June 10th, 2010 by David H. Gorski, M.D., Ph.D. in Better Health Network, Health Policy, Opinion, Quackery Exposed, Research
Tags: Belief-Based Medicine, Belief-Threatening, Certainty, Evidence Based Medicine, Journal of Applied Social Psychology, Knowledge, Munro, New Evidence, Pseudoscience, Science Based Medicine, Science-Based Evidence, Scientific Impotence, Scientific Method, Scientific Research, Skepticism, Subject To Change, USPSTF
No Comments »
“I don’t want knowledge. I want certainty!” — David Bowie, from Law (Earthlings on Fire)
If there’s a trait among humans that seems universal, it appears to be an unquenchable thirst for certainty. It is likely to be a major force that drives people into the arms of religion, even radical religions that have clearly irrational views, such as the idea that flying planes into large buildings and killing thousands of people is a one-way ticket to heaven.
However, this craving for certainty isn’t expressed only by religiosity. As anyone who accepts science as the basis of medical therapy knows, there’s a lot of the same psychology going on in medicine as well. This should come as no surprise to those committed to science-based medicine because there is a profound conflict between our human desire for certainty and the uncertainty that is always inherent in so much of our medical knowledge. The reason is that the conclusions of science are always provisional, and those of science-based medicine arguably even more so than many other branches of science. Read more »
*This blog post was originally published at Science-Based Medicine*
June 9th, 2010 by RamonaBatesMD in Better Health Network, Health Policy, Opinion, Research, True Stories
Tags: Doctors Are Victims, Dr. Lisa Chu, Dr. Robert Goldwyn, Dr. Ryan Flesher, Emergency Medicine, General Medicine, Hand Surgeon, Hand Surgery, Internal Medicine, Patient Care, Physician Burnout, Plastic and Reconstructive Surgery, Practicing Medicine, Primary Care, Teaching Violin, The Vanishing Oath, Work-Life Balance, Workaholic, Working Overtime, Working Too Much
No Comments »
Dr. Wes and Kevin, M.D. have both written reviews of the documentary film “The Vanishing Oath.” I started the process rolling of trying to get the film shown locally. No date yet, but looks like it will happen before the year is out.
This is not a new phenomenon in medicine (or any profession). Dr. Robert Goldwyn wrote a nice essay on the some of the issues that can lead to burnout, though not once did he mention burnout specifically. The title says much:
“I Bargained on Working Hard as a Surgeon, Not Working Hard to Be Able to Work Hard as a Surgeon”
The preceding title is a quote from a letter written by a resident in the last year of his training (S. A. Teitlebaum, August 20, 1994). It reflects the gloom besetting the young in particular but certainly not them exclusively. We all are uneasy about our futures, professionally and economically. Bandied in the corridors at a national meeting was a dismal figure: 1:100,000, the presumed proper ratio, as determined by Health Maintenance Organizations, of plastic surgeons to population. That 1 million Americans need only 10 plastic surgeons seems wrong and idiotic to me, but it makes good economic sense to health providers and insurance companies. Their coffers swell as they collect the same or higher premiums while curtailing what they provide. Read more »
*This blog post was originally published at Suture for a Living*
June 9th, 2010 by Richard Cooper, M.D. in Better Health Network, Health Policy, News, Opinion, Research
Tags: Family Medicine, General Medicine, Group Health, Healthcare Economics, Healthcare Policy, Healthcare reform, Healthiest Patients, Internal Medicine, Low-Income Patients, Medical Home, New Primary Care Models, Ontario, Physician Income, Poor Patients, Primary Care Physicians, Primary Care Shortage, The Poor, Urban Poor, Wealthiest Patients
No Comments »
In a recent blog posting, I described Group Health’s medical home for 8,000 patients. It proved to be a boon for primary care physicians, who were able to reduce the size of their patient panels, see fewer patients per day, refer more patients to specialists, and maintain or increase their incomes.
Patients liked it, too. And Group Health was happy because expenditures per patient were 2 percent lower. But poor patients had trouble getting through the front door of the medical home, so based on demographic differences alone, expenditures should have been lower by 10 percent or more. Nonetheless, they declared victory.
Now news filters south from Ontario’s eight-year experiment with medical homes for 8,000,000 patients, and the news is similar. Participation is skewed to healthier and wealthier patients who, in the absence of risk adjustment, yield profitable capitation for primary care physicians. Incomes have soared an average of 25 percent. Read more »
*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*
June 9th, 2010 by AlanDappenMD in Better Health Network, Health Policy, Opinion, Primary Care Wednesdays, True Stories
Tags: Dan Hart, direct-pay doctor, DocTalker, Graduating Doctors, Healthcare reform, Medical Class Of 2010, Medical School, Medical Students, New Doctors, New Medical Interns, Primary Care, Prospective Physicians
No Comments »
As a medical student in his last year, I can attest that my classmates and I would like nothing less than a crystal ball. Always a daunting time in a future physician’s career path, the direction we point ourselves as we launch out of medical school this year seems as arbitrary as ever.
As we examine the rolling seas of medicine and try to determine our individual paths, there seem to be more clouds than blue skies, and certainly more shadows than light. This may or may not be a feeling many prospective physicians feel, but for the class of 2010 it comes as a tough pill to swallow. In a profession at the heart of a national policy debate and with a storied history to examine, it’s extremely disconcerting to be faced with so many question marks. Read more »
June 8th, 2010 by Davis Liu, M.D. in Better Health Network, Health Policy, News, Opinion
Tags: Antibiotic Overuse, Diagnostics, Doctor To Lead Change, Family Medicine, General Medicine, Internal Medicine, Medical Imaging, More Medical Care Isn't Better, Over-Used Procedures, Overtesting, Overtreatment, Preventive Medicine, Primary Care, Radiology, Rational Medicine, Science Based Medicine, Science-Based Evidence, Screening Tests, Significant Overuse, Socialized Medicine, Too Many Medical Tests, Too Much Testing, Unnecessary Treatments
No Comments »
The Associated Press recent article “Overtreated: More medical care isn’t always better” reiterated a commonly known fact which is not understood by the public. This problem of doing more and yet getting little in return is a common issue which plagues the U.S. healthcare system and was illustrated quite convincingly by Shannon Brownlee’s book. Americans get more procedures, interventions, imaging, and tests but aren’t any healthier.
In fact they are often worse off. Too many unnecessary back surgeries. Too many antibiotics for viral infections, which aren’t at all impacted by these anti-bacterial therapies. Too many heart stents which typically are best used when someone is actually having a heart attack. Research shows that those that are treated with medications do just as well. As all patients with cardiac stents know, they also need to be on the same medications as well.
Eliminating unnecessary treatments is a good thing, particularly when it is based on science. Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
