Friday, April 29, 2011

Introducing the Sick Hospital blog

Common sense, straight-to-the-point, very politically incorrect plain talk about hospitalists and hospital medicine. Blogrolled stat.

When is comanagement just a work-around against the global surgical fee?

All too often in the minds of some, and some health care systems are thinking twice, apparently. See here and here.

The state of hospital medicine 2011



Via Sick Hospital and Happy Hospitalist.

More on fake-note-real-docs in Wisconsin

The UW school of medicine has reviewed the incident and is about to issue penalties:


“Personnel action will be based on the specific nature of the offense and the level of the physician’s involvement,” the statement said. “The consequences range from written reprimand to loss of pay and leadership position.”


That's about all they're saying.


Concerning one of the docs:


Dr. Lou Sanner, a family medicine physician at UW Health, told the Associated Press he wrote hundreds of medical excuses from work for protesters because they were suffering from stress.
“Some people think it’s a nod-and-wink thing, but it’s not,” he said.


Well, no, not according to the new medical ethics.

The state medical board has yet to take action. 


Via Health Care BS.

Tuesday, April 26, 2011

Obamacare's Independent Payment Advisory Board

It's not an “advisory” board. As Peter Orszag explains, its “advice” is the default policy unless Congress negates it and the President signs off. Pretty scary, actually.



Via Health Care BS.

Monday, April 25, 2011

Focused practice in hospital medicine round one---how did it go?

The very first Internal Medicine recertification exam for focused practice in hospital medicine was given in October. How did it go? This piece in The Hospitalist offers some clues.


Surprisingly, only 140 hospitalists took the test. One test taker shared his experiences in an interview. There was less ambulatory medicine content and more ICU content (not too much more, though, because not all hospitalists practice in the ICU). There was a significant chunk of quality and safety. All that makes sense. What was surprising, though, was his impression that the test content reflected what hospitalists see and do every day---stuff we already know. That's what we were told at HM 2010, too. It's sure not what the regular certifying exam is like.

Wednesday, April 20, 2011

AMSA is deeper into woo than I even thought

More blogging by The Notwithstanding Blog from AMSA 2011. This time it was about the naturopathic and ayurvedic medicine booths there and the hypocrisy of AMSA concerning evidence based medicine. By all means read the entire post and get a load of the posters!

Tuesday, April 19, 2011

What's with all these drug shortages?

No one seems to have a good answer why. Commentary from Instapundit here. Resource center from ASHP here.

Holistic ER

Funny stuff. Unfortunately the video can't be embedded. Via Respectful Insolence.

Blogging the keynote at AMSA 2011

---delivered by Patch Adams, via The Notwithstanding Blog. Highlights:


Dr. Parenti:
The 3% of the country who own 97% of the assets think that health insurance is a market in which to make money. The horrors! [capitalism is morally repugnant? not the most nuanced argument]
The Gesundheit Institute [Patch Adams' facility] has never carried malpractice insurance and has never been sued. [Am I alone in thinking that there might be a causal relationship].
The Gesundheit Institute is open to all sorts of “medicine:” homeopathy, naturopathy, ayurveda, reiki, and a few others I’ve never heard of.
Dr. Adams
“Depression is not a mental illness. It is a pharmaceutical company diagnosis. Depression is simply a symptom of loneliness.”
One of the scariest phrases in the world: “AMSA could lead the way on…”

Monday, April 18, 2011

“Performance improvement” CME

I knew we were moving in this direction but I was not aware that “PI CME” was official. Dan Carlat blogged this yesterday. As one would expect he's mainly concerned about industry getting in on the trend, but between the lines of his post I read a measure of concern about the whole idea of PI CME. I'm concerned too. Performance has little to do with quality, or good doctoring by any definition.

A view from inside the American Medical Student Association (AMSA)

So here's a somewhat contrarian AMSA member who blogged the 2011 AMSA annual conference.


Some initial observations:


The American Medical Students’ Association (AMSA) is one of the many professional (or in this case, pre-professional) organizations that represents various slices of the medical community. Of these, they are by far the biggest embarrassment to the medical community that I have encountered...
AMSA is a big pusher of the pharm-free movement, releasing an annual scorecard comparing medical schools’ policies on physician-pharm conflicts of interest. There are many polemical t-shirts on sale to this effect. In my view (and in that of many others), they’ve gone way too far… almost to the point of McCarthyism. Of course, this hasn’t stopped their conference from taking sponsorship money and selling booths to all manner of medical informatics companies, medical device companies, medical publishers, medical test prep companies, and of course… government.
AMSA is a big believer in “woo” (aka quackery of all stripes). Not only do they sponsor summer courses in such delightful nonsense as “therapeutic touch” (“reiki”), but they also invite the quacks into their conference. The Association of Accredited Naturopathic Medical Colleges has a booth here, and various naturopathic “schools” from across North America have sent students.
This group claims to represent the future doctors of America. What scares me is that they actually might.


Note: although I have not seen postings of AMSA courses devoted to therapeutic touch or reiki, the AMSA takes a promotional stance toward these and other forms of woo. In at least one of their courses there is non-critical content in the areas of ayruvedic medicine and shamanism. And they have cozied up to naturopathic medicine. I first blogged about AMSA's promotion of woo several years ago. AMSA not only shapes future leaders in medicine but also has a good deal of direct influence on medical school curricula. That's why the organization is one of the major drivers of quackademic medicine in the US.

An absurd article a day from the medical literature

Funny stuff. Via Asinine Academia.

Saturday, April 16, 2011

Internet usage caps coming?

Already here!


But from the looks of things you'd have to stream hours and hours and hours of TV and movies each month to exceed the caps now in place. Bloggers, worry not.

Friday, April 15, 2011

The new medical student syndrome

Happy writes:


Most people think medical student syndrome is the sense of worst case scenario medical students often think about when they experience a symptom related to a disease they may have recently read about. If you're a med student and you have medical student syndrome, every headache you have is a brain tumor, every leg pain is a sarcoma and every palpitation is a life threatening arrhythmia.


That was the traditional medical student syndrome. But it's been redefined.

Romney Care at five



Via The Lucidicus Project, HT We Stand Firm.

Hospitalist medicine is moving in the wrong direction

---as DB laments:


I watch in amazement at the many physician groups who are deciding that they will just let the hospitalists care for the patients. This observer assumes that they see the hospitalists doing the H&P and D/C summary, allowing them to just do their procedure.
Too often we see patients return after a procedure and have the proceduralist refuse readmission, deferring instead to the hospitalist group.
This attitude has impacted our teaching services also. We function as a hospitalist type service and have seen an increasing number of patients that traditionally would have gone to other services.


I commented thus:


Great post. That is exactly what's happening. There are multiple reasons, but the leadership of organized hospital medicine is largely to blame. They are promoting hospitalists as utility players. The trend will not reverse without a change in the direction of hospitalist leadership.

Unintended consequences: CME in an “industry-lite” world

This recent article focuses on psychiatry CME but has general applicability. It reports the changing trends in CME delivery in light of the ongoing inquisition against industry funding. I can't access the full text but Thomas Sullivan blogged the findings of the article at Policy and Medicine.


Although the proponents of an industry free CME environment haven't a shred of evidence to back up their recommendations, according to the article the inquisition is winning, with industry support way down.


Some of the negative consequences:


Decreased Funding Has Significantly Affected Management of Grand Rounds, Extended CME Events, and Other Educational and Social Functions in Academic Departments...
As a result of decreased support, many departments reported that they engage fewer nationally-renowned, out-of-the-geographic-area speakers for Grand Rounds and CME conferences...
The costs of providing Category I CME credit has led some academic departments to reduce or abandon providing Category I credits for attendees at Grand Rounds and/or other CME conferences...
Several departments described how their traditional annual CME conferences, ordinarily scheduled for 1 or 2 days, sometimes over a weekend, designed for local, regional, and occasionally national audiences, had become too costly to maintain in their previous forms. Because industry contributions frequently made the difference between making and losing money on such activities, the cuts in funding over the past few years have forced retrenchment, and, in some cases, abandonment, of these activities.
Several programs described reducing the number of high-profile, out-of-town speakers in the line-up, relying more heavily on their own faculties, and reducing meal-service at these events. Several departments found these 1–2 day conferences increasingly to be money-losers and reported that they were discontinuing them entirely...


Work-arounds academic departments have tried include seeking donations, “suggested donations” taken at the door, and bake sales and related events.

Two recent blog posts about CAM in med school

One appropriately critical and the other utterly credulous. The latter by a med student. Wonder if she's hooked up with AMSA.

Thursday, April 14, 2011

Death panel rhetoric

Repackaged by the left. Via Gateway Pundit.

Romneycare

A bust. Michael Graham counts the ways.


Via Instapundit.

6 pages of Obamacare legislation morph into 429 pages of regs

Via Health Care BS.

Decompression sickness

Review in Lancet. Via Clinical Cases and Images.

Risks vs benefits of statins

A large BMJ population based cohort study was reported here.


Individual statins were not significantly associated with risk of Parkinson’s disease, rheumatoid arthritis, venous thromboembolism, dementia, osteoporotic fracture, and several common cancers
The risk of oesophageal cancer was reduced but for liver dysfunction, acute renal failure, myopathy, and cataract it was increased
Adverse effects were similar across the statin types for each outcome except liver dysfunction where fluvastatin was associated with the highest risks


The only thing new and concerning in this report that I'm aware of is the cataract risk. The muscle and renal risks can be managed by well established means of pharmacovigilance. Study after study has now demonstrated that the liver risk is not an outcome that matters clinically. The report did not address the growing body of evidence concerning statin benefits in various acute medical situations such as surgery and critical illness.


HT Clinical Cases and Images.

Wednesday, April 13, 2011

Sleep apnea, narcolepsy or just plain boredom?



Via Gateway Pundit.

What if hospitals tweeted patients' surgeries in real time?

If there were no HIPAA constraints, that is. Well, my vet does. He's finishing up and Chum is about to go to PACU. I think I'm going to be doing some orthopedic comanagement when he comes home.

CMS innovation center's new patient safety initiative

This is one of many things that will come out of the innovation center if Obamacare survives. None of it's new. It's vague and reads like Joint Commission on steroids. We'll see how it works but I'm not overwhelmed right now. Berwick says it'll move us away from a culture of blame. That's odd considering the culture of blame already embedded at CMS.

Who's minding the store in the air traffic control tower?

Hmmm. Third time now. Looks like the patient safety movement is gonna have to find another industry model.

Blog note #2

Again, an explanation for the lack of posts. Last month it was illness. Now realities of life outside the blogosphere intrude, necessitating a break and rearrangement of priorities. Blogging resumes today, though perhaps at a reduced frequency of posts. We'll see, but know that this blog is not going away. Please keep coming back. Thanks.

Wednesday, April 06, 2011

Conscience opposition protected in Illinois

From Secondhand Smoke:


An attempt by the State of Illinois to force pharmacists to dispense emergency contraceptives against their personal religious beliefs has been thwarted by an Illinois Circuit Court. This is an important case because of its potential U.S. Constitutional implications as its potential impact the broader medical conscience issue going forward.


Good.

Monday, April 04, 2011

Death panel type rhetoric---this time from the left

Via Gateway Pundit.

129 more Obamacare waivers

We're over 1000 now.

Dang I wish the media outlets wouldn't do this

The headline screams off the page of BioCentury: Republican bill seeks to ban comparative effectiveness.


Not true, of course, but nevertheless adds fuel to the fire for those who accuse the Republicans of opposing CER. What the bill does seek to do is preserve access to the individual choices of patients and their personal physicians.


HT Drugwonks.

New study: professional autonomy is what's most important to doctors world wide

But, of course, the present push from central planning advocates is in the opposite direction.


Via Drug Wonks.

Warfarin over Pradaxa: CMS says it's a matter of “quality”

Via Dr. Wes:


It was supposed to be the greatest thing since sliced bread: the first new oral anticoagulant in 50 years that did not require INR testing in the majority of patients. It's time to effective anticoagulation was measured in hours instead of days. There were even some data that suggested a possible propensity to lower intracranial bleeding rates compared its older counterpart, warfarin.
But the world changed for dabigatran (marketed by Boehringer-Ingelheim Pharmaceuticals as Pradaxa®) yesterday. That was the day the new proposed rule for structuring Accountable Care Organizations (ACOs) was proposed by CMS and published online with its addendum of 65 quality measures.
Sadly, dabigatran (and probably most of the other direct thrombin inhibitors being developed) will no longer represent "quality care" for patients with heart failure and atrial fibrillation.


Yep, it's right there, measure 51.


Well, only the most credulous among us ever believed in the first place that the Central Arbiters of health care and the adjudicators of comparative effectiveness were going to promote quality. Please read the post by Dr. Wes in its blistering entirety.

FUO

BMJ published a review of FUO last year. I can't get past their access controls to read the full article but Clinical Cases and Images has a few of the summary points.

Ways to increase your physical activity

---and reasons it's beneficial.


Via Clinical Cases and Images.