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Archive for May, 2005

Tuesday, May 31st 2005

Reason To Consider Opthalmology

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From Grand Canyon National Park

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Tuesday, May 31st 2005

Quality of Care

Trying to understand and anticipate where medicine and the business of medicine will be in four years when I graduate or 3 or 7 or 11 years when my residencies are complete is difficult. The fact is just from the experiences I have had I almost certainly understand the current state of medicine (both private and academic) better than the majority of medical students matriculating this fall. Yet the fact remains I’m not a doctor. Yet :)

As such my view is limited, and so some of my favorite posts from the blogs I read involve discussions of business issues on which I’m fairly naive.

Medrants has dedicated significant time not just bemoaning and discussing the state of medicine as a business but also looking at the reality of the future and opining on ways that doctors can prepare for it and change with the times.

Two topics I have enjoyed and which he has discussed at length are pay discrepancies between specialties and how it effects residency choices for med students and pay-for-performance in which physicians who meet certain quality indicators and have better patient outcomes may receive better compensation. In the post above he discusses the problems with defining what shape and form these quality indicators will take in the future.

Tuesday, May 31st 2005

The Uninsured & Universal Healthcare: Support (Part 2)

In this second post on the uninsured and the potential for universal healthcare, I discuss the pragmatic realities of our current healthcare system, other countries’ universal healthcare systems, and the incredible lack of understanding amongst the American populace about the differences.

I will not try to sugar coat the first issue, despite my opposition to universal health coverage. Study after study has concluded that the uninsured do not receive the same standard of care in this country as the insured do. Emergency care is obviously available, but ERs and county hospitals are poor treatment centers for chronic illnesses and the likes which, along with un- or late diagnosed major diseases such as hypertension and cancer, account for the increase in mortality seen from the insured to the uninsured.

Here is an article on an Institute of Medicine study on the issue.

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Tuesday, May 31st 2005

Economic Caps Deter Lawsuits

The debate over whether fewer lawsuits means cheaper malpractice premiums can continue. The debate over whether economic caps means fewer lawsuits now has more circumstantial evidence supporting the caps.

In Illinois:

Since legislative leaders announced a deal on caps last Wednesday, 58 medical malpractice lawsuits have been filed in Cook County — three to four times the number normally filed

I suppose there’s an argument that these are all legitimate med mal cases and that lawyers are being forced to file early, before their cases are fully prepared, if they hope to get the best compensation for their traumatized patients. It is of note however, that like Texas, upwards of 70% of Illinois med mal cases end without a trial and without a payment to the plaintiff. Here’s a discussion of med mal cases in an Illinois county at Illinois Civil Justice League.

This fact is often used by trial lawyers to show that malpractice suits must not be responsible for the rise in malpractice premiums, if so many end without payment. What I believe it shows is a ‘hit until it sticks’ strategy. Civil attorneys can afford to take on four cases (no matter the legitimacy of any of them), knowing that only one of them will stick and get paid, because such a settlement, or less likely trial award, will be significant. Caps however will force attorneys to choose their cases more carefully as a 25 to 15% success rate will not longer be financially viable.

True, their criteria for choosing may not be ideal. It will likely remain that cases will be chosen often on their dramatic possibilities than on merit but it seems, in my opinion, that a drop in the total volume of med mal cases in Illinois will be seen soon.

With a h/t to Kevin, M.D.

Sunday, May 29th 2005

On Cue

Medrants has an extensive quote from a New York Times article (subscription service) on conservatives and liberals working together to try and fix the uninsured “problem”.

As I’ve already started discussing, just how big of a problem this actually is, is up for debate. As I will opine later, the view that it is right or necessary for the government to try to fix this “problem,” should never be as implicit and accepted as it is in pieces like Medrants’ comments on the New York Times article. That’s a utopian libertarian view I suppose :)

Sunday, May 29th 2005

The Uninsured & Universal Healthcare: The figures (Part 1)

The issue of the millions of uninsured Americans and the most vocalized solution to the situation (further government subsidization of health care, which in some people’s opinions should carry to government guaranteed universal healthcare) really consist of two distinct issues, like so many political problems.

There is the pragmatic side of the problem, which I have broken down into two posts. This is the first. Then, there is the political philosophy of the issue, which I’ll lay out in the third post.

The side talked about in this post consists of the debatable figures and costs and questions about the uninsured in this country. For all the nitpicking over it, this isn’t really at the heart of the issue (at least for me), but there are some facts and figures that should be mentioned. Proponents of universal healthcare often quotes a census bureau figure from 2003 which put the number of uninsured at over 43 million.

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Friday, May 27th 2005

Government?

From A Chance To Cut…

Friday, May 27th 2005

AMSA On Malpractice Reform

I’ve been told, and have no doubt, that come orientation and the first week of medical school I will be barraged with opportunities to join a stream of clubs, organizations, and groups. One of the chief amongst them is the American Medical Student Association, a link for which can be found on the sidebar.

This is a highly politicized group with a loud voice concerning its nearly socialist agenda for the future of healthcare.

You must give the AMSA credit, it has grown to be the largest representative organization of medical students, while making no secret of its liberal activism. However, here’s their take on malpractice reform in this country.

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Friday, May 27th 2005

Introduction

I am a film student who decided he was called to go to medical school.

This is my second attempt at a blog.

I consider my three month experiment with blogging earlier this year as a learning experience. Yet, the subject matter is the same as the blog that proceeded this one. Their was an evolution process for the content of my previous blog and I feel that because of that the intent of this blog is pretty set.

I’ve basically tried to cover three major areas –

First, I’ve lent an extremely libertarian view to political issues facing all of medicine. I spent significant time talking about the strain of illegal immigration on border region healthcare, the case against universal healthcare, and the need to keep government regulation from limiting doctor and patient decisions.

Second, I’ve tried to provide links and commentary on academic medicine, the med school admission process, and changes in such.

Finally, and this will emerge as the start of my first year draws nearer and nearer, I’d like to give some insight into the, probably fairly boring, day to day experiences of a first year medical student.