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Money will be lost in health care. This is true no matter how we describe it. Print E-mail
Written by Edwin Leap, MD | KevinMD   
Tuesday, 04 December 2018 17:33
 
Does anyone in medicine, particularly emergency medicine, understand why we lose money? Why we have to push those metrics so hard to capture every dime? I mean, we're  constantly reminded that satisfaction scores, and time-stamps and time to door, time to needle, time to discharge, reduced "left without being seen" scores are connected to the money we make. Medicine now is far less about the wonder of the body, the ravages of disease, the delight of the diagnosis and the thrill of healing. Medicine, now, is clicks and time-stamps, clipboards and strategies, through-put, input, out-put, put-out, burned out.
 

Last Updated on Tuesday, 04 December 2018 17:53
 
Are Vertical Desks Overrated? Print E-mail
Written by Aaron Carroll, MD, MS | The Incidental Economist   
Friday, 23 November 2018 14:08
 
We know that physical activity is good for us, and that being sedentary is not. Some have extrapolated this to mean that sitting, in general, is something to be avoided, even at work. Perhaps as a result, standing desks have become trendy and are promoted by some health officials as well as  some countries. Research, however, suggests that warnings about sitting at work are overblown, and that standing desks are overrated as a way to improve health.
 
Dr. David Rempel, a professor of medicine at the University of California, San Francisco, who has  written on this issue, said, "Well-meaning safety professionals and some office furniture manufacturers are pushing sit-stand workstations as a way of improving cardiovascular health - but there is no scientific evidence to support this recommendation."
 

Last Updated on Friday, 23 November 2018 14:15
 
Patient Satisfaction: Who is Rating the Ratings? Print E-mail
Written by Skeptical Scalpel via KevinMD   
Wednesday, 07 November 2018 00:00
 
Everything is being rated these days. But who is rating the ratings? As a public service, I have been blogging about the shortcomings of various rating systems since 2010. Two recent papers on this topic are worthy of review.

In a randomized controlled study, investigators from the University Hospital of M√ľnster, Germany found that medical students who were provided cookies during academic course sessions rated the experience significantly higher than students who did not receive cookies....

<Meanwhile> A research letter from the Cleveland Clinic published in JAMA Internal Medicine looked at over 8,400 patient encounters for respiratory tract infections involving 85 telemedicine doctors and found 66% resulted in an antibiotic being prescribed. The estimated prevalence of bacterial acute respiratory tract infections in outpatients is low. A substantial number of the antibiotics prescribed by telemedicine physicians were probably unnecessary. Physicians received 5-star ratings from 91% of patients who were prescribed antibiotics and 86% of those who received a non-antibiotic drug prescription. When no drugs were prescribed, 72% of patients gave 5-star ratings, a significant difference.

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Last Updated on Friday, 09 November 2018 14:14
 
Female Physicians and the Fiberglass Ceiling Print E-mail
Written by Torie Sepah, MD | KevinMD   
Friday, 28 September 2018 12:35
 
A male physician - one who sits on multiple committees at a large hospital in Dallas - was recently quoted in the Dallas Medical Journal, that female physicians earn less, and they "choose to or they simply don't want to be rushed." Adding, "most of the time, their priority is something else ... family, social, whatever." I should be astounded that a colleague, in 2018, who appears to be about my age, would think so concretely, let alone state it publicly as though he's commenting on a breed of dogs ( "... the female Yorkies tend to shy away from true terrier traits, they are not as hard-working").

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Last Updated on Friday, 28 September 2018 12:45
 
Growing Up with Women in Emergency Medicine Print E-mail
Written by Kathleen Stephanos, MD | KevinMD   
Tuesday, 07 August 2018 17:22
 
I come by many things in my life naturally - my stubbornness, my red hair and my career. I am very fortunate. Unlike many, I am the daughter of a female emergency physician. This is something I never really considered while growing up. Yes, my mom was a doctor. Did she save lives? I guess so. She didn't spend  much time talking about life outside of the home and she was still present for many holidays, birthdays, etc. All I knew was that someday I too would be a doctor. When I refused to set foot in the ED (where she worked and I had visited many times), she simply brought the supplies home to repair my lacerated chin. When I had a fever and abdominal pain, I recall the look in her eyes when she recognized my appendicitis. But, that was life in our home. She did not bat an eye when we injured ourselves because she'd seen worse.
 
After attending an all-female high school, she went on to join the first class at Loyola College of Maryland (now Loyola University) to allow women, attended University of Maryland for medical school and ultimately became board certified in Emergency Medicine (which was not an available residency when she trained).
 
 
Last Updated on Tuesday, 07 August 2018 17:24
 
What if a Study Showed Opioids Weren't Usually Needed? Print E-mail
Written by Aaron Carroll, MD, MS   
Thursday, 26 July 2018 00:00
 
Promising health studies often don't pan out in reality. The reasons are many. Research participants are usually different from general patients; their treatment  doesn't match real-world practice; researchers can devote resources not available in most physician offices. Moreover, most studies, even the gold standard of randomized controlled trials, focus squarely on causality. They are set up to see if a treatment will work in optimal conditions, what scientists call efficacy. They're "explanatory."
 
 
Last Updated on Friday, 27 July 2018 16:10
 
Is there a case against shared decision making? Print E-mail
Written by Michel Accad, MD | KevinMD   
Tuesday, 24 July 2018 18:09
 
In a matter of less than a decade, "shared decision-making" (SDM) has emerged as the uncontested principle that must inform doctor-patient relationships everywhere. Consistently lauded by ethicists and medical academics alike, it has attracted the attention of the government which is now threatening to penalize doctors and patients who do not participate in SDM prior to providing certain treatments, even if the legal process of informed consent has been fulfilled - and even if the treatment is widely considered to be clinically justified.
 
For example, in a recent issue of JAMA, an editorial approvingly reports that the Center for Medicare and Medicaid Services will soon refuse to pay physicians and hospitals for the implantation of cardioverter-defibrillators unless the decision to implant these life-saving devices was "shared" with the patient. Although the announcement is short on details regarding the formal process by which SDM must be documented to have occurred, the new policy certainly testifies to the unquestioned status SDM has rapidly acquired as a general principle of medical ethics.
 

Last Updated on Tuesday, 28 August 2018 13:53
 
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