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Emergency Medicine Dilemma: Risk Malpractice Or Overtesting?

Emergency physicians are in a dilemma. Risk missing a diagnosis and be sued, or be criticized for overtesting.

Regular readers of this blog, along with many other physicians’ blogs, are familiar with the difficult choices facing doctors in the emergency department.

The Associated Press, continuing its excellent series on overtesting, discusses how lawsuit fears is a leading driver of unnecessary tests. Consider chest pain, one of the most common presenting symptoms in the ER:

Patients with suspected heart attacks often get the range of what the ER offers, from multiple blood tests that can quickly add up in cost, to X-rays and EKGs, to costly CT scans, which are becoming routine in some hospital ERs for diagnosing heart attacks …

… and the battery of testing may be paying off: A few decades ago insurance statistics showed that about 5 percent of heart attacks were missed in the emergency room. Now it’s well under 1 percent, said Dr. Robert Bitterman, head of the American College of Emergency Physicians’ medical-legal committee.

“But you still get sued if you miss them,” Bitterman added.

The American Medical Association’s idea of providing malpractice protection if doctors follow standardized, evidence-based guidelines makes sense in these cases. Furthermore, it can also help reduce the significant practice variation that health reformers continually focus on. Read more »

*This blog post was originally published at KevinMD.com*

SGR: Tired Of Congress Hitting The 6-Month “Snooze” Button

I have not a single thing I want to write about today. I am weary of the obvious topic: the “passage” of the 6-month extension on the SGR, but do feel I need to comment.

I am tired of this. I am tired of being jerked around by congress. I am tired of congress hitting the 6-month snooze button and somehow feeling that they are doing something good. This is procrastination, not a solution. Reassurances that something will be done are starting to be irrelevant. The problem is becoming the frustration, anger, and exhaustion that congress is thrusting upon doctors and patients, not the pay cut itself. The idea of no longer having to deal with the passive-aggressive tactics of congress is becoming increasingly appealing –- and if it’s this way for me, I’m sure it’s the same for PCPs across the country. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

For Medicare Patients, “The Doctor Is Out”

In a last-minute shocker, the Senate voted Thursday against postponing a scheduled 21-percent cut in Medicare reimbursement to physicians and other healthcare providers. Sixty senators were needed to end filibuster debate and stop the cuts under Senate rules. Fifty six voted in favor, while 40 opposed. There was no Republican support. (And, of course, no support from Senator Lieberman, who is a Republican in disguise.)

Another consequence of the vote is that tens of thousands of Americans who have exhausted their jobless benefits would not be eligible for more. In addition, new taxes on wealthy investment managers would not be imposed, along with an increase in liability taxes on oil companies, leading Democrats to contend that Republicans were protecting Wall Street and the oil industry, according to the New York Times.

“We’re not going to give up,” said Senator Harry Reid, the Nevada Democrat and majority leader. “We know the American people only have us to depend on.” Read more »

*This blog post was originally published at EverythingHealth*

Congress Acts On Doc Fix: Music To Doctors’ Ears

Leading members of the Senate Finance Committee came to an agreement Thursday night on a six-month “doc fix,” paving the way for physicians to be reimbursed a little more for seeing Medicare patients instead of a lot less. (This is now separate from the rest of the legislative package it had been part of, which is still under debate.)

Sen. Majority Leader Harry Reid warned that without passage, there’d be “havoc in America.” But the American Medical Association (AMA) continued its attack on anything less than a permanent solution. The AMA compared it to fiddling while Rome burns. What tune are members of Congress playing?

A) Stayin’ Alive by the Bee Gees
B) Doctor, Doctor! by the Thompson Twins
C) Time to Get Ill by the Beastie Boys

(The Hill, Politico, American Medical Association)

*This blog post was originally published at ACP Internist*

Doc Fix Blamed On Doctors

The American Medical Association will launch a multi-million-dollar ad campaign tomorrow to heighten pressure on Congress for a doc-fix bill. The American College of Physicians (ACP) reacted by calling for doctors to contact their member of Congress directly to let their voices be heard. Robert Centor, FACP, called for doctors to protest as well. (American Medical Association, American College of Physicians, DB’s Rants)

Meanwhile, a Florida medical society predicts a crisis in that senior-laden state. The society cited but did not name eight primary care doctors who’ve stopped accepting Medicare patients this year, and 12 cardiologists who left private practice for employment elsewhere because of already reduced payments. Unbelievably, business columnist Steven Pearlstein sorted through the issues around the doc fix, and concluded that it’s the docs that need fixing for paying themselves generous salaries. (Naples News, The Washington Post) Read more »

*This blog post was originally published at ACP Internist*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

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…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

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…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

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…

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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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