October 16th, 2011 by Linda Burke-Galloway, M.D. in True Stories
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The story of Tanya* is compelling. She was 24 weeks pregnant with her third child and the hospital was threatening to send her home. Two years ago, she faced similar circumstances and delivered a baby at 23 weeks. Luckily, the baby is now two years old but the one before that was not so lucky. Tanya presented to a local hospital during her first pregnancy because of complaints of abdominal pain. She was sent home because her contractions “weren’t regular.” Ten hours later, Tanya returned to the hospital because of a “nagging feeling that something was wrong” although her contractions were still not regular. Unfortunately, her cervix was dilated and the contractions could not be stopped. Her son was born alive but died one hour later because the hospital was not equipped to deal with premature newborns. Tanya’s second pregnancy was similar to her first because she developed premature contractions again, at 23 weeks. As with the first pregnancy, her contractions were not strong and regular so she was discharged home from the hospital with a monitor that was supposed to help. It didn’t. Read more »
*This blog post was originally published at Dr. Linda Burke-Galloway*
October 11th, 2011 by Iltifat Husain, M.D. in Opinion
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Doctors love their Apple Products. Just walk into any hospital ward, and see the types of mobile devices we are using. At weekly Grand Rounds conferences, you see plenty of iPads in use. At physician meetings, the laptop of choice is often the Macbook Pro. The data backs these anecdotal examples as well.
Doctors love their Apple Products – and Steve Jobs was obviously an extension of these products, often times cited as the singular force behind these products, and it’s why physicians who love his products mourn his passing.
There are three specific reasons why :
1) Simplicity
In medicine, we deal with enough complexity. Knowing disease pathology and the mechanism of various illnesses and their treatments is a fascinating exercise, but it’s taxing. For every known in medicine, there are at least five unknowns. It’s what makes being a physician exciting, but stressful as well. We’re always on high alert – especially those of us who practice in the critical care arena.
Juxtaposed to this is Read more »
*This blog post was originally published at iMedicalApps*
October 8th, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
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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 6th, 2011 by Elaine Schattner, M.D. in Opinion
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Monday’s New Yorker has a story, Personal Best, by Atul Gawande. It’s about coaching, and the seemingly novel idea that doctors might engage coaches – individuals with relevant expertise and experience — to help them improve their usual work, i.e. how they practice medicine.
Dr. Gawande is a surgeon, now of eight years according to his article. His specialty is endocrine surgery – when he operates it’s most often on problematic glands like the thyroid, parathyroid or appendix. Results, and complications, are tracked. For a while after he completed his training he got better and better, in comparison to nation stats, by his accounting. And then things leveled off.
The surgeon-writer considered how coaches can help individuals get better at whatever they do, like playing a sport or singing. He writes:
The coaching model is different from the traditional conception of pedagogy, where there’s a presumption that, after a certain point, the student no longer needs instruction. You graduate. You’re done. You can go the rest of the way yourself…
He wonders about how this might apply in medicine: Read more »
*This blog post was originally published at Medical Lessons*
October 4th, 2011 by MotherJonesRN in Opinion
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Here is Clara Barton, posing with a new class of graduate nurses who received their nursing education through a correspondence course offered by the Chautauqua School of Nursing. Did you know that some of Clara Barton’s contemporaries did not view her as a legitimate nursing leader because she supported alternative ways of getting a nursing education? It’s kind of ironic that many nursing leaders back then didn’t view the founder of the American Red Cross as an equal. Some things never change.
It’s an old discussion. Are nurses with an advanced degree better nurses? Do they make better leaders and does getting a degree elevate the profession? My blog mother, Kim McAllister, from Emergiblog brought my attention to an article that appears at HealthLeadersMedia.com. The article contains Read more »
*This blog post was originally published at Nurse Ratched's Place*
The story of Tanya* is compelling. She was 24 weeks pregnant with her third child and the hospital was threatening to send her home. Two years ago, she faced similar circumstances and delivered a baby at 23 weeks. Luckily, the baby is now two years old but the one before that was not so lucky. Tanya presented to a local hospital during her first pregnancy because of complaints of abdominal pain. She was sent home because her contractions “weren’t regular.” Ten hours later, Tanya returned to the hospital because of a “nagging feeling that something was wrong” although her contractions were still not regular. Unfortunately, her cervix was dilated and the contractions could not be stopped. Her son was born alive but died one hour later because the hospital was not equipped to deal with premature newborns. Tanya’s second pregnancy was similar to her first because she developed premature contractions again, at 23 weeks. As with the first pregnancy, her contractions were not strong and regular so she was discharged home from the hospital with a monitor that was supposed to help. It didn’t. Read more »
