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US healthcare

Suzanne Gordon: The future of the Veteran’s Health Administration

29 Apr, 16 | by BMJ

suzanne_gordonBy the end of this year, the US will have a new president as well some new members of Congress. The results of the 2016 election will not only effect the further implementation of the Affordable Care Act (Obamacare), but the future of the country’s largest healthcare system—the Veteran’s Health Administration. That’s because most of the Conservative Republicans running for President—as well as many of those running for or already serving in Congress—are not only determined to repeal Obamacare. They are also committed to dismantling the largest and only publicly funded, fully integrated healthcare system in the US—the Veterans Health Administration (VHA). Even many Democrats are not fully supportive of the VHA. While Hilary Clinton says she does not support privatization of the VHA, only Bernie Sanders (D. VT) has demonstrated a deep understanding of what the VHA does and how it actually works. more…

Jeanne Lenzer: The Backstory—How I got the Cuba HIV story wrong

13 Apr, 16 | by BMJ

jeanne_lenzerI recently reported on the World Health Organization’s announcement that Cuba was the first country in the world to halt mother-to-child transmission of HIV, an accomplishment praised by WHO’s director-general, Margaret Chan, as “one of the greatest public health achievements possible.”

As I sat in the semi-circle of doctors who treat pregnant women in Matanzas, Cuba, I asked a question that had long concerned me: Did children who were exposed to antiretroviral drugs in utero and/or during infancy have a higher rate of congenital or developmental problems than other children? more…

William Cayley: Will mid-level practitioners replace primary care physicians?

5 Apr, 16 | by BMJ

bill_cayley_2I recently asked whether, in light of the relative drop in the number of trainees entering family medicine in the US compared to other specialties, we can continue to find ways to bolster the strengths of primary care, both in medical education and practice—since we know that primary care “helps prevent illness and death.”

Some have suggested that the best way to strengthen primary care systems, if physicians are in short supply, is to focus on further development of training for “mid-level” practitioners—for example, nurse practitioners and physician assistants.

There is certainly evidence that mid-level practitioners are an asset to a primary care team. more…

William Cayley: What’s in the future for US family medicine?

31 Mar, 16 | by BMJ

bill_cayley_2Once again, after waiting with bated breath, hope, and anxiety, medical students and residency programs alike have received the results of the annual residency “match.” After months of seemingly endless interviews and paperwork, and the submission of preference lists to the computer based algorithm at the National Residency Matching Program (NRMP), we finally know what the future holds . . . at least in part.

For graduating medical students, match results determine where (and in what specialty) they will spend the next few years of postgraduate education. For residency programs, the results tell us who we will be teaching in the coming years (and whether enough applicants “liked” us in order to fill an incoming class). And for each specialty as a community, match results tell us something (we think) about the current and future prospects for our area of medicine. more…

Jeanne Lenzer: The Backstory—The New York Doctors’ Riot

23 Mar, 16 | by BMJ

jeanne_lenzerHarriet Washington, a medical ethicist and author, opened a recent talk saying, “Alexander Hamilton and John Jay, heroes of the newly minted American Republic, did not spend 15 April 1788, penning the Federalist papers, nor were they holding forth on the virtues of a free press while bedecked in morning coats and powdered wigs. Instead they crouched, bleeding profusely, behind members of the state militia on the outskirts of New York City. Bodies lay scattered and blood pooled in the street as hordes of shrieking, outraged New Yorkers fled the militia’s bullets in a chaos of fear. Many of the fleeing were badly wounded, but the city’s doctors couldn’t help them: Nearly all were in jail.” more…

Steve Ruffenach: Electronic health records—time for machines to start sharing

10 Mar, 16 | by BMJ

steve_ruffenachLas Vegas hosted the Healthcare Information and Management System Society (HiMSS) annual meeting again last week. With more than 45,000 people in attendance, it is at once intense and unwieldy. It is also the meeting where every company and organization that controls, distributes, or touches medical information of any sort or in any way shows up to hawk its wares, brag about its effectiveness, and deliver promises of healthcare information management nirvana. more…

William Cayley: Single payer healthcare—is it here already?

23 Feb, 16 | by BMJ

bill_cayley_2Despite all the hand wringing and arguments over single payer healthcare in American social debates past and present, what most observers seem to miss (but patients and doctors know very well) is that we already have a long established single payer system of healthcare financing in the US—our healthcare is already paid for by the ubiquitous “them.”

• A physician sees a patient and recommends a battery of tests, expecting it will be paid for by “them.”
• A patient receives an unexpectedly high bill for services their insurance did not cover, and requests dismissal of the charges or recoding of the bill, because “I shouldn’t have to pay for it, ‘they’ should cover it.” more…

Huw Green: Schizophrenia—what doesn’t exist?

16 Feb, 16 | by BMJ

huw_greenpicJim van Os provides an excellent summary of why many clinicians and researchers (especially the latter) have become frustrated with the imprecision of the term schizophrenia. Among scientists, calls to abandon the diagnosis have sounded for more than 25 years and will probably eventually be heeded. Few scientists would bet that it will retain its currency another century from now. However, there is a deep philosophical tangle involved in the headline claim that “schizophrenia” doesn’t exist.

Some who oppose the label of schizophrenia have made their case by comparing it with phlogiston, a hypothetical substance which was posited in 1697 to explain the fact that some materials combust. more…

Jeanne Lenzer: The Backstory—When is patient consent needed?

12 Feb, 16 | by BMJ

jeanne_lenzerWhile I was reporting on a study for The BMJ, I suddenly felt as if I’d walked through Alice’s Looking Glass.  You’ve possibly heard about the study by now: researchers found that patients treated by sleep-deprived resident doctors were no more likely to die or suffer serious complications than patients under the care of doctors working limited hours.

Of course the study seems a bit strange given what we know about doctors’ performance and sleep deprivation.  And while sleepy truckers are well-known to be deadly on the nation’s highways (as are pilots and others entrusted with the public welfare) it appears that some doctors want to believe they are immune to the biologic limits of other humans. more…

Saurabh Jha: Britain’s junior doctors are not apprentices

12 Feb, 16 | by BMJ

Saurabh_JhaIt was Boxing Day weekend. The consultant surgeon summoned the on-call team. “We face a calamity,” he said. The house officer had called in sick. The locum wasn’t going to arrive for another 12 hours. This meant that I, the senior house officer, would have to be the house officer. The registrar would take my place. The consultant, looking tense, would have to be the registrar—i.e. a junior doctor again.

“Junior doctor” is a misnomer because it implies a master and an apprentice. Running the National Health Service (NHS) are apprentices who become Jedis very quickly, and without a Ben Kenobi showing them the ropes. more…

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