Introducing the Sick Hospital blog

Common sense, straight-to-the-point, very politically incorrect plain talk about hospitalists and hospital medicine. Blogrolled stat.

When is comanagement just a work-around against the global surgical fee?

All too often in the minds of some, and some health care systems are thinking twice, apparently. See here and here.

The state of hospital medicine 2011

Via Sick Hospital and Happy Hospitalist.

More on fake-note-real-docs in Wisconsin

The UW school of medicine has reviewed the incident and is about to issue penalties:

“Personnel action will be based on the specific nature of the offense and the level of the physician’s involvement,” the statement said. “The consequences range from written reprimand to loss of pay and leadership position.”

That's about all they're saying.


Concerning one of the docs:

Dr. Lou Sanner, a family medicine physician at UW Health, told the Associated Press he wrote hundreds of medical excuses from work for protesters because they were suffering from stress.

“Some people think it’s a nod-and-wink thing, but it’s not,” he said.

Well, no, not according to the new medical ethics.

The state medical board has yet to take action. 


Via Health Care BS.

Obamacare's Independent Payment Advisory Board

It's not an “advisory” board. As Peter Orszag explains, its “advice” is the default policy unless Congress negates it and the President signs off. Pretty scary, actually.



Via Health Care BS.

Focused practice in hospital medicine round one---how did it go?

The very first Internal Medicine recertification exam for focused practice in hospital medicine was given in October. How did it go? This piece in The Hospitalist offers some clues.


Surprisingly, only 140 hospitalists took the test. One test taker shared his experiences in an interview. There was less ambulatory medicine content and more ICU content (not too much more, though, because not all hospitalists practice in the ICU). There was a significant chunk of quality and safety. All that makes sense. What was surprising, though, was his impression that the test content reflected what hospitalists see and do every day---stuff we already know. That's what we were told at HM 2010, too. It's sure not what the regular certifying exam is like.

New guidelines for management of carotid and vertebral artery disease

Full text here. Covers stenting vs surgery and more.

AHA/ASA guideline for management of cerebral vein thrombosis

Full text here.

AMSA is deeper into woo than I even thought

More blogging by The Notwithstanding Blog from AMSA 2011. This time it was about the naturopathic and ayurvedic medicine booths there and the hypocrisy of AMSA concerning evidence based medicine. By all means read the entire post and get a load of the posters!

What's with all these drug shortages?

No one seems to have a good answer why. Commentary from Instapundit here. Resource center from ASHP here.

Holistic ER

Funny stuff. Unfortunately the video can't be embedded. Via Respectful Insolence.

Blogging the keynote at AMSA 2011

---delivered by Patch Adams, via The Notwithstanding Blog. Highlights:

Dr. Parenti:

The 3% of the country who own 97% of the assets think that health insurance is a market in which to make money. The horrors! [capitalism is morally repugnant? not the most nuanced argument]

The Gesundheit Institute [Patch Adams' facility] has never carried malpractice insurance and has never been sued. [Am I alone in thinking that there might be a causal relationship].

The Gesundheit Institute is open to all sorts of “medicine:” homeopathy, naturopathy, ayurveda, reiki, and a few others I’ve never heard of.

Dr. Adams

“Depression is not a mental illness. It is a pharmaceutical company diagnosis. Depression is simply a symptom of loneliness.”

One of the scariest phrases in the world: “AMSA could lead the way on…”

“Performance improvement” CME

I knew we were moving in this direction but I was not aware that “PI CME” was official. Dan Carlat blogged this yesterday. As one would expect he's mainly concerned about industry getting in on the trend, but between the lines of his post I read a measure of concern about the whole idea of PI CME. I'm concerned too. Performance has little to do with quality, or good doctoring by any definition.

A view from inside the American Medical Student Association (AMSA)

So here's a somewhat contrarian AMSA member who blogged the 2011 AMSA annual conference.


Some initial observations:

The American Medical Students’ Association (AMSA) is one of the many professional (or in this case, pre-professional) organizations that represents various slices of the medical community. Of these, they are by far the biggest embarrassment to the medical community that I have encountered...

AMSA is a big pusher of the pharm-free movement, releasing an annual scorecard comparing medical schools’ policies on physician-pharm conflicts of interest. There are many polemical t-shirts on sale to this effect. In my view (and in that of many others), they’ve gone way too far… almost to the point of McCarthyism. Of course, this hasn’t stopped their conference from taking sponsorship money and selling booths to all manner of medical informatics companies, medical device companies, medical publishers, medical test prep companies, and of course… government.

AMSA is a big believer in “woo” (aka quackery of all stripes). Not only do they sponsor summer courses in such delightful nonsense as “therapeutic touch” (“reiki”), but they also invite the quacks into their conference. The Association of Accredited Naturopathic Medical Colleges has a booth here, and various naturopathic “schools” from across North America have sent students.

This group claims to represent the future doctors of America. What scares me is that they actually might.

Note: although I have not seen postings of AMSA courses devoted to therapeutic touch or reiki, the AMSA takes a promotional stance toward these and other forms of woo. In at least one of their courses there is non-critical content in the areas of ayruvedic medicine and shamanism. And they have cozied up to naturopathic medicine. I first blogged about AMSA's promotion of woo several years ago. AMSA not only shapes future leaders in medicine but also has a good deal of direct influence on medical school curricula. That's why the organization is one of the major drivers of quackademic medicine in the US.

An absurd article a day from the medical literature

Funny stuff. Via Asinine Academia.

For anyone following the Righthaven case

---(and if you blog you need to be) this should be of interest.

Internet usage caps coming?

Already here!


But from the looks of things you'd have to stream hours and hours and hours of TV and movies each month to exceed the caps now in place. Bloggers, worry not.

The new medical student syndrome

Happy writes:

Most people think medical student syndrome is the sense of worst case scenario medical students often think about when they experience a symptom related to a disease they may have recently read about. If you're a med student and you have medical student syndrome, every headache you have is a brain tumor, every leg pain is a sarcoma and every palpitation is a life threatening arrhythmia.

That was the traditional medical student syndrome. But it's been redefined.

Romney Care at five

Via The Lucidicus Project, HT We Stand Firm.

Hospitalist medicine is moving in the wrong direction

---as DB laments:

I watch in amazement at the many physician groups who are deciding that they will just let the hospitalists care for the patients. This observer assumes that they see the hospitalists doing the H&P and D/C summary, allowing them to just do their procedure.

Too often we see patients return after a procedure and have the proceduralist refuse readmission, deferring instead to the hospitalist group.

This attitude has impacted our teaching services also. We function as a hospitalist type service and have seen an increasing number of patients that traditionally would have gone to other services.

I commented thus:

Great post. That is exactly what's happening. There are multiple reasons, but the leadership of organized hospital medicine is largely to blame. They are promoting hospitalists as utility players. The trend will not reverse without a change in the direction of hospitalist leadership.