Archive for April, 2008

Is Guideline Tyranny Causing Guideline Anarchy? (Part I)

Wednesday, April 30th, 2008

The Tyranny of Guidelines
Anybody practicing medicine today needs to be serious about medical guidelines.
The original idea behind medical guidelines was to provide (oddly enough) a guide to physicians in caring for patients with a particular medical problem. That is, they suggested a generally preferred approach to medical care in view of current medical evidence, but […]

Posted in Guidelines, Abuse of | 3 Comments »

Visit the Grand Rounds Smack Down

Tuesday, April 29th, 2008

Doc Gurley, revealing herself to be something other than the sweet, demure, lady-like blogger we’ve always thought her to be, hosts Grand Rounds this week in what we can only surmise is her true guise, a hard-nosed, show-no-mercy maven of professional brawling.  DrRich is proud not only to have been included in this pugnacious posting, […]

Posted in Uncategorized | No Comments »

On Crying Doctors

Wednesday, April 23rd, 2008

The New York Times yesterday published an essay by Barron H. Lerner, MD, on the question of whether doctors ought to remain stoic at the bedside, or instead ought to openly display their emotions. Lerner himself seems neutral on this question, and offers arguments from both sides (i.e., the advantages on one hand of […]

Posted in General Rationing Issues | 7 Comments »

Never Events? Never Mind

Friday, April 18th, 2008

Medicare’s newfound passion for quality has found yet another avenue of expression.
A year ago the Centers for Medicare and Medicaid Services (CMS) announced it would no longer pay for the treatment of certain medical conditions that occur after patients have been admitted to the hospital. These conditions were:
* Bed-sores
* Two kinds of catheter-associated infections
* Air […]

Posted in General Rationing Issues | 5 Comments »

Smile When You Call Me Optimist

Monday, April 14th, 2008

In a previous post, DrRich gave his thoughts on the distressing condition of the American primary care physician (PCP), and described how the feds, the insurance companies, and the currents of history are conspiring to fundamentally devalue and disrupt their once-honored profession. Further, he attempted to describe some options that disaffected PCPs might explore which […]

Posted in New business models for healthcare, Primary Care in America | 4 Comments »

Primary Care: Time to Reboot

Tuesday, April 8th, 2008

American primary care medicine has entered into a period of change. “Change” is perhaps too mild a term; many - especially the primary care practitioners (PCPs) themselves - might call it a period of crisis. In any case it is change so profound that one might be forgiven for thinking Senator Obama is […]

Posted in New business models for healthcare, Primary Care in America | 19 Comments »

More Guidelines: What Are They Smoking?

Friday, April 4th, 2008

This is a heads-up for all you primary care doctors out there, who struggle during each and every patient visit to get through your Pay for Performance Checklist of Vital Healthcare Services (different checklists for different patients, of course, depending on their insurer), during the 7.5 minutes that the feds and the insurance companies have […]

Posted in General Rationing Issues, Primary Care in America | 8 Comments »