May 26th, 2011 by Shadowfax in Health Tips
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There’s been quite a kerfuffle over the “Unprofessional” post Dr V wrote. A lot of people have been very shrill in denouncing physicians who write about their experiences using social media — blogs, twitter, facebook, etc — with particular emphasis on those who do not use their real names.
So, while I won’t tell someone how they should blog/tweet, or try to impose my vision of professional standards on a community that clearly is still coming to consensus with public conversations by healthcare workers, I will offer you my personal guidelines and values that I use in determining what I am willing to put into the public domain. These are just my opinions; your mileage may vary.
As a general principle: patients give physicians and nurses access to intimate details of their lives and they have a reasonable and valid expectations that we will respect their privacy and dignity. When using social media, that does need to be maintained. How you do that requires careful attention and may be controversial regardless of your approach.
Don’t blog or tweet anything that you wouldn’t want you boss/hospital administration to read. Stress test yourself by informing your employer or CEO about your blog and invite them to read it. That will keep you honest! Read more »
*This blog post was originally published at Movin' Meat*
May 18th, 2011 by Shadowfax in Health Policy, Opinion
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I shouldn’t do this. It’s madness to try to delve into the minds of conspiracy theorists and try to make sense of their ravings. But I can’t help myself; I’m drawn like a moth to the flame. It never ends well. I only wind up with a horde of trolls in the comments telling me that I’m a glib supercilious idiot and should stick to medicine or go die in a fire or something.
Sometimes it’s too hard to stay away. Maybe it was the personal affront I felt in the false imputation of ill motives onto progressives. Maybe it was the gross errors in fact, sitting there ripe for the plucking. I don’t know, but I just can’t resist a rebuttal to Dr Rich at Covert Rationing, who weaves a technocratic cost control body into a paranoid web of fantasy, concluding that:
Progressives are dedicated to “progressing” to a perfect society, and they know just how to achieve it. … Specifically, the Progressive program requires individuals to subsume their own individual interests to the overriding interests of the collective – and human nature just doesn’t function that way. Thus, the Progressive program inevitably relies on a cadre of elites – those who have dedicated themselves to furthering the Progressive program – to set things up the right way for the rest of us, while manipulating we in the teeming masses to let them. And the rest of us, once the correct programs and systems are in place, will at last understand that it was all for our own good.
I suppose this paragraph tells you everything you need to know … about Dr Rich. Any supposition that he was approaching the view of policy with a fair mind or that he is willing to attribute anything but the worst motivations to those on the other side of the aisle is completely shredded by this paragraph. As rhetoric goes, it’s up there with “Conservatives want old people to die in pain.” So we can scratch Dr Rich off the list of people who are willing to discuss health care policy with a neutral mindset. He’s engaged in a holy war of ideology. Read more »
*This blog post was originally published at Movin' Meat*
May 1st, 2011 by Shadowfax in Health Policy, Opinion
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One interesting comment I have seen come up over and over is the idea that end-of-life costs are the thing that is spiralling out of control and that if we could somehow find a way to curb the costs of futile care, then that would somehow solve the health care inflation crisis. Andrew Sullivan endorsed such an idea the other day, a “Modest Proposal,” which is not nearly as radical or amusing as Swift’s. And indeed, there is a modicum of sense in the idea.
Estimates are that spending in the last six months of a person’s life account for 30-50% of their overall health care costs, and that the spending in the last year of a person’s life accounts for 25% of overall medicare spending. So — simple solution, right? cut down on the futile care, and we’re good to go.
Only problem — as a doctor, I sometimes have a hard time telling when someone is in their last DAY of life, let alone last year. Read more »
*This blog post was originally published at Movin' Meat*
April 22nd, 2011 by Shadowfax in Health Policy, Opinion
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I wrote at some length yesterday about the prerequisites for a medical group to self-insure. What I didn’t go into in detail was the why — the benefits and the risks. I’m going to tackle that a bit today.
Potential Benefits to self-insurance
Those who have been around a few years can testify that the medical malpractice insurance market is highly cyclic. It seems that about once a decade a crisis hits. Whether this is a rational market is another question entirely. Some have attributed these crises to macroeconomic factors, like the market crash of 2002, after which insurers had to recoup investment losses, or hurricanes and natural disasters in which insurers cost shifted onto other product lines. Other obervers cite skyrocketing medical malpractice losses as the driver of these intermittent price spikes. I don’t pretend to know the reason, but it’s a reality that prices go up, and sometimes rapidly so, for no apparent reason. Additionally, during these times of market disruption, it’s common for carriers to drop clients, leave states they perceive as too risky, or leave the med mal market altogether.
One big advantage of self-insurance is that you can control your own destiny and insulate yourself from these market forces. You set your own premium and it only has to go up if you deem it necessary and prudent. You have a carrier that is guaranteed to issue a policy, and that will never leave the market. These are not small considerations.
I know a group that liquidated because their insurer dropped them and they could not find insurance; a contract management chain picked up the contract. I know several groups whose insurer stopped writing med mal and they were left high and dry. They had to purchase a group tail at an exorbitant mark-up and scramble on very short notice to find a new carrier, whcih was excruciatingly stressful. So to have carrier permanence, guaranteed issue, and premium stability is a huge benefit of self-insurance. Read more »
*This blog post was originally published at Movin' Meat*
April 16th, 2011 by Shadowfax in Health Tips, Opinion, Research
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There was an interesting study published this week in the journal Radiology:
Rising Use of CT in Child Visits to the Emergency Department in the United States, 1995–2008 (Abstract)
The results are not surprising to anyone who has been working in medicine in the US over the last fifteen years. Basically, in 1995, a kid visiting the ER had a 1.2% likelihood of getting a CT scan, and by 2008, that number was 5.9%.
I had written about this general phenomon not too long ago, in defense of the general increase of CT utilization in the ER, largely on the basis that CT is a better tool: it provides diagnoses in a rapid and timely manner, and excludes many potential life threats, saving lives and mitigating malpractice risk. That was largely relevant to the adult population, though, and kids are not, as they say, just little adults. The increase in scanning children is more dramatic, especially given the generally lower incidence of disease in kids compared to adults and the chonrically ill. Read more »
*This blog post was originally published at Movin' Meat*
