Medical Rants

Lessons from Medicare’s Demonstration Projects on Disease Management, Care Coordination, and Value-Based Payment Here are the lessons: For disease management programs -  On average, the 34 programs had little or no effect on hospital admissions. There was considerable variation in the estimated effects among programs, however (see figure below). In nearly every program, spending was [...]

During the first 2 years of medical school we study basic sciences.  We learn biochemistry, physiology, histology, anatomy, pharmacology and microbiology. Jerome Kassirer, in a wonderful Academic Medicine essay,  These concepts foster the teaching and learning of the diagnostic process, the complex trade-offs between the benefits and risks of diagnostic tests and treatments, and cognitive [...]

Thanks for the comments that have encouraged me to expand on the previous post. 1. Often we obtain labs in response to the patient's history and physical examination.  We should understand how different lab tests might help us, and what the indications are for ordering those tests. 2. Often when someone is "sick", they have [...]

During the first 2 years of medical school we take a course on the physical examination.  Most courses present a laundry list of exam processes.  During our 3rd year we do many exams.  Despite this training, few interns have physical exam proficiency. While occasionally a "complete history and physical" will reveal important findings, much more [...]