Medical Rants

Competition can save Medicare money

April 19, 2012

I love this story in the NY Times today - In a Shift, Medicare Pushes Bids The experiment represented a sharp break from the usual fee-for-service Medicare program, under which beneficiaries can choose any supplier or provider of goods and services. In the experiment, Medicare officials invited bids and awarded contracts to 356 suppliers of medical [...]

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Too many definitions for primary care – and this is the problem!

April 18, 2012

Back when I was a young pup, primary care had one clear definition.  Those were the exciting days for the primary care movement.  Internal medicine had just discovered primary care and programs sprouted up around the country to train internists to provide such care.  In 1994 the IOM provided this definition: Primary care is the [...]

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A spontaneous tweet up on medical prices

April 15, 2012

Earlier today I tweeted the NY Times article on the confusing state of medical pricing.  I am specifically referring to prices rather than costs, because likely only accountants or economists could begin to understand medical costs. First some assumptions: Health care does not generally operate on free market principles.  As a physician I cannot set [...]

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Push back against “choosing wisely”

April 14, 2012

We physicians dislike authority.  We do not like authority telling us what to do. I suspect that this dislike explains the push back that I have heard against the choosing wisely campaign.  Having read many of the recommendations from the Choosing Wisely campaign, I remain impressed with the campaign. Some physicians fall back on the [...]

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Lessons learned from listening to Bubba Watson

April 9, 2012

My friends know that I love golf.  I love playing golf, practicing golf, talking golf and watching golf.  So yesterday I played all morning and watched all afternoon. As I was watching, listening and reading about Bubba Watson, the following thoughts coalesced.   At this stage of his career, Bubba remembers who he is and [...]

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How should we judge medical schools?

April 8, 2012

US News and World Report ranks medical schools (and many other schools each year).  But these ranking really measure reputation.  Disclaimer: I have the opportunity to vote in the rankings and did once or twice.  The rankings include reputation, MCAT scores, research dollars and other markers that do not even attempt to address education! Schools [...]

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Doctors and iPads

April 6, 2012

Let me state my bias upfront – iPads help and will help physicians greatly.  Of course, whenever new technology enters our universe, the luddites find all the problems.  The early adopters (I just replaced my original iPad with the new version) find all the potential.  As I have written about previously, this likely represents the [...]

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An old codger does not understand the young turks

April 5, 2012

I was browsing The Hospitalist online and saw this poll: What is the No. 1 perk of working as a hospitalist? They do not even list activities related to internal medicine.  They do not consider the possibility that hospital medicine allows us to practice the Oslerian ideal. The top two answers (over 50% of the [...]

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We should treat diseases not create diseases to treat

April 4, 2012

This article speaks loudly to me - Legal Drug-Pushing: How Disease Mongers Keep Us All Doped Up Readers know how mad direct to consumer advertising makes me.  I love the advances that the pharmaceutical industry has given us.  I hate their marketing departments. Primum non nocere Why not apply our motto to the pharmaceutical industry?  Why [...]

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How important is training duration in medicine

April 3, 2012

Zeke Emmanuel, along with Victor Fuchs, authored an opinion piece in JAMA (link for subscribers) - Shortening Medical Training by 30% As one might expect, the essay contains anecdotes and extrapolations that many physicians would find amusing if the topic was not so important. Of course I will argue against the article using my own experience [...]

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