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Money For Nothing: Capitation Medicine

My dad’s wife called to ask if I could see a friend of my brother’s. This 30 year old woman had been “put through the ringer” by her HMO dermatologist. He looked at her nose diagnosed a “pre cancer” and treated her with freezing. Then he put her on a cream. The “wart” is still there and she can’t get in to see the doctor (actually a physician’s assistant) for 2 months.

Welcome to capitation medicine.

This evil creation of your local managed care plan pays a doctor Read more »

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

Are People Undergoing Body Contouring Following Bariatric Surgery?

A study on this topic was presented at the recent American Society of Plastic Surgeons (ASPS) annual conference in Denver.   The article is also in the October issue of the Plastic and Reconstructive Surgery journal (reference #2 below).

The article notes that more than 220,000 bariatric procedures are done annually in the United States.  This number (IMHO) is likely to increase as these procedures have become an major tool in the treatment of obesity which now affects a third of adults in this country.

Massive weight loss, regardless of whether by bariatric procedure or by diet/exercise, will often leave the individual with excess skin.  This excess skin can be both a cosmetic and functional issue for the individual.

Jason Spector, MD and colleagues designed their study to “explore demographic features and patient education regarding body contouring procedures in the bariatric surgery population.”

Their study consisted of Read more »

*This blog post was originally published at Suture for a Living*

Point: Bureaucrats Propose To Discontinue Home Glucose Monitoring Coverage

The larger the bureaucracy the more inefficient a system becomes. Several things can happen in the decision making process.

1. The decision making process can become opaque rather than transparent.

2. Decisions are made by a committee by consensus.

3. Consensus committee decisions might not sharply define the original goals.

4. Blame for errors gets dissipated.

5. Decisions are only as good as the information that is gathered.

6. Changing a wrong decision can be difficult and costly.

President Obama’s healthcare reform law is creating 256 new agencies to gather information and recommend decisions for other agencies to write regulations.

The following decision is being made by an agency in Washington state. It is not only the wrong decision, but is a decision that will set back the care of Type 2 Diabetes Mellitus 15 or 20 years. It is a decision being made using the wrong information. Read more »

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

Life Line Screening Promotes Unnecessary Medical Tests

A patient brought in a flyer for Life Line Screening, where for $129 an individual can have their carotid (neck) and peripheral (leg) arteries screened for blockage, their abdominal aorta screened for aneurysm (swelling), and be tested for osteoporosis. The advertisement claims that “we can help you avoid a stroke,” and their logo notes “Life Line Screening: The Power of Prevention.”

Are these tests worth your money? Short answer: No.

Although the flyer correctly indicates that 80 percent of stokes can be prevented, the National Stroke Assocation does not recommend ultrasound as a screening test. Preventing stroke includes quitting smoking, knowing your blood pressure and cholesterol numbers, drinking alcohol in moderation (if already doing so), exercising regularly, and eating a low-sodium diet. Their is no mention of an ultrasound test. Why? Because there is NO evidence that it helps save lives in individuals who are healthy and have no symptoms (except for the following situations). Read more »

*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*

Some Insurance Companies Deny Coverage Of Facial Reconstruction After Trauma

I noticed this article title on MDLinx, then went to the Journal of Plastic and Reconstruction website to read the full article.  The abstract is free to read, the full article requires a subscription.

The study was prompted by the authors noticing third party insurers increasingly deny coverage to patients with post traumatic and congenital facial deformities.  This denial is often cited as due to the deformities not being seen as “functional” problems.  The authors cite the recent facial transplants patients as having demonstrated  that the severely deformed are willing to undergo potentially life-threatening surgery and extended chemotherapy in an attempt in look normal. Read more »

*This blog post was originally published at Suture for a Living*

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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