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Sunday, July 31, 2005

House Passes Malpractice Bill

The House has passed a $250,000 cap on non-punitive awards...for the third time. Let's see if the Senate will take action this time around.

A story can be found on CNN.com.

It's a Crazy, Crazy, Crazy...

...world.

I start on Monday with a clinical skills/ethics class and then gross. I read through the first part of my syllabi for this ethics course and have become very inticed by ethics, which I have certainly not studied prior.

Consider the following quotes from the syllabi and the notes I've written in the margin.

  • "In return for their committment and service, health professionals receive certain benefits from society." -- Do we truly recieve such benefits because of our committment and service? I find it extremely hard to believe that physician's are allowed the privilige of self-regulation as a reward for their committment to society.
  • "...not to have compassion is to treat the patient as an object, as simply a particular instance of a disease process. The patient is divested of the rich particulars of age, gender, race, values, occupation -- of those particulars that define us as persons and give us identity." -- And so? There's a case that completely divested interest makes a physician more objective and better in curing the patient. It seems incredibly new age to think that a physician must cure a patient's spirit along with his or her body. If I had to make a choice between a skilled procedural clinician or one who treated me with compassion...uh...I'd take the skilled physician any day of the week.
  • "Conflicts of conscience sometimes emerge in healthcare because people regard as unethical some role obligation or official order that descends from a hierarchical structure of authority. In cases of refusal, the individual need not rebuke others or obstruct them from performing an act, but only say, 'Not through me'." -- I'm confused by this. There will certainly be an ethical argument later in this course that there is no distinction between a sin of omission and one of comission. Where however is the line drawn? It is unethical to watch someone get mugged and not call for help but it's okay, if I am opposed to it, to sit around and watch another doctor take out a comatose patient's feeding tube as long as I don't do it myself. That seems a little off base...
I'll post Monday after my first day of class.

Monday, July 25, 2005

It Begins

I had my white coat ceremony on Sunday and my first day of orientation today. Unfortunately, I'm heading out to meet more of my classmates. More posts on my moving white coat ceremony pending.

Saturday, July 23, 2005

MCAT Gets Digital

The MCAT will be taken entirely on a computer.

Seems like a good idea which will improve test security and integrity, as well as speed up the test day and the turn around time for students and medical schools to get the test scores.

Can America Compete With China?

Fortune asks and answers whether a new 'crisis of confidence' is different than America's fear of a growing Japanese economy in the 1980s.

I think a decline in quality of life, wealth, and loss of American political influence abroad is inevitable before my retirement age if America can't change it's economic relationship with the developing world.

Seattle and Mt. Ranier
















Thursday, July 21, 2005

Negligent

I've been woefully away from my computer. I have no news topics to write about.

I will share with the world however that I met and went out with about 30 of my future classmates last night. Amazing time. I love some of these guys already...they all seem great.

I'll be back over the weekend to discuss Judge John Roberts, Jr. (hooray for no filibuster!), electronic health records as Kevin, M.D. has here, and on how a brain dead woman's fetus could possibly survive.

I'll post before the big day -- my White Coat Ceremony -- on Sunday.

Saturday, July 16, 2005

Texas Tort Reform

Here's a blip in Internal Medicine on tort reform success in Texas. It's a fluff piece, but at least provides some quotes on the necessity of tort reform.

H/T to Kevin, M.D.

Orientation

I got my orientation schedule today, online, even though I'm in Seattle.

It's an all day thing Monday - Wendesday, however after that I'm a little bit concerned. I want to be sociable and continue to meet my new classmates, but there's little reason for me to be on campus Thursday or Friday for very long. A single "optional workshop" relates to me seeing as I have no kids, am not married, am not gay, etc.
As well, since I already live near my medical school, I've taken the time to do things like get my ID badge and parking permit which the orientation schedule actually have booked out.

In any case, I can't believe how quickly it is coming up.

Thursday, July 14, 2005

Trip

8 Days & I've taken a couple days off work to experience at least a little bit of summer vacation. I'll post before my white coat ceremony however.

Saturday, July 09, 2005

The Opposite Sex

An Observation From Wandering The Halls of My School: There are cute girls in medical school. And you know they're smart.

Friday, July 08, 2005

Faulty Malpractice Study

I was going to ignore this, but it's appeared on too many news sites. The CJD, a law advocacy group with Erin Brokovich on it's Board of Directors and a quote from Michael Moore on their website (the stuff of credibility), has released a study "showing" that malpractice premiums have increased over the past several years even as payouts have declined.

As Kevin, M.D. has said, Point of Law "rips this study a new one."

I don't know how anyone can say an industry in which the single largest supplier simply stops supplying is in good shape. If Microsoft stopped making an operating system or General Motors stopped making personal automobiles, people would notice. In 2001 St. Paul didn't sell or spin off it's medical malpractice division, it simply decided it wasn't going to write any new policies or renew their current policies when they expired. It pulled out of the medical malpractice insurance business with barely a peep.

This insurance company was the largest medical malpractice underwriter in the nation and derived a considerable portion of it's gross from the business. And yet, underwriting malpractice claims was so unprofitable, it simply stopped doing it. If insurance companies are gutting doctors where are the new companies in this highly profitable business? Has any trial lawyer even taken 'Introduction to Economics'?

Thursday, July 07, 2005

HIV & Circumcision

Circumcision may lower the risk of HIV infection while having heterosexual sex with infected women by 70%. Wow.

God Be With The Brits

Wednesday, July 06, 2005

Academic Medicine's Finances

Health Care Renewal has taken the time to bash Hermann Memorial, the main teaching hospital for the University of Texas Medical School at Houston, for trying "to increase [their] exposure to paying customers."

I'm tired and my response seems unfocused. I suffer from that sometimes, however, I've quoted my comment on HCR's site below:

You were incredibly hard on Hermann in your post. Academic community teaching hospitals are in horrific financial shape.

It really is an issue that needs to be in the mind of physicians, even those not intimately involved in academia. Teaching hospitals account for less than 20% of all U.S. hospitals and yet are burdened well over half of non-payment patients. To further complicate the issue, they perform the highest risk lowest profit procedures because no one else will do so.

Consider, speciality hospitals. For the sake of a hypothetical we'll go with heart hospitals. These non-teaching, for profit centers do plenty of high profit CABGs, and despite the comparative ease of the procedure, the fact they have so much experience with them means people choose them over the non-profit academic options.

What the for profit centers don't take is complicated low profit procedures, which often go hand in hand for three reasons -- reimbusement doesn't rise quickly enough, poor out come expenses (longer hospital stays, lawsuits, etc.) are associated with complicated procedures, and those complicated procedures are more likely to be associated with low income, even indigent, individuals. So the for profit centers take all the healthy paying patients but probably don't see a whole lot of complicated congenital heart surgeries.

This trend can be broadened to all specialties. Sadly comparatively simple high profit procedures are the only thing allowing the academic health center to break even in the first place.

I applaud Hermann's candor in trying to improve their financial situation by bringing in healthy, paying customers. In the end, only a stable financial situation can guarantee quality healthcare for those who cannot pay.

Entitlement

There was an older gentleman checking out from the clinic I work at today. He was on Medicare and was peeved at the twenty dollars he owed as a deductible. For outpatient services patients pay a yearly deductible of $110.00.

This man had already paid that but failed to realize he owed 20% of every office or most outpatient tests after he had met the $110.00. The man was ranting about how much money that was but the thing is there was a cell phone clipped to his pant pocket. I sat there and thought, there's no way that guy's cell phone bill is less than $20 a month.

Another example -- a mother bringing in a child covered by a state Medicaid program. As heartless as it sounds, she needed to be dressed worse. Maybe she didn't buy the clothes, they were a gift, or there's another scenario of explanation. Clearly she didn't need to dress nice to find a job, cause if she's making so little she qualifies for Medicaid then the clothes clearly have failed her already.

I know everyone is not like this. I know it sounds like I'm heartless, but like Mark Twain said...

To extend my two observations out, I just think that people make financial choices for things above their healthcare. Not everyone but more of this country can afford to be insured, than are, and instead they buy a $25,000 car. That's not overtly expensive but if they'd spent 15 grand instead, there'd be no argument over the government helping their family out with their health insurance cause they'd be able to afford it.

Tuesday, July 05, 2005

Less Than 20 Days

19 days, until the beginning of the future.

Sunday, July 03, 2005

Pharmaceutical DTC Advertising

Direct-to-Consumer advertising, television and print ads for prescription drugs, have been blasted by physicians and their policy arms for the past several years. They feel, and some evidence supports this, that ads effect the inappropriate prescribing of drugs.

Take this as a typical case -- a patient sees an ad for Vioxx; previously diagnosed with arthritis the patient becomes convinced the drug will better manage her pain; the patient asks her doctor about it; although the doctor has reservations about the drug's potential side effects he is so busy and so afraid that the patient will simply move to another doctor that he gives it to her.

Recently even Sen. Frist has come out for restrictions on DTC. The trouble is, this really isn't a matter of irresponsibility amongst the drug companies, it is one amongst physicians. There are legitimate uses for direct to consumer advertising of prescription drugs and it would be a failure of the judicial system if it didn't see any attempt to restrict such as a violation of the first amendment. I understand that their are limits to such speech rights and that the argument is that the drug companies are overstepping their boundaries, and almost 'giving medical advice' by running these ads. I simply don't believe such a threshold has been met, especially when physicians themselves seem to be skirting their own responsibility whenever a patient shows up asking for a certain drug. If you read some of the Op/Eds on the issue you'd imagine that the defense, "She's just going to get it somewhere else," is a legitimate one. Try imagining a junkie coke dealer saying the same thing in court...

However much more time it consumes of a physician's day, they need to do two things to firm up their own responsibility in this matter. First, despite evidence drug companies have a giant hand in studies of their drugs, become informed on the unbiased studies surrounding popular prescription drugs. Two, have the resolve to tell a patient 'no', and explain yourself, even if the consequence is the loss of such a patient.

It is irresponsible to limit the rights of others, even if they are faceless billion dollar corporations, just because physicians feel too 'burdened' to deal with their end of this problem. Anyway, that's a libertarian take on the situation.

You can read more on Sen. Frist's leap into the debate at Med Rants.

Saturday, July 02, 2005

Fixing Eminent Domain

The Supreme Court decision broadening eminent domain was one step from activism. The court didn't order the government to do something, but it broadened it's powers significantly in order to allow it to.

Luckily, the Republican controlled house understands the importance of property rights. The new measure restricts the use of federal dollars to build transportation projects on land gathered through eminent domain. Granted, this doesn't help the citizens of New London's waterfront but considering the most common use of eminent domain was the seizure of land for roads and light rails and highways, over the past half century, I think it'll put a dent in the practice.

Friday, July 01, 2005

Malpractice Verdicts Hit Home