When Cardiologists Sue

It's sad that cardiologists have had to sue as their last resort to save their practices:

"Heart specialists on Monday filed suit against Secretary of Health and Human Services Kathleen Sebelius in an effort to stave off steep Medicare fee cuts for routine office-based procedures such as nuclear stress tests and echocardiograms.

The lawsuit, filed in U.S. District Court for the Southern District of Florida, charges that the government's planned cutbacks will deal a major blow to medical care in the USA, forcing thousands of cardiologists to shutter their offices, sell diagnostic equipment and work for hospitals, which charge more for the same procedures.

Perhaps other professional organizations will be forthcoming with similar suits as private doctors and their patients pay dearly for the reform efforts underway. Meanwhile hospitals continue to build. Pharmaceutical and medical device companies stocks rise. But did we really think the government's promise to find nearly $500 billion in "wasteful spending" from Medicare and Medicaid to resolve the fiscal realities of the ridiculously expensive legislative reform efforts could happen any other way?

No doubt the suit will bring this issue to the forefront for patients. It will be interesting to see how this plays out. Perhaps a compromise. Perhaps a further delay.

But make no mistake. specialists are first in the sights of the health care reformers. They and their technology are the bad guys. They are expensive. Innovation is evil. And while the American College of Cardiology may have significant resources to fight this fight and have a legitimate gripe, the government's legal purse is infinite. Eventually, the ACC's finances will be worn thin.

And so all the great reform efforts underway, America will have "primary care" for most of its citizens lucky enough to find a primary care doctor and specialist care only for those living close enough to a hospital to receive it.

-Wes

Our Senatorial Gift

As the Senators vote to pass their bill to extend insurance to thirty million more people while failing to address malpractice or physician payment reform, we can all only hope and pray that it's worth it in the end.

On thing's for sure, 2010 is shaping up to be one heck of a year.

Merry Christmas.

-Wes

Chart source.

A LIttle Holiday Cheer

From our lab to yours, complete with a heart, pacemaker and defibrillator ornaments, defibrillator pads, pacing-lead tinsel, and an ablation catheter tree-topping:

Click image to enlarge

Wishing you a happy holiday season and very Merry Christmas!

-Wes

Small Miracles

They sat, huddled together beneath the brightly lit Christmas tree, giggling as they described to their new found friend how they'd never seen snow before. Slowly as the week progressed, it melted, but not before the snowfight, the tree purchased, the shops invaded, the parties attended, and the tours taken. Their high school exchange program was soon to end, but not before they reflected on their visit, sharing one last set of digital pictures.

They sat, huddled together, working on tomato soup. There's has been an incredible journey: from childbirth, to grade school to college and beyond. There were seemingly endless Christmas's spent tearing through packages before, but now it is quieter. Other things are more pressing. "Would a chocolate shake taste good?" She is weak, but smiles. "I love chocolate shakes," she says. She calls and asks if she should add Ensure. She sleeps more now and good news comes in small bits: her white count's normal and she only needed two liters of fluid IV this week. "Mom, Mom? Mom, we're heading home now. You going to be okay, Mom?" She drifted back to sleep while her husband, exhausted, looked on.

I woke this morning and discovered that another blanket of snow had arrived overnight. Undisturbed, its perfect lumninescent contours served to soften even the most jagged of nature's edges.

It's a wonder how the peace of the holiday season can be found in the most unlikely of places.

-Wes

The Rule of Twenties

Heard from a local independent gerontologist tonight who does not accept Medicare or other insurance payments in our state:

"When it comes to geriatrics, it's the rule of twenties:

20 problems
20 medications
20-minute phone calls
20 minutes to take their clothes off
20 minutes to put their clothes back on.

With the initial physical exam, three follow-up visits, and one EKG that Medicare pays for, I would receive only $360 in total. I pay $40,000 per year in malpractice, yet have never had a judgement against me. Think how may patients I'd have to see to cover just that expense. (editor's answer: 111)

You wonder why I am not a Medicare provider? I'd never survive at that their payment rate. And Blue Cross? They're no better and often pay less.

Funny thing is, Medicare was only too happy to have me opt out, because to them, I'm no longer part of their problem."

And the reason every primary care doctor's not doing this???...

-Wes

Beware of Voice Recognition Software for Reading Chest X-Rays

You might get something like this:

"Single view.

There are no prior studies for comparison. The heart is mildly enlarged. The ovarian veins are engorged area.

"The increased density in the medial portion of the right base may be parenchymal or due to vascular structures. The remainder of the lungs is air. No effusion."

Um, did I miss something in medical school?

Dang.

-Wes

We Interrupt This Blog

... to do a bit of self-promotion. Cafepress, our distributor for our medical t-shirt website, MedTees.com, is offering a free upgrade in shipping until midnight tonight so t-shirts ordered for yourself or a loved one can arrive by Christmas eve. For overseas and non-US territories, today's the last day to have orders received in time for Christmas via express delivery.

Remember, 10% of proceeds from the shirts helps support plenty of worthy charities.

-Wes

Can a Website Teach CPR?

The American Heart Association, in conjunction with a $1 million dollar grant from the Medtronic Foundation, thinks it can, especially if schools can win a thousand bucks for their effort promoting the idea:

Through the Be the Beat campaign, the Medtronic Foundation is providing $1,000 grants for school staff to help fund CPR and AED training outreach programs within their school or community. The deadline for application is January 15, 2010. More information is available in the “Teachers and Administration” section of the Be the Beat Web site, BetheBeat.heart.org/schools.

BetheBeat.heart.org engages 12- to 15-year-olds to learn the basics of cardiopulmonary resuscitation (CPR) and how to use an automated external defibrillator (AED) through interactive games, videos and songs on the Web.

Sadly, the music selections that play at 100 beats/minute, (like "Stayin' Alive" and "Another One Bites the Dust") aren't available for download, but a expanded list of songs that play at that rate is included. Songs like U2's "I Still Haven’t Found What I’m Looking For" or Simon and Garfunkle's "Cecilia" (yep, "Celilia, you're breakin' my heart, I'm down on my knees, beggin' you please, to come home, to come home!" made the list. This alone is sure to be a source of endless entertainment, though I'm not sure about the appropriateness of singing ABBA's "Dancin' Queen" during CPR...)

And while the games kids are expected to play on the website are right up there in challenge level with the first iteration of "Pong," the concept of getting a broader, younger demographic to even think thirty seconds about CPR and how to use an AED is a novel one.

-Wes

Are We Seeing the Death Spiral of Conventional Medical Conferences?

I think so.

It was apparent to me at the Heart Rhythm Society Scientific Sessions meeting and now a similar trend was noticed by Dr. Steven Sedlis at this year's American Heart Association meeting:

It felt like a ghost town. I ran into Ira Schulman, my medicine resident at Bellevue when I was a third year medical student; we looked at one another and simultaneously blurted out “where is everybody?”
. . .

There are probably numerous reasons for plummeting attendance at AHA. The economy, the on-line publication of trial results prior to presentation, the ubiquity of conference calls, e-mail strings and yes blogs that keep one in regular contact with colleagues throughout the country and the world without the need for face-to-face encounters are just some of the obvious causes.

The scaling back of industry support may be another major factor at play here. Certainly there are fewer exhibitors and the exhibits are far less lavish. As Muhamed Saric pointed out when I met him on the floor of the exhibit hall there were no Siemens or Philips exhibits, and in fact I could not find any cath lab manufacturers presenting their products at the AHA. The need to diminish the influence of industry on the medical profession and the need to avoid conflicts of interest were brought up at many of the presentations at the session by leaders of the AHA and other thought leaders in academic medicine, but one unintended consequence of this well-intentioned effort seems to be less financial support for the meeting itself.

I've always enjoyed the socialization and camaraderie that comes with medical conferences, but with the uncertainty of the current health care climate for doctors, the rising costs of these conferences for attendees, and the increased comfort doctors have for receiving medical information via the internet and social media, the need for traveling to medical conferences has quickly become obsolete. While medical device company or pharmaceutical reps might still find these venues moderately entertaining, without their ultimate customers in attendance, the medical scientific session conference marketing circuit will slowly fade away.

-Wes

Scientific Medical Journals and the Media

The article appeared yesterday in the Wall Street Journal: "Study Shows Older Patients Benefiting From Defibrillators."

One would think a doctor might like to read the article, especially one dealing with defibrillators.

So I checked late last night and wouldn't you know, no such article was on-line. Then I checked again early this morning. Still no reference on line. I checked Google. I checked Circulation: Heart Failure's website. I checked for the press release on the American Heart Association's press release web page.

No such article.

But Reuters had seen it (I think) (or at least they saw the American Heart Association's press release about the article, I really don't know).

And so I waited and waited, only to find that the article was finally posted on-line publically on the Circulation: Heart Failure's website at about 12-1PM CST, almost a full 18 hours later the manuscript was reported upon by the main stream media.

The article certainly has plenty to comment upon, but I will forgo that for the moment and instead focus on this disturbing trend of media releases pitched to journalists before the scientific community.

Given that this study was funded by GlaxoSmith Kline and the journal Circulation: Heart Failure is published by the American Heart Association who acknowledges multimillion dollar funding from the pharmaceutical and medical device companies we have to wonder: why are physicians being left out of the opportunity to critically review scientific publications before mainstream media broadcasts information to our patients and the public? Might it be that the sponsors of these trials might not like what certain doctors might say about the study? Or are such press releases being more like classic TV ads hoping to prod patient's to "Ask Your Doctor" about study's findings? What potential implications might these press releases have on public policy mandating doctors to "Get With the Guidelines" for the treatment of heart failure going forward?

I find the feeding of jounalists these manuscripts before the very scientists who subscribe to the these journals troubling at best and potentially subversive and manipulative at worst.

-Wes

Grand Rounds Is Up

... with a Charlotte's Web theme over at Florence dot com:

Welcome to this holiday edition of Grand Rounds! It's the time of year when friends and family gather, when stories are told and memories are made. But the winter weather and short days here in the northern hemisphere seem to prompt brevity in our everyday comings and goings. It seems like the right time to combine storytelling and brevity and channel Charlotte, one of the most masterful storytellers I met during a childhood spent with my nose in a book.

Enjoy!

-Wes

Live on TV: An Implantable Cardiac Defibrillator Fires

As implantable cardiac defibrillators (ICDs) are increasingly ubiquitous in society, it is not suprizing that their effects might be caught on television. We've already seen the remarkable benefit of an ICD correcting ventricular fibrillation in the professional Belgian soccer player, Anthony Van Loo, but when it happens to a conscious scientist at the 2009 Coppenhagen Climate Summit, it certainly turns heads:



Danish physicist Henrik Svensmark was attending the Coppenhagen Climate Summit '09 and had three repetitive ICD firings recorded on live television. Reportedly he was rushed to a hospital and his condition stabilized.

Implantable cardiac defibrillators fire when the ventricular heart rates exceed a pre-determined heart rate that is sustained for a predetermined number of heart beats. It is unclear if his heart rate was elevated from a lower heart chamber (ventricular) arrhythmia (the most likely cause) or a racing upper chamber (atrial) heart rhythm abnormality that drove the lower chamber too fast. Unlike Mr. Van Loo, Dr. Svensmark heart rate was probably not fast enough to cause him to lose consciousness. Nonetheless, when the defibrillator fires, it delivers the equivalent of approximately 830 volts in a tenth of a second, causing the muscles of the chest, heart, vocal coards and diaphragm to contract forcefully, occassionally resulting in the "yelp" heard at the just before the video ends.

Communicating with the patient's ICD with a programmer after such an event helps doctors determine the cause of ICD firings and assure the device was working as expected. Based on that information, medication therapies or device adjustments can be made to help prevent future firings.

It should be noted that this event was NOT a "heart attack," or a sudden disturbance of the blood flow that supplies the heart, but rather an implantable cardiac defibrillator treating the sudden onset of a potentially lethal heart rhythm disturbance. As such, because the defibrillator responds so quickly, heart muscle function is usually preserved.

-Wes

h/t: A faithful reader.

US Health Care Reform Photoshop Contest Winner

My wife and I would like to thank all those who contributed to the first (and perhaps only) US Health Care Reform Photoshop Contest. Polling for the favorite finalist stopped at 11:59 PM on 11 Dec 2009 and, like American Idol, the blog-o-sphere tallied the most votes for "Taking Care of the Healthcare Pest," submitted by "Elisabeth" of Peidmont Healthcare.

Congratulations and Merry Christmas!

-Wes

Rural Versus Urban Primary Care Wars

As the primary care crisis grows, it seems rural areas are seeing their competitors snatch up primary care doctors who were supposed to return to their community after training:

Competition for physicians pits rural communities against each other, and many of those “may, in fact, be losing out to urban hospitals,” said Creighton's Frey. “Unless some major changes occur in the physician work force, the future is very frightening.”

Marvin Neth, administrator of Callaway District Hospital in central Nebraska, said he believed he had a doctor signed up through a federal loan-forgiveness program a few years ago.

But a bigger hospital recruited the physician away, most likely by agreeing to pay the loans and the penalty for not fulfilling the physician's obligation to the rural health care program, Neth said.

Addding to the crisis is the fact that some primary care doctors quickly find the workload and lifestyle untenable and decide to specialize:

Rural areas have battled the health care access problem for a long time. Many rural physicians have patient volumes that are too high and are on call too much to make that lifestyle appealing to young physicians.

Dr. Matthew Johnson joined a North Platte, Neb., group of several internal medicine physicians about four years ago. As a young newcomer, he was to gradually take over the patients of a physician who was easing into retirement. But the physician retired immediately.

“The clinics were full,” Johnson, now 34, recalled recently.

He was swamped and frequently worked 80 hours a week. He saw patients in his office, in the hospital and sometimes in the aisles at Walmart, where they would complain that they couldn't get in to see him and went to the emergency room instead.

Johnson recalled thinking: “I can't do this for 30, 35 years.”

Johnson said he neglected his wife and two children and grew irritable. “I'd treat my patients better than I'd treat my family.”

Last year, Johnson left that practice to study at UNMC to become a heart specialist. He knows he'll work hard as a cardiologist, but not 80-hour weeks, and he'll make more money.

“Cardiology's been all that I expected,” he said.

"The grass is always greener...", I guess.

-Wes

Controlled Drug E-Prescriptions: Policy Versus Practice

"Hello, Dr. Fisher?"

"Yes, this is Dr. Fisher"

"This is Sam Smart, pharmacist at Walgreens over in East Elsewhere."

"Yes, sir, how can I help you?"

"Well it's about that prescription you gave to Mr. Pacertoday for Norco."

"What about it?"

"Well, it's not printed on the right controlled drug presciption paper."

"But that's how we've been issuing prescriptions. I haven't seen any of that special printer paper with that squiggly-lined paper for months. I know we're 'sposed to use in that kind of paper, but it's never in the printer and there's no special printer for controlled drugs, so we just use regular paper. It has my signature, right?"

"Well, there's a signature, but I really can't tell if this is an authorized signature without the proper paper..."

"But you're talking to me, right?"

"Uh, yeah."

"And you called my office phone number, right?"

"Uh, yeah."

"So can you fill the prescription now that you've verified that I'm the one who wrote the prescription?"

"Well, I'm really not supposed... Well, I will this time. But in the future, make sure you use the right paper, okay?"

No, not okay.

Doctors, nurses, and secretaries do not have time to fill special paper in printers to write prescriptions for controlled drugs, yet this is what our fabulous regulators require in order to prevent Medicare fraud. Practically speaking, this isn't happening for the simple fact that it's impractical.

How about just allowing us to send our controlled drug script electronically, like all of the other prescriptions we send? Or maybe add an encoded PIN number?

Using fully implemented e-prescribing would likely have much less potential for fraud and abuse...

..unless, of course, our electronic medical record systems aren't as secure as the bureaucrats say they are.

-Wes

Reference: "Frequenty Asked Questions Concerning the Tamper-Resistant Prescription Law (Section 7002(b) of the U.S. Troop Readiness, Veterans’ Care, Katrina Recovery, and Iraq Accountability Appropriations Act OF 2007), Center for Medicare and Medicaid Services.

When Politics Get Local

... suddenly, things become very real for both cardiologists and patients.

-Wes
.

Difficult Case? Ask Dr. Obama!

... and you can have instant access to him in your lab, too!

-Wes

Coming Full Circle in the Health Care Reform Efforts

It's like rain on your wedding day
It's a free ride when you've already paid
It's the good advice that you just didn't take
Who would've thought... it figures

Well life has a funny way of sneaking up on you
When you think everything's okay and everything's going right
And life has a funny way of helping you out when
You think everything's gone wrong and everything blows up
In your face

-Alanis Morissette, "Ironic"

Isn't it ironic that here, months and months after starting the health care reform efforts to correct the fiscal insolvency of Medicare, a system that has proven itself incapable of reining in health care costs, that Congress is now in discussions to expand that same program to people ages 55-65

Negotiators Monday were considering a proposal that would open Medicare to people ages 55 to 64 if they couldn't find coverage elsewhere. The proposal would allow them to buy insurance coverage at subsidized rates under Medicare, though the subsidies wouldn't be as great as those for people 65 and over, said congressional aides and lawmakers.

How much money have we spent to get to this point?

I'm seeing a health care cost savings, aren't you?

-Wes

Getting Ready for the Cardiology Cuts

There are potentially plenty of ways cardiologists will see their payments decline next year: from the loss of Medicare inpatient consultation code payments to the 2010 physician fee final rule issued last week by the Centers for Medicare & Medicaid Services (CMS) which threatens to cut to cardiology practice procedural payments an average of 27 percent.

For those who want to calculate the potential impact to their practice, the American College of Cardiology has prepared a nifty Practice Impact Calculator that contains two worksheets: one for your practice and the other for the impact that loss of consultation codes will impart. Just enter this year's volumes and the calculator will do the rest.

Try not to get too depressed filling it out and consider sending your results to the ACC.

Oh, and more good news: please keep in mind that the proposed 2010 payments shown on the spreadsheet do not include the across the board 21.5% cut to the Medicare conversion factor that will take effect on January 1 if Congress fails to prevent it. Also, remember that this spreadsheet shows only the impact on Medicare payments. Many private payers follow along with Medicare’s payment trends, so reduced Medicare payments could be only the beginning.

-Wes

Photo credit.

The New American Medical School Challenge

Nature abhors a vacuum.

And no where is this more clear than residency slots in Internal Medicine.

Today, I learned some interesting statistics that should alert medical students applying to residency programs across the country.

1. Surprisingly, applicants to our categorical residency program is up 15% this year.


2. The number of foreign medical graduate students to this year's applicant pool has increased 50% over last year.

In short, the medical marketplace for doctors is becoming a global one, and the need to support current salary levels is likely to erode in the not-so-distant future.

-Wes

The Inefficiency of Medical E-Mail

I am fortunate to work at an institution that has a fully deployed electronic medical record (EMR) system that incorporates outpatient physician notes and inpatient notes under one umbrella. By and large, patient care is facilitated since both outpatient and inpatient notes appear simultaneously in the patient's chart, along side telephone messages and clinical results. While there are plenty of kinks to work out, most of us have to admit that there are huge patient care advantages to such a system.

The system also promotes a secure e-mail service for patients to e-mail their physician and a mechanism to have their results forwarded directly to them. With the ability to empower patients directly, many would consider this as the Utopian model for heath care delivery of the future.

And what could be better? Patients get virtually unlimited access to their health care provider, 24-7. Results are whisked to the patient. Speed. Efficiency. "Green." It's all good, right?

Maybe.

At least until a complicated health care situation occurs.

Then the four-page e-mail is sent, asking for clarification. A lengthy reply is made attempting to answer every question. The response is quickly followed by questions. More answers. "What do you mean?" "But what I thought you said..." More responses. More questions. "But have you considered ...?" "But I have to be in New York that weekend. Do I really need it?" "I've been thinking..." "What about....?" "Like I said..." Back and forth. A constant stream of electronic anxiety.

Then a pause.

"Doctor, why haven't you answered my question, doctor? I sent you three mesages today and haven't heard from you. Doctor? Your nurse practitioner wrote that you'd ... I don't understand why there's such a disconnect...."

Hours and hours of back and forth, pounding on a keyboard producing the cold, hard blandness of text. Broken streams of communication. No emotion. No visual cues. No empathy. No give and take.

Just text.

* Click clack, clack click. *

It's about as inefficient as it can get, absorbing huge amounts of physician and nursing time.

Granted, it doesn't happen often. Most patients are sensitive to this mode of communication and e-mail's inherent limitations. But occassionally there are the highly computer-saavy patients who live online, over-use the service, and expect their answers instantaneously. The reality is that few doctors type well, are still putting their hands on and in patients, and do not continuously reside at a computer screen (despite what the hospital administration wants you to believe). That being said, there are still many times where it is far more efficient to see the doctor in person when tough treatment decisions have to be made.

That is, of course, as long as the doctor can pull his face from the computer screen during the office visit.

-Wes

Photo credit.

ICD Implantation, Hugh Hefner-Style

Well, at least it's one way to make a former tattoo three-dimensional:


Just putting the sexy back... :)

-Wes

Photo used with patient permission.

Boston Scientific Issues 'Soft' Defibrillator Advisory

Boston Scientific recently issued a new device advisory for their current line of Teligen ICD and Cognis CRT-D automatic defibrillator devices. The advisory affects only those devices that are implanted beneath the breast muscle (subpectorally) on the chest wall. It seems two (2) devices implanted (of 77,000 total devices implanted worldwide) in this location experienced weakening of a header bond caused by significant forces applied to the header by the pectoralis muscle to the rib. This resulted in altered lead impedances and the introduction of noise to the defibrillator sensing lead that might inhibit pacing or result in inappropriate tachycardia therapies (shocks).

The submuscular implantation location is an uncommon location to implant the devices. It is estimated that only 5% (3850) of the 77,000 devices implanted, were implanted in the subpectoral location.

From Boston Scientific's "Dear Doctor" letter:

Boston Scientific has determined that the bond between the header and case could be weakened by significant forces associated with a subpectoral implant procedure or when a device in a subpectoral position is pushed against a rib during contraction of the pectoralis muscle. A weakened header bond may alter lead impedance and introduce noise that may inhibit pacing therapy or initiate inappropriate tachy therapy. Additional mechanical stress applied to a weakened bond may eventually cause header connection wires to fracture, resulting in loss of therapy.

. . .

Rate of Occurrence
The implant orientation of devices is not reported to Boston Scientific, making it difficult to provide rate of occurrence and prediction information. We have received two (2) reports worldwide of subpectoral implants with weakened header bonds. We estimate that 5% of approximately 77,000 COGNIS and TELIGEN devices worldwide have been implanted in a subpectoral location.

The following factors may also impact the risk of failure if implanted in a subpectoral location:

• Exact location of the patient’s ribs relative to the device
• Body size and/or muscle mass of the patient (risk may increase for larger/muscular patients)
• Activity level and/or occupation of the patient (risk may increase for more active patients)

Recommendations

For future implants:
• Boston Scientific recommends that subpectoral implantation of affected COGNIS CRT-Ds or TELIGEN ICDs (Table 1) be avoided until improvements to header bond strength are available for devices in your geography.

For affected devices (Table 1) implanted in a subpectoral location:
• Follow patient at least once every three months as recommended in device instructions for use.
• Consider advising patients to contact their physician or clinic if they receive shocks, in order to ensure timely review of associated electrograms and other device data via in-clinic or remote interrogation.

In summary, the devices need to be followed as usual (every three months), but are not recommended for removal unless they begin to develop erratic behavior. The warranty and unreimbursed medical expenses "may" be honored in "certain geographies."

-Wes

Reference: Boston Scientific's webpage with more information as well as links to the Dear Doctor and Dear Patient letters

Coronary Stent Gift Cards for the Holidays

Target has them.

Walmart has them.

Best Buy has them.

Just about every retailer has them for the holidays.

So why not get a gift card worth more than $1000 given to you by your friendly neighborhood coronary stent dealer?

Sign up today and you could:

• Save up to $30 each month for six months on prescription antiplatelet (anticlotting) medication.


• Participate in a personalized reminder service for your antiplatelet (anticlotting) medication.


• Save up to $30 each month for six months on three cholesterol medications from Abbott Laboratories.


• Through the FreeStyle Promise Program*, receive one FREE Freestyle Lite or FreeStyle Freedom Lite blood glucose monitoring system, save up to $50 every month (or up to $600 per year) on test strip co-pays, and have access to personalized health expertise by certified educators and ongoing product support.

To enroll, simply call 1-800-547-4386

To sign up for this program, you'll need your XIENCE V Patient Care Program card. You received this card from the hospital following implantation of a XIENCE V stent. When you call you'll also need your stent's product lot number. The product lot number can be found on the stent implant card. You received this card in your patient materials following the implantation of a XIENCE V stent. The stent implant card is purple and white, and has a color photo of a heart on it. If you do not have or have lost your XIENCE V Patient Care Program card or your stent implant card, be sure to contact your physician or the hospital.

Hey, what's a few perks among friends?

I've got mine (from our rep, mind you, not because I have a stent):


How about you?

-Wes

PS: Oh, if you have Medicare, Medicaid and these things are covered, you can't use the card! (In other words, it's just a bad joke...)

Could the Stethoscope Gain on the Echocardiogram?

Some seem to think it could:

Early tests of the (stethoscope) system suggest that it could eliminate more than eight million unnecessary echocardiograms and cardiologist visits a year, saving some $9.4 billion and, even better, catch more of the dangerous murmurs. For doctors, and anyone with a heart, this stethoscope’s upgrades are well worth the two-century-long wait.

One thing's for sure, the crappy plastic yellow stethoscopes in the rooms of isolation patients have to go.

-Wes

h/t: Matthew Bodish, MD

US Health Care Reform Photoshop Contest: The Vote

Okay, the entries for the 2009 US Health Care Reform Photoshop Contest are in and it's time to vote! The idea was to create a single picture using your snark, your wit, your creativity to encapsulate your feelings about the US Health Care Reform efforts underway in a single photograph.

We appreciate the efforts by all of those who made to effort to submit an entry, but only one lucky winner will receive an iTouch in time for the holidays. So here are the entries one more time, in random order:

1) "Healthcare Budget":




2) "Health Care Cat" (in the spirit of LOLCats):



3) "Gonnorrhea for Rationed Health Care"



4) "Taking Care of the Healthcare Pest":



So think carefully, and vote. Please, no voting he "Chicago-way," okay? One vote per person, please. Polls close 11 Dec 2009:

Which is Your Favorite Health Care Reform Photoshop Picture?

The Problem With Making Medical Devices Look Hip

With the advent of trendy-looking insulin pumps and event recorders that look like hip MP-3 players or cell phones, there might be a downside, like theft:

School officials say it's inconclusive whether the pump was "misplaced or taken." Police say they're still investigating.

But Raube and her parents believe someone stole it: Maybe they mistook the tiny shiny pink pump with cords wrapped around for an iPod. Maybe they knew what they were stealing.

-Wes

The Electronic Medical Record and The Challenges Ahead

For those who have not seen it, one of the better discussions on the achievements, limitations, and future challenges of the adoption of the Electronic Medical Record can be found at the blog of Howard Luks, MD, The Orthopedic Posterous in a guest blog by R. Vaughn, MD. Be sure to read the comments from some very informed patients, IT experts, doctors and even, yes, yours truly.

Although long, you'll learn something.

Not bad for an ortho guy...

;)

-Wes