The Under-appreciated Role of the ED in Terrorism Response

Responding to Terrorism

As new threats arise from Al Shabaab and ISIS encouraging attacks by isolated radical volunteers at specified targets throughout the western world; media outlets and pundits are recommending all sorts of mitigation measures: everything from heightened security measures to increasing vigilance by the public to counter-publicity. Unfortunately, no matter what we do to prevent this tragic violence, it is likely to erupt in some anticipated or unlikely venue and challenge us to respond to the ravages of … Continue reading

Posted in Peering into the Future, Rants, Uncategorized | Tagged , , , , , , , , , , | Leave a comment

Will Consolidation Undermine Emergency Medicine Registries ?

Consolidation of EM Groups

The consolidation of independent emergency medicine groups continues apace: and as these groups get larger, and have more resources to call upon; it is likely that they will attempt to build and qualify their own Clinical Data Registries for PQRS reporting purposes under CMS’ Group Practice Reporting Options program.   ACEP has already initiated preparations for the development of a Qualified Clinical Data Registry, and is also interested in developing a claims based ‘economic’ registry for … Continue reading

Posted in Health Care Reform, Medicare, Payment Reform | Tagged , , , , , , , , , , | Leave a comment

Medicine, Politics, Anecdote, and Pandering to the Base

Pandering to the evidence

When Senator Rand Paul told a cable news host that “I have heard of many tragic cases of walking, talking normal children who wound up with profound mental disorders after vaccines”, he reinforced a widely held and often abused misconception. I am not talking about the idea that immunizations are dangerous; I am talking about the idea that if B follows A, then A must cause B. The temporal relationship between cause and effect is … Continue reading

Posted in Rants | Tagged , , , , , , , , , , | Leave a comment

Telemedicine, Robotics, and the Inevitable Demise of the Physician–Patient Relationship

I, Doctorbot

Let’s take a look into the future, say around 2035. By then, patients all over the world will have become not only comfortable with, but dependent on telemedicine to provide timely, cost-effective care for most medical problems. This development will not only be disruptive to the current modalities for health care delivery in 2015; it will expand and evolve despite even the most ardent advocates of the traditional physician-patient ‘hands-on’ relationship.   The response of the … Continue reading

Posted in Peering into the Future | Tagged , , , , , , , , , , | Leave a comment

Unlimited Access to Primary Care May Not Reduce ED Costs


In a recent article in The Direct Primary Care Journal, a primary care medical group in Washington State called QLIANCE published a review of two year’s worth of healthcare claims data on thousands of patients that purports to show that unlimited access to primary care visits “drives down overall costs while improving patient outcomes and experience”. This report of the impact of a direct primary care managed care model that provides ‘unrestricted’ access to primary … Continue reading

Posted in Bending the Cost Curve | Tagged , , , , , , , , , | Leave a comment