Category Archives: General Interest

Dr. Gawande has done it again – almost – a review of “Being Mortal”; Gawande, Atul; Metropolitan Books; New York; 2014

This book is almost on track to be a potential game changer. The title is engaging. However, on my first reading, I found the book a little difficult to follow. Dr. Gawande has essentially written about two distinct components of … Continue reading

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General Shineski Needn’t Have Been Ousted – He Was Betrayed

At the end of May, after a series of exposés and congressional hearings, General Eric Shinseki, was pressured to resign as Secretary of the Department of Veterans’ Affairs… Could the VA scandal have been prevented? – In all likelihood yes. Would it have been easy to prevent? – No. Continue reading

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Diagnosis may be the Achilles Heel of Incentive Based Payment.

“Diagnosis is the mental act of selecting the one explanation most compatible with all the facts of clinical observation”.  – Raymond Adams in Harrison’s Principles of Internal Medicine – 4th edition In almost all instances, Government and other third party … Continue reading

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What is Quality? It Depends on Who Does The Measurement

There are more than a dozen sets of publicaly reported quality metrics … with between 8 & 80 individual components to each set. It is small wonder that they don’t agree. Continue reading

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What is Evidence Based Medicine?

One definition would be: Delivery of Medical Care based on results of best available evidence. This usually means finding or relying upon data, some of which will be from outside one’s immediate memory to help answer a clinical question. EBM … Continue reading

Posted in effectiveness/efficacy, General Interest, Quality, treatment options | 2 Comments

Providers, Patient Care Delivery and Policy: Hospitalist story

There are often perverse incentives in health care. These incentives can, at times, create competing drives where providers are encouraged to do things that directly increase the costs of care.  Consider the reaction to the mandate to cut down hours … Continue reading

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Why do Physicians Behave the Way They Do?

I believe that the vast majority of physicians do “the right thing” for their patients. I don’t think I’m being a Pollyanna. On the other hand, the “The Tragedy of the Commons”, which describes behavior in many cultures, doesn’t bypass … Continue reading

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Who worries about physician behavior? Who is ultimately responsible?

There is a true story of a 30 yo woman who has a history of rheumatoid arthritis, and who developed unusual eye symptoms. She went to a physician who referred her to a neurologist (both were “independent medical practitioners”). The … Continue reading

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Who is responsible? Is there Enough Accountability in Medicine?

The Alligator Allegory reads: “ The objective of all dedicated employees should be: To thoroughly analyze all situations, Anticipate all problems prior to their occurrence, Have answers for these problems, And Move swiftly to solve these problems when called upon. … Continue reading

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Medical Ethics should address more than the individual patient encounter

George Lundberg, reviewed what he called the Principles of medical ethics in his blog on  MedPageToday.com on December 20, 2010. He’s done us a service by bringing this up as the season for reflection is upon us. The AMA’s Code … Continue reading

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