It's a fair question (in the US, anyway) to ask us how much a procedure costs, but each procedure has multiple components with different prices set by negotiation with each insurance company, and a separate amount for uninsured patients, often with a modest discount. Insurance companies consider the negotiated prices proprietary; if they were posted, doctors could collude in setting prices (which is illegal).
Your insurance company changes these prices each year, and does not make them available for ready viewing by physicians, as that is not to their advantage. Your insurance company also sets deductibles and copays, and doesn't tell us what they are or how paid up your are on them. When we try to call your insurance company to figure this out, we get put on hold for 20 minutes (just like you) and as often as not are told we need to fill out form 2204-09, available on their website hosted in North Korea, to get permission to access information about your particular plan in order to make some guess about how much you're going to owe based on the procedure we think you're going to need and the particular agreement your plan has with our office.
If your physician gets paid right away by your insurance company, s/he is truly blessed. The insurance folks have 30 days to mull over the payment, and then can contest this and that and claim the diagnosis code needs another procedure code and so forth, with several weeks turnaround each time on muddied fax; they have little incentive to pay promptly. I can assure you they make as many mistakes paying us as they do billing you. And then we get to send you revised bills based on their (often) capricious decisions.
When patients call our office complaining about a bill, my preferred response is typically "fine," since I'd rather not spend another 40 minutes on the phone with your insurance company asking why the $120 we charged to remove your pre-cancerous mole shouldn't be bundled into the $10 toenail removal we did 2 months ago, and the 3 pages of paperwork designed in Kyrgyzstan where I can try to justify our billing to some insurance company bureaucrat. So we can get the $43 your insurance company has negotiated the $120 procedure down to. For the work we already did. I expect if we made your auto mechanic go through this bullshit 20 times a day they might just kill themselves with an air compressor.
It's not just Apple; all US workers are more productive than workers anywhere else in the world, where productivity is measured in terms of revenue generated per worker. For Apple, this may be based on cheap Chinese labor (though the expense of the labor in China versus the US doesn't seem to be the main reason iPhones are made in Shenzhen; it's because the rest of the supply chain and a huge supply of middle-skilled workers are there). But Foxconn's productivity is still likely dwarfed by Apple's; manufacturing is not where the profits are - Apple has demonstrated good design gets the high margins. It just hasn't lead to a lot of jobs for mid-level US workers.
That makes Apple's US workers more productive than Foxconn's Chinese laborers. I think you may be conflating productivity and employment. Apple's model (of doing the design and marketing themselves, and farming out the manufacturing to lower-margin contractors) just doesn't require that many workers, leading to low unemployment in Shenzhen and high unemployment in Detroit (and the US manufacturing sector in general).
Whether we could duplicate the manufacturing supply chain in the US is another matter, even if we could convince US workers to work (and live) under conditions like those at Foxconn. (Foxconn chairman compares his workforce to ‘animals’.)
While this may vary from state to state, as far as I am aware in the US, medical records belong to the physician or their institution: that's what I learned in medical school and residency. This looks to be the same in Canada, as well (http://www.cba.org/bc/public_media/health/421.aspx).
Who owns medical records? Do the records belong to me?
No, they do not belong to the patient. Medical records are the property of the medical provider (or facility) that prepares them. This includes films and tracings from diagnostic imaging procedures such as x-ray, CT, PET, MRI, ultrasound, etc. The patient has a right to view the originals, and to obtain copies under Health and Safety Code sections 123100 - 123149.5.
And, from "The Encyclopedia of Everyday Law," (http://www.enotes.com/healthcare-reference/medical-records)
Background
Medical records are the property of those who prepare them (medical professionals) and not the property of those about whom they are concerned (patients). However, patients have a privacy right in the information contained in the records. These two interests may or may not conflict when it comes to releasing medical records to outside or third parties, who may also have another interest at stake. Once these basic and often competing interests are separated and assessed, it becomes easier to understand the issues that may surround the right to request, view, copy, or protect medical records and medical information.
I can't speak to lawyerly records however, as I didn't go to law school.
As a doctor, I really think of your medical record as mine: what I gleaned from your complaints, what exams I did, who I talked to, and what I thought was going on and what to do about it. I know you are paying for it, but I'm the one doing the work and putting all that medical school to use.
That said, I think you should have access to it, for free, and modern electronic health records allow that: once I review a result or record I can release it so you can look at it online. I also now document in my charts with the idea that the patient or family member might read it, so in addition to the technical detail I write the plan and diagnosis in as plain language as possible, and send patients home with this at each visit. (More than half immediately lose this paperwork, in my experience.) These systems, naturally, come at significant, expense and require a fair amount of upkeep, so they are mostly available only at larger practices.
Having worked previously in a developing nation where patients were responsible for keeping their own medical records (on 5 x 8 index cards), I'm glad we don't do it that way here (I'm n the US). I need a secure copy of what's been done to you and what you're taking, and recall having had a lot of trouble reconstructing lost information from the memory of illiterate folks or damaged records that had gotten submerged in open sewers and whatnot.
For those playing along at home, Michael is referring to Toxic Shock Syndrome (http://en.wikipedia.org/wiki/Toxic_shock_syndrome), which occurred in some cases with the Rely super-absorbent tampon, no longer on the market for this reason. And, tampon boxes in the US now include warnings not to use tampons continuously and to watch out for fever (http://www.nytimes.com/1982/06/22/us/us-sets-new-rules-for-warning-labels-on-tampon-boxes.html).
It's not clear to me if Michael (and his various dogs and guns - see his fascinating journal!) is advocating for a stronger FDA or a weaker one (based on their inability to predict all potential hazards of all medical devices and drugs); I think this is a clear example of a government agency doing its job and preventing significant harm among its citizens.
Sheesh, touchy! FDA approval is based on (typically manufacturer-funded and run) studies that are supposed to prove the safety and efficacy of the drug or medical device. It may not always be perfect, but it is based on holding companies to well-designed, well-run studies - you know, the scientific method.
The Dalkon Shield (http://en.wikipedia.org/wiki/Dalkon_shield) was approved based on flawed studies, and was a frickin' dirt magnet, with woven strings and plenty of nooks and crannies into which bacteria could set up shop (in the normally sterile intrauterine environment), risking septic shock in users: that is, it killed not just fetuses, but moms.
You may also recall the sad case of thalidomide (http://en.wikipedia.org/wiki/Thalidomide), in wide use throughout Europe, but denied approval by (a brave, lone) FDA staffer based on inadequate study data. We can now thank our lucky stars she did so, given limb reduction deformities that only later on were attributed to the drug (at least in its racemic form).
There is an example of a market of pharmacologically active compounds not approved by the FDA: herbs and dietary supplements. Most of them purport to "support health" and relieve a variety of ailments, and the market is in the $US billions, but the number shown to actually work better than placebo in the sort of study the FDA uses for drugs hovers slightly above zero. In terms of what people actually use in common practice (well, my practice anyway - I'm a cheapskate family physician who sticks to older generic drugs) herbs and supplements aren't significantly cheaper. I've got quite a few sophisticated (and not so sophisticated) patients who use supplements regularly, based on thin or non-existant evidence, including a fair amount of folks who are going to die sooner (for example, by avoiding cholesterol medicine despite heart conditions) as a result of wanting to stick to "natural medicine." Caveat emptor, I suppose.
1. The AMA came up with the CPT code list, so they hold it hostage for money to fund updating it (and perhaps for hookers and coke - who knows). In any event, most electronic medical record software has searachable CPT lists; most doctors only use a small subset of the list which they memorize; and if you're stuck and don't have a book around you can do a search on the AMA website for free (https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp?locality=OR) or just google it (try "CPT circumcision").
2. Thanks for the anal raping analogy, but the issue isn't copyright over names of diagnosis but a bunmch of numbers that go with them that the AMA and feds agreed to standardize on. Doctors may be slow to adapt some technology (due to immense cost of anything that gets used in medicine, the relative simplicity of paper, the fact that historically most physician practices were independent small businesses with fairly low overhead, and that most electronic medical record software sucks) but it's not due to ignorance. Where technology is easier to implement with fewer rules and hope of remuneration (surgical robots, diagnostic ultrasound, MRI imaging), if anything, it's overused by physicians.
1. France has 3.4 doctors per 1000, the US 2.4 (http://www.oecd.org/dataoecd/53/12/38976551.pdf), though the US also has nurse practitioners and physician assistants working as "physician extenders"; I'm unaware of the equivalent in France or the EU in general.
2. The AMA isn't limiting medical school admissions. Seriously, this is repeated so often on Slashdot I'm figuring y'all must have gotten it from somewhere, but I don't know where. The AMA represents physicians; the AAMC (https://www.aamc.org/) certifies allopathic medical schools, and AACOM (http://www.aacom.org/Pages/default.aspx) certifies osteopathic med schools in the US. Osteopathic physicians practice in parallel in the United States (though not, generally speaking, elsewhere). I'm not aware of any entity limiting the number of medical schools in the US; in fact, enrollments are expanding (http://www.nytimes.com/2010/02/15/education/15medschools.html) - about 6 in the last few years, with an 18% increase expected. Moreover, allopathic (traditional) medical school education is expensive, with only about 50% of costs covered by tuition (at least where I went to school; the remainder came from income from clinical faculty, grants, and donations).
3. Practicing physicians in the US are more obviously limited by availability residency slots (post-medical school training), which are funded by the government (largely Medicare) - training in exchange from (somewhat brutal) labor. Residency spots aren't likely to expand anytime soon, as this would require more tax dollars. And, more doctors seems to just result in more stuff being done (not always obviously beneficial), and more money being spent.
4. Med schools take hardly any foreign students, but residencies do (or did - it's becoming a bit less common), since relatively few US med school grads are interested in primary care. Some of the brightest primary care physicians I've run into have been foreign grads, who compete mightily for US residency slots, and provide a huge portion of primary care in underserved US communities (because relatively few US grads will, so a special visa waiver program allows these spots to be filled by non-US grads).
5. Given the above, artificial supply limitations have just about nothing to do with the expense, waste, and all-around brain damage of the US health care system. In my (daily) experience, grievously mis-applied capitalist and "free market" incentives have just about everything to do with how delightfully broken the US system is.
Methadone is actually a pretty good painkiller (http://www.aafp.org/afp/2005/0401/p1353.html) when used with 3 times daily dosing (methadone for heroin/diamorphine addicts is usually dosed once daily). Methadone's risk is that it has a long half-life (up to 5 days), and no 1:1 dosing equivalency with (say) morphine, so if you aren't careful it can accumulate and cause respiratory drive suppression - you just stop breathing. It can also cause disturbances of cardiac rhythm (that is, screw up your natural pacemaker) in higher doses.
I do not frequently prescribe methadone (I am a physician) because it's not often I have patients on chronic opioid medicine who I consider responsible enough to use it safely. And, I have seen inexperienced staff at pain specialty clinics nearly kill people a few times. But, if your drug plan won't cover sustained-release oxycodone or morphine (common until a few years ago in the US when morphine SR finally went generic) it's a viable alternative.
For a list of "worst" opioid agonists in terms of effectiveness for pain, consider codeine and propoxyphene (as in Darvocet in the US), both of which don't seem to be more effective than acetaminophen/paracetamol.
Bone tenderness along the distal 6cm of the posterior edge of the tibia or fibula just means "does it hurt when you press on the back bottom part of the bones sticking out on either side of your ankle." You really can do this (and I have successfully gotten people to do it over the phone);
Scope of practice laws vary from state to state; an RN could probably get an x-ray ordered after doing such a test provided there was a written protocol signed off by a physician in most places, though I know of know actual emergency departments that do this. Having an RN (who is not an independenty practicing nurse practitioner anyway) do this on their own in the absence such a protocol would probably illegally stray into the actual practice of medicine.
We have such a system where you can see medically knowledgeable people who aren't doctors. They are called nurse practitioners and physician assistants in the US, and "medical officers" in other places.
I don't know who you're working for, but in my health care system we're happy about the potential for health care reform because in an Accountable Care Organization we can direct more resources toward keeping a population of people healthy, rather than racking up as many procedures as possible to keep the lights on. (It turns out we primary care physicians get paid more for paring corns on your feet than spending half an hour providing evidence-based preventive care for your 2 year old's checkup.) It makes more sense to get paid to keep a population of patients healthy than treading water (and racking up charges) for often pointless medical piecework with misdirected incentives. Our current expansion involves trying to figure out how to take care of more patients more efficiently by keeping them out of the office, when possible, including e-visits and better phone triage. No one I know (in our 5 state organization) seems to have significant dollar sign eye-flashing.
Why, you use the Ottawa Ankle Rules, which are an evidence-based method to determine whose sprained ankles deserve an x-ray to rule out a fracture. It turns out the same mechanism of injury - getting your foot bent under (usually the outside part going down, called inversion) is not only an excellent way to cause a painful ankle sprain, but has a habit of tearing the very bottom part of your fibula off, which will buy you a few weeks in a walking boot or similar cast.
In case I'm still not being clear, this means that the parent's suggestion of going to a hospital, urgent care clinic, or your primary physician's office is reasonable. Using the Ottawa ankle rule rule on yourself, I suppose, might save you a trip, though in my experience it tends to rule most people in for an x-ray, so you'll be headed in anyhow.
1. Why post anonymously?
2. About 1:1 000 000 people who got the 1976 H1N1 vaccine got Guillain Barre (http://www.ncbi.nlm.nih.gov/pubmed?term=20797646), and influenza itself is more likely to cause Guillain Barre than the vaccine.
3. The flu kills between about 3 000 and 49 000 people each year in the United States (http://www.cdc.gov/flu/about/disease/us_flu-related_deaths.htm).
4. Your statements that "everyone who gets them [flu vaccines]" gets sick and "some people die... from said vaccine" each year demonstrates why schools would be better off teaching statistics and critical thinking than trigonometry.
5. I'd happy to have you take your chances if only to allow evolution to exert selective pressure on your ilk, except for the risk you present to those around you at high risk of dying from the flu (kids under 5, adults over 65).
Catholic teaching aside, I'm not aware of any evidence that zygotes conceived longer after ovulation than shorter have any increased pregnancy loss rate. I'd be interested in a citation.
I don't know what setting you work in (or where - I'm in the United States), but in outpatient settings (where most of physicians are, I think) every MD/DO/MA I know uses ICD-9 codes all day long. They are used for eligibility, insurance, lab ordering, referrals and if they aren't exactly right it leads to a world of hurt (patients get improperly billed, sick people can't get tests done or see specialists), , and clerical staff expect us to do the actual coding; they do the processing.
Evernote stores notes locally when you use the Mac or PC versions; under Linux, you'd be limited to the browser version which uses the cloud. It will store notes locally on a smartphone if you use the paid version.
In my experience, on the wards, when some beady-eyed attending starts pimping you, more students come up with more answers quickly if they've got a handheld (or an eidetic memory), since even though computers are prevalent, in teaching hospitals they tend to be busy and not necessarily accessible right outside of a patient's room. Now that we have computers in our clinic exam rooms I don't need to rely on my handheld as much, but that thing was indispensable during 7 years of med school and residency ward rounds. (It was a Palm back then, but those days are over.)
Having a link to UpToDate on your device is also going to be helpful; if your hospital has wifi, it's likely free. And a Sanford Guide app would be nice, if they ever come out with one; until then you're stuck with the book. (Or the Johns Hopkins app, which I have not tried.)
I agree that Sharepoint is a great idea with absolutely terrible implementation. At least in our environment, search is horrible. Evernote search is really amazingly good, using fulltext (even in PDF's and scans for crissakes) and multiple tags. While a flat file OS X database would probably work well, unless you're hauling your laptop everywhere (which you won't be) it's not going to be practical. The fact that you're considering suggests you may be a 2nd year. Are any 3rd or 4th years at your school bringing their laptops on the wards? Around here anyway, that thing would get stolen. (So would your iPad.) Some of those poor VA patients need to steal your laptop so they can eat when they get discharged, which might be a good thing; god knows they deserve it.
I use Evernote, and so do a lot of my med students. It is cross platform, the free version is quite functional and stores PDFs, rich text and graphics. It is searchable and shareable.
His data really is pretty good (as you can imagine, it gets collected easily enough in living kidney donors). From my favorite reference, "Overall long-term survival after donor nephrectomy is the same as similar matched individuals who did not undergo surgery."
(Segev DL, Muzaale AD, Caffo BS, et al. Perioperative mortality and long-term survival following live kidney donation. JAMA 2010; 303:959.
Ibrahim HN, Foley R, Tan L, et al. Long-term consequences of kidney donation. N Engl J Med 2009; 360:459.)
But it doesn't account for trauma (so maybe mother nature has given us some paired organs in case a spear goes through one), and you don't account for the fact that mother nature works by trial and error (e.g., sperm need to be at 35 C, so let them hang out vulnerably in a scrotal sac instead of making them happy at 37 C).
Oh hi. You don't have gonorrhea (again)? No? And we're using birth control pills? And we're married/together/have 3 children together/in high school so we don't think more than 3 hours into the future/are self-deluding evangelical Christians/don't really give a crap? And you would never sleep around on me? So it must be safe to have sex, then, right?
Gonorrhea (and it's fellow-traveler) chlamydia deserve some credit here - they're good at what they do, and have been for thousands of years, and will probably continue to do so until we find something more new-fangled than current antibiotic therapy.
Convincing people not to have risky sex is about equally challenging.
The idea is supposed to be it requires you to have insurance before you get sick... just like having fire insurance is required (by mortgage lenders) before your house catches on fire.
Medical school enrollment IS increasing (with several new allopathic schools opening in the next few years - in Florida, Pennsylvania) and new osteopathic schools as well. This is unlikely to lower costs, as areas in the US with more doctors tend to have higher spending on physicians services - more doctors simply do more stuff. The same seems to be true of hospital beds - see the reports on supply sensitivity in the Dartmouth Health Atlas. So long as doctors get paid principally for doing stuff, and not for keeping people healthy, you can expect increased costs as a side effect.
The organization you are looking to blame is the AAMC by the way, which licenses medical schools, not the AMA, who spend their time making press releases and filling my mailbox with "Renewal invoices" despite the fact I haven't been a member for 10 years.
Sorry about your proposition, but it's really very manifestly wrong.
I guess you meant this to be modded "funny," but then it' truer than you know. Medicaid insurance in most states typically has no copays (patients would not be able to afford it), whereas a 50% copay (typical around here for brand name drugs) on a typical dose of, say, Abilify, would be $250. A month.
Brand name psych meds are one of the few expensive things on the drug formulary in our state - for now. I suspect this is cost effective, since having people with thought disorders push innocent citizens in front of buses would be truly cost prohibitive.
Slashdot Mirror
Your insurance company changes these prices each year, and does not make them available for ready viewing by physicians, as that is not to their advantage. Your insurance company also sets deductibles and copays, and doesn't tell us what they are or how paid up your are on them. When we try to call your insurance company to figure this out, we get put on hold for 20 minutes (just like you) and as often as not are told we need to fill out form 2204-09, available on their website hosted in North Korea, to get permission to access information about your particular plan in order to make some guess about how much you're going to owe based on the procedure we think you're going to need and the particular agreement your plan has with our office.
If your physician gets paid right away by your insurance company, s/he is truly blessed. The insurance folks have 30 days to mull over the payment, and then can contest this and that and claim the diagnosis code needs another procedure code and so forth, with several weeks turnaround each time on muddied fax; they have little incentive to pay promptly. I can assure you they make as many mistakes paying us as they do billing you. And then we get to send you revised bills based on their (often) capricious decisions.
When patients call our office complaining about a bill, my preferred response is typically "fine," since I'd rather not spend another 40 minutes on the phone with your insurance company asking why the $120 we charged to remove your pre-cancerous mole shouldn't be bundled into the $10 toenail removal we did 2 months ago, and the 3 pages of paperwork designed in Kyrgyzstan where I can try to justify our billing to some insurance company bureaucrat. So we can get the $43 your insurance company has negotiated the $120 procedure down to. For the work we already did. I expect if we made your auto mechanic go through this bullshit 20 times a day they might just kill themselves with an air compressor.
That makes Apple's US workers more productive than Foxconn's Chinese laborers. I think you may be conflating productivity and employment. Apple's model (of doing the design and marketing themselves, and farming out the manufacturing to lower-margin contractors) just doesn't require that many workers, leading to low unemployment in Shenzhen and high unemployment in Detroit (and the US manufacturing sector in general).
Whether we could duplicate the manufacturing supply chain in the US is another matter, even if we could convince US workers to work (and live) under conditions like those at Foxconn. (Foxconn chairman compares his workforce to ‘animals’ .)
In terms of economic output per worker, American workers really are the most productive in the world (even the TFA cites $400,000/y/worker at Apple). See http://money.cnn.com/galleries/2011/fortune/1109/gallery.america_economic_strengths.fortune/2.html, which also notes that part of this is due to US worker's long hours - Norway has the most productive workers per hours worked.
(http://www.mbc.ca.gov/consumer/complaint_info_questions_records.html#10)
Who owns medical records? Do the records belong to me?
No, they do not belong to the patient. Medical records are the property of the medical provider (or facility) that prepares them. This includes films and tracings from diagnostic imaging procedures such as x-ray, CT, PET, MRI, ultrasound, etc. The patient has a right to view the originals, and to obtain copies under Health and Safety Code sections 123100 - 123149.5.
And, from "The Encyclopedia of Everyday Law," (http://www.enotes.com/healthcare-reference/medical-records)
Background
Medical records are the property of those who prepare them (medical professionals) and not the property of those about whom they are concerned (patients). However, patients have a privacy right in the information contained in the records. These two interests may or may not conflict when it comes to releasing medical records to outside or third parties, who may also have another interest at stake. Once these basic and often competing interests are separated and assessed, it becomes easier to understand the issues that may surround the right to request, view, copy, or protect medical records and medical information.
I can't speak to lawyerly records however, as I didn't go to law school.
As a doctor, I really think of your medical record as mine: what I gleaned from your complaints, what exams I did, who I talked to, and what I thought was going on and what to do about it. I know you are paying for it, but I'm the one doing the work and putting all that medical school to use.
That said, I think you should have access to it, for free, and modern electronic health records allow that: once I review a result or record I can release it so you can look at it online. I also now document in my charts with the idea that the patient or family member might read it, so in addition to the technical detail I write the plan and diagnosis in as plain language as possible, and send patients home with this at each visit. (More than half immediately lose this paperwork, in my experience.) These systems, naturally, come at significant, expense and require a fair amount of upkeep, so they are mostly available only at larger practices.
Having worked previously in a developing nation where patients were responsible for keeping their own medical records (on 5 x 8 index cards), I'm glad we don't do it that way here (I'm n the US). I need a secure copy of what's been done to you and what you're taking, and recall having had a lot of trouble reconstructing lost information from the memory of illiterate folks or damaged records that had gotten submerged in open sewers and whatnot.
It's not clear to me if Michael (and his various dogs and guns - see his fascinating journal!) is advocating for a stronger FDA or a weaker one (based on their inability to predict all potential hazards of all medical devices and drugs); I think this is a clear example of a government agency doing its job and preventing significant harm among its citizens.
The Dalkon Shield (http://en.wikipedia.org/wiki/Dalkon_shield) was approved based on flawed studies, and was a frickin' dirt magnet, with woven strings and plenty of nooks and crannies into which bacteria could set up shop (in the normally sterile intrauterine environment), risking septic shock in users: that is, it killed not just fetuses, but moms.
You may also recall the sad case of thalidomide (http://en.wikipedia.org/wiki/Thalidomide), in wide use throughout Europe, but denied approval by (a brave, lone) FDA staffer based on inadequate study data. We can now thank our lucky stars she did so, given limb reduction deformities that only later on were attributed to the drug (at least in its racemic form).
There is an example of a market of pharmacologically active compounds not approved by the FDA: herbs and dietary supplements. Most of them purport to "support health" and relieve a variety of ailments, and the market is in the $US billions, but the number shown to actually work better than placebo in the sort of study the FDA uses for drugs hovers slightly above zero. In terms of what people actually use in common practice (well, my practice anyway - I'm a cheapskate family physician who sticks to older generic drugs) herbs and supplements aren't significantly cheaper. I've got quite a few sophisticated (and not so sophisticated) patients who use supplements regularly, based on thin or non-existant evidence, including a fair amount of folks who are going to die sooner (for example, by avoiding cholesterol medicine despite heart conditions) as a result of wanting to stick to "natural medicine." Caveat emptor, I suppose.
1. The AMA came up with the CPT code list, so they hold it hostage for money to fund updating it (and perhaps for hookers and coke - who knows). In any event, most electronic medical record software has searachable CPT lists; most doctors only use a small subset of the list which they memorize; and if you're stuck and don't have a book around you can do a search on the AMA website for free (https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp?locality=OR) or just google it (try "CPT circumcision").
2. Thanks for the anal raping analogy, but the issue isn't copyright over names of diagnosis but a bunmch of numbers that go with them that the AMA and feds agreed to standardize on. Doctors may be slow to adapt some technology (due to immense cost of anything that gets used in medicine, the relative simplicity of paper, the fact that historically most physician practices were independent small businesses with fairly low overhead, and that most electronic medical record software sucks) but it's not due to ignorance. Where technology is easier to implement with fewer rules and hope of remuneration (surgical robots, diagnostic ultrasound, MRI imaging), if anything, it's overused by physicians.
1. France has 3.4 doctors per 1000, the US 2.4 (http://www.oecd.org/dataoecd/53/12/38976551.pdf), though the US also has nurse practitioners and physician assistants working as "physician extenders"; I'm unaware of the equivalent in France or the EU in general.
2. The AMA isn't limiting medical school admissions. Seriously, this is repeated so often on Slashdot I'm figuring y'all must have gotten it from somewhere, but I don't know where. The AMA represents physicians; the AAMC (https://www.aamc.org/) certifies allopathic medical schools, and AACOM (http://www.aacom.org/Pages/default.aspx) certifies osteopathic med schools in the US. Osteopathic physicians practice in parallel in the United States (though not, generally speaking, elsewhere). I'm not aware of any entity limiting the number of medical schools in the US; in fact, enrollments are expanding (http://www.nytimes.com/2010/02/15/education/15medschools.html) - about 6 in the last few years, with an 18% increase expected. Moreover, allopathic (traditional) medical school education is expensive, with only about 50% of costs covered by tuition (at least where I went to school; the remainder came from income from clinical faculty, grants, and donations).
3. Practicing physicians in the US are more obviously limited by availability residency slots (post-medical school training), which are funded by the government (largely Medicare) - training in exchange from (somewhat brutal) labor. Residency spots aren't likely to expand anytime soon, as this would require more tax dollars. And, more doctors seems to just result in more stuff being done (not always obviously beneficial), and more money being spent.
4. Med schools take hardly any foreign students, but residencies do (or did - it's becoming a bit less common), since relatively few US med school grads are interested in primary care. Some of the brightest primary care physicians I've run into have been foreign grads, who compete mightily for US residency slots, and provide a huge portion of primary care in underserved US communities (because relatively few US grads will, so a special visa waiver program allows these spots to be filled by non-US grads).
5. Given the above, artificial supply limitations have just about nothing to do with the expense, waste, and all-around brain damage of the US health care system. In my (daily) experience, grievously mis-applied capitalist and "free market" incentives have just about everything to do with how delightfully broken the US system is.
I do not frequently prescribe methadone (I am a physician) because it's not often I have patients on chronic opioid medicine who I consider responsible enough to use it safely. And, I have seen inexperienced staff at pain specialty clinics nearly kill people a few times. But, if your drug plan won't cover sustained-release oxycodone or morphine (common until a few years ago in the US when morphine SR finally went generic) it's a viable alternative.
For a list of "worst" opioid agonists in terms of effectiveness for pain, consider codeine and propoxyphene (as in Darvocet in the US), both of which don't seem to be more effective than acetaminophen/paracetamol.
Bone tenderness along the distal 6cm of the posterior edge of the tibia or fibula just means "does it hurt when you press on the back bottom part of the bones sticking out on either side of your ankle." You really can do this (and I have successfully gotten people to do it over the phone);
Scope of practice laws vary from state to state; an RN could probably get an x-ray ordered after doing such a test provided there was a written protocol signed off by a physician in most places, though I know of know actual emergency departments that do this. Having an RN (who is not an independenty practicing nurse practitioner anyway) do this on their own in the absence such a protocol would probably illegally stray into the actual practice of medicine.
We have such a system where you can see medically knowledgeable people who aren't doctors. They are called nurse practitioners and physician assistants in the US, and "medical officers" in other places.
I don't know who you're working for, but in my health care system we're happy about the potential for health care reform because in an Accountable Care Organization we can direct more resources toward keeping a population of people healthy, rather than racking up as many procedures as possible to keep the lights on. (It turns out we primary care physicians get paid more for paring corns on your feet than spending half an hour providing evidence-based preventive care for your 2 year old's checkup.) It makes more sense to get paid to keep a population of patients healthy than treading water (and racking up charges) for often pointless medical piecework with misdirected incentives. Our current expansion involves trying to figure out how to take care of more patients more efficiently by keeping them out of the office, when possible, including e-visits and better phone triage. No one I know (in our 5 state organization) seems to have significant dollar sign eye-flashing.
In case I'm still not being clear, this means that the parent's suggestion of going to a hospital, urgent care clinic, or your primary physician's office is reasonable. Using the Ottawa ankle rule rule on yourself, I suppose, might save you a trip, though in my experience it tends to rule most people in for an x-ray, so you'll be headed in anyhow.
1. Why post anonymously?
2. About 1:1 000 000 people who got the 1976 H1N1 vaccine got Guillain Barre (http://www.ncbi.nlm.nih.gov/pubmed?term=20797646), and influenza itself is more likely to cause Guillain Barre than the vaccine.
3. The flu kills between about 3 000 and 49 000 people each year in the United States (http://www.cdc.gov/flu/about/disease/us_flu-related_deaths.htm).
4. Your statements that "everyone who gets them [flu vaccines]" gets sick and "some people die... from said vaccine" each year demonstrates why schools would be better off teaching statistics and critical thinking than trigonometry.
5. I'd happy to have you take your chances if only to allow evolution to exert selective pressure on your ilk, except for the risk you present to those around you at high risk of dying from the flu (kids under 5, adults over 65).
Catholic teaching aside, I'm not aware of any evidence that zygotes conceived longer after ovulation than shorter have any increased pregnancy loss rate. I'd be interested in a citation.
I don't know what setting you work in (or where - I'm in the United States), but in outpatient settings (where most of physicians are, I think) every MD/DO/MA I know uses ICD-9 codes all day long. They are used for eligibility, insurance, lab ordering, referrals and if they aren't exactly right it leads to a world of hurt (patients get improperly billed, sick people can't get tests done or see specialists), , and clerical staff expect us to do the actual coding; they do the processing.
Evernote stores notes locally when you use the Mac or PC versions; under Linux, you'd be limited to the browser version which uses the cloud. It will store notes locally on a smartphone if you use the paid version.
In my experience, on the wards, when some beady-eyed attending starts pimping you, more students come up with more answers quickly if they've got a handheld (or an eidetic memory), since even though computers are prevalent, in teaching hospitals they tend to be busy and not necessarily accessible right outside of a patient's room. Now that we have computers in our clinic exam rooms I don't need to rely on my handheld as much, but that thing was indispensable during 7 years of med school and residency ward rounds. (It was a Palm back then, but those days are over.)
Having a link to UpToDate on your device is also going to be helpful; if your hospital has wifi, it's likely free. And a Sanford Guide app would be nice, if they ever come out with one; until then you're stuck with the book. (Or the Johns Hopkins app, which I have not tried.)
I agree that Sharepoint is a great idea with absolutely terrible implementation. At least in our environment, search is horrible. Evernote search is really amazingly good, using fulltext (even in PDF's and scans for crissakes) and multiple tags. While a flat file OS X database would probably work well, unless you're hauling your laptop everywhere (which you won't be) it's not going to be practical. The fact that you're considering suggests you may be a 2nd year. Are any 3rd or 4th years at your school bringing their laptops on the wards? Around here anyway, that thing would get stolen. (So would your iPad.) Some of those poor VA patients need to steal your laptop so they can eat when they get discharged, which might be a good thing; god knows they deserve it.
I use Evernote, and so do a lot of my med students. It is cross platform, the free version is quite functional and stores PDFs, rich text and graphics. It is searchable and shareable.
His data really is pretty good (as you can imagine, it gets collected easily enough in living kidney donors). From my favorite reference, "Overall long-term survival after donor nephrectomy is the same as similar matched individuals who did not undergo surgery." (Segev DL, Muzaale AD, Caffo BS, et al. Perioperative mortality and long-term survival following live kidney donation. JAMA 2010; 303:959. Ibrahim HN, Foley R, Tan L, et al. Long-term consequences of kidney donation. N Engl J Med 2009; 360:459.) But it doesn't account for trauma (so maybe mother nature has given us some paired organs in case a spear goes through one), and you don't account for the fact that mother nature works by trial and error (e.g., sperm need to be at 35 C, so let them hang out vulnerably in a scrotal sac instead of making them happy at 37 C).
Gonorrhea (and it's fellow-traveler) chlamydia deserve some credit here - they're good at what they do, and have been for thousands of years, and will probably continue to do so until we find something more new-fangled than current antibiotic therapy.
Convincing people not to have risky sex is about equally challenging.
The idea is supposed to be it requires you to have insurance before you get sick... just like having fire insurance is required (by mortgage lenders) before your house catches on fire.
The organization you are looking to blame is the AAMC by the way, which licenses medical schools, not the AMA, who spend their time making press releases and filling my mailbox with "Renewal invoices" despite the fact I haven't been a member for 10 years.
Sorry about your proposition, but it's really very manifestly wrong.
Wakefield had a financial conflict of interest with lawyers suing HM Government
His sample size was 12
His study population were not randomly recruited
Some of the study siubjects showed signs of autism prior to their MMR vaccination
Brand name psych meds are one of the few expensive things on the drug formulary in our state - for now. I suspect this is cost effective, since having people with thought disorders push innocent citizens in front of buses would be truly cost prohibitive.