Posts by Brad Flansbaum

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,…

The Nursing Home Get Out of Jail Card (“We Don’t Want Our Patient Back”). It’s Now Adios.

The Centers for Medicare & Medicaid Services (CMS) has not updated its rules ("conditions for participation") for nursing homes in twenty-five years. Late last year they finally did. Many of the changes will have an impact on the daily lives of NH residents but are far removed from hospital medicine.  Think a resident's ability to pick their own roommate and have all hours visitors.  However, there are a few changes that intersect with HM, and a notable one will affect how you respond to a frequently encountered roadblock long-term care facilities sometimes throw our way. First, though, some of the changes CMS finalized.  With SHM members now moving into the post-acute and LTC realm, several have real relevance (I only cite a sliver of them): (more…)

Online Ratings For Hospital CEO, CFO’s, etc.

This week's NEJM features an article on hospital-sponsored online rating sites for docs.  The author, Vivian S. Lee, M.D., Ph.D., MBA, a prominent health services researcher discusses the adoption and success of her program at the University of Utah and how the system uses a portal open to patients to evaluate staff. In the piece, she covers familiar ground. Early renunciation and eventual acceptance by faculty in a manner you can predict: initial fears of reputation and prestige loss give way to a stable system allowing docs to obtain feedback in real time to improve their game.  It is not all wine and roses in her telling, but like all things, the apocalypse never materializes, and the once unthinkable becomes business as usual. Docs adjust.  Life moves on. Also in her viewpoint, she cites a recent study of interest that continues to get a lot of attention whenever inquiring minds consider provider ratings.…

Male Versus Female Hospitalists

If you have paid attention to the news, you picked up the study out in JAMA concerning how male versus female physicians deliver inpatient care.  Not just any inpatient docs, though, but hospitalists. The investigators were meticulous in their analysis of over a million Medicare beneficiaries and looked at readmit and mortality rates.  They examined various diagnoses and adjusted for the usual doctor and hospital characteristics. Across the board, males took a drubbing and the NNT for both outcomes of interest hovered around 200 (0.5% absolute difference). Ashish Jha, one of the investigators and a leader in the study of hospital quality and safety (who really needs to speak at an SHM annual, incidentally) goes into more depth over at his blog: (more…)
12345...102030...