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Showing posts from May, 2014

Are Emergency Rooms Admitting Too Many Patients?

This blog has discussed conflicts of interests.  Indeed, every player in the medical arena has found itself challenged by conflicts where one’s self-interest competes can skew what should be pure advice.   This issue is not restricted to the medical universe.  Every one of us has to navigate through similar circumstances throughout the journey of life.  If an attorney, for example, is paid by the hour, then there is an incentive for the legal task to take longer than it might if the client were paying a flat fee.  The fee-for-service (FFS) payment system that had been the standard reimbursement model in medicine has been challenged and is being dismantled because of obvious conflicts that were present.  (This is not the only reason that FFS is under attack, but it is the principal reason offered by FFS antagonists.)  Physicians who were paid for each procedure they performed , performed more procedures.   This has been well documented.  Of course many other professions and trades stil

Should Physicians Offer Disclaimers to Patients?

Why does is seem that so much information given to us comes with disclaimers?  The weight loss product ads on TV that promise more than they will deliver, are always accompanied by 5 nanosecond disclaimers in a font size that can’t be discerned by the human retina stating that the results are not typical. Watch the Pounds Melt Away! It seems deceptive to be advertising a product by showcasing a performance that the vendor admits is not typical. Let’s extend this philosophy to other professions and trades. Financial Planner:   Invest with us and earn 20% returns annually over 5 years. Results not typical. Attorney: When I catch your ambulance, I’ll make us both millionaires!  Results not typical. SAT Tutor:  My students have the dilemma of choosing between Harvard and Princeton.   Make your kids my kids. Results not typical. Airline Industry:  When our customers call us on the 800 line, a live human answers by the 3 rd ring. Results not typical. Politician:  I wi

Why I'm Against Wellness

I’m a physician and I’m against wellness.  Let me explain. Wellness is the new health mantra that has much more to do with marketing than with evidence-based medicine.  Wellness institutions and practitioners are omnipresent promising benefits that are often untested or rejected scientifically.   Hospitals that years ago would have shunned new age healing arts, now offer yoga, meditation, Reiki and massotherapy.  Do they do so because they have had a Damascus Road experience and now believe that these techniques are effective?  Guess again. Paul's Conversion on the Damascus Road Wellness is no longer restricted to medical campuses, costly weekend retreats for emotional and physical catharses and ubiquitous yoga storefronts.  Wellness is now championed by corporate America.   Business leaders argue that keeping employees well is not only a demonstration of good corporate citizenship, but is also good business.   Healthy employees, they claim, will reduce health care

Are Doctors Sued Enough for Medical Malpractice?

Remember personal responsibility?  There actually was an Era of Responsibility when folks admitted when they screwed up and didn’t blame others for their own mistakes.  I know this may seem incredible to the younger generation who simply assume that when something goes wrong today, it must be someone else’s fault.   In today’s culture, this is not scapegoating, but the pursuit of justice.  Welcome to the Era of Big Victim. In the olden days, if someone slipped on ice and sustained injuries, he went to a doctor. Today, we could expect a court case where a jury would hear testimony from an Illumination Expert testifying that the wattage and angle of the sidewalk lighting was clearly deficient.   A Saline Expert would add that the salt that the proprietor applied to the sidewalk was not dispensed with a certified salt sprayer, thereby allowing dangerous ice crystals to survive.  Perhaps, an Ambulation Expert would instruct the jury that the soles of the fallen man’s shoes containe