Billy Rubin's Blog

great!

2012-05-25T15:26:30.135-04:00

great!

Seriously? The Hunger Games is PG-13? I find it s...

2012-05-17T10:46:46.502-04:00

Seriously?
The Hunger Games is PG-13?

I find it shocking and very disturbing.

In support of positive solutions to the problem, c...

2012-04-25T15:26:38.438-04:00

In support of positive solutions to the problem, consider following
http://shotatlife.org/ on facebook and twitter and supporting Sustainable Healthcare for Haiti as well as we have in our plans an outpatient clinic with solar powered refrigeration so we can be part of the developing Cholera Vaccine Supply Chain.

For individuals and small businesses, health insur...

2012-04-20T16:00:51.381-04:00

For individuals and small businesses, health insurance companies usually do provide insurance; they take a premium and assume financial responsibility for paying the bills.
it contractor mortgages

Accountable care organizations will increase coord...

2012-04-20T15:43:03.797-04:00

Accountable care organizations will increase coordination of patient’s care and shift the focus of medicine away from treating sickness and toward keeping people healthy.
file llc

Wonderful blog & good post.Its really helpful ...

2012-04-20T03:58:18.736-04:00

Wonderful blog & good post.Its really helpful for me, awaiting for more new post. Keep Blogging!

Medical Manuscript Writing

Thanks Sharon. I distinguish between a "right...

2012-04-16T07:41:24.695-04:00

Thanks Sharon. I distinguish between a "right to die", which I'd define as a patient's right to be free to refuse any and all (i.e. including life-sustaining) medical treatments offered by docs, and PAS, which constitutes a pact between doc and patient to aggressively terminate a life. I support the former but not the latter.

To use a practical example, I see nothing wrong with patients asking docs to turn off an implanted cardiac assist device, which keeps people alive by administering electroshocks to the heart when one's heart goes into the life-threatenting rhythm of ventricular fibrillation. I've seen this happen, and invariably the patients die of V-fib arrest within weeks or months. I have no problem with turning the device off as that's a passive action (the withdrawal of life-sustaining medicine). I see a big difference between that an actively administering medications whose specific functions are to bring about death. For what it's worth, I think that view is shared by the large majority of my professional colleagues. For once I'm not so far out on a limb with radical ideas, which is comforting. Best, Billy

really interesting post. i generally support peop...

2012-04-16T01:48:50.675-04:00

really interesting post. i generally support people's right to die, but i do have concerns about pas and think that physician's have a moral obligation that works counter to the idea of pas. but i had really never really considered the implications of the us health care system in regards to pas. super interesting point of view, and quite valid. scary stuff.

I think the principle in health care is that the p...

2012-03-26T20:42:39.356-04:00

I think the principle in health care is that the providers put too much premium in gaining a profit that is obscures the credo of health care concept.

I agree that there's an "asymmetry of inf...

2012-03-12T08:04:28.184-04:00

I agree that there's an "asymmetry of information" relating to evaluating the technical aspects of a doctor's performance, a point that several doctors stressed in the comments section of the Times article. The same is no less true for my being able to rate my electrician or my auto mechanic. But most people want their docs to be able to be approachable, reasonably prompt, fairly accessible and emotionally empathetic--all things for which any patient could offer a fair critique.

I think most patients understand that it's very difficult to evaluate a doctor's knowledge base and expertise. There's a great story in Jerome Groopman's "How Doctors Think" where Groopman himself, a full Professor of Medicine at Harvard and an obviously talented clinician got totally snookered by several orthopods when he presented with funky wrist pain; only after finding the right doc did he understand the answers of the previous docs were technically inept. In other words, even for those with a pretty high level of expertise, it's hard to be an accurate judge of that aspect of doctorhood. But most gossip that I hear about bad-experience-this or bad-experience-that with a doc has to do with someone's comfort level, and I think that's a very reasonable thing for patients to evaluate...and I'm a touch surprised that you, free marketeer that you are, don't appear to fully agree.

I think the general concern that people who make the "technical expertise can't be evaluated" argument have is that they're going to find some very highly rated doc who is strong on social skills but low on actual medical knowledge. Since the quality control of physician training is relatively high, I don't think that's a major concern, although I would carve out an exception. Lord help me for saying this as I may rain down derision on my head, but the one field in which I would hesitate to seek a doc is Family Medicine. I don't think it is possible for them to be superior in competence to their Internal Medicine or Pediatric counterparts--and indeed think it's more likely than not to be less competent--but without doubt these docs are among the most patient-friendly in the biz. Based on my experience teaching, students interested in Family Medicine are among the least driven in terms of academics and most driven in terms of the pastoral aspects of care. Possessing the latter qualities is great, but lacking the former qualities not so helpful if your patient has Brougada Syndrome and winds up dead because you didn't catch it on the EKG.

I thought about mentioning this in the main article, but there are two areas where online info about docs (not "reviews" per se) can be useful for laypeople to technically evaluate performance, and it deals with surgeons. For moms looking at OBs, they should be able to find out C-section rates of a given OB relative to her peers if that's important to them. Second, if someone's going in for routine surgery, it's reasonable to look up postoperative infection rates on a given surgeon (though this info is probably pretty hard to find right now, though I suspect it's coming). I would not recommend that anyone try to evaluate a surgeon by "outcomes data", i.e. how many patients die or have complications under a given surgeon's knife, since nobody has yet figured out an apples-to-apples comparison of the patients undergoing surgeries. This holds true for non-surgeons as well. Docs at large, academic medical centers are typically willing to take on cases that community docs won't touch, which means that the patient base at an academic center is sicker and more likely to have a higher mortality rate, but frequently the technical skills of such docs are higher, not lower, than their community counterparts.

It's easy to rate restaurants: I get feedback ...

2012-03-12T02:58:18.644-04:00

It's easy to rate restaurants: I get feedback on their quality immediately and I've been to hundreds of restaurants, so I have a good sense what the good ones are.

With doctors, there's asymmetry of information. I go to the doctor, she gives me advice, and I rarely have any idea how good the advice is, sometimes only learning it's bad months later, like the doctor who missed my torn rotator cuff. So I can rate them on friendliness and on wait times and ease of scheduling appointments, and not much else, and have little to compare them with.

For the record, Sharon is not a paid employee of t...

2012-02-07T09:30:32.363-05:00

For the record, Sharon is not a paid employee of the Billy Rubin Blog. If we did have a staff, Sharon would be the first paid member, however.

well said, as always.

2012-02-07T00:24:48.102-05:00

well said, as always.

WOW--I forecast the future with that last sentence...

2012-02-03T12:49:43.551-05:00

WOW--I forecast the future with that last sentence. They have already changed their tune.

UPDATE: this is a fast-moving story, indeed. Accor...

2012-02-03T12:07:50.037-05:00

UPDATE: this is a fast-moving story, indeed. According to CNN (http://news.blogs.cnn.com/2012/02/03/komen-to-restore-planned-parenthood-funding-senator-says/?hpt=hp_t2), Komen has reversed its stand on Planned Parenthood. As far as can be divined at the moment, no such reversal has occurred with respect to institutions that sponsor ESC research.

Someone pounced on the red meat:) I characterized...

2012-02-03T09:26:05.499-05:00

Someone pounced on the red meat:) I characterized your side as "pro-abort" bc my side was characterized as "anti-abortion", "anti-choice"--not pro-life as we prefer:) And I wrote "women's freedom" as that is how Billy referred to it in his original post. I am much more concerned about the rights of the growing human life, rather than women's rights which is code for abortion on demand.
I don't think allowing a poor 13 year old in foster care to go through a secret abortion is in her best interest--I'm sure we differ there.
And obviously since I am a conservative, many things my tax dollars go to make me sick--but not many more than supporting the taking of innocent life.
We are not going to change each other's minds--but your side has won--just look at the recent HHS ruling as an example--so I don't get all the outrage towards a charity that funds breast cancer research that no longer supports an organization that does many things including abortion. SGK has said that it will give the same amount of money to the cut-off communities but to other organizations that do the same breast screenings, etc. So breast health of poor women is not in jeopardy--just funding to the largest abortion facility is. And pro-lifers shouldn't even be too sure this is going to last bc Brinker said if PP can write a grant that meets requirements, they will return to giving them money.
Heidi

People should not take advantage of accidents or s...

2012-02-03T03:39:41.563-05:00

People should not take advantage of accidents or sick notes. Thanks.

Dear Heidi, I find it odd that you claim to unders...

2012-02-02T18:28:18.420-05:00

Dear Heidi,
I find it odd that you claim to understand the argument on both sides yet you completely misrepresent who the "other side" is. The other side is pro-choice, not "pro-abotion." Its not about "Women's Freedom," it is about Women's rights. Not so subtle differences. If you disagree you are only affirming my point.
Second, that poor 13 year old was in foster care. I beg you, ponder that for a moment while you wave your loving adoption sign. As for your Federal dollars, if you really cared to know what those dollars supported I would hope your intelligence would lead you to be sick over other things than providing healthcare to woman who have no health insurance.

Thanks, Build. I am all for passing the contempt a...

2012-02-02T18:11:46.513-05:00

Thanks, Build. I am all for passing the contempt around to as wide a net of deserving people as possible. Best, Billy

I would also suggest making an donation in honor R...

2012-02-02T18:00:10.668-05:00

I would also suggest making an donation in honor Rep. Cliff Stearns. You can make a donation as small as $5 to PP and they will send a card to the honoree.

that is too bad that now Komen is not supporting P...

2012-02-02T12:53:32.034-05:00

that is too bad that now Komen is not supporting PP, that many people--I assume those who support abortion, will not support them in their efforts to stop breast cancer. Why were they not partisan before when they supported PP, but you assume that now that they don't support PP--it will become partisan? I suggest it is because of the fanaticism on the left in this case. PP's will not have to be shut down simply because Komen does not support them--you can still donate to PP. I have been to a few pro-life events--Hezbollah fanatics we were---all that praying and holding up signs with slogans like "Adoption is a loving choice", caused people to scream in horror. The pro-abortion groups also will stop at nothing to prevent common sense restrictions on abortion--such as parental consent, watching an ultrasound, etc. I wouldn't call them Hezbollah fanatics but they do everything in their power to keep abortion a common practice that is not even regulated as much as my dentists office--and you now how I hate regulations:) Don't worry--you all have won the battle--any 13 year old could be statutorily raped by a 20 year old, he could take her in to a PP, or she could ask her school counselor to take her, and get her an abortion and the parents would never know. If that doesn't make pro-abortion people realize they have basically won this battle--I don't know what will

Oh--and I think the reason PP is targeted is that they perform the most abortions by far of any other abortion mill in the country and my tax dollars have to support it. It would still be targeted if it were a totally private, but I don't think to this extent. And please don't tell me no tax dollars go to abortion--the money they don't have to use to support their other services that are being subsidized by tax money is then freed up to be used for abortion.

Heidi

First, technical matters: when you post the commen...

2012-02-02T09:41:48.266-05:00

First, technical matters: when you post the comment, at the bottom of the field, there is a tab that asks you for your identity. You can choose from among various “identities”, though signing off as “Heidi” in the anonymous post works perfectly fine. The Billy Rubin Blog audience, which likely numbers less than twenty, is not the type to engage in posting people’s addresses for the purpose of intimidation, with the possible exception of when I waded into discussing the coaching atrocities at Texas Tech a while back.

I agree that the Hezbollah-like fanaticism by which anti-abortion groups pursue their ends makes it difficult for anyone who does not share their views to find common ground. Planned Parenthood does a good deal more than provide abortions, but anti-abortion activists have targeted PP with a zeal that would warm the cockles of the hearts of men with long beards in Tehran. Komen has apparently calculated that it is better to throw their lot in with those who support breast cancer awareness but are opposed to helping women who might even consider abortion services than it is to remain neutral on the issue of abortion and attempt to help all women vis-à-vis breast cancer no matter where they get their help.

You may be happy that you will now be able to donate to the women who participate in the Komen walks; my guess is that such walks will be diminished in their broad popularity and become essentially partisan events.

Best, Billy

The reason the abortion conflict will never be sol...

2012-02-02T08:34:31.218-05:00

The reason the abortion conflict will never be solved is that one side sees abortion as "women's freedom", and the other side sees abortion as taking of an innocent human life. I don't think there is any way these two sides will ever come together. As far as the Komen issue--I don't get why those who support abortion and breast cancer research can't donate their money and time to both organizations--but instead insist that one fund the other. If you really believe that PP helps poor women with breast health, donate to them. But now, for those of us who could never donate to Komen and other organizations that support PP, we are happy that we can now donate--as many of my friends walk in the Walks and I hated not being able to support them.
This is Heidi--couldn't figure out to put this on here except anonymous

Point well taken, Indirect. Today I was choosing t...

2012-02-01T21:42:17.188-05:00

Point well taken, Indirect. Today I was choosing to set aside the issue of BSE, which, unlike mammography, costs nothing and has I suspect far fewer downsides than the mammogram. But you're right: BSE and mammography were great ideas a generation ago that, alas, aren't standing up to the test, and will need to go the way of the Dodo eventually.

Nice one, Billy.

2012-02-01T21:18:30.906-05:00

Nice one, Billy.