nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Thursday, November 29, 2007


This email is a personal message to friends and family. It represents my opinion on healthcare issues, for the entertainment (if not benefit) of those I know and care about. I do not represent any interest or organization, and I try not to impugn named individuals or organizations—we do too much scapegoating already. My concern is with poor processes and system defects. I am aware that some of you forward these things on. While that was not my intent, it’s OK, and I stand by what I say…but, please don’t forward my email address with it. I don’t have the time or interest to engage in a dialogue with a stranger who has something on their mind, or a decided opinion to argue. We live in a strange world. Thanks.

New York state lawmakers to enact physician-ranking legislation.

In continuing coverage from previous briefings, the AP (11/27, Matthews) reports, "Acting on concerns about possible 'physician profiling,' state lawmakers said Monday they would pass a law to force health insurers that rank doctors to put patient care first, instead of using cost as the sole measure." The lawmakers "joined state Attorney General Andrew Cuomo (D) to announce the proposed law, which is based on a so-called model code for doctor ranking that Cuomo has persuaded top insurers to adopt." In recent years, physician-ranking programs have become "a rapidly growing practice within the healthcare industry," and "Cuomo said major insurers nationwide either operate or are in the process of developing these programs." Reacting to the announcement, Nancy Nielsen, M.D., Ph.D., president-elect of the AMA, stated, "Attorney General Cuomo is to be credited for persuading many of the nation's largest health insurers to acknowledge the risks of physician profiling."

Doc D: Getting “cut rate” care (ie., efficiency) is one issue with physician ranking. The companies that are promoting this are in the business of making money, and the govt is trying to control rising costs. While modern medical practice has to efficient, I’m not sure I want to be taken care of by the cheapest doc around. Maybe, like the old used car salesman joke, he/she “makes it up in volume.” But, there’s another problem: the doctors with the best quality results may not be the doctors you want to see. In the medical community we knew those docs who would take on the hard cases, and those who wouldn’t. We also knew which ones were the best at the hard cases, and their mortality results were not as good as the others…but I would trust my life to them. In my opinion, there’s no substitute for your own personal knowledge: find somebody who deals with you in a straightforward manner, and whose opinions make sense. IF they don’t, ask for an explanation. Develop a sense of trust or find somebody else. These quality and efficiency indicators can’t substitute for that.

Rhode Island hospital fined for wrong-site surgeries.

The AP (11/27) reports, "A Rhode Island Hospital was fined $50,000 and reprimanded by the state department of health Monday after its third instance this year of a doctor performing brain surgery in the wrong side of a patient's head." According to the health department, much like a similar incident four months earlier, the 82-year-old woman suffered no long-term ill effects. Still, "in August, a patient died a few weeks after a third doctor performed brain surgery on the wrong side of his head."

Doc D: I cannot understand how this stupidity happens. The article goes on to say that they are considering developing a pre-operative checklist. Duh. That’s been standard of practice for a long time. In hospitals where I’ve worked, there is not only a checklist, but the ENTIRE surgical team (incl. doc) meets outside the door and runs through the whole process…anybody can ask a question, from the gas passer to the orderly. This process is repeated inside the room, as everything is checked off that is needed, armbands checked and re-checked, the patient asked to state their name and what they are having done, etc, etc. And finally, as the first cut is about to be made, there’s a final “have we thought of everything?” At any time during the operation, anyone can call a “time-out.”

I know one surgeon who signs his name to where he’s going to operate (directly on the skin) on the day before. A lot of surgeons do this, but this guy tells the patient “don’t wash it off, because if my name aint on you tomorrow, I’m not operating.”

Study indicates non-white women with metastatic breast cancer experience more pain than white women.

The UPI (11/27) reports, "Whites with metastatic breast cancer have less pain," and the pain occurs later during the course of the disease compared to nonwhites, according to a study published in the Jan. 1 issue of Cancer.

Doc D: They were all taking the same medicines, and in the same amounts. But, in my opinion, this is trash science. According to this article, the researchers offer no hypothesis and their only recommendation was to consider treating non-whites’ pain earlier. Wouldn’t it be better to just ask the patient if they’re having pain and treat it then, white or not? Duh, again. Perception of pain is a complex phenomenon, and individual assessment is the only guide. This study may represent your tax dollars at work. Let’s hope not.

Doc D

Opinions solely my own

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