Make a file for all good info Read up on Expert Systems "We eat what we kill" Emergency rooms

in the USA must treat every patient that comes in a research study came out showing an 83 percent increase in complications after elective surgery when the surgeon was on call the night before and hadnt gotten adequate sleep. minimally invasive surgery vs traditionally open surgery is largely a matter of doctor preference (and not what is best for the patient). Physicians in private practicewho treat more than three-quarters of cancer patients in the United States are expected to generate certain revenues, and their take-home pay is usually determined by the amount of medical services and drugs they provide. With these powerful incentives set in motion, many hospitals and oncology practices in the United States instructed nurses to ask leading questions about fatigue with the intent of expanding sales to a growing number of patients and upping the dosage to each patient. In August 2007, during a conference call with investors, an Amgen official introduced a chilling term: an ESA treatment opportunity. Ive heard of community oncology practices that hold regular meetings to inform doctors about treatment techniques that maximize billing.

I will show how we academic physicians who practice in nonprofit institutions such as Emory are not pristine either. If you dont watch out, well sell you on a clinical trial that will get our names on scientific papers, but not necessarily be appropriate for your disease. Even as academics, we may be motivated to maximize billing to support our departments. Oil is the reason we go to war. Without oil, our country is literally fucked (example: Gulf Oil Crisis of the 70s and the ensuing inflation). Dr. Rex had a strong suspicion that even some colonoscopies performed within his own famed center were substandard. To evaluate the quality or thoroughness of the procedure as it was being done by seven of his partners, he secretly began to watch videos of their procedures stored in the system in the procedure area. As he watched the videos, he was shocked at how the length and the quality of the procedure varied dramatically at his own top center. Blinded to the name of the partner that did the procedure, he and his research team began to formally record the amount of time that each doctor spent looking for tumors. He also assigned a quality score based on how well the doctor inspected suspicious-looking areas. After watching one hundred procedures and recording this information, he announced to his seven partners that he would be timing and scoring the videos of their future procedures (even though he was already doing it). Overnight, things changed radically. All of a sudden, the average length of the procedures done by his partners increased by 50 percent and the quality score increased by 30 percent.3 Same doctors, same hospital,
same doctor pay, same patient bills. The only thing different was that the doctors knew that somebody was going to be watching the video of what they were doing.

Doctors who do procedures are known to understate their complications. The complication rates a doctor will quote out of textbooks and the medical literature, however, are generally two to three times higher in the real world. This is a well-known bias in the literature that in the medical community is called publication bias. It refers to the fact that only doctors with low complication rates dare submit their results to a medical journal; thus, the rates reflected in the scholarly literature are all much lower than the national average.3 My research team found, for example, that even though patients are often quoted a pancreas-surgery mortality rate of 1 percent based on published studies, the real-world mortality rate is closer to 7 percent.

1 in 5 heart defibrillator's isn't needed (money). back surgery -- unnecessary many times "Research shows that half of all patients dont comply with the treatment regimen their doctor outlines, so confusion is clearly rampant."

"they said being ordered to do something by someone who didnt know their name was insulting. Being called by name restored their dignity, they said."

The first year that New Yorks hospitals were required to report heart-surgery death rates, wide variation was foundthe death rate by hospital ranged from 1 percent to 18 percentconfirming long-standing rumors that quality of cardiac surgery was wildly variable among hospitals When I ask friends how they choose a doctor, some say they go with the doctor with the most experience (as if they have read the New England Journal of Medicine studies I cite earlier). Choosing an experienced doctor certainly makes good sense. Yet theres one serious pitfall to choosing a doctor based purely on experience: Fred Flintstone care. Fred Flintstone care is doctor speak for antiquated, outdated medicine. Its what one well-known political figure recently got when she underwent a major open operation to remove a small abdominal tumor. That small tumor could have been removed with a minimally invasive method with lower risks than a large open operation. But the chief of surgery emeritus had never learned how to do minimally invasive surgery.

Many surgeons I know dont offer patients minimally invasive or cutting-edge options only because they dont know how to do them. Further, the pattern of which doctors offer it and which doctors dont has no correlation with the prestige or size of the hospital in which they practice. Google your medical condition to learn about a minimally invasive operation equivalent, then ask your doctor about it. You want the person with the most experience in treating your specific condition. For example, if you need a hip operation, choose the surgeon who has done a lot of hip operations. Childrens hospitals make hundreds of millions more dollars than full- service hospitals, which average a meager 1 to 3 percent profit margin annually. In 2009, the last year records were available, Texas Childrens Hospital recorded a $275 million profit and Childrens Hospital of Philadelphia (CHOP) $359 million. That same year, Reuters reported that half of the nations full-service hospitals werent even breaking even.