Posts by Brad Flansbaum

How Often Do You Ask This (Ineffective) Question?

How often do we get complacent with knowledge?  We hear the same thing over and over, and the message becomes lore.  Drink eight ounces of water per day or turkey makes you drowsy—not only do we as docs believe it but we tell family members and patients the same. I came across a new study in CMAJ that fractures another piece of lore we hold fast. And not only should this study put the kibosh on it, but also upends a practice (a patient question) that teachers from eons past have instructed us to use over and over and over.  The question has intuitive appeal, is easy to gestalt, and has a universal understanding.  Non-physicians and laypeople can grasp what the answer implies without any difficulty.  (more…)

We Are All Accomplices In The Great American Coding Swindle

"Membership in the American Academy of Professional Coders has risen to more than 170,000 today from roughly 70,000 in 2008." "The AMA owns the copyright to CPT, the code used by doctors. It publishes coding books and dictionaries. It also creates new codes when doctors want to charge for a new procedure. It levies a licensing fee on billing companies for using CPT codes on bills. Royalties for CPT codes, along with revenues from other products, are the association’s biggest single source of income" Aint that something? Okay, I would rank Elizabeth Rosenthal up there with Atul Gawande and Lisa Rosenbaum in the pantheon of standout healthcare writers active today.  They are all docs and have more skill in their writing pinky than I have in my entire body. They have a unique talent in stitching together narratives that speak to both docs and patients in their language--and do it within…

Dont Compare HM Group Part B Costs Hospital to Hospital. It’s About the Variation Between Individuals.

I have been and will be light on the blogging these days.  However, a new JAMA online first study out looking at hospitalist Part B cost variation deserves some attention.  Bestill my heart.  It's not about groups.  It's about individual physicians.  The gap between high- and low-spending doctors in the same hospital was larger than the gap in spending between hospitals. From the editorial: In this issue, Tsugawa et al3 analyze spending by individual physicians in relation to patient outcomes. The research team compared Medicare Part B spending per hospitalization by hospitalists practicing within the same hospital. To profile each physician’s level of spending, average Part B spending per hospitalization for 2011 and 2012 was used, then applied to clinical outcomes (30-day readmission and 30-day mortality rates) for 2013 and 2014. The split-sample approach mitigates bias if a physician treats a complex set of patients in one year and therefore has…

My Top Five Drugs I Want Now

This is a serious list.  We get conditioned on what we have and accept the untoward effects or inconveniences of the drugs in our armamentarium. These five tweaks would make our lives a helluva lot easier: A non-opiate pain reliever without the nasty side effects of an NSAID.  By far and away, this is my number one. An oral insulin.  Can you imagine how much easier life would be? A rapid-acting antidepressant that works.  We (adult providers) neglect the limited functional abilities from cardiovascular or musculoskeletal disorders our patients live with.  The problem is only getting worse. Imagine an accelerated resolution to mental health issues which invariably magnify and worsen the physical ones we have a hard enough time dealing with in the first place. A systemic anti-inflammatory that is not prednisone.  We use that train wreck of a drug so often we forget what a horror show it is.  Its list…

US Versus Foreign Trained Docs: Who Saves More Lives?

Yeah, I know the headline drew you in.  I sleuthed ya---but I have a reason. A study out in BMJ today, and its timing is uncanny given the immigration ban we are now experiencing. First, to declare my priors. I will take an IMG to work by my side any day of the week.  You need to be twice as smart, motivated, and industrious to make your way to American shores. The paper:   The researchers analyzed data on 1.2 million hospital admissions of Medicare patients aged 65 and over between 2011 and 2014 and for 44,227 internists. The average age of patients was 80, and the most common causes of death were sepsis, pneumonia, congestive heart failure, and chronic obstructive pulmonary disease. The difference in results was slight, but I post the tables if only to show, at least based on this sample set, at worst, IMGs are equal to, and best,…
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