Sunday, June 17, 2007

Criminal actions against MD's further complicated treatment of Chronic Pain patients

MD be aware of treatment of chronic pain patients. In the emergency department (ED) we know all too well the presentation of a chronic pain patient who shows up on the weekend or after office hours complaining of pain and inability to reach their pain specialist or their primary care doctor.

Its hard to prove or disprove anything regarding chronic pain in the quick encounters we have in the ED. This story in the Sunday NY Times magazine is a frightening tale of one pain specialist who was sentenced to 30 years in prison for what appears to be treating chronic pain in a manner he deemed clinically appropriate. He was perhaps eccentric, disorganized in his record keeping, and unconventional is his dosing practices, but was he a criminal?

Click the link and read this engrossing cover story.

Ethylene Glycol poison in OTC med kills dozens of Haitian Children

Click on the link above for the second article in the NY Times regarding tainted glycerin exported from China to countries all over the world which over the past 10-15 years has resulted in many deaths (hundreds, perhaps thousands).

This series is frightening from the perspective of an emergency medicine physician. If this happened in my town would I be astute enough to pick up on it. Luckily the FDA has been applying some simple tests to pharmaceutical raw materials to test for dangerous ethylene glycol contamination. But for the international crowd or border crowd someone who walks in with a bottle of cough syrup purchased from outside the USA and signs of ethylene glycol toxicity then beware.

Thursday, May 31, 2007

Doctor Foils A Malpractice Suit By Blogging

A pediatrician under a pseudonym posted blog entries about a malpractice suit. Reports state that the physician made derisive comments about the plaintiffs and jury. This ill considered blogging practice by the physician led to him being confronted on the stand about his blog entries and admission as to the pseudonym used.

Shortly after admitting to being the source of the blog commentaries the physician and his defense team were forced to settle the case for a significant sum. Moral: Think before you blog. Even if you think identities are protected.

Click on the link above to read the article in the Boston Globe.

Monday, May 28, 2007

Outbreak of Eye Infections Puzzles Officials

"Epidemiologists from the Centers for Disease Control and Prevention have linked the acanthamoeba keratitis outbreak to AMO Complete Moisture Plus Multi-Purpose Solution. Advanced Medical Optics of Santa Ana, Calif., manufactures the solution, which is used to clean and store soft contact lenses."

Lost Chances for Survival, Before and After Stroke

....Dr. Richard Burgess, a member of Dr. Warach’s stroke team, explained the situation: There is no particular penalty for not giving tPA. Doctors are unlikely to be sued if the patient dies or is left with brain damage that could have been avoided. But there is a penalty for giving tPA to someone who is not having a stroke. If that patient bleeds into the brain, the drug not only caused a tragic outcome but the doctor could also be sued. Few emergency room doctors want to take that chance....

Excerpt from the NY Times Article. Click link to read this article

Friday, May 18, 2007

Retail Clinics Acquired

National pharmacy chain Walgreen Co. has agreed to acquire retail clinic operator and partner Take Care Health Systems. The deal positions Walgreen to compete better with CVS/Caremark, which previously acquired retail clinic operator MinuteClinic. Take Care, which operates 50 clinics across the U.S., already runs some clinics at Walgreens locations. Walgreens will use the acquisition to power its upcoming retail clinic expansion. The chain plans to have more than 400 "Health Corner Clinics" running in its stores by the end of 2008.

While the deal's financial terms weren't announced, this probably didn't constitute a huge financial investment for Walgreens, which had 2006 sales of $47.4 billion. On the other hand, it suggests that Walgreen execs see retail clinics as strategic to the chain's future. Also, it suggests that savvy Hal Rosenbluth, chairman of Take Care, believes that retail clinics aren't going to be as successful going it alone. We would have predicted that Rosenbluth would grow Take Care further before selling it, but he may have decided that retail drug chains were going to control the business and cashed out while the getting was good.

Sunday, May 6, 2007

Ethylene Glycol and mass poisonings in OTC meds

Globally contaminants in medications becomes a growing issue. This fascinating article in the NY Times explores the case of a Chinese factory which exported diethylene glycol tainted glycerin later used to make cough syrup. The result was tragic.

Its a good read. Click the title to link to the article.

Friday, April 6, 2007

U.S. Hospital Errors Continue to Rise

The fourth annualHealthGrades Patient Safety in American Hospitals Study, put out by HealthGrades, an independent health care ratings company, examined over 40 million Medicare hospitalization records at almost 5,000 hospitals from 2003 to 2005.

Friday, March 30, 2007

Hospitals, clinics, Wake to track uninsured patients

There appears to be a trend in the nation. County and state governments are tackling the cost crisis of health care and the uninsured. Creating systems that address the challenges not being addressed effectively by the federal government. This trend is promising. A better way has a greater chance of emerging.

Click on the title above to link to the article.

Tuesday, March 27, 2007

Medical malpractice insurance payouts increased as the insurance claims advanced through the legal system

ADVANCE FOR RELEASE AT 4:30 P.M. ET Bureau of Justice Statistics
SUNDAY, MARCH 25, 2007 Contact: Stu Smith 202/307-0784
www.ojp.usdoj.gov/bjs After hours: 301-983-9354

MAJORITY OF MEDICAL MALPRACTICE CLAIMS IN SEVEN STATES
CLOSED WITHOUT COMPENSATION PAYMENTS

WASHINGTON – The majority of medical malpractice claims in a study of seven states were closed without any compensation paid to those claiming a medical injury, the Justice Department’s Bureau of Justice Statistics (BJS) announced today.

BJS conducted a study of medical malpractice insurance claims that were closed from 2000 through 2004 in Florida, Illinois, Maine, Massachusetts, Missouri, Nevada and Texas. These states were identified as having comprehensive medical malpractice insurance claims databases, some of which extended back to the early 1990s. An examination of closed medical malpractice insurance claims allows for a broad overview of some of the key issues associated with medical malpractice.

About one-third of the medical malpractice insurance claims closed in Maine, Missouri and Nevada resulted in a payout. In Illinois about 12 percent of closed claims ended in a payout.

Few medical malpractice insurance claims produced payouts that exceeded $1 million. Less than 10 percent of the claims in Florida, Maine, Missouri and Nevada had payouts of $1 million or more. In Florida, Maine and Missouri, about two-thirds of the claims were closed with insurance payouts of less than $250,000.

Among persons receiving compensation, insurance payouts were highest for claimants who suffered lifelong major or grave permanent injuries. In Florida and Missouri, claimants with these types of injuries received median payouts ranging from $278,000 to $350,000. Insurance payouts were lowest for claimants who suffered temporary or emotional injuries. In Florida and Missouri, claimants who suffered these types of injuries received median payouts ranging from $5,000 to $79,000.

Medical malpractice insurance payouts increased as the insurance claims advanced through the legal system. Payouts were typically lowest for claims closed prior to the filing of a lawsuit and highest for claims closed after trial. In Florida, Nevada and Texas, claims decided by trial resulted in median payouts that were at least two and a half times larger than claims that were settled. Claims closed after a trial also cost more for insurance firms to defend than claims settled at or prior to a trial. In Florida, Nevada and Texas, 95 percent or more of medical malpractice claims were settled prior to a trial decision before a jury or judge.

The median damages paid to medical malpractice claimants have increased since the early to late 1990s. In Missouri, for example, the median insurance payouts grew from $33,000 in 1990 to $150,000 in 2004. During the various time periods covered by these insurance claim databases, median payouts also increased by 57 percent in Massachusetts, 49 percent in Illinois, 36 percent in Florida, 26 percent in Nevada and 27 percent in Texas.

In general, claimants did not file medical malpractice claims with insurance companies immediately after an injury. In Florida, Missouri and Texas, medical malpractice claims were filed with insurance companies an average of about 15 to 18 months after injury. After the claim was received, it took an average of 26 to 29 additional months to close the claim in these states.

The report, Medical Malpractice Insurance Claims in Seven States, 2000 – 2004 (NCJ-216339), was written by BJS statisticians Thomas H. Cohen and Kristen A. Hughes. Following publication it can be found at http://www.ojp.usdoj.gov/bjs/abstract/mmicss04.htm.

For additional information about the Bureau of Justice Statistics statistical reports programs, please visit the BJS Web site at http://www.ojp.usdoj.gov/bjs.

The Office of Justice Programs (OJP) provides federal leadership in developing the nation’s
capacity to prevent and control crime, administer justice and assist victims. OJP is headed by an Assistant Attorney General and comprises five component bureaus and an office: the Bureau of Justice Assistance; the Bureau of Justice Statistics; the National Institute of Justice; the Office of Juvenile Justice and Delinquency Prevention; and the Office for Victims of Crime, as well as the Community Capacity Development Office, which incorporates the Weed and Seed strategy and OJP’s American Indian and Alaska Native Affairs Desk. More information can be found at http://www.ojp.usdoj.gov.

Friday, March 23, 2007

Brain Injury Said to Affect Moral Choices

I know some people in the business that arguably have some of these lesions. Some are practitioners and others are patients. Again a fascinating glimpse into the forces that drive humans and the hardwired features of the human being.

Thursday, March 22, 2007

Japan Warns on Tamiflu for Teens

What are the important safety issues and adverse events?

When Tamiflu was studied in clinical trials as treatment for children with influenza, children taking Tamiflu experienced similar side effects as children not taking Tamiflu. Serious side effects were not identified. The most common side effects observed in both the treatment and prophylaxis trials were nausea and vomiting. In these trials, a small number of children stopped taking their Tamiflu because of nausea and vomiting or other adverse reactions.

In the safety review mandated by the BPCA, a number of adverse event reports were identified associated with the use of Tamiflu in children 16 years of age or younger. These adverse event reports were primarily related to unusual neurologic or psychiatric events such as delirium, hallucinations, confusion, abnormal behavior, convulsions, and encephalitis. These events were reported almost entirely in children from Japan who received Tamiflu according to Japanese treatment guidelines (very similar but not identical to U.S. treatment guidelines). The review identified a total of 12 deaths in pediatric patients since Tamiflu's approval. All of the pediatric deaths were reported in Japanese children. In many of these cases, a relationship to Tamiflu was difficult to assess because of the use of other medications, presence of other medical conditions, and/or lack of adequate detail in the reports.

The review also identified severe skin reactions (like allergic reactions) in some pediatric patients. These events were not all reported in Japanese children and have also been reported in adults. Severe skin reactions in all age groups are currently being reviewed in more detail.

Source: http://www.fda.gov/cder/drug/infopage/tamiflu/QA20051117.htm

Wednesday, March 21, 2007

Health Care Administration Consumes Nearly One-Third of Health Care Costs, Say Hospitals and Insurance Companies


-Nationwide survey finds patients want increased efficiency, greater transparency-

PITTSBURGH, March 20 /PRNewswire-FirstCall/ --

Administration associated with health care claims and billing accounts for nearly one out of every three dollars that patients spend on health care, according to a nationwide survey of executives from hospitals and insurance companies.

In contrast, more than three-quarters (76 percent) of the U.S. consumers surveyed said they think that health care administration should account for just 10 percent or less of total health care costs, with a large majority indicating they would be "highly upset" if those administrative costs were as high as 30 percent. Approximately eight in 10 consumers (79 percent) said they would like to see an itemization of the portion of their health care bills that goes to administration versus clinical care.

The health care industry survey of 200 hospital and insurance company executives and 1,000 U.S. consumers was commissioned by The PNC Financial Services Group, Inc., (NYSE: PNC) (http://www.pnc.com) and conducted by the independent research firm Chadwick Martin Bailey.

"While it is possible that consumers do not fully appreciate the cost and complexity of health care administration, hospital and health plan executives identified significant inefficiencies in the business office, describing a medical claims, billing and payment process that is error prone, redundant and costly," said Paula Fryland, executive vice president and manager of PNC's national health care group (http://www.pnc.com/go/presskits).

Additional survey results include:

- Hospital executives reported that one in five claims submitted, on average, is delayed or denied and 96 percent of all claims must be submitted more than once.

- Hospitals that do not use electronic billing or claims submission processes reported, on average, resubmitting a claim 11 times or more, or nearly four times more than those hospitals using electronic processes.

- Insurance executives surveyed said they go back to hospitals two times,on average, to get all the information needed to pay a claim.

- Nearly a quarter of consumers reported having had a legitimate claim denied by their health plan; one in five ultimately paid the claim out of their own pocket.

Improving Efficiencies Impacts Costs and Patient Care Nearly three-quarters of executives from hospitals and two-thirds of executives from insurance companies indicated that making the claims, billing and payment process more efficient throughout the health care system would help slow the rising cost of health care in the U.S.

Similarly, nearly three- quarters of consumers (72 percent) agreed.

Additional findings include:

- When asked how much could be saved annually if they had a more efficient claims, billing and payment process, one-third of hospital and health plan executives both said their organizations could save at least $1 million a year.

- The benefit of automated processes most often cited by insurance executives was that claims processing time significantly reduced, and 63 percent said that customer satisfaction had improved.

- When asked where the cost savings would be applied, the area most often cited by hospital executives was "reinvested in improving patient care."

Health Care Consumerism and Transparency

"Health care consumerism is an emerging trend that transfers more decisions regarding health care choices, as well as responsibility for payments, back to the patient," said Fryland. "The survey supports that this growing trend will result in consumers seeking more information about their health care costs. And, both hospital and insurance executives agreed that the demand for transparency will focus on administrative overhead costs that will ultimately root out inefficiencies."

In addition, the survey findings include:

- Nearly three-quarters of hospital executives surveyed (72 percent) expect high deductible health plans, which require consumers to pay more upfront costs for care out of their own pockets, to add another layer of complexity to the claims, billing and payment process.

- More than half (58 percent) of consumers said that knowing what hospitals or doctors charge for treatment and what insurers are paying for their services would influence where they seek care.

- A majority of consumers (83 percent), hospitals (77 percent) and insurance executives (60 percent) responded that insurance companies should disclose what they reimburse for medical services.

Survey Methodology

The PNC e-Health Study was conducted by the independent research firm, Chadwick Martin Bailey, based in Boston, Massachusetts. The study was based on telephone interviews conducted with 150 executives from U.S. hospitals or health systems, 50 executives from insurance organizations and an online survey of 1,000 U.S. consumers. The survey was completed in February 2007.
A PNC e-Health Study media kit containing survey highlights and background information is available through PNC's website at http://www.pnc.com/go/presskits.

For over a decade, PNC has been helping health care providers and insurers re-engineer workflows and reduce the costs associated with handling massive volumes of monthly transactions. PNC currently processes about 3.5 million health care transactions per month for more than 500 hospitals through established connectivity between hospitals, physician groups, pharmacies and their respective payers nationwide.

The PNC Financial Services Group, Inc. (http://www.pnc.com) is one of the nation's largest diversified financial services organizations providing consumer and business banking; specialized services for corporations and government entities, including corporate banking, real estate finance and asset-based lending; wealth management; asset management and global fund services.

SOURCE The PNC Financial Services Group, Inc.

For the Entrepreunerial Minded Physicians

Center for Venture Research

March 19, 2007

Contact: Lori Wright

UNH Media Relations

603-862-0574

lori.wright@unh.edu

ANGEL MARKET GROWS 10 PERCENT IN 2006

Healthcare Sector Most Popular With Investors

DURHAM, N.H. -- The angel investor market experienced steady growth in 2006, with total investments of $25.6 billion, an increase of 10.8 percent over 2005, according to the 2006 Angel Market Analysis released today by the Center for Venture Research at the University of New Hampshire.

A total of 51,000 entrepreneurial ventures received angel funding in 2006, a 3 percent increase from 2005. The number of active investors in 2006 was 234,000 individuals. The sharp increase in total investment dollars was matched by a more modest increase in total deals, resulting in an increase in the average deal size of 7.5 percent, compared to 2005. This continued rise in total investments points to a healthy angel market.

“If the angel market is to achieve sustainable growth, there needs to be a reasonable augmentation in active investors, and thus, level of participation is an important consideration. While the number of angel organizations, and individuals that are members of organized angel groups, is increasing, there is a larger percentage of latent angels (individuals who have the necessary net worth, but have not made an investment),” said Jeffrey Sohl, director of the UNH Center for Venture Research at the Whittemore School of Business and Economics.

As in 2005, healthcare services, and medical devices and equipment accounted for the largest share of angel investments, with 21 percent of total angel investments in 2006, followed by software (18 percent) and biotech (18 percent). The remaining investments were approximately equally weighted across high-tech sectors.

“Since the angel market is essentially the spawning ground for the next wave of high growth investments, this sector diversification provides an indication of investment opportunities that will be available for later stage institutional investors,” Sohl said.

Angel investments continue to be a significant contributor to job growth with the creation of 201,400 new jobs in the United States in 2006, or four jobs per angel investment. However, this tracks jobs created at the time of the angel investment and thus it is likely that this job creation of 201,400 is the minimum number of jobs created by angels in 2006.

“Since the angel investment is used by the venture to fuel growth, launch new products and explore new markets, it is highly likely that the number of jobs created by the angel investment will increase as the firm grows,” Sohl said.

Angels continue to be the largest source of seed and start-up capital, with 46 percent of 2006 angel investments in the seed and start-up stage. This preference for seed and start-up investing is followed closely by post-seed/start-up investments of 40 percent. According to the analysis, this appetite for post-seed/start-up investing continues a trend that began in 2003 and represents a 10 percent increase in historical levels. Given the four-year trend, angel seed and start-up stage investments in the 45 percent to 55 percent range appears to be the reasonable range for the foreseeable future, according to the analysis.

“While angels continue to represent the largest source of seed and start-up capital, market conditions and the capital gap in the post seed investing stage are requiring angels to engage in more later-stage investments. New, first sequence, investments represent 63 percent of 2006 angel activity, indicating that some of this post seed investing is in new deals. This restructuring of the angel market has in turn resulted in fewer dollars available for seed investments, thus exacerbating the capital gap for seed and start-up capital in the United States,” Sohl said.

In 2006 women angels represented 13.8 percent of the angel market. Women-owned ventures accounted for 12.9 percent of entrepreneurs seeking angel capital, and 21.5 percent of these women entrepreneurs received angel investment in 2006. Minority angels accounted for 3.4 percent of the angel population, and minority-owned firms represented 6.9 percent of entrepreneurs who presented their business concept to angels. Compounding this low participation rate, the yield rate for minority-owned firms was 7.1 percent, which is close to two-thirds below the general yield rate.

The Center for Venture Research (CVR) has been conducting research on the angel market since 1980. The CVR’s mission is to provide an understanding of the angel market and the critical role of angels in the early stage equity financing of high growth entrepreneurial ventures. Through the tenet of academic research in an applied area of study, the CVR is dedicated to providing reliable and timely information on the angel market to entrepreneurs, private investors and public policymakers.

Tuesday, March 20, 2007

AMA asks Justice Department to block takeover of Sierra Health Services

To my surprise the AMA has asked the Department of Justice to block a merger between insurance companies in Nevada stating it would represent a near monopoly and would undermine care for patients and physician ability to negotiate terms with the insurance companies.

Click it, link it above....

Monday, March 19, 2007

Allina, Fairview settlement could mean discounts for some uninsured

A local health care system in Minneapolis has been mandated to discount care for the uninsured. We all know there is the bizarre practice in the business of medicine with regard to discrepancies between medical charges and collections. This has always intrigued me. I would love to have my plumber send me a bill then have a third party negotiate with him to pay only forty percent of the bill. Essentially that is the role of the insurance companies, third party price negotiators.

Unfortunately the uninsured have no negotiating leverage, hence the hospital collections arms can aggressively pursue collections at percentages that even insurance companies don't pay. I am not so sure this is a big problem in my neck of the woods. In fact I think the opposite is true in the majority of systems across the nation, but I have to source to support it.

Click above link to read the article..

Is Dr. Blogger telling too much?

Some food for thought about medical blogging. Click the title above to link to the on-line article.

Sunday, March 18, 2007

Hospital Group Offers Plan on Health Coverage for All

HCA cared for over 1 million uninsured patients in their emergency departments nationwide and spent over $1 billion doing it. Caring for the uninsured is costing hospitals about $40 billion a year nationally.

Click and Link a look at the article.

Saturday, March 17, 2007

Without Mouth-to-Mouth, CPR Still Works

This is an interesting debate, but I wonder if it really matters in the practical world.


Click title above to link it out...

Friday, March 16, 2007

FDA Clears Rapid Test for Meningitis

This was released to the Associated Press today.


FDA News

FOR IMMEDIATE RELEASE
P07-46
March 16, 2007

Media Inquiries:
Karen Riley, 301-827-6242
Consumer Inquiries:
888-INFO-FDA


FDA Clears Rapid Test for Meningitis

The U.S. Food and Drug Administration (FDA) today cleared for marketing a test that uses molecular biology to quickly detect the presence of viral meningitis.

The Xpert EV test, when used in combination with other laboratory tests, will help physicians distinguish between viral meningitis and the less-common, but more severe, version of meningitis caused by bacteria.

Meningitis is an infection of the cerebrospinal fluid surrounding a person's spinal cord and brain, causing inflammation of the tissues in these areas. The illness is diagnosed by testing the fluid obtained from a patient during a spinal tap. Typically, diagnostic tests for meningitis can take up to a week to get results. But results from the Xpert EV test are available in two and one-half hours.

"Because this test is significantly faster than existing methods for diagnosing meningitis, it could minimize delays in treating patients. Swift recognition of the cause and appropriate treatment is critical to patient recovery," said Daniel Schultz, M.D., director of the Center for Devices and Radiological Health. "Since bacterial meningitis can be deadly within as little as two days, patients who have viral meningitis are frequently treated with antibiotics as a safeguard against the more dangerous bacterial meningitis. This test should help physicians manage patients appropriately and prevent unnecessary treatment with antibiotics."

Knowing whether the meningitis is viral or bacterial is imperative to early effective treatment. But distinguishing between the two types of infection is difficult because of similar symptoms. Patients with viral meningitis usually recover within two weeks without any medical intervention. Bacterial meningitis, however, can lead to brain damage, hearing loss and even death if not treated properly.

For patients over two years of age, symptoms of meningitis include fever, severe headache, stiff neck, nausea, sleepiness, confusion, and sensitivity to bright lights or seizures. These symptoms may be absent or difficult to detect in newborns and small infants who may only appear slow or inactive, or be irritable, have vomiting or feed poorly.

The Xpert EV test is the first fully-automated medical diagnostic test that isolates and amplifies viral genetic material present in a patient's cerebrospinal fluid by a process called reverse transcription-polymerase chain reaction. The test identifies infection resulting from a class of viruses known as Enterovirus, which are responsible for approximately 90 percent of all viral meningitis cases.

The Xpert EV test is performed by adding the sample directly to a disposable, single-use cartridge. The cartridge is loaded into the GeneXpert DX instrument which then conducts all the necessary laboratory procedures in a one-step, easy-to-use format that helps minimize errors.

The accuracy of the Xpert EV test was confirmed in a multi-site study at six institutions. A total of 255 patient samples were tested and demonstrated that 96 percent of patients who tested positive did have viral meningitis, and that 97 percent of patients who tested negative did not have viral meningitis.

The Xpert EV test was developed by Cepheid, a company located in Sunnyvale, Calif.

Thursday, March 15, 2007

Death Rate Higher in Heart Attack Patients Hospitalized on Weekends, Study Finds

You may be working for the weekend, but get sick on the weekday. You'll be better off. This study opens the door to conversations about staffing and medical care during off-peak hours. Our evidence for this is empirically in the ED. Patients who present during normal business hours have quicker and greater access to a wider array of doctors and services. Getting people to do their jobs on a Saturday at 2:30 am isn't easy. You gotta love it. Good work from a 4th year medical student.

Click title and get linked.

Wednesday, March 14, 2007

F.D.A. Issues Warning on Sleeping Pills

Bizarre nocturnal behavior and severe allergic reactions.

Click, link and read the title above.

Tuesday, March 13, 2007

Neurolaw

If you haven't read this article its worth taking a look. The legal and neuroscience communities are collaborating on research which in the near future may impact not just the legal system, but science as well. And even perhaps all medico-legal interactions.

It is a fascinating detour into human behavior, personal responsibility and use of technology. I am waiting for the first patient in the ED to use the phrase,"Doc, my amygdala made me do it!!" Its just a matter of time.

Its a great article written by Jeffrey Rosen. Click the title and get linked.

Monday, March 12, 2007

Medical Blogs worth Exploring

This is a healthy list of blog sites to check out. They can be entertaining.


click the title and get linked.

C. diff rate tops 1,000 a month

Ohio local newspaper reports dramatic increase in C. diff rates of infection and a 325% increase in deaths from C. diff over 5 year period.

click the title for the link.

Sunday, March 11, 2007

The Difficult Patient, a Problem Old as History (or Older)

Some things never change. This is a somewhat interesting take/history about....

just click on the title and read.

Saturday, March 10, 2007

Brief Awakening From a Coma

I am never sure what to do with these type of articles in the news. There are so many factors that influence individual cases. Makes me think twice about the content and delivery of information I give to families of patients who are in a coma.

Thursday, March 8, 2007

U.S. Doctor and Daughter Sickened by Poison in Russia

A case of Thallium poisoning. Only in Russia.... or maybe not? This family could have landed in any ED upon traveling back home.


Click title above to link to the article.

Without Health Benefits, a Good Life Turns Fragile

Rising uninsured among the middle class. The future of medical care coverage will be about distributing risk and cost amongst the tax payers.

Click title above to link to article.

Warnings Over Privacy of U.S. Health Network

Concerns about the rise and push by the US government for electronic medical records.

Link to the NY Times article by clicking on the title above.

Wednesday, March 7, 2007

Nursing Shortage In Critical Stage

(CBS) American hospitals are in a serious crisis, from large numbers of uninsured patients to spiraling costs, from outlandishly expensive prescription drugs to a severe and dangerous shortage of nurses, a shortage that can best be summed up by the fact that there are now over 120,000 open positions for registered nurses nationwide.

Click the above title to link to the article on CBS 60 minutes web-site.

What's it cost?

There is information that doctors have not been good with. Anytime I am asked about price I usually say I have no idea. And thats the truth. I have no idea. Part of that ignorance lies in the fact that I like to do what is medically necessary without regard of cost, but the other part of the problem lies in the effort involved in getting an answer. Piercing the veil between the practice of medicine and the business and cost of medicine has become essential as government, business and society start to wrestle with the impressive cost of our health care system.

Also with over 40 million uninsured citizens walking around people like to do some shopping. I am amazed how many people will pay out of pocket. Emergent medical care will not likely be effected, but for places with busy (and profitable) Fast Track services this will lend some food for thought.

Click above and read about HCA's move to make cost more transparent.

Patient Surveys. Someone's got your stats...

Many hospitals across the nation use Press-Ganney surveys to measure patient satisfaction with their Emergency Department visit. You probably only hear about the results once every third full moon, but there is a profile assigned to your name. Someone is paying attention, even if its not you.

I find that the stuff that I complain about is in sync with patient complaints, but usually action to remedy the problems are variable and inconsistent at best. Well, add this a the long list of people and organizations following your stats and setting goals for you. The federal government is caring enough to link dollars, medicare dollars!, to hospitals tracking patient experiences. The information will be posted on consumer web-sites, which will allow people to vote with their feet.

The silver lining here is that this gives EM docs an opportunity to make long needed improvements and gain administrative support.... At least in theory.

Click the link on the title above to read the WSJ article.

The Hard Stick. Anyone heard of this?

If every problem presents opportunity then these guys are in the opportunity business. These technologies will someday be common place in the Emergency Department. I haven't had requests yet, but get ready I am sure you'll be hearing about them, perhaps by request. Spare your patients the blank stare. Take a look.

Click on title above to see Wall Street Journal article.

See a video: http://www.luminetx.com/video/Fox5NYC_Sm.wmv

http://www.luminetx.com/main/content.aspx?mnu=veinviewer