Why Do Physicians Over-test and Over-treat?
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Over-testing....why not?

What prompts physicians to over-test and over-treat patients?  This is a very big and important question, and I find it sometimes helps to make a list when I am trying to get my arms around this kind of multifactorial issue. This list isn’t an attempt to be complete or even statistically valid or evidence based, but it does reflect some of the thoughts and studies that have been published on this question. In no particular … Continue reading

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Posted in Bending the Cost Curve, Health Care Reform, Payment Reform | Tagged , , , , , , , , , , , , | Leave a comment

Inaction on ED Closures Kills 8,000 Californians in 12 Years
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Impact of Hospital and ED closures

According to a study just published in Health Affairs by Liu, Srebotnjak and Hsia; inpatient mortality rates were 5% higher for patients who were admitted to hospitals in areas that were affected by the closure of nearby emergency departments. This means that of the 4 million patients who were admitted to impacted hospitals (some 25% of all inpatient admissions) from 1999 to 2010, about 8,000 died who would have otherwise survived their hospital stay. By … Continue reading

Posted in Rants, The ER Experience, Uncategorized | Tagged , , , , , , | 2 Comments

Using, and Misusing, Consultants in the ED
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Consultants in the ED

I must admit than over the course of my emergency medicine career, I have misused the services of a lot of consultants in the ED. Initially, this misuse was primarily due to my limited knowledge and experience (exacerbated by the fact that I did not do an EM residency). Much of what I learned in those first few years of practice was from the specialists I consulted, augmented by attending innumerable continuing education courses, many … Continue reading

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Pissing Off Your Doctor – What is Your Physician Satisfaction Score?
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When there's a failure to communicate ... who's failure is it?

Recently, a reporter asked me if I had any suggestions for patients who wanted to avoid pissing off their doctor? Really? Are doctors in such short supply that patients now fear alienating, and losing access to, their physician; or are there other, more compelling reasons for patients to be concerned about this possibility?   Ever since medicine was in its infancy, most physicians have been concerned with establishing good rapport with their patients. From Hippocrates, and … Continue reading

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How Emergency Physicians Can Participate in Gain Sharing
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Emergency physician groups across the country being asked to find ways to participate in gain sharing, in order to become more fully integrated with their hospital’s or ACO’s or HMO’s efforts to reduce the cost of care.  These groups (especially those that are contracted to staff their ED as opposed to emergency physicians that are employees of the hospital or HMO) are finding it very difficult to work out these types of risk/value-based compensation arrangements. … Continue reading

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