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Blast From The Past: A $2 Million Hospital

I love the sliding baby and the smoking father. The X-ray tech is unfortunately dead now since he wore no protective shield for the high tech $25,000 machine . And who wouldn’t want the pneumatic tubes for sending records?

This hospital was $2 million. The cost of building a hospital in 2009 is $2.5 million per bed. And that doesn’t include electronic medical records. Bring back the pneumatic tube.

(hat tip to Medical Jokes)

*This blog post was originally published at EverythingHealth*

Study Shows That Thin Thighs Are Associated With Heart Disease

Finally, a study that many women can like. The British Medical Journal published a study out of Denmark that looked at the association between thigh circumference and the incident of cardiovascular disease and mortality. Why anyone would even think of thigh circumference being of importance is beyond me, but the Danes seem to think it was important. They found people with thin thighs had more risk of developing heart disease or premature death.

The study looked at 1436 men and 1380 women and examined them for height, weight, hip, thigh and waist circumference. The results showed that small thigh circumference (below 60cm or 23 inches) was associated with more cardiovascular disease and mortality. They did not find the same association with waist size and the findings were independent of percentage body fat mass or obesity. Small thighs were a disadvantage to health and survival for both sexes.

Twenty three inches is not a very small thigh, and in fact, more than half of the men and women aged 35-65 have thigh circumferences below that size. Maybe it has to do with muscle mass (less exercise, less mass). I can’t imagine any other reason this strange finding should occur.

I think this study will probably not hold up to analysis and further investigation. There are just too many variables and I don’t think people with large thighs should feel they are immune to heart disease.

But the idea that, for once…the skinny models and actresses don’t have the advantage is kind of heart warming.

*This blog post was originally published at EverythingHealth*

Counter Point: American Healthcare Is Not The Best In The World

Let’s get honest, OK? America does not have the best health care in the world. Europeans and Canadians are not flocking to our borders to get to our health care. It is time we realize that we can learn from our neighbors and we don’t have to claim we are the “best” at everything. It makes us look really stupid in the eyes of the world.

Here are some facts. We do spend the most money on health care in the world. We do spend the highest percentage of Gross National Product (GDP) on health care and we do spend more dollars per capita than any other country on Earth.

The claim that the United States has the best health care in the world has been proven false by every broad metric used. The World Health Organization and the nonpartisan Commonwealth Fund rankings rate the U.S. last of the Western industrialized countries. The WHO ranks us 37th of all measured countries.

The Commonwealth Fund says, “Among the six nations studied—Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2006 and 2004. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last on dimensions of access, patient safety, efficiency, and equity. The 2007 edition includes data from the six countries and incorporates patients’ and physicians’ survey results on care experiences and ratings on various dimensions of care.”

The U.S. also lags in information technology. (We have been awaiting a robust electronic medical record for 10 years) and in coordination of care and in measured quality outcomes.

One of the ways we improve in health care is when we face the brutal truth. How can you make improvements if you don’t know where you are starting from? If you truly believe you are the best in the world…there would be no need for health care reform.

Perhaps that is why these myths and lies are being propagated.

*This blog post was originally published at EverythingHealth*

High Blood Pressure & Eye Damage

Ever wonder what the doctor is looking for when she shines the light into your eyes, up close and personal?
This is what she sees if the patient has severe hypertension. The retina shows blurring of the optic disc (in the middle left) and the white areas are called “cotton wool spots”. The blurry part at the bottom is a partial retinal detachment. The patient’s blood pressure was 220/150.

*This blog post was originally published at EverythingHealth*

Open Letter To President Obama: Fix Medicare


Dear President Obama,
I am in favor of Health Care Reform and I agree with you that universal coverage and eliminating the abuses that both patients and doctors have suffered at the whim of the for-profit insurance industry must be curtailed.

But I also want you to fix Medicare. Medicare is so bureaucratic that expanding it in its current form would be the death knell for primary care physicians and many community hospitals. The arcane methods of reimbursement, the ever expanding diagnosis codes, the excessive documentation rules and the poor payment to “cognitive, diagnosing, talking” physicians makes the idea of expansion untenable.

May I give you one small example, Mr. President? I moved my medical office in April. Six weeks before the move I notified Medicare of my pending change of address and filled out 22 pages of forms. Yes, Mr. Commander in Chief…22 pages for a change of address. It is now mid-August and I still do not have the “approval” for my address change.

I continue to care for my Medicare patients and they are a handful. Older folks have quite a number of medical issues, you see, and sometimes it takes 1/2 hour just to go over their medications and try to understand how their condition has changed. That is before I even begin to examine them and explain tests, treatment and coordinate their care. Despite the fact that I care for these patients, according the Medicare rules, I cannot submit a bill to Medicare because they have not approved my change of office address.

I have spent countless hours on the phone with Medicare and have sent additional documentation that they requested. I send the forms and information “overnight, registered” because a documented trail is needed to avoid having to start over at the beginning again and again. I was even required to send a signature from my “bank officer” and a utility bill from the office. Mr President, I don’t have a close relationship with a bank officer so this required a bank visit and took time away from caring for patients…but I certainly did comply.

I am still waiting to hear from Medicare. At my last call they said they had not received yet another document, but when I gave them the post office tracking number, they said it was received after all. They could not tell me when or if they will accept my address change.

I have bills stacking up since April and I just found out that they will not accept them if they are over 30 days old. I have cared for patients for 5 months and will not receive any reimbursement from Medicare. The rules state I cannot bill the patient or their supplemental Medicare insurance either.

Believe me, Mr. President, I commend you for taking on such a huge task. Please also know that Medicare reform is needed along with health care reform.

A loyal American ,
Internal Medicine (aka: primary care) physician

*This blog post was originally published at EverythingHealth*

Latest Interviews

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Latest Book Reviews

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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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