You are 30 years old. You smoked for 10 years but quit last year. You started getting a dry cough recently and becoming strangely short of breath when walking long distances and you can hear yourself wheeze. A search for “cough with wheezing” on Google returns a very long list of medical words – some you know, some you don’t – like asthma, emphysema, bronchiolitis. And then you come upon some heavy-weight diagnostic jargon like “allergic bronchopulmonary aspergillosis,” “acute respiratory distress syndrome,” and “bronchogenic pulmonary adenocarcinoma.”
Now you are really worried.
Welcome to the world of medical information overload.
A medical residency is not easy. Part of the coping mechanism involves complaining among your fellow residents about everything from the work hours to the deteriorating quality of vanilla pudding parfait in the cafeteria. Generally the discussion goes something like this:
Resident A: “The vanilla pudding parfait has too much whip cream and not enough pudding.” Resident B: “We get paid fifty-thousand dollars a year for working eighty hours a week, and they can’t even have a respectable dessert in the cafeteria.” Residenc A: “I am going to go have a chocolate parfait. That one comes with an Oreo.”
While Resident A is probably just partial to chocolate, Resident B’s observation begs for an obvious non-dessert-related question. If medical residents create such immense value at a low cost to hospitals, then increasing the size of the residency program must also be highly desirable. But the truth is even in the face of increasing demand for physicians, America is not making many more doctors to match the demand. Continue reading “The Two Faces of Physician Shortage”→
In a prior post, I read Steven Brill’s story on health care hospital bills and offered a brief analysis of the “average hospital” in contrast with MD Anderson. The data show that average hospitals are low-margin organizations.
In an article titled “Bitter Pill: Why Medical Bills are Killing Us,” Stephen Brill outlines a well-researched investigation on hospital over-billing. In the article, Brill begins by highlighting the unreasonable mark-up MD Anderson places on every medication, service, and imaging that it provides. He argues that this “hard-nosed approach pays off,” earning MD Anderson $531 million operating profit in 2010, and that this comprises a 26% operating margin. $1.8 million of that went to the pockets of Ronald DePinho, the president of the cancer center.
Although Brill never outright states the connection, his implication is clear: general hospitals are the oft ignored mammoth in the health care debate, operating under the veil of legitimate non-profit business. A general hospital funds its astounding operating income by making the uninsured and under-insured suffering patients an offer they cannot refuse. It then funnels this unfairly earned profit into the pockets to the Godfather of the organization. Continue reading “Why Can’t Hospitals Stop Over-Billing Us? (Part 1/2)”→
“Mathematical reasoning may be regarded rather schematically as the exercise of a combination of two facilities, which we may call intuition and ingenuity.” – Alan Turing
Sherlock Holmes is fictional expert in what he calls the “exact science of detection” (A Study in Scarlet). Despite his genius in deductive reasoning and intuition is unparalleled, much of the detective success relies upon the calm and composed guidance of his trusty sidekick Dr. Watson. In most of the canonical novels, Watson acts as the sanity check for Holmes’ storm of ideas and, of course, the meticulous chronicler of their adventures together.