Friday, March 30, 2007

Still more cogent critcism of P4P and guidelines that ignore risk adjustment

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Two important analyses are discussed in the March 30, 2007 posting on Health Care Renewal. They deal with the fantastically, overhyped goa...

Does ACP's proposal for Medical Home ignore the reality of how patients run their lives?

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I recently wrote about how P4P is very unlikely to work based on the way that patients run their lives and see various doctors. Exercising ...
Thursday, March 29, 2007

Guidelines-the mantra "treat to goal" re-shaping medical thought?

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Two things stimulated the thoughts that follow. The first was comments made by Dr. Jerome Groopman in the first chapter of his new book ...
Tuesday, March 27, 2007

The COURAGE trial-fewer PCIs down the road for stable angina

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The biggest news from the American College of Cardiology meeting in New Orleans(March 2007) has to be the results of the COURAGE trial. Thi...
Sunday, March 25, 2007

How doctors think and the importance of "check your premises"

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Jerome Groopman's new book , "How Doctors Think" has attracted a bit of media attention replete with a favorable write-up i...
Tuesday, March 20, 2007

Dueling ethical views in Archives Internal Medicine re: "tiered" health care systems

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In the March 12,2007 issue of the Archives of Internal Medicine, we find two differing views on the ethical status of a tiered medical care ...
Friday, March 16, 2007

More data showing why P4P will not work-planners undaunted

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A recent (free without subscription) article in the NEJM presents data that indicate that the reality of medical care in the U.S. is such ...
Wednesday, March 14, 2007

Momentum builds for use of aromatase inhibitors in estrogen positive breast cancer

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A recently published c linical trial provides more reason to prefer the aromatase inhibitors to tamoxifen in the treatment of estrogen posi...
Wednesday, March 07, 2007

Internists doing fewer traditonal internist procedures

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The results of a survey sent to 2500 general internist members of the American College of Physicians and replied to by 1389 indicate that in...
Thursday, March 01, 2007

Communication between Hospitalist and primary care physicians

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It has been so long since I functioned as a officist and a hospitalist -a role known at the time as an internist- that I read with conside...
2 comments:
Thursday, February 22, 2007

Family Practice may be joining Internal Medicine in identity crisis

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This recent commentary in a family practice journal speaks of a major attitudinal change in family practice . Recently trained Family doct...
1 comment:
Tuesday, February 20, 2007

Tight blood sugar control for ICU patients-stay tuned again

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Randomized clinical trials work best for discrete outcomes in well defined groups of patients. In studies involving more complicated, hetero...
Monday, February 19, 2007

Medical Knowledge Self Assesment Program (MKSAP) -one more time at least

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MKSAP 14 has been available for over a year and I finally could resist it no longer and ordered a hard copy of it.I have enjoyed/suffered t...
2 comments:
Wednesday, February 14, 2007

The efficacy-effectiveness phenomenon stirkes again-this time with drug eluting stents

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Our old friend,the efficacy-effectiveness phenomenon (EEP) can be found in the drug eluting stent (DES) controversy.The NEJM electronic iss...
Tuesday, February 06, 2007

A patient as "a fellow creature in pain"

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A reprint of a  no longer recent " A Piece of My Mind" section of JAMA should be handed out to all medical students. The title- ...
Tuesday, January 30, 2007

New Guidelines for Thromboembolic disease

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New guidelines for DVT and PE are appearing in the Feb. Annals Internal Medicine and the Journal of Family Practice and a overview of is fo...
Monday, January 29, 2007

Are SSRIs bad for the bones?

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In the January 22, 2007 issue of the Archives of Internal Medicine, Dr. J.B. Richards et al have written a paper providing evidence tha...
Saturday, January 27, 2007

Is endurance exercise bad for the right ventricle?

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For someone who recently finished his 50 th marathon, (with a - modestly put- incredible comeback from a mysterious orthopedic disability) t...
Wednesday, January 24, 2007

Hand off problems or lack of personal responsibility by physician

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Here is an interesting and alarming story of what went wrong at teaching hospital allegedly because of problems in the system of "ha...
6 comments:
Tuesday, January 23, 2007

Heuristics invaluable but need to be understood and monitored

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I was impressed by and wrote about an article by Dr. Croskerry who has studied how physicians think and how they can think better diagnos...