Family Practice Rocks and other Cheers !

  As I walk around my study, between thoughts about my blogs and social media lurking I am struck by the enthusiasm and total immersion of family medicine and it's cheering squad. Many young family medicine residents speak about a 'revolution' and regret the passage of what some of we older physicians lament....a long gone vision of an iconic Marcus Welby, indelibly marking our memories. Featured statements such as, "Either you're at the table or you're on the menu." and other quotes from the blog, of the California Academy of Family Physicians (CAFP) as stated by Dr Roland Goertz, AAFP President, "Our time is now." I have been a super specialist in the scheme of things....an ophthalmologist, now retired. I was strongly buffered and...

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Vermont’s Bold Experiment: A Rebuttal

As commented on The Health Care Blog Vermont's Bold Experiment           Hsaio 1989                                  Hsaio 2010 Harvard Professor William Hsiao is fond of the phrase “bold experiment'. In the late 1980s Hsiao supervised and analyzed a study of expenses in medical practice which specifically analyzed services by physicians accounting for physician time, overhead, capital outlays, malpractice and other physician overhead items. He developed the RBRS scale based upon RVUs (relative value units). The formula was based...

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Why Would Anyone Want to become a Physician?

Good question, given the current atmosphere of doom and gloom amongst my colleagues and peers. Well first of all like most folks when one has worked at the same job for 10-20-30-and even 40 years the human spirit does need replenishment. Many pubic servants (and that is what we are), police, fire department personnel, correction officers have some things very much in common. Stress ! Stress related disability is actually a compensated employment related disability category. Medicine is stressful….but not so much about the art and science of  medical practice.  Some things are life threatening, but for most MDs the day is routine. Perhaps in some specialties such as cardiology, surgery, ophthalmology where the outcomes are critical...

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Philosophers and Economic Reality

  “Change, before you have to…” Jack Welch “We live in a society that loathes uncertainty – particularly the unintended consequences that sometimes result from a catastrophic event or in the case of PPACA, landmark legislation”, this according to Mike Turpin in today’s edition of The Health Care Blog. And accordingly this is the thing which prevents an active recovery, and also why the huge infusion of stimulus funds, is not being distributed by the holders of the capital. Common sense overrides the edicts of big government. If I had just been through an economic disaster, or my neighbor became unemployed or my business was tottering, would I spend a largesse handed to me or bank it against another rainy day? My family voted this week...

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Health Works Collective

There is a new kid on the block, HWC, otherwise known by the title of this post.  What does this have to do with Health Train Express? Well since there are limited hours in my day I will be publishing Health Train Express less often. Regular readers may have noticed the frequency of  the posts here have diminished. I was  invited to add some exclusive content to HWC. This week the first article is on the entrance of Google Plus into the Social Media Stream for Physicians, along with the demise of Google Health. It may be that snail mail, memorandums, yellow sticky pads, and even email or plain old chat have been dealt another blow. eBooks are now also ‘The Rage’ as some large book franchises like Borders Books are in ICUs...

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Health Care Conundrum

It requires an unusual mind to undertake the analysis of the obvious. The daily review of health blogs, social media, and Health 2.0 pundits gives birth to today’s Health Train Express. I can not but help quoting some profound statements. It requires an unusual mind to undertake the analysis of the obvious. Alfred North Whitehead, Science and the Modern World It’s much more important to know what sort of patient has the disease than what sort of disease the patient has.  William Osler, MD, 1648-1919  There’s no other profession as personal as the medical profession. If physicians continue to allow non-physicians and businesses such as hospitals and insurance companies to control them, they will lose their patients and will be nothing...

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Google + Replaces Google Health

  How convenient Google + is the new girl on the block. Just like a new face in school, everyone wants to get to know him/her. After a few days you will either love or hate the new one. I spent the greater part of the weekend learning about this 'stranger'. It was about like waiting for a chance to meet the mysterious new stranger as I waited and pleaded with those who already had access to the “G+”. Twitter came in great handy as I asked everyone for an introduction to the seductress. It seems she had already been in many bedrooms, living rooms, and even perhaps in the backseat of a few vehicles. Everyone seemed quite willing to share the temptress, she has several personalities, friend, family, professional, acquaintances and more....

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If Airline’s were run like Healthcare

  Fasten your seatbelt, it’s going to be a bumpy ride, if you can get there at all. If you wish to read Jonathon  Rauch’s popular article in National Journal Review, read on…..comparing Airline Travel and Health Care.  otherwise watch the video. del.icio.us Tags: airlines,healthcarebluebook,jonathon rauch...

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A Marxist Turned Libertarian on The Health Train

  In preparing for today’s journey on the Health Train my travels took me to a video by Thomas Sowell. Dr. Sowell was born a poor African-American black man (as opposed to a poor white African American (which is a real possibility, although statistically unlikely),  whose innate intelligence, drive, and smart choices enabled his gifts. He chose to follow the ideas and the man who mentored him rather than the institutions that brought them together. Thomas Sowell indicates that his mentor was Milton Friedman, a name well known to those interested in economic theory.  Here is the video….it should spark some controversy and lead you to learn more about Mr. Sowell and more important, the simplicity and detail about how Government Medicine works and why it does not work well. Dr....

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Which List Do You Want to be On?

  Tweeting has added a new dimension for connecting to others with similar interests. The short 140 character only slightly exceeds my short attention span. I can quickly absorb and scan through tens of ideas between patients, while waiting in the doctor’s lounge to start a surgery, and G-d forbid waiting for an attorney to give a deposition. A tweet attracted my attention from @MtnMd, ,Founder&Chief Medical Officer of eMedicalMall, technology company serving medical community & patients to improve health care. @ MtnMD also posts a blog,  Sprocket, a compendium of lists divided into categories of credibilty. Sprocket is now added to my followed blogs, I find it useful as a starting point to expand my meager knowledge base...

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Medical State of Mind

  Medicine has gradually been drawn into a state of mind where legalese and bureaucracy have replaced medical and scientific results.  “Evidence based medicine” has surpassed scientific results, or empirical outcomes as the arbiter for treatment choice.  Anecdotal clinical opinion has been replaced by ‘hearsay’, and humans are enhanced or even replaced at times by machines. Evidence Based Medicine can best be graphically modeled by the ‘evidence pyramid’ a term borrowed from the food pyramid: The pyramid best outlines the progress in medicine, and the addition of 4 new levels of critical analysis of treatments.  Clinical medicine is never stationary,nor should it be, without which there would be no progress. Has blogging...

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