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Showing posts from September, 2010

Cost Effective Medicine: A Lesson from the Legal Profession

Missouri, the ‘show me’ state, is showing the country an interesting and novel concept. Judges there will be apprised of the financial costs of various punitive options before issuing a sentence. For example, a judge would be informed that a convicted drug user could be sentenced to 5 years in prison for $50,000, or could do community service with a probationary period instead for a fraction of the cost. Blind justice? This new policy has generated spirited debate. Some welcome the reform, which aims to bring some measure of cost sanity to the justice system. Others oppose the effort arguing that justice must be meted out without regard to financial costs. Is this issue being driven by difficult economic realities? Some are hostile to incarceration for reasons independent of its exorbitant expense. These folks favor rehabilitation and treatment over confinement as a matter of policy. Is there any cost of justice that is too high? I viewed this report through the prism of a practici

The Healing Power of Prayer: Faith vs Reason?

Our society thrives on tension and competition. GOP vs Democrats Civil Libertarians vs Eavesdroppers Ohio State vs Michigan Creationists vs Darwinists Ideas, like sports teams, compete to win. We are the referees of these contests. Many of these competitions in the public square are ongoing. Some of these duels are locked in a dead heat. Others are in overtime. Some are ‘challenge matches’ when a vanquished idea wants another shot to change the original outcome. Many of these controversies may never be resolved. In addition, the outcomes may change because we – the referees – have changed. What was considered to be a foul years ago may now be regarded as fair play. The medical profession is riddled with many internal conflicts that will not be easily resolved. Here are a few, and I’m sure readers could add generously to the list.  Primary Care vs Medical Specialists Physicians vs Insurance Companies Obstetricians vs Medical Malpractice Attorneys Fee-for-Service vs Salaried

Electronic Medical Records, Surgery or a Grand Canyon Hike - Which Hurts More?

Two weeks ago, I did what had to be done. Months of procrastination had to end. Fears had to be put aside. Anxiety and misgivings had to be overcome. Second opinions always confirmed the need to proceed. So, when the excuses ran out, I jumped. What decision did I make? Did I… (a) Finally have rotator cuff surgery? (b) Begin electronic medical records (EMR) in the office? (c) Retire from medicine to be a full time ‘Whistleblower’? (d) Agree to a family vacation when we will hike up and down the Grand Canyon sans mules? (e) Agree to become an expert witness for a medical malpractice plaintiff’s attorney? (f) Apply an Obama 2012 bumper sticker on my car? Two weeks ago, our office entered the paperless universe. The era of ink on paper was over. The manner that I had seen office patients for 20 years suddenly evaporated. And, I wasn’t happy about it. For our small group of gastroenterologists, even though we are aware of the potential advantages of computerized charts, we adopted EMR be

Gastric Bypass Surgery: Cure or Disease?

Last week, a female patient saw me in the office for the first time to discuss her chronic digestive issues. Luckily for her, my recommendations did not include probing into her alimentary canal with the endoscopic serpents that we gastroenterologists rely upon. As the visit concluded, she advised me that she intended to have a gastric bypass (GIB) procedure performed, and even used the medical term of bariatric surgery. I suppose that she mentioned it because the issue falls within my specialty, and she wanted my reaction to her plan, although she didn’t directly solicit my opinion. Nevertheless, she received it. I am not surprised anymore when the critical medical issue emerges at the end of the office visit. Every physician has this experience regularly. “So, Mrs. Fleets, I think that this new medicine will really help your constipation. My nurse will be happy to arrange your next appointment. Do you have any questions?” “How come I now have trouble breathing when I walk