"doctoring with one hand tied behind my back"
discuss this article
When insurance companies handicap physicians, patients lose. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 8, 2008 Category: Family Physicians Source Type: blogs
Medblog power 8
discuss this article
5/07/2008 - 5/13/2008Next revision: 5/13/2008(Key: Rank, Blog name, Last week's rank, Post of note)1) The Happy Hospitalist (2), This Deserves The Middle Finger2) WSJ Health Blog (3), Doctors Shun Less Lucrative Specialities3) Health Beat (5), Health Care Reformers Debate the Road to Universal Coverage, Part II4) DB's Medical Rants (6), The waning art of history taking5) Dr. Wes (7), Subspecialist Shortages and the EMR6) Notes from Dr. RW (-), Unhealthy pressure to implement electronic medical records7) Musings of a Dinosaur (-), Just (Don't) Do It8) Street Anatomy (-), Christopher Huet: Retouching into BeautyThe MedBlog P...
Source: Kevin, M.D. - Medical Weblog - May 8, 2008 Category: Family Physicians Source Type: blogs
Vampire
discuss this article
Starting a week of nights again. I miss my family terribly when I have to be at work by 4 p.m. and don't get home until 4 to 8 a.m., depending on how the night is going. I sleep when they are getting ready in the morning. Overall, I enjoy nights at work, but I do miss my boys.Spent the morning messing around on the internet. Now need to pick up the mess in this house before hitting the shower.Toodles. (Source: Fat Doctor)
Source: Fat Doctor - May 8, 2008 Category: Family Physicians Tags: work Source Type: blogs
The ruc, medical home and the specter of single-payer
discuss this article
Roy Poses: "This is a reminder of what can go wrong with a 'single-payer health care system,' which is what Medicare is. When the government sets what physicians are paid, which is what happens in Medicare . . . the government ought to provide a rational, transparent, accountable method of doing so. The current RUC based system is the opposite, irrational, opaque, and unaccountable."I wonder if the physicians on the vocal, radical left are listening. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 8, 2008 Category: Family Physicians Source Type: blogs
Optimism
discuss this article
Robert Centor: "I do believe we will have a payment revolution within 5 to 10 years. Our current system of payment makes little sense. Many writers and influence leaders now understand the problem. More physicians are leaving insurance dependence, and I predict that this trend will only increase." (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 8, 2008 Category: Family Physicians Source Type: blogs
Banning pharmaceutical gifts
discuss this article
Edward Craig: "To throw this away in some misguided attempt to avoid the appearance of unseemly influence of industry on physician’s decision making is a simplistic, holier-than-thou response to what is essentially in 2008 becoming a non-issue, as medical organizations, individual physicians, and industry alike respond to increasing scrutiny by the federal government by changing substantively how they relate to one another." (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 8, 2008 Category: Family Physicians Source Type: blogs
Doctors unite
discuss this article
An Open Letter from America's PhysiciansDear Fellow Americans,For decades the United States has led the world in healthcare. We have enjoyed the finest hospitals, medical schools, research, technology, and resources. Unfortunately, our healthcare system has lost focus to the point where patient wellbeing is placed after politics, profits, and special interests. Healthcare costs are on the rise and patients have lost their freedom of choice. These trends are hurting our economy and compromising the doctor-patient relationship. As a result, it has become difficult for physicians to deliver the best possible care.Our heavily ...
Source: Kevin, M.D. - Medical Weblog - May 8, 2008 Category: Family Physicians Source Type: blogs
At least pretend to respect your patients
discuss this article
A NEJM piece on the bare minimum physician etiquette standards:“[I]t’s simpler to change behavior than attitudes,” Kahn writes. In other words, we won’t get all doctors to respect their patients, but maybe we can get them to act like they do. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 8, 2008 Category: Family Physicians Source Type: blogs
"medicare should pay for dnr orders"
discuss this article
#1 Dinosaur: "Recognizing the sensitive, difficult and time-consuming nature of the effort required by a physician to discuss end-of-life issues with patients and families, Medicare (and by extension, all other insurers) should create and pay for a procedure code for obtaining a DNR order. This payment should be significant; I'd suggest on the order of at least a Level 4 office visit ("25 minutes face to face time") given the time usually needed for these conversations." (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 8, 2008 Category: Family Physicians Source Type: blogs
The dnr code
discuss this article
You get what you pay for.Medicare pays for procedures, so by FSM, procedures are what you're going to get. If the American people decide that futile care is indeed futile -- and that something needs to be done about it -- I have a proposal:Medicare should pay for DNR orders.Recognizing the sensitive, difficult and time-consuming nature of the effort required by a physician to discuss end-of-life issues with patients and families, Medicare (and by extension, all other insurers) should create and pay for a procedure code for obtaining a DNR order. This payment should be significant; I'd suggest on the order of at least a Lev...
Source: Musings of a Dinosaur - May 8, 2008 Category: Family Physicians Source Type: blogs
Local shots 8
discuss this article
Originally uploaded by baggas.
Boring looking photo I know, but significant to me. This is the Safety Bay Scout Hall, where in grade 4 in 1984 I was part of the first ever class of students at Maranatha Christian School - we had a combined class of grade 4 - 7 students and around 40 kids total in the school.
Now I’m parked outside the current, much huger, Maranatha College waiting to collect my grade 2 son. I noticed the other day in the office here that they still have a few plaques with my name on up on the wall. Scary how fast time flies. Life is too short… (Source: Baggas' Blog)
Source: Baggas' Blog - May 8, 2008 Category: Family Physicians Authors: baggas Tags: Local Personal photos flickr rockingham safety bay Source Type: blogs
Heal thyself
discuss this article
This a video clip from Heal Thyself, an upcoming documentary from emergency physician Ryan Flesher who pulls back the curtain on our dysfunctional health care system:Dr. Flesher, driven by the altruism that brought him into medicine, with camera in hand, will pull back the curtain. In so doing, he becomes both observer and participant in this unique exploration into the psyche of physicians today.Using High Definition Video cameras we have captured over 200 hours of footage that has brought out from Boston to San Francisco to Denver and from Ecuador to Maine and back. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 8, 2008 Category: Family Physicians Source Type: blogs
Reader takes
discuss this article
Reader Takes is a regular feature where selected op-ed style pieces from the audience at Kevin, M.D. will be published on the blog.Posts are between 500 and 600 words in length, and can argue any opinion related to medicine and health care.Original articles that are provocative, well-written, free of grammatical or spelling errors, and generally follow these guidelines are preferred.Once a reader take is published, it will remain at the top of the blog above the fold for one day. A link to the author's book, blog, or website will be included.Kevin, M.D. receives in excess of 10,000 visits daily, and is regularly read by ma...
Source: Kevin, M.D. - Medical Weblog - May 8, 2008 Category: Family Physicians Source Type: blogs
Insidermedicine
discuss this article
I would like to thank Insidermedicine for their continuing sponsorship at Kevin, M.D.Insidermedicine (www.insidermedicine.com) is a physician-led news organization that allows you to keep on top of the latest medical information by watching unique videos that are created each and every weekday by Insidermedicine's team of medical experts. Their goal is to reach patients, medical doctors and students around the world to ensure that each is receiving a daily 'evidence based' health and medical update.Given their wide and diverse audience, Insidermedicine offers health and medical content that is unique for their viewers. Her...
Source: Kevin, M.D. - Medical Weblog - May 8, 2008 Category: Family Physicians Source Type: blogs
Sad news
discuss this article
Just got some depressing news - one of my good friends from university (who was my age) passed away last month. I hadn’t heard anything about it until another friend who just arrived back in town after a couple of years dropped me an email. Even now, the only information I know is what I can glean from comments on his facebook page, which is very sketchy. We hadn’t seen much of each other in the last couple of years living busy doctors’ lives at opposite ends of the city, but even so I will miss him very much - he was a good mate. Wish I had’ve known sooner so I could have attended the funeral but m...
Source: Baggas' Blog - May 8, 2008 Category: Family Physicians Authors: baggas Tags: Personal Source Type: blogs
Photo printing advice
discuss this article
I need to get a batch of photos printed over the next few days. Usually if it’s just a few photos that need printing I’ll use our printer at home, which puts out pretty nice looking prints, but if it’s a bigger size batch I prefer taking them to a shop to get them done. I’ve used Harvey Norman printing a bit in the past because it’s nice and close to us, but the last time I went there the prints were awful quality.
SO, I’ll ask for advice… anyone have any tips on where is the best place to get digital photos printed, preferably in the Rockingham area (though other tips are welcome ...
Source: Baggas' Blog - May 7, 2008 Category: Family Physicians Authors: baggas Tags: photos Local printing Source Type: blogs
Local shots 7
discuss this article
Originally uploaded by baggas.
You could call it a beach, or you could call it a sea weed depository … either way Safety Bay is a nice spot.
Now let’s see if this works - the flickr blog posting is a bit inconsistent - the photos I send from my phone always make it to flickr, but don’t seem to then make it to blog every time. It’s a bit hit and miss - so here goes…
[yep - the photo made it to flickr but not to the blog. Although it’s then easy to send it on using one click from the flickr website but it’s a shame the mobile posting is not so reliable…] (Source: Baggas' Blog)
Source: Baggas' Blog - May 7, 2008 Category: Family Physicians Authors: baggas Tags: Local photos beach flickr Source Type: blogs
Retreating from military families
discuss this article
After four years of providing care to military personnel, their families and retirees, Dr. Brewer is giving up. He's had it with the hassles of working with the government's health-care program. (Forum) (Source: WSJ.com: The Doctor's Office)
Source: WSJ.com: The Doctor's Office - May 7, 2008 Category: Family Physicians Source Type: blogs
Early mother's day
discuss this article
Because I'm working nights and will sleep through Mother's Day, Son and Husband gave me my presents today, when I'm off work, rested and alert.Diamond stud earrings (my first pair) and a Garmin Nuvi 250W.Jewelry and a gadget. And, knowing my knack of losing things, Husband chose these screw back posts. What more could a girl want? Got my two boys who are healthy and happy. I'm so, so, so lucky. (Source: Fat Doctor)
Source: Fat Doctor - May 7, 2008 Category: Family Physicians Tags: husband son Source Type: blogs
Married in a kuspuk
discuss this article
(Source: Tundra Medicine Dreams)
Source: Tundra Medicine Dreams - May 7, 2008 Category: Family Physicians Source Type: blogs
Medblog power 8
discuss this article
5/07/2008 - 5/13/2008Next revision: 5/13/2008(Key: Rank, Blog name, Last week's rank, Post of note)1) The Happy Hospitalist (2), This Deserves The Middle Finger2) WSJ Health Blog (3), Doctors Shun Less Lucrative Specialities3) Health Beat (5), Health Care Reformers Debate the Road to Universal Coverage, Part II4) DB's Medical Rants (6), The waning art of history taking5) Dr. Wes (7), Subspecialist Shortages and the EMR6) Notes from Dr. RW (-), Unhealthy pressure to implement electronic medical records7) Musings of a Dinosaur (-), Just (Don't) Do It8) Street Anatomy (-), Christopher Huet: Retouching into BeautyThe MedBlog P...
Source: Kevin, M.D. - Medical Weblog - May 7, 2008 Category: Family Physicians Source Type: blogs
Twitter and facebook
discuss this article
In case you're looking for other ways to keep up with Kevin, M.D., my posts are now broadcast on Twitter and updated continuously on Facebook. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 7, 2008 Category: Family Physicians Source Type: blogs
Grand rounds is up
discuss this article
Suture for a Living hosts the weekly best of the medical blogosphere. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 7, 2008 Category: Family Physicians Source Type: blogs
Lady of the house
discuss this article
Buckeye Surgeon recounts a post-op visit with an au pair. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 7, 2008 Category: Family Physicians Source Type: blogs
Raising medicare eligibility
discuss this article
The first step to rein in out of control costs. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 7, 2008 Category: Family Physicians Source Type: blogs
Er, the show and real life
discuss this article
No, they're not the same. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 7, 2008 Category: Family Physicians Source Type: blogs
Gossypiboma
discuss this article
Also known as a retained surgical sponge. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 7, 2008 Category: Family Physicians Source Type: blogs
Dnr as default
discuss this article
#1 Dinosaur: "It would solve a lot of problems." (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 7, 2008 Category: Family Physicians Source Type: blogs
Infant tossing
discuss this article
Pediatricians are debating health risks versus cultural sensitivity. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 7, 2008 Category: Family Physicians Source Type: blogs
Supraclavicular approach
discuss this article
Shadowfax talks about an uncommon, yet effective, central line approach. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 7, 2008 Category: Family Physicians Source Type: blogs
My take: slow medicine, destroying the medical home, animosity, patient communication
discuss this article
1) Dartmouth Medical School is leading the "slow medicine" movement, where the elderly are given the decision whether to pursue more intensive medical therapies.My take: Bravo. This trend needs to be publicized and spread nationwide. Much of Medicare's spiraling costs can be attributed to unnecessary end-of-life care.We need to communicate the acceptability of saying "no", and give patients more of a say in the treatments they undergo.2) The RUC is responsible for coming up with a payment mechanism for the medical home.My take: Specialists continue to hold primary care by the balls.The RUC is dominated by specialists and s...
Source: Kevin, M.D. - Medical Weblog - May 7, 2008 Category: Family Physicians Source Type: blogs
Popping the retail clinic bubble
discuss this article
Growth is slowing, and stores are thinking twice about the profit potential of retail clinics:"We have seen fallout in this industry, on a smaller scale, that is not unlike the dot-com bubble," says Tom Charland, the owner of industry consultant Merchant Medicine LLC and a former vice president for strategy at MinuteClinic. "The big mistake was for people to think they could reach break-even in six months," he says. "People are learning this is an 18-to-24-month process to get to break-even." This is without the multi-million dollar malpractice lawsuits that will be sure to come. I would be interested to see how the indust...
Source: Kevin, M.D. - Medical Weblog - May 7, 2008 Category: Family Physicians Source Type: blogs
Canada's nicu shortage
discuss this article
The Globe and Mail: "More than 100 Canadian women with high-risk pregnancies have been sent to United States hospitals over the past year – in what a doctors' group attributes to the lack of a national birthing plan."(via Catron) (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 7, 2008 Category: Family Physicians Source Type: blogs
Fun stuff
discuss this article
Son and I are having a jammie day at home. He's on his SmartCycle and I'm catching up on email. Fun stuff in my laptop just waiting for me!Mom & More sent this bubblewrap stress reliever (for more stress relief, check "manic" button). Seattle Redhead sent this video of a Bulgarian American Idol contestant who thinks she is singing in English.Cousin sent this video of El Caminito del Rey, super scary for me as I don't like heights. Some adventure enthusiasts shot some amazing video. (Source: Fat Doctor)
Source: Fat Doctor - May 7, 2008 Category: Family Physicians Tags: video fun Source Type: blogs
A proposal: nhp = dnr
discuss this article
Think for a moment what the world would look like if everyone admitted to a nursing home was immediately considered a DNR (or, perhaps more acceptably, "AND" as in "Allow Natural Death.") What if the whole concept of Hospice was applied to the nursing home setting? Comfort care only; living life to its fullest, each day. No invasive medical interventions except to relieve suffering.It would solve a lot of problems.No more fishing through mounds of paperwork from the nursing home in the ER trying to determine a patient's code status; hell, if they're all DNR, why send them over in the first place? How much of a dent might b...
Source: Musings of a Dinosaur - May 7, 2008 Category: Family Physicians Source Type: blogs
Coffee in a can
discuss this article
- Five Senses Coffee - Premium Coffee Roasters in Australia
If there’s a product that is wacky, strange, weird, or downright scary, you can trust the Japanese to come up with it. And this product is scary indeed - canned coffee. The thought of it makes me shudder… but check out the above blog from 5 senses nonetheless - if for no other reason than to laugh at the hilarious photo of Dean!
And if you seriously want to explore more of the bizarro world of coffee in cans - then check out this blog for the full story about the life and super powers of ‘Boss Black’, or try cannedcoffee.com. Very distu...
Source: Baggas' Blog - May 7, 2008 Category: Family Physicians Authors: baggas Tags: Coffee japan Source Type: blogs
Imedexchange
discuss this article
I would like to thank iMedExchange for their continuing Premium Sponsorship at Kevin M.D.If physicians want it, iMedExchange is building it...It's rare when a company actually listens to their customers. Even more rare when a company has enough insight into their market that they can anticipate their customer needs.iMedExchange is accomplishing both. A seasoned team of Web 2.0/social networking gurus, along with a team of several hundred physician advisers, is quietly building a new model for physician social networking.Not satisfied to merely provide clinical information and resources, the iMedExchange model takes into ac...
Source: Kevin, M.D. - Medical Weblog - May 7, 2008 Category: Family Physicians Source Type: blogs
Local shots 6
discuss this article
Originally uploaded by baggas.
Whenever my drug pushers disappoint and do not bring me lunch, I like to visit this joint up the road - Perth Noodle Wok. Always very tasty. Today’s meal - Phad Thai noodle box - and it was very nice indeed (Source: Baggas' Blog)
Source: Baggas' Blog - May 7, 2008 Category: Family Physicians Authors: baggas Tags: Local Personal photos flickr food Source Type: blogs
Crime and punishment
discuss this article
from The Brave and the Bold #59 (April/May 1965)
Tags: comics brave and bold crime punishment (Source: Polite Dissent)
Source: Polite Dissent - May 7, 2008 Category: Family Physicians Authors: Scott Tags: newtag Source Type: blogs
Local shots 5
discuss this article
Originally uploaded by baggas.
Coffee, crossaint, ocean, and trees - a perfect breakfast before work… along with a good book of course!
Had a little case in theatre this morning so I’ve half an hour to kill before my clinic starts. (Source: Baggas' Blog)
Source: Baggas' Blog - May 6, 2008 Category: Family Physicians Authors: baggas Tags: Local Personal photos flickr Source Type: blogs
Paying for e-mails
discuss this article
The Independent Urologist: "If the patient's question can be handled satisfactorily by email, doing so will free up a slot for a better paying new patient or procedure. Why spend 15 minutes explaining something for $30, when you can spend 15 minutes doing something for $200?"Unfortunately, primary care doesn't have the luxury of substituting a $200 procedure in a 15-minute visit. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 6, 2008 Category: Family Physicians Authors: Kevin Source Type: blogs
Csi: whitecoat
discuss this article
Try to guess what happened to this patient who was shot. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 6, 2008 Category: Family Physicians Authors: Kevin Source Type: blogs
"we are trying to put a price on something that is, by its nature, priceless"
discuss this article
One of the best reasons I've seen explaining why health reform is so difficult. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 6, 2008 Category: Family Physicians Authors: Kevin Source Type: blogs
"abuse-resistant oxycontin"
discuss this article
Sounds like an oxymoron to me. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 6, 2008 Category: Family Physicians Authors: Kevin Source Type: blogs
Bad time to be a drug rep
discuss this article
Merck has announced mass layoffs. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 6, 2008 Category: Family Physicians Authors: Kevin Source Type: blogs
99232
discuss this article
The Happy Hospitalist's coding clinic continues. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 6, 2008 Category: Family Physicians Authors: Kevin Source Type: blogs
Salaries
discuss this article
Merrill Goozner: "The more important reform is that physicians be organized into group practices that encompassed all the necessary specialties. And they should be paid not by the number of patients they see or can run through their individual offices, but by skill, experience and their relative importance to improving patients' overall health." (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 6, 2008 Category: Family Physicians Authors: Kevin Source Type: blogs
Passing the futile care buck
discuss this article
#1 Dinosaur: "First and foremost, you -- the ER docs and the hospitalists -- must stop passing the buck back to us, the primary care docs, to help patients and families make end-of-life decisions." (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 6, 2008 Category: Family Physicians Authors: Kevin Source Type: blogs
Patient history
discuss this article
Two takes on this today.Robert Centor: "Do not blame the decline in history taking or decision making on the EMR. Such comments make one sound like a Luddite. Neither should we champion the EMR as the solution to quality care. The EMR is a tool that makes data retrieval easier, makes orders legible, and makes it easier to spot laboratory trends. We must learn to use the EMR as another tool in our toolbox."Dr. RW: "The whole thing, of course, is driven by economics. The less time you have to spend on the H&P the more patients you can see, the more procedures you can do and up goes productivity." (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 6, 2008 Category: Family Physicians Authors: Kevin Source Type: blogs
Web 2.0 and asthma management
discuss this article
Clinical Cases suggests using Twitter and Facebook to help manage asthma. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 6, 2008 Category: Family Physicians Authors: Kevin Source Type: blogs
