tag:blogger.com,1999:blog-52762648527842923722011-12-25T05:21:41.026-05:00Policy, business and (above all) the practice of medicineZagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.comBlogger2631100tag:blogger.com,1999:blog-5276264852784292372.post-536893019153499652008-08-20T11:56:00.001-04:002008-08-20T11:59:14.627-04:00

In my last post, I told about the Value Code, a book that was published at the worst possible time for its ideas to gain any traction. The majority of the companies the book highlights no longer exist, have been taken over or abandoned the activity for which they were being mentioned.So much for new ideas.But on closer reading, the point must be accepted; that value is created as much by the

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com12tag:blogger.com,1999:blog-5276264852784292372.post-26579098485065409812008-08-11T01:46:00.004-04:002008-08-20T11:51:32.831-04:00

I've been reading an old book a friend once recommended while she was employed at the now-bankrupt Arthur Andersen. The book, "Cracking the Value Code" was intended for prospective Andersen clients and probably remained quite useful as the consulting group re-invented themselves under the Accenture name.It was famously published at the peak of the Internet boom. I'm not kidding, it was published

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-75215976760536392312008-08-07T11:44:00.003-04:002008-08-08T18:57:52.803-04:00

I once asked a urologist what he thought about universal screening for prostate cancer by framing the question in very personal terms. I asked him about letting a doctor's finger to approach him. His answer: "Keep the finger away from me."This was in 1989. And nothing has changed.The Post reports on the USPSTF revision to PSA screening recommendation, downgrading prior enthusiasm. Note the

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com6tag:blogger.com,1999:blog-5276264852784292372.post-68891576801289810272008-08-02T12:50:00.002-04:002008-08-02T22:27:23.301-04:00

I have always had an interest in the liberal arts and philosophy in particular. I never got the formal training, but as a perennial dilettante, articles such as this (courtesy of aldaily) tend catch my interest.It is a brief and digestible history of the idea of compassion. It made me consider how the religious right views the morality of health care as a kind of theological experience of

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com1tag:blogger.com,1999:blog-5276264852784292372.post-59466126224362093472008-08-01T09:29:00.004-04:002008-08-01T10:25:48.404-04:00

When I was a resident I still believed in the incontrovertibility of medical facts. Now that I am older, I am a little more skeptical. I do not doubt truth so much as my access to it.The thing that brought this to mind this cool coastal morning (yes, we're traveling) is the Lancet's publication of a study out of Seattle's Group Health Cooperative that challenges the degree of protection from

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com2tag:blogger.com,1999:blog-5276264852784292372.post-1768201428174346912008-07-30T12:46:00.003-04:002008-07-30T13:32:29.818-04:00

Different constituents can come to an issue that concerns them both in a manner that sabotages their ability to work with the other. There are many stakeholders in health care, not the least of which are patients (or the consumer, in another parlance), management, nursing and so on. The central constituents is the physician, who has taken a remarkable beating in recent decades.I doubt there is a

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-19004251789633733072008-07-24T01:46:00.003-04:002008-07-24T02:58:06.863-04:00

I share a lot with the society in which I live.Shopping at Costco, you always notice the overstock items run in a small number of sizes. Somebody overestimated the number of items manufactured in a given size. Sometimes it's easy to find your size, which probably means it was either butt-ugly or mis-priced.My size is not easy to find. People with 18 inch necks are not usually 34 sleeve. You can

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-52605873308083877102008-07-19T13:47:00.002-04:002008-07-19T16:40:14.021-04:00

over the years, I have been asked some interesting questions about a general reluctance amongst some people with medical degrees to actually practice medicine.For example, I was recently asked in an interview for a medical management position why "doctor's didn't do as they were told?"Nearly a decade ago an administrator asked me "why all us doctors wanted to do was anything but see patients."I

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-71131891092362529602008-07-17T11:51:00.004-04:002008-07-17T12:39:24.038-04:00

I was hell-bent on coming out West, knowing that coming to a turn-around could be dangerous. I recently discovered that my 6-month tenure as Chief Medical Officer was beaten on the short side in recent company history. So the worst-case scenario of living here for six months to decide if it would finally become a long-term living decision has come to pass. The cost was living through some

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-27779136465106996622008-07-12T12:20:00.002-04:002008-07-12T12:49:42.328-04:00

Wow! What started off as an apology by the fairly delightful Guitar Girl, RN turned into a slugfest after a somewhat provocative comment by The Happy Hospitalist. It's worth taking a gander at the comments, although it strikes me as an old story.My surprise is that, in this day and age, any animosity between nurses and physicians still exists. Notably, a physician points out that the medical

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com1tag:blogger.com,1999:blog-5276264852784292372.post-71178678844515927562008-07-10T23:47:00.003-04:002008-07-11T13:37:39.997-04:00

The last time I needed general anesthesia, I was five years old. The last time I needed an IV was thirty one years ago! Knock on wood, for real!I'll keep the juicy details to myself, but the procedure I underwent today was interesting to say the least. I suppose every interaction with the health care system, upon which I pontificate with such earnestness, becomes an opportunity for reflection.I

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com3tag:blogger.com,1999:blog-5276264852784292372.post-29977388919437876582008-07-03T10:26:00.004-04:002008-07-06T20:35:41.296-04:00

So, now it's official. I am unemployed.On vacation, with internet access problems, a market melt-down and the intense heat... oh the heat. Well, I'm the guy who wanted to live in the desert!This is the summer of our discontent.I was having a discussion with a colleague about the option of going into practice for myself versus being an administrator at a larger organization. This is probably a

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-38262946446490855232008-06-21T11:23:00.000-04:002008-06-21T13:09:00.006-04:00

With the impending arrival of the Unemployed Physician Executive, I have been catching up on my reading.Some things catch my eye, in both the medical and management literature that are worth passing commentary. I sometimes feel as though I have one foot in each of two different worlds, as though Alice were in both Wonderland and Kansas at the same time. These moments are probably not worthwhile

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com3tag:blogger.com,1999:blog-5276264852784292372.post-90079841786952016392008-06-19T04:22:00.000-04:002008-06-19T04:22:00.404-04:00

She had raven hair, a vicious temperament, and an unerring sense of people's character. She smoked like a sandstorm and swore like the first time you see Mount Ranier from Seattle.She was a friend of mine.We met at the University where she worked as a transcriptionist. She was quite a bit older than me, but we kept bumping into each other at coffee. I tend not to stand on protocol or social class

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-14989462961986827772008-06-18T12:41:00.002-04:002008-06-18T12:57:24.872-04:00

Just when you thought things couldn't get any worse, I catch this little tid-bit of news (courtesy GruntDoc):According to a June 11 CMS announcement, doctors will have to reconcile their NPI data with their IRS legal name data in order to get paid.It is a befuddling regulation since, as an employed physician, 100% of my billings have gone to organizations that paid me a salary. Why check my

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-37966669283245881292008-06-16T13:11:00.001-04:002008-06-16T13:11:01.232-04:00

Call me a skeptic, but this health care system (which does not serve the majority of its stakeholders) is not likely to change overnight, even (especially) if Obama wins the election. What we have in the US is an undesigned, organic, chaotic system which accomplishes exactly what it is designed to accomplish. Problem is, everybody thinks it is designed to do something different and the result is

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com5tag:blogger.com,1999:blog-5276264852784292372.post-25167264447424446422008-06-15T23:20:00.001-04:002008-06-15T23:20:00.611-04:00

Edwina Froelich, founder of La Leche League, passed away last week. La Leche League used to state that the three main obstacles to successful breast-feeding were doctors, hospitals and social pressure.My experience has been one of utter frustration with maternity nurses, who should know better, but frequently feed their wards sugar water for no reason. Some kids can get hypoglycemic, but

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-89403130631727926452008-06-10T12:15:00.003-04:002008-06-10T12:49:22.602-04:00

Here is a potpourri of my morning reading rounds. They come together more coherently than I would have expected.Dr. Val (via Joe Paduda) reports from "Fighting Chronic Disease: The Missing Link In Health Care Reform" conference that 50% of the (? adult) population has a chronic disease. In addition, chronic disease accounts for 75% of health care costs.No wonder we can't afford health care in

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com2tag:blogger.com,1999:blog-5276264852784292372.post-25879077163909321852008-06-07T10:49:00.004-04:002008-06-07T12:17:33.063-04:00

I guess it may have been apparent to a few that the new job in the Great American desert is not going well. When I took the job, it looked like a turn-around was well under way and the group was ready to establish a quality and improvement agenda.I was wrong.The CEO was fired six weeks into the job, the board is locked in a self-destructive lawsuit driven by ego and an attorney running for public

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com2tag:blogger.com,1999:blog-5276264852784292372.post-7741893046849626192008-06-03T22:30:00.005-04:002008-06-03T23:44:12.323-04:00

Illinois' House Bill 5372 is a much more enlightened approach to quality health care than Massachussetts caving in to the pecuniary interests of a small group of entrepreneurs and pandering to the consumers' need for immediacy in their interactions with the health care system, no matter what damage results.However, it is a fantastic example of how not to produce a sensible solution.The FTC has

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com4tag:blogger.com,1999:blog-5276264852784292372.post-85503760240985229902008-06-02T23:39:00.002-04:002008-06-03T00:26:43.174-04:00

WSJ's Health Blog devotes a post to some of the craziness surrounding the side effects that are being reported all of a sudden.In case you've not been paying attention, there have been two waves of adverse event reports starting with reports of neuropsychiatric effects, such as suicide and depression. Now there are reports of convulsions in drivers and even simple personal accidents. The FAA

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-16292144795202675402008-05-31T11:38:00.005-04:002008-05-31T12:52:03.563-04:00

I had an interesting conversation with a feller from Texas the other day. I was telling him how I had formed my impressions of docs in employed situations from my experience on the East Coast. It just seemed that the solo practitioner was almost dead, if not completely so. Even in rural Maryland, it was more likely to find groups of two or three docs in private practice fiercely holding on to

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com3tag:blogger.com,1999:blog-5276264852784292372.post-38369444892648331262008-05-29T11:03:00.001-04:002008-05-29T11:04:55.834-04:00

The venerable Mr. Hank Stern has The Health Wonk Review again. A terrific job, for the fourth time, I understand. I never fail to learn something.

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-81041176693717514362008-05-29T10:11:00.002-04:002008-05-29T10:47:17.961-04:00

The Commonwealth Fund reports (it's a big file) on Child Health, ranking states according to access, quality, cost and other factors (check out the map).Number 1 is Iowa, a state with a great family practice residency and a primary care oriented medical school, along with a quality research university. Good access to top-notch reasonably-priced health care probably trumped the reputation of

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-6845992860124075772008-05-28T10:26:00.002-04:002008-05-28T10:35:55.441-04:00

The most remarkable thing... I found an article that says cost reduction efforts don't work and tend to alienate physicians.The final paragraph of the article is particularly enlightening:Judgmental programs tend to interfere with quality improvement. They score but do not support physician work and therefore are perceived by physicians as disempowering. Accountability combined with perceived

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-14194727283939543722008-05-27T22:44:00.004-04:002008-05-27T23:16:48.586-04:00

Hospital chains have been consolidating for years. Given how tight capital markets are these days one would expect that there would be fewer deals now.Bzzz. Wrong answer.The large chains are having less trouble dealing with their debt than smaller rivals, so it is easier for them to snap up relatively smaller entities opportunistically. The Tennessean (courtesy FierceHealthcare) suggests it may

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-79131325128445639352008-05-23T10:54:00.003-04:002008-05-24T10:30:38.831-04:00

It looks like regulation that could hurt the nation's safety net has been killed for now (reg required). The AHA has weighed in (reg required) on the underserved rule. With a new administration coming in a few months, I wonder if anyone believes the threat is gone for good.CMS was going to reduce payments to safety net institutions and close so-called loopholes that allowed states to invest

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-65680738113471078482008-05-23T10:38:00.004-04:002008-05-23T10:51:46.393-04:00

I am always impressed by good quality management and amazed that there isn't more of it. Physicians have decided to sue a Massachusetts insurance oversight agency over physician rankings.The agency freely admits their ratings are faulty, but docs should just suck it up because it's a step in the right direction. However, despite the flaws, patients are charged different copays according to the

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-27273888831611960992008-05-21T21:57:00.002-04:002008-05-21T22:27:04.426-04:00

Sorry, the sarcasm is out of control lately...This recent JAMA article (subscription required) carefully studies the role of adding ultrasound to mammography in breast cancer screening. They found that the combination picked up more cancers but also increased the false positives. In the parlance of clinical epidemiology, it increased sensitivity but decreased specificity.Or as Homer Simpson would

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com7tag:blogger.com,1999:blog-5276264852784292372.post-25316194961347024802008-05-20T20:24:00.002-04:002008-05-20T20:42:03.017-04:00

What have we given up?I have been an employed physician for going on 15 years and an independent contractor for a handful. I enjoyed the contract years the most, but it was not a settled lifestyle and something told me to do what everyone else was doing. You know, settle down, get a job, travel on two weeks off a year like the rest of humanity.Teaching was fun and it could only be done in a large

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com3tag:blogger.com,1999:blog-5276264852784292372.post-13174211697736461542008-05-19T11:14:00.002-04:002008-05-19T11:24:03.981-04:00

This one is a bit of a bother; my conscience versus insurance company shenanigans...The LA Times reports that consumer groups are getting their noses out of joint about the practice of balance billing, where a health care provider tells the patient that the insurance company did not cover the fee and charges the patient directly. If you're a patient, that's a pretty scary prospect. The San Diego

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-23106550272448885602008-05-12T10:33:00.002-04:002008-05-12T11:04:21.213-04:00

There is a perverse pleasure seeing health-care leadership get some of their own. Ingenix is a subsidiary of United Health Group and is a prime resource for health plans and administrators in a score of lines of work related to health. One of the things they do is determine pricing by collecting fee schedule data... you know, that troubling little piece that the consumer-driven health care people

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com4tag:blogger.com,1999:blog-5276264852784292372.post-20518929248040817072008-05-11T23:53:00.003-04:002008-05-12T00:37:17.516-04:00

Kevin, MD's recent posting of an anonymous primary care physician from the heartland seems to have struck a cord with a whole lot of people, judging from the comments.Let me tell you how much it resonates with me.Our own administration is pretty incompetent and think it knows all that is required to run a community health center without the physician leadership. But I'm not sure. Our chief

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com1tag:blogger.com,1999:blog-5276264852784292372.post-68844729440811621732008-05-09T09:20:00.003-04:002008-05-09T17:54:02.712-04:00

Under new CMS rules, low income individuals will probably have as much help in the US as the mentally ill; that is to say nothing.There are seven new regulations being floated at CMS attracting a lot of attention and push-back. The net effect of each of these regulations is to reduce the federal health care budget. The two proposed regs that caught my eye were the one altering the byzantine rules

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-10555461171652977852008-05-07T08:40:00.003-04:002008-05-07T08:52:08.939-04:00

Immunizations are simply the best and most cost-effective intervention ever conceived by the science of medicine. They are so important that health care providers have toyed with various techniques to improve immunization rates. For example, my current facility has a full-time immunization nurse who can give missing vaccines to children following a sick visit (as long as they don't have a fever.)

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-90638447303256897372008-03-15T14:56:00.005-04:002008-03-16T16:44:14.354-04:00

I appreciate the concern about my welfare, especially since it's been nearly a month.I could tell you about my current company's soap opera, but I would rather maintain my anonymity for the time being... The hostility between administration and the physician staff was greater than I originally thought and some mis-steps are pretty much inevitable under the circumstances. Organizations don't

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com7tag:blogger.com,1999:blog-5276264852784292372.post-5411643081089557582008-02-22T00:12:00.004-05:002008-02-22T00:28:52.755-05:00

And so dies pragmatism, on the altar of principle.The NYT reports on the case of a woman in England who is being denied cancer treatment in the public NHS if she pays privately for a part of her treatment. It sounds as misguided as Canada's Principle of Universality.Health care is expensive and there are multiple potential levels of effectiveness, including one of cost-effectiveness. The NHS and

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com3tag:blogger.com,1999:blog-5276264852784292372.post-69855994355988402552008-02-20T20:39:00.003-05:002008-02-20T21:51:56.823-05:00

Between Hillobama (my wife says it should be Baralinton now) and accusations that Senator McCain is a skirt-chaser, all I can say is that I have always been proud of my adoptive country. If we are still talking about being ready for a woman or a black person in the White House, then we're not ready. Unless it's Condi Rice. Hey, I'd vote for a Phillipino, as long as nobody asked if we were ready

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-85668546543837042302008-02-14T09:08:00.003-05:002008-02-14T10:06:35.175-05:00

No, not Valentine's Day. I may have gotten my titles backwards but I wanted to continue some themes from my previous post on dysfunctional environments.Health Punk commented that "Sounds like a level of dysfunction that requires drastic measures. Jolting an organizational culture can only happen with a severe enough shock." That insightful response is certainly part of the answer. A radical

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com2tag:blogger.com,1999:blog-5276264852784292372.post-68052708485165199562008-02-07T09:46:00.000-05:002008-02-07T10:11:31.846-05:00

I have not had much time to read, much less write any blogs recently. Needless to say, my current job is much more challenging than the last one.The environment is dysfunctional, but more to the point, it is more dysfunctional than the average clinic, family or corporate entity. A series of chief executives and turnover amongst the leadership have left the ship somewhat rudderless. The current

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com2tag:blogger.com,1999:blog-5276264852784292372.post-89150443422149264482008-02-01T00:22:00.000-05:002008-02-01T01:01:17.744-05:00

We are in a political race and when I hear Mrs. Clinton talk up quality in health care as she did on last night's televised debate, I get really nervous.I have seen an organization's ratings for patient satisfaction rise from dead last to number 2 in three months. It is a testament to the effort of the organization and its response to poor performance -- as well as to statistical over-sensitivity

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com3tag:blogger.com,1999:blog-5276264852784292372.post-72197697156721941462008-01-30T00:12:00.000-05:002008-01-30T00:26:05.370-05:00

Two articles tonight yield some reassurance. My first and second tirades state my position as clearly as a poor neophyte blogger can do.Grady is mismanaged, even though the CEO is hardly the cause of a half-century's neglect of market realities. He has resigned.Retail clinics are a diversion and a general drain on scarce medical resources, but some readers have reminded me they are not likely to

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-87047744281793634252008-01-29T09:42:00.000-05:002008-01-29T10:17:18.615-05:00

The problem is that it's always about the pain.I actually have had a patient come in and tell me "If I have to live with pain, I'll live with it, but what is causing it. I really need to understand it."I gave that guy narcotics.I had someone come in and tell me, I really don't like how they make me feel, so I don't take the pills.I encouraged her to take them, at least when she was home or in the

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com1tag:blogger.com,1999:blog-5276264852784292372.post-47233464944651348462008-01-27T12:23:00.001-05:002008-01-27T13:00:59.271-05:00

I came across two posts today which, in an abstract sort of way, brought up in my mind how we decide what is best for the patient.First, Dr. Suburban [whose new blog Suburban Emergency is starting off with some interesting provocations] describes a procedure that would have been done in many (but most definitely not all) ER's in the country. A conflict erupted over different stakeholders'

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-88412210940589883292008-01-25T08:48:00.000-05:002008-01-25T09:38:02.828-05:00

It is hard to believe that The Physician Executive has not yet received his new state license. It has been over six weeks, but physician readers will not be surprised. Fortunately, our insurers have already assured us that the moment the license is verifiable online, they will honor charges in his name.In Maryland, the Board of Physicians says it takes 120 days to obtain a license (it usually

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com4tag:blogger.com,1999:blog-5276264852784292372.post-86012204474518453512008-01-24T08:59:00.000-05:002008-01-24T09:05:51.288-05:00

I would like to congratulate Paul Levy and Dr. Val, amongst the winners of the 2007 Medical Weblog Awards. Reading their blogs, amongst those of the many other nominees, helped inspire me to put fingers to keypad. Untold numbers of other readers are edified and provoked by their works.Medgadget and Scrub Gallery must be congratulated for their work and diligence, given how appropriate and worthy

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-48028662181290712942008-01-21T11:33:00.000-05:002008-01-21T12:34:32.386-05:00

Before you read this remember I am a family physician. The value I bring is precisely my generalism. Adam Smith saw greater value to specialization in conceiving the division of labor, but one may consider that every ideology has some practical limitations.I was once blasted by the venerable Dr. Larry Green in public (which was embarrassing, given I was wearing a name tag with my real name)

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com4tag:blogger.com,1999:blog-5276264852784292372.post-57643406740417173052008-01-18T09:46:00.000-05:002008-01-18T10:03:47.325-05:00

I always thought that a market incentive involved more money. But that's not the way finance people think.At my first US job, it took only a couple of years after leaving my secure Canadian base (yes, I am being sarcastic) to find myself analyzing an incentive plan that was developed in the wake of the consumer backlash against managed care and the collapse of the forces spurring the

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com1tag:blogger.com,1999:blog-5276264852784292372.post-23585059693615090272008-01-17T09:38:00.001-05:002008-01-17T10:33:57.165-05:00

The news that a race-specific drug for heart failure has failed and the company could go out of business raises some interesting questions about pharamceutical profits and innovation, as well as the way we think about race.BiDil, pushed by NitroMed was a very effective combination of two old medications whose use hinged on a study that suggested that it was more effective in African Americans.

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com3tag:blogger.com,1999:blog-5276264852784292372.post-74188894817717739732008-01-16T23:37:00.000-05:002008-01-16T23:40:09.902-05:00

Julie Ferguson does a terrific job with Cavalcade of Risk #43.Remember, the practice of medicine represents an assumption of risk for levels of compensation that are not always appropriate. It is a good area to expand into if one is medically curious.

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-30259848866643401122008-01-15T22:33:00.000-05:002008-01-16T00:29:26.383-05:00

The little tempest in a teapot about labeling cloned foods is similar to the one over genetically modified food. I think we're arguing over the wrong thing and not insisting enough about the right to know. It's doubtful there are any safety issues. It's just a consumer's right to decide what industries and practices to support.First Cato reminds us that the food is not what's cloned, it's the

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-16313167134750548732008-01-13T22:19:00.001-05:002008-01-13T22:31:42.826-05:00

I had a long discussion with a friend today. His wife, having tender breast post-partum had elected not to breast-feed. Following non-pharmacological measures and several courses of antibiotics, she was eventually diagnosed with MRSA. However, it seems that the OB-GYN managed the situation by phone and did not ever examine her breasts. His management was correct by antibiotic choice and proper

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-18057539386935121732008-01-12T21:50:00.000-05:002008-01-13T01:15:32.778-05:00

I am struggling with the fiscally conservative approach to health care policy this weekend, since I have just finished reading Greenspan's memoirs and find a number of interesting insights.Given the apparent anti-competitive stance of my last post on retail clinics, I am feeling a little schizoid.But the more I think about it, I am more convinced than ever that retail clinics are harmful because

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com6tag:blogger.com,1999:blog-5276264852784292372.post-33660765687486445242008-01-11T12:45:00.000-05:002008-01-11T00:55:33.338-05:00

This morning, two stories caught my eye. KevinMD is pointing to another article on Grady's plight in Atlanta; another public hospital struggling to survive.The other story was one of several reports on CVS' MinuteClinics being cleared to operate in Massachusetts: WSJ, David Harlow's Health Blawg, White Coat Notes at the Boston Globe, and Paul Levy at Running a hospital.So hospitals are dying

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com31tag:blogger.com,1999:blog-5276264852784292372.post-11308624769688225602008-01-10T01:51:00.000-05:002008-01-10T02:03:31.366-05:00

One of my pet peeves is how the press handles health news. In the rush to sell more papers and ads, every little piece of old news is treated as a breakthrough even though science is a slow, dogged, methodical pursuit of incremental truths.In obesity, we have been running through scientific assessments of fad diets for a significant portion of the post-WWII period. Of course, the years have

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-23699488896629320942008-01-09T09:30:00.000-05:002008-01-09T09:52:55.372-05:00

Well, wouldn't you know, I am now settled in and spoiling for a bit of a blogging dogfight. So I go over to my favorite sparring partners at InsureBlog only to find out that I am a finalist for the 2007 Medical Weblog Awards in two different categories.I am a co-finalist with Dr. Val and the Happy Hospitalist who have been favorites of mine, in the New Blog category.I also made the best Health

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com1tag:blogger.com,1999:blog-5276264852784292372.post-71600666287863953322008-01-09T08:56:00.000-05:002008-01-09T09:25:00.068-05:00

The December issue of Managed Healthcare Executive has, as its cover article, a piece on Massachusetts Connector.Jon Kingsley is quoted as saying:"Community rating alone does not ensure value, but must be combined with guaranteed issue, guaranteed renewal and broad if not universal participation so that insurers don't just end up pricing premiums to cover the sick," Kingsdale says.But Kingsdale

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-90226520374599504952008-01-07T20:48:00.000-05:002008-01-07T21:07:49.008-05:00

Well, it was my first day on the job at my new community health center in the Great American desert. I came across management that expects the CEO to be hands on and a CEO who is working at 30,000 feet. It remain unclear what the organization needs, but expectations are what they are.I came across physicians frustrated with a series of ineffectual management teams that they are not giving the

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com5tag:blogger.com,1999:blog-5276264852784292372.post-13215992654781155362008-01-04T09:08:00.000-05:002008-01-04T09:10:30.904-05:00

In my drive across the country, I encountered many languages. Coming from a polyglot city like DC, it is easy to be jaded about the American heartland and consider fairly white-bread. This is why it struck me that I encountered so many cultures along the way. I could have said that there were more non-English culture Americans along the way, but then I would be grandstanding. I did run into a

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com1tag:blogger.com,1999:blog-5276264852784292372.post-90802337070807895992008-01-01T08:35:00.000-05:002008-01-01T07:38:24.151-05:00

This is the season of resolutions. Another year over, a new one just begun...Weight, smoking, exercise... these are the things that people typically resolve to improve. But how often do we hear someone say, my resolution this year is to improve my relationship with my daughter? How often is the resolution to keep in touch with my friends, or reconnect with colleagues from my last job?In fact,

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-73091928393673803032007-12-29T07:54:00.000-05:002007-12-29T09:02:59.461-05:00

On our drive across the country, we took a little detour into a West Virginia canyon. The New River Gorge is full of great views and spectacular rapids (including a few class V's that got my former paddler heart palpitating). Winding our way between the New River and Charleston West Virginia, we found ourselves driving through an environment I had not previously been familiar with, although I had

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com1tag:blogger.com,1999:blog-5276264852784292372.post-33014970763542045022007-12-27T03:07:00.000-05:002007-12-27T03:19:22.666-05:00

Posting has become spotty, not due to traveling and the holidays, as much as the fact that this morning, my wife and I begin our 3500 mile coast-to-coast drive. The packing has been intense, shoehorned as it was between jobs and graced by the festivities of the season.We will spend New Year's on the road and the details of the road trip must be shrouded in the veil of my anonymity, which is

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com4tag:blogger.com,1999:blog-5276264852784292372.post-70028014778716194442007-12-25T07:50:00.000-05:002007-12-25T08:15:06.360-05:00

Merry Christmas. Christianity was seen by Bertrand Russel as an excuse for mediocrity. I think this perception can arise from Christianity's insistence on the potential for change.Christianity is (or at least should be) about forgiveness and redemption above all. That means no matter how inadequate we are, how erroneous our ways, how mediocre our performance, there is always the opportunity for

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com1tag:blogger.com,1999:blog-5276264852784292372.post-37367023342062545042007-12-23T08:23:00.000-05:002007-12-23T09:36:17.908-05:00

Because The Physician Executive is leaving Maryland, headed to the Great American Desert, he has been spending an inordinate amount of time talking to other companies' customer service experts. When a customer calls to cancel their service, they usually are shuffled off to some of the better folks at handling customer service issues.My response to this experience is to wonder how, for a service

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com4tag:blogger.com,1999:blog-5276264852784292372.post-15444553677776065032007-12-20T08:00:00.000-05:002007-12-20T08:03:01.916-05:00

Back when I got my management degree, albeit at a school of public health, I noticed how many approaches to understanding management involved divisions by four. The two-by-two matrix seems an easy way of characterizing the world and the approach has made many a career.Take for example the service process matrix and the BCG matrix; even a SWOT analysis can be interpreted as a 2x2 box.It always

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com1tag:blogger.com,1999:blog-5276264852784292372.post-13248765950123173712007-12-18T20:34:00.000-05:002007-12-18T21:21:14.230-05:00

I'm not sure what to make of this post at "Every Patient's Advocate." It follows up on a Steven Cole OpEd in the Dallas News, in which he points out that doctors prescribe medicines and order tests just to justify higher reimbursing billing codes.There are certainly some medicolegal reasons for ordering tests and prescribing medications, many of which can be addressed by working on the

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-38322257234272658222007-12-18T09:18:00.000-05:002007-12-18T09:21:33.847-05:00

MedGadget is running the 2007 Medical Blog Awards. I think I'll nominate myself, but it would be so much cooler if you did.

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-20797693053349837752007-12-18T08:28:00.000-05:002007-12-18T09:00:45.732-05:00

There is a great phrase I hear frequently on financial news programs. Usually it is from the mouth of a CEO, like Lily's new chief being interviewed this morning, and it goes something like this, "We will continue to drive change."It sounds like a sports athlete coached to use canned sound bites like "our goal is to play hard and come together like a team."The question that comes to mind

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-21463210506642077742007-12-17T15:10:00.000-05:002007-12-17T15:03:42.685-05:00

With all due respect to one of my former colleagues (who shall remain nameless), we recently got into a discussion regarding my future work plans.She told me that she did not believe in God or an afterlife and figured what she was going to do with the last few years of her work life and into retirement was based on an accounting of what she valued. It's from zero to 10, she said, there's nothing

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com2tag:blogger.com,1999:blog-5276264852784292372.post-9950758759235096432007-12-15T08:45:00.001-05:002008-01-29T10:13:40.198-05:00

There have been some recent storms in medical blogdom over physicians refusing to prescribe pain medication. It seems some patients, especially someone named 'Anonymous Anonymous,' have taken exception, vomited vitriol and demonstrated that action and reaction are most visible at the point of conflict.Consider the following:Scalpel or Sword original Letter From a Chronic Pain Sufferer and a

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com14tag:blogger.com,1999:blog-5276264852784292372.post-55362064859390623422007-12-13T19:06:00.000-05:002007-12-14T19:22:30.057-05:00

Have you ever thought about how we die in America?I guess there are occasions that a certain latent anger disturbs my usually inscrutable internal peace. Such as this earlier post, for example...An off-line commenter (nobhilltreehouse) chastised me, saying the following:Comes across callously and jaundices other posts. I know what you mean but I would have preferred: '"cause these days a

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com3tag:blogger.com,1999:blog-5276264852784292372.post-55533343441343812582007-12-13T08:55:00.001-05:002007-12-13T09:08:28.458-05:00

Jerome Groopman's book How Doctors Think is doing really well and is on Amazon's Best of 2007 list.I came across this article in one of my literature scans and thought about how we use the technique of "thinking aloud" in teaching residents. Clinical reasoning can only be taught if the learner's reasoning is made explicit for the purpose of evaluation, reinforcement and occasionally correction.So

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-42669027701301834662007-12-13T08:33:00.001-05:002007-12-13T08:40:36.027-05:00

HealthBlawg presents the latest Health Wonk Review, an end-of-year, Happy Holidays wonkfest. It is heavy on politics, given current action on the hill and approaching primaries. Rob Laszewski's Huckabee analysis is most welcome (that man frightens me).

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-72172711867839125642007-12-12T11:57:00.000-05:002007-12-13T08:24:22.173-05:00

Health care is expensive. Making use of people's expertise and motivating them to take on responsibility and risk is expensive. Having a workforce belonging to a licensed healing class is expensive, whether you call them doctors, nurses or PA's. The more educated, the greater the number of years in training and the greater the debt, the more expensive they will be.The Happy Hospitalist shows us

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com3tag:blogger.com,1999:blog-5276264852784292372.post-84870569863881471522007-12-11T06:46:00.000-05:002007-12-12T00:09:05.524-05:00

Mass customization is a concept which, more than any other in the business world, has the potential of reaching physicians.Attempts to improve health care quality and performance have relied on ideas imported from the business world, most specifically from manufacturing. Mass customization comes from that environment, but is also increasingly applied in the service industry.The first system that

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com3tag:blogger.com,1999:blog-5276264852784292372.post-79535793796433039892007-12-08T21:44:00.000-05:002007-12-08T21:55:29.220-05:00

Sitting in Denver is called catch-up time. All things considered, there were a lot of interesting articles along the way and a few reached the level of this weekly award's criteria: well-written, good/atmospheric vignette or clear brief essay.My selections for the top 3 this week:1. james gaulte @ retired doc's thoughts on The Good Doctor Worries About His Patient2. Bob Wachter @ Wachter's World

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com1tag:blogger.com,1999:blog-5276264852784292372.post-5011735987198540092007-12-08T20:43:00.000-05:002007-12-08T21:56:30.561-05:00

The Economist's take on the US health care debate makes the assumption that the lack of universal coverage is an anomaly for so wealthy a country. The concerns about mandates is prominent, especially given the general lack of information as yet about the success or failure of the Massachusetts plan, which relies so heavily on the individual mandate.Maybe a scaled-down employer mandate would work

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-85605493049424837192007-12-08T19:15:00.000-05:002007-12-08T19:35:08.281-05:00

I am stuck at the Denver airport in the snow. Our plane was delayed for two hours at the gate in Baltimore which means we missed our connection. Now, it's getting dark and the flurries are threatening a good old fashioned blizzard. We're still scheduled to get out of here by 6:30 this evening.One good side of airport delays is the opportunity to read more print text than I have in the past three

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-87012713140420737452007-12-06T05:35:00.000-05:002007-12-06T06:19:20.432-05:00

Wow! Is there any reason to believe that between physicians and business interests, physicians will ever get it together enough to win?I have been looking at the Medicare payments reduction of 10% with dismay, knowing full well that an increasing number of physicians are dumping Medicare. I always thought the major problem would be in rural areas where physicians dedicated to their communities

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com1tag:blogger.com,1999:blog-5276264852784292372.post-65847743922239671682007-12-05T13:53:00.000-05:002007-12-05T13:56:09.588-05:00

This biweekly collection of matters related to risk, including insurance of the health type, is a fascinating window into a world outside medicine, which mysteriously and ineffably alters how medicine is practiced. As such, I recommend this week's Cavalcade at Joe Paduda's ever-opinionated, erudite and intelligent blog. I particularly like Lisa Emrich's take on Montel and big pharma.

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com1tag:blogger.com,1999:blog-5276264852784292372.post-71028737102001600982007-12-04T13:37:00.001-05:002007-12-05T17:37:51.616-05:00

So what happens when a retail pharmacy chain and pharmacy benefits manager merge? [PBM's are used by your managed care company to handle the pharmacy benefits side of the insurance.]A war breaks out between retail chains, that's what.CVS and Caremark are among the largest retail pharmacy chains and PBM's respectively. they also became one company in March of this year. So Walgreen's terminated

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-47111549120906433022007-12-04T13:34:00.000-05:002007-12-04T13:28:20.627-05:00

I've been approached recently by a couple of Canadian mags about my American experience. It got me thinking about Canada's contributions and got me reading some Canadian content online.I came across this article. It seems that Canada's scientific contributions have accelerated of late, despite a highly socialized system and government-run health care. Highly accretive societies like the US can

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-11323148247328174782007-12-04T09:00:00.000-05:002007-12-04T09:00:28.108-05:00

The Harvard Business Review has a feature on how people who feel strongly about their choices make better business decisions.I can think of a couple of former bosses who could have benefited by not crowding out the emotionality with which I have approached key decisions in the past. I do my best not to say "I told you so" because I know there are other occasions that an apology would be more in

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-15888575246796310782007-12-02T20:32:00.000-05:002007-12-02T22:18:40.368-05:00

This weekend we decided to make a visit to the National Gallery of Art to see the Edward Hopper exhibit.The Nyack, New York painter came to fame between the two wars of the past century and came to represent introspection and solitude. "The loneliness thing is overdone," he once said.Perhaps he was right, but the element of loneliness is recurrent precisely because so many people seem to respond

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com3tag:blogger.com,1999:blog-5276264852784292372.post-41146222320837065582007-12-02T19:56:00.000-05:002007-12-02T20:21:11.179-05:00

This is probably the longest I have gone without a post since I started this blog! But The Physician Executive is winding down his old job and preparing for a cross country trip. Sometimes you just got to take some time out for local recreational activities which will not come around any time soon. Museums, Belgian restaurants were on the menu and our entire CD collection has now been ripped.

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-70680355060358019282007-11-30T13:30:00.000-05:002007-11-30T13:32:48.962-05:00

[Update at the bottom]It hasn't happened yet but there is insight to be had from CMS' handling of nursing homes. They just published a list of their Special Focus Facilities. The public list is restricted to facilities that have persistent deficiencies for several consecutive months.The background paper on the CMS web site describes the following:Most nursing homes have some deficiencies, with

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com3tag:blogger.com,1999:blog-5276264852784292372.post-17817296653920074072007-11-28T20:56:00.000-05:002007-11-28T21:07:45.908-05:00

Health Care Renewal is abuzz of late over drug company ethics. Comments from Maggie Mahar and Howard Brody are commendable, along with the discussions over Dr. Carlat's NYTimes Sunday Magazine article. It should be clear by now that regulation and legislation needs to level the playing field between consumers and pharmaceutical manufacturers.Also check out the GoozNews article on health care

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-66982678065151871642007-11-27T22:03:00.001-05:002007-11-28T07:26:30.453-05:00

Both the NYTimes and the AJC report on the attempt to save Atlanta's Grady Hospital by replacing the current Board and demanding an infusion of capital from the usual players: the State and the two counties that the hospital serves. This does not sit well with Georgia's Governor.There is a great tragedy being played out in many an inner city these days. My experience with Grady was brief but

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com4tag:blogger.com,1999:blog-5276264852784292372.post-91947426900138297462007-11-26T15:40:00.000-05:002007-11-26T15:44:51.256-05:00

I am getting into this Carnival thing,much like Grand Rounds and Health Wonk Review, where the best blog posts around a common theme are featured.I offer The Carnival of Life, Happiness and Meaning because it is good to remember that health has to do with much more than medicine, management and policy.This is the Holiday Season and whichever holiday you celebrate, remember to take some time out

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-47691878183119659322007-11-26T08:58:00.000-05:002007-11-26T14:22:16.073-05:00

Forgive me, for sometimes I see humor in very serious issues. I developed a hyper-realist viewpoint a few years ago after reading Robert Greene and Joost Elffers' "48 Rules of Power", Machiavelli's "The Prince" and Sun Tzu's "The Art of War," the latter in the context of a strategic management course.The events related to Avandia seem to me a brilliant depiction of power relationships and

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-62953153296139128132007-11-24T10:00:00.000-05:002007-11-24T09:52:31.841-05:00

For all the policy talk and all the problems of managing physicians and designing efficient delivery systems, the rubber has to meet the road some time. This happens where a provider of health care is working with a patient with the door closed. Beyond the door is the maddening world of what we call the health care system. There was once a time that the things that passed behind the closed door

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com2tag:blogger.com,1999:blog-5276264852784292372.post-30743369953721862222007-11-23T23:20:00.001-05:002007-11-23T23:42:33.549-05:00

Maria and I are trading coasts. Goodbyes are hard and again, she makes the list:1. Discordant at Intueri (vignette with a friend, resentment or loss?)2. Listen by Vitum Medicinus (essay by a student learning the most important part of medicine)3. Things to Be Thankful For by Dr. Wes (OK, it's hard to justify as literature but it's seasonal... You could always check out Fire Drill for a vivid

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-37999450130600545032007-11-22T03:02:00.000-05:002007-11-27T11:58:18.900-05:00

On this wonderful occasion of over-eating, imbibing and then looking for a few minutes away from the rest of the family, I thought I would share a few reasons to be thankful, from a health perspective of course.Above all, since the most important determinant of health is socio-economic status, we must be thankful that we have not been born into abject poverty.How do I know this about my readers?

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com2tag:blogger.com,1999:blog-5276264852784292372.post-19932030111992563042007-11-21T12:01:00.000-05:002007-11-21T18:17:46.085-05:00

Jason Shafrin asks Why Are We Obese?He comments on an NBER article and points out that a food tax would unfairly affect the poor.I have two counters:1. Who cares? As a matter of fact, the fact that a food tax affects anyone is the only way that it can potentially affect behavior. If a parking ticket costs me less than parking in the lot up the street, guess what I am going to do. The question is

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-12720052371591783442007-11-21T08:55:00.000-05:002007-11-21T11:18:51.363-05:00

I am becoming more and more convinced that the work of physicians and health care is an exercise in managing risk. For this reason, I have become a regular reader of Cavalcade of Risk, the latest edition of which is currently up at Colorado Health Insurance Insider.First, there is a picture of a couple of turkeys at the White House, only one of which received a presidential pardon [I really

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-53173734787979001552007-11-20T17:02:00.000-05:002007-11-20T19:39:28.005-05:00

I have previously touched on the issue of a physician shortage here, here (in the context of concierge physicians), here (referring to the distribution of risk), here (in the context of mid-levels) and here (in discussing an influx of foreign physicians) . I am aware of literature that suggests otherwise, that there are too many physicians, who can generate their own demand.Maggie Mahar makes hay

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com2tag:blogger.com,1999:blog-5276264852784292372.post-52545643538231340412007-11-20T11:30:00.000-05:002007-11-20T11:37:42.427-05:00

Musical Grand Rounds this week comes from Mexico, so I have a couple of new International blogs to add to my reader... The first is Rico's own Mexico Med Student and the second is other things amanzi, which earned Rico's "Editor's Choice" this week along with the ever-present Sid Schwab . A truly excellent effort, despite not including my personal favorite late 20th century composer.

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-81396754724153062832007-11-20T08:00:00.000-05:002007-11-20T10:35:36.498-05:00

I have previously said (in a the context of disease management) that if you want quality improvement, you may want to take the doctors out of it.While it may seem paradoxical to improve the quality of care delivered by physicians by removing a part of the physicians' responsibility, the fact remains that physicians are generally preoccupied by the most acute findings in front of them at any given

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-23762834129794254492007-11-19T00:45:00.000-05:002007-11-18T22:40:11.356-05:00

Primary care was the main driver for managed care through the 80's and 90's. It was based on the observation that health care costs were lower for people with primary care than without. Somehow the idea that primary care was important became subverted by the concept of "gatekeeper."But insurance companies created the paperwork burden of a referral requirement, patients pushed back and primary

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com0tag:blogger.com,1999:blog-5276264852784292372.post-6976918600390606572007-11-18T12:24:00.000-05:002007-11-18T22:41:50.009-05:00

Panda Bear is a great blog; intelligent and well-considered.A little story from the emergency room does a great job describing the factors that ended in an unsatisfied customer in the waiting room. Everyone plays into the system:Not only are there not enough doctors to go around, especially in primary care, but we have an aging and incredibly sick population already making huge demands on our

Zagreus Ammonhttp://www.blogger.com/profile/07237186267904028944noreply@blogger.com3