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Emergency Physicians Are Slaves to Highway Billboards Print E-mail
Written by Sandra Scott Simons, MD | KevinMD   
Monday, 06 March 2017 00:00

"Mom, that's a little unreasonable," piped up my 9-year-old from the backseat as we drove by an ER billboard that prominently displayed an average wait time of four minutes. "That would be stressful, seeing everyone that fast." Even my kids understand how absurd some of today's time metrics are. "Hospitals probably make more money showing shorter wait times on a billboard because people want to go there because it's faster," he concluded. Out of the mouths of babes.

EPs are never more stressed about time than when we're in the ED, where every move is timed, tracked, and reported to the guys in suits to make us move even faster (as if we are sitting around eating bonbons). Each time we meet their time metric for door-to-physician greet, they lower it again.

I had a rare slow shift recently, and two patients complimented my bedside manner, and a third asked me to be her doctor. Sadly, this isn't the norm because I'm usually too rushed to establish rapport.

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Last Updated on Tuesday, 07 March 2017 19:07
The Exploding Cost of Prescription Drugs Print E-mail
Written by Homayoun L. Daneschvar, MD | KevinMD   
Monday, 27 February 2017 00:00

The amount of prescribed medications and the number of individuals taking them are increasing rapidly. The share of Americans taking one or more prescription drugs has risen among all age groups. According to the IMS Health Study, the total spending on prescription drugs in the U.S. reached $310 billion in 2015. This is almost three times more than total drug expenditures in the year 2000. It is forecasted that the U.S. spending on medicine will reach $370 to $400 billion in 2020. Moreover, several drug makers have notably increased their drug prices in recent years.

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Federalism and the End of Obamacare Print E-mail
Written by Nicholas Bagley | The Yale Law Journal   
Thursday, 16 February 2017 00:00

Federalism has become a watchword in the acrimonious debate over a possible replacement for the Affordable Care Act (ACA). Missing from that debate, however, is a theoretically grounded and empirically informed understanding of how best to allocate power between the federal government and the states. For health reform, the conventional arguments in favor of a national solution have little resonance: federal intervention will not avoid a race to the bottom, prevent externalities, or protect minority groups from state discrimination. Instead, federal action is necessary to overcome the states' fiscal limitations: their inability to deficit-spend and the constraints that federal law places on their taxing authority. A more refined understanding of the functional justifications for federal action enables a crisp evaluation of the ACA-and of replacements that claim to return authority to the states.

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Last Updated on Friday, 17 February 2017 19:11
Medical Errors Are Not the 3rd Leading Cause of Death Print E-mail
Written by Cory Fawcett, MD | KevinMD   
Monday, 13 February 2017 00:00

I read it again this week, and I wonder why the editors of our medical journals continue to perpetuating this falsehood. An article in a prominent journal stated again that medical errors are the third leading cause of death in the United States. We all know this is not the case, and yet editors continue to let this be stated in their journals as if it were fact.
Ever since the offending article was published last year making this ridiculous claim, other authors have perpetuated it as if it were true. Yet it is painfully obvious to every practicing physician that it is not true. The top ten causes of death, according to the national center for health statistics, are the following...

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Last Updated on Tuesday, 14 February 2017 14:40
Civil War Over Opioids Print E-mail
Written by FHI's Week in Review   
Monday, 23 January 2017 19:24

In a STAT Special Report by Bob Tedeschi on January 17, 2017:

Two years after the United States saw a record 27,000 deaths involving prescription opioid medications and heroin, doctors and regulators are sharply restricting access to drugs like Oxycontin and Vicodin. But as the pendulum swings in the other direction, many patients who genuinely need drugs to manage their pain say they are being left behind.

Read more in the current issue of Week in Review>>
Is 'Physician Engagement' Code for Physician Control? Print E-mail
Written by Michael Breen, MD | KevinMD   
Monday, 09 January 2017 00:00

Are physicians unruly children?

That's the attitude I see at hospital C-suite meetings. As in, "Our doctors are protesting our new unproven proton beam therapy center. How cute! They think they know how hospitals work. Even cuter, they think their opinion matters." Chuckles all around.

That smiling dismissiveness doesn't surprise me. Call me cynical, but when people have power over other people, they become contemptuous. And in today's world hospital executives have that power over their interchangeable, expendable physicians. Their ridicule is regretful, but almost fitting. After all, many physicians they patronize once took that same attitude toward their patients.

At least, though, that behind-the-scenes contempt is sincere. What I resent more is articles like one I just read: "The best way hospitals can engage physicians, nurses, and staff."

Engaging physicians is very much in vogue these days. The purpose is to tactfully bring physicians around to the institution's way of doing things.

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Last Updated on Tuesday, 10 January 2017 20:24
Why doctors are rebelling against saving lives Print E-mail
Written by Michael Breen, MD | KevinMD   
Wednesday, 28 December 2016 00:00

When I was in medical school, "real" doctors saved lives. Period.

Specialists who focused on a patient's quality of life, (the plastic surgeons, bariatric surgeons, holistic practitioners, infertility experts, etc.) were considered sellouts. (We won't even consider the med school status of future psychiatrists.)

We disparaged these doctors because they could be saving lives and chose not to, because they were often paid (God forbid) out-of-pocket by their patients, and because they actively self-promoted themselves to the public (another doctor no-no). These "greedy" docs were scorned as entrepreneurs in a profession too sacred to be tainted by money. (This as traditional docs plundered third party payers. Don't get me started.)

Fast forward. Many future doctors now choose "quality of life" specialties.

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