ACP Internist

Tuesday, November 3, 2009

QD: News Every Day--health care reform splits urban, rural hospitals

ACP Internist's daily digest of news and events continues with the focus of health care reform shifting toward the U.S. House of Representatives. Also, urban and rural hospitals eye each other for the lion's share of reimbursement.

Health care reform
Legislation released in the House faces opposition from abortion and immigration. The $1.2 trillion price tag over 10 years made many take a second look at what Americans would get for their money. Meanwhile, the deadline for potentially passing legislation is slipping into next year. (AP, Politico)

Rural and urban hospitals would fare differently under health care reform. For example, New York City facilities are worried about losing money to Iowa; Iowa, in turn, is already worried about subsidizing urban areas. (New York Times, WQAD.com)

H1N1 influenza
Pregnant women and children ages 10-17 need only one dose to inoculate against H1N1 influenza. But children ages 6 months to nine years still need two doses for best efficacy. Anne Schuchat, FACP, reports that half of all vaccinations have gone to minors. While the World Health Organization is recommending one dose for all kids and the use of adjuvanted vaccines to stretch supplies, U.S. officials are still recommending two doses. Adjuvanted doses have not been cleared for use in the U.S. Research on them was reported in the Sept. 15 ACP InternistWeekly. (Washington Post, Washington Times, New York Times)

Scientists have used a supercomputer to predict a third wave of H1N1 coming this spring. But others want to use handheld devices to predict which individuals might get sick before they actually do. (Wall Street Journal)

Labels: flu, H1N1, health care reform, hospital medicine, QD

QD: News Every Day--public option in da House!

ACP Internist's daily digest of news and events covers how health care reform is being reconciled in Congress, how the primary care shortage impacts local emergency rooms, and how community doctors in Bermuda are reacting to the introduction of hospitalists.

Health care reform
While the Senate stares down a threatened filibuster of legislation that includes a public option, the House introduced its version, which includes it. As the House and Senate reconcile their respective bills into one per each chamber,
Cecil B. Wilson, MACP, who is also the American Medical Association's president-elect, told Floridians at a union-sponsored rally that the majority of Americans, including physicians and AMA members, want reform. (Washington Post, Miami Herald)

Primary care shortage
A column in The Olympian (Olympia, Wash.) points out that the community already has universal health care. Unfortunately, it's the local emergency room. In Palm Beach, Fla., county commissioners are considering whether to build a public hospital for just that purpose. Jose Arrascue, ACP Member, representing the Palm Beach County Medical Society, told commissioners, "We believe the health care delivery system in Palm Beach County is in critical condition. We have escalating numbers of uninsured, diminished access to care, an aging physician population and a lack of specialty care." (Palm Beach Post)

University of Pennsylvania bioethicist Arthur Caplan told an audience in Bakersfield, Calif., that one way to alleviate the primary care shortage is to forgive medical school loans. (Bakersfield.com)

H1N1 influenza
Now, there's an app for that. Harvard Medical School has launched an iPhone application that includes information on the pandemic's spread, practical steps people can take to mitigate their risk of infection, key symptoms to watch for, and what to do in case of infection. The application includes text, video and links to government databases. It also provides information to businesses for managing through the pandemic. People need all the help they can get. Richard Wenzel, MACP, reports that half of all outpatient H1N1 influenza cases don't develop a fever, so the patients don't take precautions. Even among hospitalized patients, 15% don't get a fever. (Minnesota Public Radio)

In case you missed it ...
Family doctors claim that the switch to hospitalists has shut them out of their community hospital ... in Bermuda. The chief of staff at King Edward VII Memorial Hospital feared being hanged in effigy outside his office after general practitioners lost their hospital privileges and communication suffered between community and hospital doctors. But, the chief said outcomes have improved and the move is needed as his facility moves from being a rural provider to a modern metropolitan facility. (Bermuda Sun)

Labels: flu, H1N1, health care reform, hospital medicine, primary care shortage, QD

QD: News Every Day--the need for health reform

ACP Internist's daily digest of news and events continues with more on how the need for health care reform plays out across the country, as well as the uneven distribution of H1N1 vaccines.

Health care reform
Sen. Reid's announcement of a public option in Senate legislation follows statements by legislators who said they'd oppose any bill without it. He still doesn't have 60 Senators on board to prevent filibuster. (AP/The Washington Post)

ACP Fellows continue to vent about the need for health care reform. In the latest op-ed, Rod Hochman, FACP, CEO of Swedish Medical Center in Seattle, talks about how the patient-centered medical home plays out in what he calls "the other Washington." (The Seattle Times)

The largest private group practice in Kansas City, Mo. has stopped accepting walk-in Medicare patients. At Kansas City Internal Medicine, 65% of its nearly 70,000 active patients are 65 or older. Keith Jantz, ACP Member, says that it's a harbinger of things to come if Medicare reimbursement is cut by 21%. (CNN) It's a situation that one patient experienced in Grand Junction, Colo. (KJCT8.com )

A Thomson Reuters piles on the blame, finding the health care system wastes between $505 billion and $850 billion every year, about a third of the overall bill. (Reuters)
--antibiotic overuse and lab tests to protect against malpractice are 37% of the wasteful spending, or $200 to $300 billion a year,
--fraud is 22% of waste,
--administrative inefficiency and redundant paperwork are 18%, and
--mistakes are 11%.

H1N1 influenza
Despite shortages and some tales of uneven or nonsensical distribution, the vaccine is worth getting late rather than never, said Health and Human Services Secretary Kathleen Sebelius. (ABC News; Los Angeles Times; GetBetterhealth.com; AP/The Washington Times) Also, USA Today breaks down H1N1 flu incidence by region.

In case you missed it ...
One medical student prefers primary care, despite the financial shortfalls he'll face. His profile is here. (Minneapolis Star Tribune)

Labels: flu, H1N1, health care reform, primary care shortage, QD

QD: News Every Day--H1N1 'emergency' and vaccine shortage

ACP Internist's daily digest of news and events continues with H1N1 updates, and physicians speaking out about health care reform.

H1N1 influenza
The weekend's health news had one theme: President Obama declared a national emergency, coupled together with pictures of long lines of people waiting for vaccines. Lines formed despite the large numbers of people refusing to get inoculated. (Half of all Canadians!)

Health insurance
Health care reform may have to start at the (medical) home. Eleven percent of health care workers are uninsured. Ambulatory care workers are three times as likely as hospital employees to not have insurance; residential care workers are four times as likely; and service workers are 50% more likely to be uninsured than those involved in treatment. Meanwhile, Blue Cross Blue Shield of Florida, that state's largest insurer, is moving its 5,000 employees to a high-deductible insurance plan linked to health savings accounts.

In case you missed it ...
Internist Randy Silverstine, MD, turned his solo office into a concierge practice but only charges $600 a year, a fraction of what others have charged. He joins the ranks of the 12% of internists who no longer accept health insurance. "This was the only way I knew how to keep practicing the kind of medicine I loved," he told the Sarasota, Fla. Herald-Tribune.

ACP Fellows are sounding off about health care reform. Charles M. Fischman, FACP, spells out how the possibility of a 21% cut in Medicare reimbursement would play out in Florida--with a mass exodus, he predicts. Paul Dolinsky, FACP, says there's plenty of blame to spread around for rising costs.

Labels: flu, H1N1, health care reform, QD

QD: News Every Day--slow start for H1N1 vaccine

ACP Internist's daily digest of news and events continues with the answer to the age-old question: Which came in first, H1N1 influenza or its egg-based vaccine?

Twenty percent of U.S. children had a flu-like illness earlier in October, and most of them likely H1N1 flu. And 7% of the surveyed adults said they'd had a flu-like illness in the past week, according to a household survey of more than 10,000 adults done in the first 11 days of October. Now, an already slow process of using chicken eggs is now burdened by vaccine-makers trying to make diseases for seasonal and H1N1 strains. Also, the virus on which the swine flu vaccine is based reproduces very slowly in eggs, moreso than seasonal flu.

New York City is seeing fewer cases than expected, but Philadelphia's childrens' hospitals are already hunkering down from ER cases that probably could have been treated at home. Both cities had been suggested to have acquired a "herd immunity" from having been hit so hard in the spring.

Leave it to Moody's to break it down into investment advice. Hospitals usually see some positive cash flow during flu season, but H1N1 could muddle the picture.

And, don't miss the H1N1 robotic simulator.

Health care reform
Senators met with White House officials Thursday evening to discuss how to merge the two health care reform bills in the Senate. Politico reported negotiators are contemplating a national government health plan, but allowing states to opt out. But then it's not a national plan ...

Labels: flu, H1N1, health care reform, QD

QD: News Every Day--health care reform and H1N1

ACP Internist's daily digest of news and events continues with health care reform, H1N1 influenza and how primary care shortage issues play out regionally.

Health care reform
Halts to the annual cuts to physician reimbursement under Medicare died in the Senate because legislators objected to $247 billion in unfunded costs over the next decade. Enough legislators from both parties objected to an effort to freeze reimbursement for 10 years while Congress found an alternative to the sustainable growth rate formula. ACP President Joseph W. Stubbs, FACP, said, "Although many [legislators] will claim that their vote against cloture was a vote for fiscal responsibility, there is nothing fiscally responsible about pretending that Medicare will save money, from cuts that Congress has no intention to let go into effect, in order to make it seem like Medicare will spend less than it really will."

Meanwhile, some versions of health care reform legislation in the U.S. House would raise the rate of medical spending, not lower it, reports the Office of the Actuary, an independent arm of the Centers for Medicare and Medicaid Services. Spending would increase by 2.1% over 10 years, or $750 billion, because 34 million more people would have health coverage, according to the report. (Wonks can read it here.)

A lesson can be taken from Massachusetts physicians, who support their health care reform laws by a 5-to-1 margin, albeit with some desired changes, reported the Boston Globe. That's slightly higher than in the rest of the public, according to the most recent general poll by Robert Wood Johnson Foundation and Blue Cross Blue Shield of Massachusetts Foundation. Highlights include:
--Two-thirds of doctors say the law has not diminished the quality of care;
--19 percent say it has improved quality;
--62% say the law has not affected the amount of time they spend with their patients; and
--Nearly 80% say the law had no negative impact on their practice overall or had a positive impact.

The original study was published in the New England Journal of Medicine. Health care reform can expand access but not reduce costs, if lessons from Massachusetts teach us anything, reports The Christian Science Monitor.

H1N1 influenza
Production of a vaccine for swine flu virus is behind schedule, said Anne Schuchat, FACP, director of CDC's National Center for Immunization and Respiratory Diseases. Officials expect "widespread availability" by mid-November.

Meanwhile, public radio presents more on "presenteeism" and how a lack of sick days forces some sick workers to show up.

Primary care shortage
ACP's governor of its Connecticut Chapter addresses why so much money is spent on some health care items, such as prescription drugs, medical scans and durable medical equipment, and not on more important areas such as public health education and training medical students. The consequences are dire, as this profile of the Sacramento, Calif. area shows. California has 59 primary-care physicians per 100,000 citizens, whereas 60-80 considered sufficient.

Labels: flu, H1N1, health care reform, primary care shortage, QD

QD: News Every Day--the H1N1 fist bump

ACP Internist's daily digest of news and events continues with ways to avoid spreading the flu (and how it's making us rude), Michigan's proposed doctor tax, and a review of evidence-based medicine.

H1N1 influenza
A feature story profiles how ways to avoid spreading disease are making society less civil (fist bumps instead of handshakes) Thomas Fekete, FACP, says that it's only reducing risk by 1%-2%.

Primary care shortage
Michigan is considering taxing physicians. They propose a 3% physician tax to offset Medicaid cuts to hospitals. The measure could generate $300 million, which would recoup another $525 million in matching federal money. Michigan's hospitals, nursing homes and health plans already pay a physician tax, as do 44 other states. The Michigan State Medical Society Michigan Osteopathic Association oppose it, saying it will exacerbate the primary care shortage and shortchange specialists, but the Michigan College of Emergency Physicians supports it, saying the tax would fund increased reimbursement for Medicaid, which in turn would encourage more primary care doctors to accept those patients.

On the plus side of the balance sheet, Pikeville College will expand its School of Osteopathic Medicine to reduce the primary care shortage in eastern Kentucky. The $4.5 million expansion may eventually increase each year's class from 75 to 125 students. Of course, once they're students, they're overwhelmed by the pace and the scope of school loans, as profiles in northwest Indiana relate.

Evidence-based medicine
One doctor relates the dangers of trying to apply rigorous reviews to individual patients, in this case, his own mother. Another caveat to evidence-based medicine is who's providing the evidence base. Online health sites that allow patients to directly compare (sometimes unapproved) treatments and outcomes are cropping up more rapidly--nearly 500 by now. These sites combine social media with aspects of wiki-style medical references and evidence-based medicine. Patients are turning to them for H1N1, for example. ACP Internist profiled one such site and the controversy it generated a year ago.

Labels: evidence-based medicine, flu, H1N1, primary care shortage, QD

QD: News Every Day--legislative tricks, treat the underserved and banning sick kids ... from hospitals

ACP Internist's daily digest of internal medicine in the news continues with a look at legislative tricks for health legislation, a medical school that sends students into poor neighborhoods as part of their training, and hospitals that are enacting bans on minor visitors to avoid spreading H1N1.

Health care reform
Senates are seeking a bill that increases Medicare fees by $247 billion in the next decade. Because it will raise the deficit, Senators are trying a two-bill approach, a bit of legislative sleight-of-hand, to let them claim that health care reform won't cost more. At stake is a 21% reduction in Medicare reimbursement that was is scheduled to take effect in January.

In another bit of having one's cake while eating it, too, seniors will pay more for Medicare Advantage when costs increase from an average of $32 to $39 per month next year. Insurers are cutting plans that have no premiums--a federal requirement. Also being scrutinized are the free perks meant to entice traditional Medicare patients into private Medicare Advantage policies. But free to patients means paid for by the government--or sometimes hidden as higher co-pays and additional fees.

Investor's Business Daily points out a looming fight between primary care and specialty medicine. Legislation in the Senate gives primary care doctors a 10% bonus if they work in a Health Professional Shortage Area and 60% of their services are primary care. Half of the funding for the bonus comes from across-the-board cuts for specialists, who are refusing support.

Primary care shortage
Federally qualified clinics could treat more than 20 million patients this year, 2 million more than last year, the AP reports. The increase comes at a time that states are cutting their health care budgets.

To serve this need, Florida International University curriculum will send medical students to poor neighborhoods as part of their training. TIME profiles the program (and quotes ACP president Joseph W. Stubbs, FACP in the process.)

Finally, an emergency room doctor wrote an open letter to President Obama, making the points that:
--people without health care head to ER for treatment,
--medical training is expensive and causes primary care shortages, and
--legislators would discuss the space program without involving astrophysicists, so it's time to get doctors involved in health care reform.

These are all familiar points, but the letter is worth a read.

In case you missed it ...
To avoid spreading H1N1 influenza, hospitals have begun banning visitors less than 18 years old. These are children's' hospitals, too. M.D. Anderson followed suit, as well.

Labels: flu, health care reform, medical education, medicare, primary care shortage, QD

QD: News Every Day--The disconnect of health reform

ACP Internist's daily digest of internal medicine in the news continues with the disconnect on health care reform, a larger analysis of who was hospitalized for H1N1, and more on the primary care shortage.

Health care reform
Americans want health care reform to change, but they don't want to pay for it.

Meanwhile, the Economic Policy Institute, a think tank focused low- and middle-income Americans, points out that Medicaid and the SCHIP held in check the number of children who would have gone without health between 2000 to 2008. Children without insurance dropped 1.7% between 2000 and 2008, while adults less than 65 without insurance rose 3.1%. By contrast, children with public coverage grew 8.8%, compared to a 3.5% increase for the adult population under 65.

H1N1 influenza
Health officials now say that 46% of 1,400 adults hospitalized with H1N1 influenza did not have a chronic underlying condition, according to the largest analysis to date. The study looked at adults and children hospitalized from April through August in 10 states at medical centers participating in a special disease surveillance network. Anne Schuchat, FACP, who heads the CDC's National Center for Immunization and Respiratory Diseases, said the larger analysis looked at underlying conditions not previously examined. Among adults, 26% had asthma, 10% had diabetes, 8% had some other chronic lung disease, 8% had weakened immune systems and 6% were pregnant.

Primary care shortage
A financial advisor chimes in with his analysis of why primary care doesn't pay, including input from his own internist. The doctor says, "The average income of a primary care doctor in Massachusetts is about $86,000. Why do I do it? Because I love it."

The medical home
Profiles of practices trying the patient-centered medical home include Greenhouse Internists in Mt. Airy, Pa. and the Adirondack Regional Medical Home Pilot, which also an effort to stop the loss of primary care practitioners in the region. And for a lighter note, don't miss ACP Internist's own Stacey Butterfield's report from the MGMA meeting in Denver.

In case you missed it ...
In Minnesota, the Vitality Project prompted one town to build sidewalks and bike trails; restaurants, groceries and schools to push healthier foods; and employers to give workers time to exercise. The experiment added an average 3.1 years to the longevity of about 2,300 residents who calculated their lifespans by answering 36 lifestyle questions.

Labels: diet, exercise, flu, H1N1, health care reform, health insurance, health policy, patient-centered medical home, primary care shortage, QD

QD: News Every Day on insurance coverage, primary care shortage and H1N1

ACP Internist's daily digest of internal medicine in the news continues with who's covering the uninsured, students weighing in on why they eschew primary care careers, and H1N1's widespread but less lethal path.

Covering the uninsured
While the number of uninsured people rose slightly from 2007 to 2008, more people were covered by government programs as employer-sponsored coverage continued to decline, according to the U.S. Census. The ACP Advocate reports census figures showing that 15% of the population was uninsured in 2008, increasing from 45.7 million to 46.3 million. However, coverage by private plans fell from 67.5% to 66.7% and coverage by employers fell from 59.3% to 58.5%. Government coverage rose from 27.8% to 29%.

Primary care shortage
Medical students weigh in on health reform, and have their doubts. Also, they won't go into primary care. "When it's a difference of $200,000 in your paycheck, it's tough," one student said.

Flu update
The H1N1 pandemic has been more widespread than lethal, notes the Harvard Health Letter. The virus seems to cause fewer cases of serious disease than expected. Harvard experts discussed the latest at a forum, with video posted online. In short, estimates for the death rate for H1N1 range between one death for every 2,000 symptomatic cases and one death for every 14,000 (0.007%). In comparison, the death rate for seasonal flu is roughly one death for every 1,000 to 2,000 cases. Seasonal flu infects roughly 5% to 20% of the population annually, whereas pandemics infect 25% to 40%. This H1N1 epidemic may not rise to pandemic levels.

In case you missed it ...
Doctors drive medical consumption, not patients. Illness and patient preference play a much smaller role. NPR reports on one epidemiologist's lifelong work. Meanwhile, a Newsweek columnist weighs evidence-based medical treatments against clinical judgment. It's the age-old question: How does a study impact treatment of the patient sitting before a doctor, seeking a cure?

Labels: epidemiology, evidence-based medicine, flu, H1N1, health insurance, medical education, primary care shortage, QD

QD: News Every Day

Health care reform
Nothing good gets done until a committee has considered it. Now, the Senate Finance Committee put off voting on health care reform until the Congressional Budget Office chimes in with estimate of how much it will cost.

Flu vaccination
Health departments in three states began administering the first of the 7 million currently available H1N1 flu vaccine doses this week. Don't sweat it if your state wasn't one of them; 40 million doses will be available by mid-October and 10 million to 20 million will become available each week after that.

Globally, the World Health Organization has begun mass vaccination campaigns in China and Australia and will be starting soon in the U.S. and Europe. Worldwide, governments have ordered 440 million doses of GlaxoSmithKline's H1N1 vaccine Pandemrix.

In case you missed it ...
The U.S. fares worse than other industrialized countries in rates of preventable deaths--premature deaths caused by diabetes, epilepsy, stroke, influenza, ulcers and pneumonia--and has been falling further behind over the past decade, according to a Commonwealth Fund study published in the journal Health Affairs.

Labels: Diabetes, flu, H1N1, health care reform, QD, stroke

QD: News Every Day

ACP Internist's daily digest of primary care in the news continues with legislative jockeying for health care reform, public rejection of flu vaccination and primary care's dominance of mental health prescribing.

Health care reform
Legislation proceeds apace, with congressional members jockeying and pushing for the House and Senate bills to reach their respective chambers by mid-month. Abortion restrictions were defeated, as were other provisions. But there are many hurdles to clear as legislators threaten to cancel the Columbus Day break to get the legislation finished by either Thanksgiving or the end of the year.

Meanwhile, former Senate Majority Leader Tom Daschle said lawmakers were “flummoxed” when attempting to craft specific reform legislation, so Gary R. Gibson, FACP, has created an algorithm to help them understand it.

Flu prevention
Consumer Reports says only a third of Americans plan to get the H1N1 vaccine. More than half of adults with risk factors don't know what complications the flu could cause. They're worried about risks from the vaccine itself, or they're not confident of its efficacy. Or, they just don't think they'll get the flu.

In an NEJM perspective, authors say there's a pressing need for research into whether N95 masks work better or worse than surgical masks to prevent spreading the flu. So JAMA obliged with a study finding that surgical masks work just as well. An accompanying editorial notes that other preventive measures, such as vaccinating health care workers and hand washing, are critical but overlooked.

In case you missed it:
Mental health issues affect 1 in 4 Americans, 1 in 17 severely. Mostly, they go to their primary care clinicians for help, says the Agency for Healthcare Research and Quality.

Fifty-nine percent of U.S. mental health drug prescriptions are written by family doctors, reports Researchers from Thomson Reuters and the U.S. Substance Abuse and Mental Health Services Administration. They examined 472 million prescriptions written for psychotropic drugs from August 2006 and July 2007 and found general practitioners prescribed 62 percent of antidepressants and 52 percent of stimulants, mainly drugs for treating attention deficit hyperactivity disorder.

Labels: flu, H1N1, health care reform, mental health, mental illness, QD

ACP Master speaks his mind on H1N1 vaccines for health care workers

Following studies on Canadian and Hong Kong health workers unsure about getting vaccinated for H1N1, William Schaffner, MACP, now questions whether American health workers will, as well.

"There isn't a doubt that it's a severe challenge," Dr. Schaffner told MSNBC. "It's primarily a patient safety issue."

He's not only a Master of the College but also chairman of the infectious diseases division at Vanderbilt University in Nashville, and is in a position to encourage others. Clinical trials for it appear safe, he said, and health care workers should protect themselves and their patients.

"It's a professional and ethical responsibility of every health care worker to be vaccinated," he said.

Labels: flu, H1N1, infectious disease, swine flu, vaccination

Sermo launches flu tracker

Sermo, the online social network for physicians, has launched its own flu tracking system that it says improves on those offered by the CDC, Google and Harvard Medical. Whereas other sites aggregate content from online searches and lab result reports, Sermo says its tracker is based on input from actual physicians and updated in real-time. After logging in, physicians can exchange geographically based clinical observations instantly.

According to Sermo, the site's analysis of each flu outbreak is based on:
Patient breakdown for vaccinated vs. not vaccinated
Age distribution - which age is most affected
Symptom breakdown - which symptoms are presenting more than others
Voracity of outbreak - how many per day/week/month, etc.

Physician members of Sermo (registration is free for MDs and DOs) can link directly to the flu tracker after signing in.

Labels: flu, infectious disease

Googling the flu

The datameisters at Google say they can track potential flu epidemics two weeks earlier than the CDC by tracking people's searches for flu information online.

Google's non-profit arm, Google.org, is trying to apply its heft as the most popular search engine to tackle poverty, renewable energy and small-business growth. And now, they're applying the power of the millions of global users looking for health data to track the flu.

According to Google's blog, millions of users around the world search for online health information weekly. There are more flu-related searches during flu season, more allergy-related searches during allergy season, and more sunburn-related searches during the summer. A pattern emerges when all the flu-related search queries from each state and region are added together, Google says.

To test their hypothesis, Google compared search queries with CDC data to find out which searches occured during flu season, and then extrapolated that frequency provides an estimate how much flu is circulating. They used last year's flu season as a test and now claim to have accurately estimated flu levels one to two weeks faster than published CDC reports across the nine U.S. surveillance regions.

Additional details are available in a draft manuscript and a later version has been accepted in Nature.

Labels: epidemiology, flu, infectious disease

ACP Internist hosted Grand Rounds on June 16, wrapping up the best of the medical blogosphere. Click here for the complete wrap-up.

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Send comments to ACP Internist staff at acpinternist@acponline.org.

Blog log

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

db's Medical Rants
Robert M. Centor, FACP, contributes short essays contemplating medicine and the health care system.

Everything Health
EverythingHealth is designed to address the rapid changes in science, medicine, health and healing in the 21st Century.

Getting Better with Dr. Val
Getting Better is the continuation of Dr. Val Jones' previous blog at Revolution Health. It is devoted to helping people understand health issues from a balanced, scientifically sound perspective.

HealthHombre
A roundup of health policy news drawn from a database of hundreds of Web sites.

Interact MD
Michael Benjamin, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

Kevin, MD
The alter ego of Kevin Pho, ACP Member, is the closest thing to royalty in the medical blog world.

LSUHSC-S Medical Library Evidence Alert
Major guidelines, systematic reviews, meta-analyses and/or major reviews by national and international organizations.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by a doctor.

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ACP Internist

Tuesday, November 3, 2009

QD: News Every Day--health care reform splits urban, rural hospitals

Thursday, October 29, 2009

QD: News Every Day--public option in da House!

Tuesday, October 27, 2009

QD: News Every Day--the need for health reform

Monday, October 26, 2009

QD: News Every Day--H1N1 'emergency' and vaccine shortage

Friday, October 23, 2009

QD: News Every Day--slow start for H1N1 vaccine

Thursday, October 22, 2009

QD: News Every Day--health care reform and H1N1

Monday, October 19, 2009

QD: News Every Day--the H1N1 fist bump

Thursday, October 15, 2009

QD: News Every Day--legislative tricks, treat the underserved and banning sick kids ... from hospitals

Wednesday, October 14, 2009

QD: News Every Day--The disconnect of health reform

Friday, October 9, 2009

QD: News Every Day on insurance coverage, primary care shortage and H1N1

Tuesday, October 6, 2009

QD: News Every Day

Thursday, October 1, 2009

QD: News Every Day

Friday, August 28, 2009

ACP Master speaks his mind on H1N1 vaccines for health care workers

Wednesday, December 3, 2008

Sermo launches flu tracker

Wednesday, November 12, 2008

Googling the flu

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