Not dead, just on vacation
The joy of locum tenens work is that I can, actually, take a vacation. I have been working a lot, and so now I am going to be away from anything that begets blogs about medical care for most of a...
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Back, but still a bit jet lagged: Health care in the Republic of Georgia
The Republic of Georgia is beautiful, welcoming, has great food, ancient and rich culture, is quite inexpensive, and I am now back. The language is fascinatingly complex, with an alphabet that does not...
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The changing nature of truth, answering questions for a chance to win a free...
I am presently really excited about learning all over again what I thought I knew when I finished my medical education about 25 years ago. Since that time I have become wiser, learning how to do things...
View ArticleThe Ryan Plan and the Affordable Care Act--can market forces improve quality...
In today's New England Journal of Medicine an article by Republican health policy analyst, Gail Wilensky, brought up several excellent points. The article is entitled "The Shortcomings of Obamacare"....
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Balancing the budget: how exactly will we eventually pay for health care?
This week the American Medical News featured an article with the disturbing title, "Massive health job losses expected if Medicare sequester prevails." I wasn't entirely sure what a "sequester" was,...
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What is health care like in India, why do Indian doctors come to the US and...
Lately I've been working in an unfamiliar state in a rural, but not small, hospital, and have been noticing all kinds of curious things. This is not the first time I've noticed these curious things so...
View ArticleA sort of apology to hospitals, especially little ones struggling to make...
In my previous post I said that an obvious reason why we over-diagnose serious conditions in patients who are not terribly sick is that this results in higher reimbursement to hospitals, "...and when a...
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Hospitalists and the field of Hospital Medicine: why we are sometimes...
Internal Medicine is the branch of medicine that deals with diseases of the internal organs in adults. It also involves dermatology, minor surgical procedures, general psychiatry and preventive care of...
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Creating dependency--is that what we do for a living?
Lately, it seems, I have been treating quite a lot of people who end up in the hospital as a result of prescription drug abuse. Most of them have chronic pain and have been generously prescribed long...
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Mammogram screening--reconsidering the wisdom of saying "No."
Three days ago, on November 22, 2012, an article was published in the New England Journal of Medicine questioning the utility of mammogram screening for prevention of death from breast cancer. The...
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Multitasking and information toxicity--is that why I feel stupid?
Today I've been feeling stupid. My job absolutely requires critical, creative thinking and the ability to focus well, which was really hard today. But I don't think I'm actually stupid. I think it has...
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Evidence based medicine--but which evidence?
In the last year I've become more and more comfortable using online resources to determine the best treatments for the diseases I see. My favorite site is Up To Date, which has experts write articles...
View ArticleIn the wake of marijuana legalization, what exactly are the health risks?
Colorado and Washington state have legalized the recreational use of marijuana. I thought this would take longer to legislate, especially with the recent backlash from the federal government about...
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Transitioning from fee for service medicine and spending money where it does...
I just read in a recent issue of "Aequanimitas," the newsletter of Johns Hopkins Osler medical service, a brief interview with J. Mario Molina, the CEO of Molina Healthcare, an organization which...
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Small hospitals, the bystander effect and a hospital that works well
I just finished another week of hospitalist shifts at a small hospital in Alaska. It was a good week. People worked well together, the patients were well served and seemed to feel good about their care...
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Patient safety: How might we avoid killing or hurting people in our care
Hospitals are very focused on avoiding harming patients lately. They have been moving in that direction for a long time, but with health care reform legislation, payments are on the line, which makes...
View ArticleAddendum to patient safety: the "Post Hospital Syndrome"
Harlan Krumholz, a Yale University professor of cardiology and public health, just published an article in the New England Journal of Medicine entititled "The Post-Hospital Syndrome--An Acquired,...
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Hospitals are still awful: movement toward patient centered care and Eric...
First a disclaimer: People often receive compassionate, considerate and effective care at hospitals. They have countless interactions which impart the miracle of human caring and enrich their lives. It...
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More on fecal transplants: a less icky alternative, but why?
The bacteria that live in our healthy guts are a garden of cooperating and competing species that help to determine our intestinal health. When we take antibiotics, we kill countless bystander bacteria...
View ArticleHow to become a locum tenens hospitalist and why you may or may not want to
Locum tenens (literally "place holder") is professional work done to fill in where help is needed. It is what I have primarily been doing for the last year, and has been an interesting ride.When I...
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