available to seniors. It is very complicated and completely confusing to me.

My physician gave me a prescription for Levequin 500 mg once a day for 10 days. The pharmacist told me it would cost me $330 dollars. Medicare Part D would pay an additional $110 dollars for a total of $440 dollars.

I asked the pharmacist if there was a generic equivalent. The answer was yes. It cost $10 dollars.

This is unconscionable. It is highway robbery.



Several issues are presented in this readers note. It is essential to understand these issues. The issues are an indictment against government “controlled” programs. Read more »

*This blog post was originally published at Repairing the Healthcare System*

What Is The Most Costly Healthcare Expenditure?

The National Institute for Healthcare Management Foundation is a nonprofit, nonpartisan organization focused on healthcare. The foundation just published an excellent report on the distribution of  healthcare costs in the population.

The results indicate that reducing healthcare cost is all about reducing and managing chronic diseases.

U.S. healthcare spending has sharply increased between 2005 and 2009 by 23 percent from $2 trillion to $2.5 trillion per year.

This is a result of a combination of factors. Chief among them is the increasing incidence of obesity.

Who spends the money? Read more »

*This blog post was originally published at Repairing the Healthcare System*

Doctors Refuse To Treat Obese Patients in Florida

In a nation with 93 million obese people, a few ob-gyn doctors in South Florida now refuse to see otherwise healthy women solely because they are overweight. Fifteen obstetrics-gynecology practices out of 105 polled by the Sun Sentinel said they have set weight cut-offs for new patients starting at 200 pounds or based on measures of obesity — and turn down women who are heavier. Some of the doctors said the main reason was their exam tables or other equipment can’t handle people over a certain weight. But at least six said they were trying to avoid obese patients because they have a higher risk of complications.

While I have not specifically “refused to treat” obese patients, I have in a few cases recommended against surgery or recommended weight loss and re-evaluation later. Than again I am not in primary care and do understand what these OB/GYNs are saying. Obese patients do represent more risk when it comes to surgery and that would of course cover pregnancy and child bearing.

Take into account that Read more »

*This blog post was originally published at Truth in Cosmetic Surgery*

The Heart And The Holidays

The human heart resides in a lighltless 98.6-degree chest cavity. Its contracting muscles are further cushioned by the well-lubricated glistening smooth pericardial sac. One wouldn’t think that the heart could sense the time of year. The heart’s rhythm should remain independent of the holiday season. But then there is December in the EP lab. They are as busy as the malls.

Is it the depressing weather? Or the short days? Or a post-Thanksgiving hangover? It’s hard to say, but every year for as many as I can remember, the EP lab rocks in November and December. And with the advent of deductible health plans, this holiday phenomenon has only intensified.

The I-90 of the heart, the AV node, seems to give out more in the holidays. I’ll never forget the Saturday in December many years ago when I did five “urgent” pacemakers — and neither will the pacemaker rep. Read more »

*This blog post was originally published at Dr John M*

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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