Politics

A political lament

August 24, 2009

This is usually a medical blog. This weekend I have thought a great deal bout politics. As I tweeted earlier today, I greatly admire Joe Scarborough’s comments on Meet the Press yesterday. I consider myself a Scarborough Republican in general, although, with reservations I hope we get meaningful health care reform. What I oppose is [...]

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Do you favor a public plan?

June 10, 2009

  At the risk of jumping into the hornet’s nest, I will start by linking to Bob Doherty – Are the right questions being asked about the public plan? For liberal and conservative true-believers, the debate over a public plan has become a surrogate for the broader debate over the role of government in our [...]

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Nurse practitioners and the PCMH

May 31, 2009

  Several comments to this blog have addressed the inclusion of nurse practitioners as possible leaders of medical homes (only if the state certifies NPs for independent practice).  Because of the first two comments, I must clarify that I am not talking about NPs working with physicians, but rather my comments refer to NPs in [...]

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How large is the pie?

April 29, 2009

  My son has joined the world of blogging.  He blogs about urban planning and the economy.  I highly recommend this thought-provoking piece he wrote this week – Where is the pie?  It has nothing to do with medicine directly, but health care is part of the pie.

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Should we have preferred the devil we knew?

February 4, 2009

  Tom Daschle had no choice.  He made a dumb, arrogant mistake.  His lack of tax paying would have become the story for the week and perhaps next week.  Neither he nor Obama could explain his error. We knew where Daschle stood.  I agreed with many of his positions, and understood that he was a politician.  [...]

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If I were health czar – steps to decrease health care costs

January 13, 2009

  First, I would not want to be the health czar.  I like my current position.  Still, it is fun to provide advice from the sidelines. Our job is to consider health care costs and which are unnecessary.  I have some candidate categories for potential health care savings. Our biggest hurdle remains the privacy issue.  We [...]

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Answer to new acidosis case

October 13, 2008

I am trying an audio version of explanation for the case presented 4 days ago.  I need your feedback – do you like this strategy, or should I type out the answer.  Acidosis discussion   49-year-old man, previously in good health, presents after a few weeks of progressive weakness and dizziness.  He admits to polyuria.  [...]

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What is primary care? (revisited)

May 20, 2008

In response to a comment yesterday, for the first time I reprint a rant.  This rant is so important that I consider it classic for this blog.   A reader writes: My question: Is there a plan to move MD’s away from primary care and turn this function over to NP’s and others who will [...]

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On perioperative beta blockers – another hole in the performance indicator movement

May 16, 2008

  Once again a study challenges dogma – POISE Published, Debate on Perioperative Beta Blockers Continues Publication of the landmark Perioperative Ischemic Evaluation (POISE) trial online May 12, 2008, in the Lancet has triggered another heated debate about the pros and cons of using beta blockers perioperatively in noncardiac surgery [1]. In one corner are [...]

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Cutting health care expenditures

October 27, 2005

In other countries with government run health care, budgetary issues lead to changes in health care spending. Oops! In case we forgot, the government represents a major purchases of health care in the US. So when trying to adjust for a fiscal mess caused by natural forces (Katrina), legislators look for cuts everywhere – Senate [...]

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