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Latest Posts

Hospital Markets $99 Spiral CT Scan, Claims It Could Save Your Life

A hundred bucks doesn’t buy much these days. A crisp Ben Franklin can be exchanged for

  • 50 Big Macs
  • A Broadway show ticket
  • A night in a New York City hotel (just joking)
  • A college textbook (paperback)
  • Your life

Your life? Yes, 5 crumpled Andy Jacksons can save your life, as was reported earlier this year in a front page article in The Plain Dealer, Cleveland’s only daily newspaper. University Hospital is now offering a $99 spiral computed tomography (CT scans) of the chest in individuals who are at increased risk of developing lung cancer. The rationale is that if cancers can be detected early, then the cure rate for surgical removal is very high.

Gary Schwitzer, medical blogger and press watchdog, tries to bring some balance to the distorted media coverage of CT lung cancer reportage.

The test is Read more »

*This blog post was originally published at MD Whistleblower*

Boehner’s Announcement Means An Extension Of Current Medicare Payment Rates

Last week, Speaker Boehner announced that the House and Senate have agreed on a two month extension of current Medicare payment rates, the payroll tax cut, and unemployment benefits.

My understanding is that the agreement has the House accepting the Senate’s proposal to extend the payroll tax break, unemployment insurance benefits, and current Medicare payment rates through the end of February, along with an agreement with the Senate to appoint a House-Senate conference committee to begin negotiations on a longer-term extension. It remains unclear exactly when the votes in the House and Senate will take place, and at least in the Senate, it will require unanimous consent by all Senators. If it passes both the House and Senate, Read more »

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

Diabetes: An Expensive Disease

Back when I was a young bird with type 1 diabetes, insulin cost about $70 dollars per bottle.  (And I had to walk uphill both ways to the endocrinologist’s office.)  I had no concept of this cost, or how it played into my family’s finances, at the time.  I would just open the fridge door, grab the bottle, uncap the orange top to a 1cc syringe, and take the units my mom would yell to me from the kitchen sink.

“Two. Two of Regular should do it.  Rotate to your right arm this time, okay?”

“Okay!”  (And then I’d proceed to jab it into my left arm because I’m right-handed and also stubborn.)

Now, twenty-five years later, insulin has taken a bit of a price hike.  I just ordered a three month supply of Humalog from Medco and the total for the insulin came to six hundred and ninety-seven dollars.  For six bottles of Humalog that will be all gobbled up by early March.  (And thanks to a high, but manageable-on-paper deductible, we’re responsible for the full cost this round.)  Almost seven hundred dollars worth of insulin.

We’re lucky that we’re able to pay for that cost without panicking, but knowing what these bottles cost without the assistance of insurance makes me look at everything through a diabetes lens.  When three days are up on my insulin pump site, I am very aware of Read more »

*This blog post was originally published at Six Until Me.*

Combining Telehealth And Mobile Technology To Improve The Quality Of Health Care

Bill Crounse, MD, Senior Director, Worldwide Health, Worldwide Public Sector Microsoft Corporation shares his insights and describes four leading trends and technologies that will transform health and health care in 2012 and beyond.

These leading technologies include:  cloud computing, health gaming, telehealth services and remote monitoring/mobile health.

Telehealth, Remote Monitoring, Mobile Health

I’d like to focus on telehealth and remote monitoring/mobile health since I feel telehealth is the nucleus of patient care, and telehealth can help reduce health care costs, and improve quality health care for patients. Telehealth technology combined mobile technology such as smartphones will make monitoring patients conditions easier and more efficient, and “cheaper and more scalable.

Patient Quality Health Care

Through the Accountable Care Organizational Model (ACO), the core concept is to Read more »

*This blog post was originally published at Health in 30*

Study Shows That Most Women Do Not Choose Immediate Post-Mastectomy Breast Reconstruction

Despite the benefits of immediate post-mastectomy breast reconstruction, only a small minority of women, regardless of age, choose this option, a new study indicates. Research has shown that compared with a delayed procedure, immediate post-mastectomy reconstruction improves psychological well-being and quality of life. The new study, headed by Dawn Hershman, M.D., associate professor of medicine and epidemiology at Columbia University Medical Center, indicates that only about one-third of women opt for the procedure, according to the American Association for Cancer Research.
Source: cosmeticsurgerytimes.modernmedicine.com/
cosmeticsurgerytimes/article/articleDetail.jsp?id=751765

Immediate breast reconstruction does lead to better results in patients with early stage breast cancer. That is a pretty much well known fact. This statistic of less than a third of women seeking this type of reconstruction in this light seems kinda sad, but keep reading: Read more »

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

Latest Interviews

How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

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Caring For Winter Olympians In Sochi: An Interview With Team USA’s Chief Medical Officer Dr. Gloria Beim

I am a huge fan of the winter Olympics partly because I grew up in Canada where most kids can ski and skate before they can run and partly because I used to participate in Downhill ski racing. Now that I m a rehab physician with a reconstructed knee I…

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Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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Click here for a musical take on over-testing.

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Latest Book Reviews

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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Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

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