October 9th, 2011 by Shadowfax in Opinion, True Stories
Tags: AAA, Abdominal Aortic Aneurysm, Angio, Balloon Catheter, Emergency Room, Endovascular Grafts, ER, Femoral Artery, Future, Groin, High Income, Interventional Radiology, Money, Mortality Rate, Physician, Technology
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My father in law, now deceased, was a nephrologist. I met him while I was in medical school. He was a reserved guy, not prone to butt into what he saw as others’ business. So I still remember that while I was considering what sort of residency to pursue, he took a surprisingly strong stance that I should go into interventional radiology. His reasoning was simple: they have a great lifestyle, they make bags and bags and bags of money, and they get to play with all the coolest gadgets.
It was tempting, I admit. As anyone who knows me can attest, I am ALL about the gadgets. I’m not averse to bags of money either. But I never gave it much consideration, mostly because I am just not real good at radiology, though for an ER doc I do OK. (A low bar, it is true.)
I sometimes regret that decision. For example, I wrote the other day about a gentleman who presented with a ruptured abdominal aortic aneurysm. We had some heroic fun in the ER resuscitating him and getting him to the OR. After the fact, I had to wonder whether it was all in vain — Read more »
*This blog post was originally published at Movin' Meat*
October 8th, 2011 by John Mandrola, M.D. in Health Tips, Opinion
Tags: ACE-inhibitors, AF, Beta Blockers, Blood Thinners, Cardiology, Dr. Groopman, Dr. Hartzband, Exercise, Fitness, General Medicine, Heart Attack, Heart Disease, Heart Rhythm, High Blood Pressure, Physically Active, Primary Prevention, Secondary Prevention, Statins, Wall Street Journal
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I recently wrote about the incredible sensations that come with vigorous exercise. Perhaps it was the post ride cannabinoid flurry, but it’s possible that I went too far in suggesting that ‘we’ (doctors, patients, the whole of Western Society) default first to pills before healthy living.
Two commentors called me out on this snark. They wrote about valid points.
One comment focused on the fact that her AF medicines were causing side effects that made vigorous exercise difficult. The second objected to my inference that exercise alone could substitute for the many benefits of modern medicine.
To the idea that medicine Read more »
*This blog post was originally published at Dr John M*
October 8th, 2011 by RamonaBatesMD in Opinion, Research
Tags: Bariatric Surgery, Body Contouring, Cosmetic Surgery, Cost, Demographic Features, Excess Skin, Expense, Insurance Coverage, Jason Spector, Massive weight loss, Patient Education, Plastic Surgery, Research, Sagging Skin, Surgery
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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*
October 8th, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
Tags: Adam Smith, Compatability, Consumers, Doctors, Drug Companies, Economy, Efficiency, Government Intervention, Healthcare System, High Prices, Hospital Systems, Incentives, Insurance Company, Leoid Hurwicz, Market Driven, Patients, Physicians, Stakeholders, Vested Interests, Wealth of Nations
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Mechanism Design has demonstrated that the most efficient systems are created when everyone’s vested interests are aligned.
“An example is defense contracting. If you agree to pay on a cost plus basis you have created incentive for the contractor to be inefficient.
The defense contractor will build enough extra into a fixed price system to account for cost overruns. The cost overrun would be permitted in the rules if the price was transparent. If there were no cost overruns the contractor’s profit would be increased. It would provide incentive to be efficient.
“If you agree to pay a fixed price, you can come close to an efficient price if you have all the truthful information.”
A reader wrote,
Stanley:
History has proven over and over again that only the market mechanism of willing sellers and willing buyers is the optimal way to allocate economic resources. This presumes an informed buyer, and a willingness of sellers to compete for buyers. Adam Smith was clear on this in the Wealth of Nations.
If incentives are aligned and truthful price information is available an efficient system is created. Most stakeholders think they can do better by not sharing truthful information. If the rules of the game require truthful information the system can become an efficient market driven solution.
The healthcare system must become market driven. At present Read more »
*This blog post was originally published at Repairing the Healthcare System*
October 7th, 2011 by Michael Kirsch, M.D. in Opinion
Tags: American Medical Association, Council on Ethical and Judicial Affairs, Honesty, Improve, Journal of Medical Practice Management, Medical Quality, Placebo, Pseudopatients, Quality Assessment, Secret Shoppers, Trust
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Physicians are still debating whether prescribing placebos is ethical. Dissenters argue that this is dishonest and would erode trust between patients and their physicians. If the practice were to gain acceptance, then physicians’ credibility would be diminished. Patients would wonder whether the medicines their doctors are recommending are evidenced-based or fraudulent.
Patients can now push their own snake oil right back onto their physicians. I learned that the ‘secret shopper’ mechanism for quality assessment has been introduced into the medical profession. I first read about this in the March/April 2010 issue of the Journal of Medical Practice Management, a periodical that I suspect is not widely read by physicians.
Folks are hired as pretend patients and are dispatched to doctors’ offices and hospitals to document their findings. Their mission is to assess office staff, appointment issues and the waiting room experience. I wonder if Read more »
*This blog post was originally published at MD Whistleblower*
