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The Medical Professionalism Blog

Monthly Archives: June, 2011

It’s a Mad, Mad World: Medicare and Cost-Effectiveness

The recent establishment of the Patient-Centered Outcomes Research Institute (PCORI) stipulates that its findings from comparative effectiveness research cannot be construed as mandates for coverage recommendations and that the government cannot use these reports to determine coverage and payment decisions. This in effect, prohibits PCORI from determining cost-effectiveness of alternative treatments. This explicit stipulation in [...]

Vampires and Urban Legends: Teaching Residents about Health Care Costs

This past weekend, I gave a talk at the Committee of Interns and Residents, the largest housestaff union in the United States.  The most inspiring moment of the meeting that I witnessed were the two standing ovations earned by Dr. Koffler for advocating for residents to get paid in 1936 (her first paycheck was 15 [...]

Changes That Face the Nation and Madison

Two previous posts reflected on the meeting that convened in Madison, Wisconsin. The purpose of the meeting was to discuss the current costs of health care and provide recommendations for building an economically sustainable system. I wrote about the “divided self” – the inner conflict between personal beliefs and actions – and competition as a [...]

Bone of Contention

I recently consulted with an infectious disease specialist about a patient of mine who was having drenching night sweats, increasing pain and swelling in his left ankle, and a draining sinus in that same ankle. He had severely broken the ankle 10 years earlier and had screws and rods put in. He said that at [...]

The Dark Side of Competition

The participants at the Madison meeting told us that the biggest barrier to collaboration was competition. One is hard-pressed to find a community where competition doesn’t rule the day. For the last 30 years, competition has been part of this country’s health care policy strategy to reduce costs and enhance quality. The theory is that [...]

Walk the Walk, NEJM!

I recently picked up the latest issue of the New England Journal of Medicine (NEJM) to read one of the clinical cases. I began reading NEJM clinical cases over 30 years ago while attending medical school. Today, I oftentimes use the clinical cases for discussions with medical students and residents for great examples in teaching [...]