Effectiveness/Efficiency

Why Obama Made the Right Call on Berwick

The recess appointment of Don Berwick to lead CMS can be seen as a cynical act of political opportunism, sidestepping the Congressional approval process using a tactic worthy of Machiavelli, or Karl Rove. Or it can be viewed as a pragmatic decision by Obama to avoid a lengthy and exasperating re-litigation of the healthcare reform debate. Death Panels. Been there, done that. So I'm going with Choice #2.The right side of the blogosphere has erupted, painting Berwick as an effete academic who would have withered under the Klieg lights and piercing questions of the likes of John Ensign and Jim Bunning. Those of us who know Don have no doubt that he would have more than held his own in debating the lessons of England’s healthcare system and the necessity of clear-headed rationing choices. Don is serious, hyperarticulate and intellectually nimble; in a real debate with members of the Senate…

HOW SMALL IS TOO SMALL?

John Nelson writes . . . Recently one of our blog readers wrote in with the following question for our blogging team: Our small general IM group (3) is interested in starting a hospitalist group for our small community hospital (50bed) because neither our group or our family practice groups can recruit without one. There are no hospitals our size that have hospitalists. Where do we start? My blogging colleagues may have additional thoughts on this subject, but I’ll get the ball rolling with the following (more…)

DISCLOSURE: A LEADER WALKS A THIN LINE

Mike Radzienda writes... A man presented with urinary retention and a UTI. He also complained  of mid -thoracic spine pain that was sub-acute. His PMD treated him with antibiotics but his symptoms persisted. He had worsening urinary symptoms and developed lower extremity weakness. On presentation to the hospital, he was admitted to the neurology service and was found to have spastic paralysis of his lower extremities. Exam at that time showed marked upper motor neuron sign in his legs. A brain MRI was read as normal. An MRI of the spine revealed no evidence of spinal cord disease but the thoracic images were not interpretable due to motion artifact. The neurologist commented in his note that the MRI of the spine was normal. The following day the MRI was redone and reported out as, “a retro-pulsed disc is compressing the spinal cord at T-8 and there is enhancement in the…

Make It Right

Troy Ahlstrom writes... My wife and I managed to get away for a weekend this spring.  It’s something we hadn’t done for years with everything else going on, and we were both looking forward to it. I made reservations at a nice resort about an hour away from home.  They had a romantic getaway package with a nice room, champagne, and chocolate covered strawberries.  I reserved the package and off we went.  We had a great time, but there was a small glitch.  (more…)

What’s Behind Today’s Primary Care Crisis: You Don’t Know the Half of It

If you’ve ever been on a diet, you know that it really helps to keep a food log. Seeing your consumption chronicled in one place is illuminating – and often explains why those love handles aren’t melting away despite two hours on the treadmill each week.In today’s issue of the New England Journal of Medicine, internist Rich Baron chronicles the work of his 5-person Philadelphia office practice during the 2008 calendar year. Rather than “Why am I not losing weight?”, Rich’s study aims to answer the question, “Why does my work day feel so bad?” The answer: an enormous amount of metaphorical snacking between meals. In the NEJM study, Rich (who is a dear friend – we served together on the ABIM board for several years) found that each of the physicians in his practice conducted 18 patient visits per day (a total of 16,640 visits over the year for…
...1020...2829303132...