I have been in senior executive management in both managed care and a major hospital system. I find the hysteria over “reform” bitterly amusing because it is so misdirected.
The real problem with health care in America? Greed, indifference and incompetence, pure and simple. But not in the places everyone is pointing.
Insurer side
Insurance companies have to maximize their revenue because they answer to their boards. They are in no rush to fix claims systems that make copious errors and delay payments to providers. There are hundreds of claims processing software programs out there. Some are acceptable, some are useless. None are really good or efficient. And there is the human error factor. A careless mistake by an apathetic claims processor can create payment problems that could literally last for years. Read more »
*This blog post was originally published at KevinMD.com*
Several years ago I was urgently paged by a patient who had discovered a lump at the bottom of his chest. He came straight over to my office, fairly certain he had cancer. The lump turned out to be a normal part of his sternum (breastbone), a small piece of cartilage called the xiphoid. Now that’s the kind of diagnosis I like to make. Read more »
I want to share this section of the old textbook, A Text-Book of Minor Surgery by Edward Milton Foote, MD (1908) mainly because I want to share the photo of the “angular knife for incision of the tympanic membrane” with you.
Otitis Media
This is a common disease of childhood, usually following a cold in the head. The prominent symptom is earache. Every physician ought to be able to recognize the bulging outward of the membranum tympani and to relieve the pressure by incision of the membrane at the most favorable situation – viz., the inferior and posterior portion. The introduction of warm olive oil into the external meatus will sometimes relieve pain, and the application of external heat may also be tried; but the pain of a severe earache, unless relieved by puncture of the membrane, usually demands the internal administration of morphine. Read more »
One of the major themes of the Science-Based Medicine blog has been to combat one flavor of anti-SBM movement that believes, despite all the evidence otherwise, that vaccines cause autism and that autism can be reversed with all sorts of “biomedical” quackery. Many (but by no means all) of these so-called “biomedical” treatments are based on the false view that vaccines somehow caused autism. I and my fellow SBM bloggers have expended huge quantities of verbiage refuting the pseudoscience, misinformation, and outright lies regularly spread by various anti-vaccine groups and two celebrities in particular, namely Jenny McCarthy and her boyfriend Jim Carrey. Most of the time, we discuss these issues in terms of the harm to public health that is done by falling vaccination rates due to the fear engendered by the message of the anti-vaccine movement and the threat of the return of vaccine-preventable diseases that once wreaked havoc among children.
There is another price, however. There is a price that is paid by autistic children themselves and their parents. It is a price paid in money and lost time. It is a price paid in being subjected to treatments that are highly implausible from a scientific standpoint and for which there is no good scientific evidence. It is a price that can result in bankruptcy, suffering, and, yes, even death. Read more »
Conditional love is finally getting the press it deserves – and it is all bad! Sorry Dr. Phil and Supernanny, many of us do not believe that what children need or want (specifically approval or love) should be offered contingently or doled out as rewards or withheld until they behave according to our wishes. Praising children for doing something right or punishing if they do something wrong – are both conditional and counterproductive.
Research completed in 2004 (Assor & Roth) with adults and recently replicated with ninth graders (Deci) suggests that children who received conditional approval were in fact more likely to do what a parent wanted, but as adults, the children tend to not like their parents much, feel internal pressure to do things versus a sense of choice or control, and they often felt guilty or ashamed of their behavior. In addition, children who reported feeling more loved when they lived up to their parents’ expectations feel less worthy as adults. Read more »
It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…
I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…
I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…
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…
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…
