While you may be 100% confident, you are not 100% correct.
Unemployment is at 14.6% for the US for August 2012.
It's called U6 and is a much more telling number than the U3, which is the oft-manipulated rate used by the press which is at about 8.1% for August, 2012.
It's not often I see a slashdot post that is wrong on every single point.
Bush didn't have people demanding to see his birth certificate, and then denying its legitimacy once they saw it.
No, they said he wasn't elected by the people, he wasn't a real pilot (or really in the military), and that he was stupid.
Bush didn't have a congress whose Democratic members vowed to make him a one-term president by any means necessary.
No, he had the press doing that. (Dan Rather for starters)
Bush didn't have a senate whose Democratic members filibustered more (by a huge factor) than any other senate in history.
Cloture is not the same as filibuster.
Bush didn't inherit a financial crisis created by his predecessor (quite the opposite in fact.) I could go on but what's the point.
Ummmm, actually he did. The Clinton go-go '90's were done. A recession had started as Bush was being inaugurated. To use Obama's words "We inherited that"
Interesting, but...
If a physician is in the hot seat being deposed, he's already lost. Period. Full stop. Perhaps not to the legal community, but to his ego, his confidence, and the confidence from others, he's lost. The proliferation of online grading systems (which I support) don't help the trap.
I'm not saying that a poor outcome should not be investigated and perhaps tried, but there is enormous profit in making the letter from an attorney to a physician and a quick settlement. Why do you think an attorney advertises on TV? "Get your money"
I'm cynical because I hate the bottom feeders. It's free to send a request for information. I'm relatively insulated from surgery or medicine poor outcomes, but let me tell you--when reading breast films we always err on the side of defense. If a tumor is found/palpated and a DX-mammo or MR was read in the last year, I'm getting hauled in whether or not there was a finding I missed. You can always find someone "an expert" who can find something that you missed, whether the image signature is really there or not.
So while I agree with you, and can still argue "Of course unnecessary medicine can be very profitable" so is unnecessary lawyer action.
That and the Medicare fraud.
Bullets can easily be cast.
Actually, they are not really getting paid for the MRI directly, they simply have an expectation of a certain level of testing to occur. An Ortho I know is supposed to bring in $8-10MM in revenue for the hospital.
But to "why is it defensive"
There are attorneys (I get them frequently asking me questions) asking if a read I was doing was clear, was it performed correctly, was there patient movement--all pretty boring questions. Patients hire these attorneys to look into their case--maybe because it was a slip and fall, a car accident, work-comp, etc. The bad side of that is *if* there was a problem, the attorney becomes aggressive and then insinuates that the best was not provided for a patient. Now I'm liable because I may have read an image series and not commented that the patient moved or one of a hundred other possible compromises.
So for the surgeon--if the outcome is not 100% (patients have a very high expectation of what their outcome will be) the attorney will not only dig into standard of care, but ultimate care. So if a knee is repaired and the surgeon did not have the latest MRI performed the same day (or day before), the attorney will start a suit that indicates his client did not receive the ultimate care.
Really. This happens all the time. I read 60 cases a day. I get standard letters on maybe 10% of them. So 6 cases per day are going to be analyzed. Which is fine and I'm confident of my work. But I do 5 days a week. That's 30 cases reviewed per week, with the review being performed by an attorney who only paid if he can find something wrong--usually in process--and the definition of "wrong" is subjective. That should answer your question on being defensive.
On guidelines--it would be wonderful if a judge would be able to say "the physician followed the guidelines and therefore a judgement cannot be made based on him not following procedure" but it does not happen. I can follow every rule, recommendation, paper, and I still get questioned for the process I follow (and not even the correctness of the case) and merely the suspicion of a poor outcome is enough to mark my public profile.
Gingrich has some very interesting ideas that might work (he was working with Hillary Clinton on the issue several years ago--quite a pair.) I saw him speak at a AAFP session in Washington DC a few years ago.
The oil/mining economy in Canada is running well. The rest, benefiting from the oil economy, will continue run well as long as the oil/mining economy is running well.
Canada made some hard decisions in the 1980's and early 1990's. It was hard. Brutal, even. These are some of the same choices the US needs to make today.
Bill
The hospital I work at would probably not charge for the Q-tip itself, but add the fully burdened cost to the service provided.
Follow through, though. I'll try to make it easy for you.
The Q-tip was purchased and probably has an acquisition cost of $.01.
It was stocked by a nurse who needed to track inventory to maintain a non-profit status ($35/hr). 30 seconds to place it in the correct position and check off that it is now in inventory. ($0.50)
It was housed in a rolling cabinet that cost $2K. (assume cost is amortized over several years) The cart is cleaned once a week. The Q-tip bucket's share of this cleaning is 30 seconds @ $20/hr. let's say it's $0.01
It was requested by a care provider and took 60 seconds to log the care request into the government mandated electronic medical records used for tracking and assuring proper follow up to care. Cost of 60 seconds of care from a family practice physician (assuming $120K/year) is $1.
The request was printed out at a nurse station and picked up by charge nurse. Evaluation: 15 seconds. Delegation of the service 10 second. For a nurse making $70K/year, that is approximately $0.24.
The CNA ($25/hr) will open up the cabinet, get the Q-tip, walk the Q-tip to the patient. (2 minutes) Cost: Approximately $0.25
CNA logs the patient ID band and confirms the service will be performed: 30 seconds. (approximately $.10)
Actual use of Q-tip by CNA: 1 minute, including disposal in approved container. (approximately $0.20)
Disposal of Q-tip by janatorial staff: $0.01.
If procedure is properly performed and there are no adverse issue, you have an OCOGS of over $2. And you think it should be free?
Direct costs of malpractice, which include premiums, damage awards in excess of premiums, and associated litigation costs, represent no more than two percent of health care costs. Thus, tort reforms can have a substantial effect on health care costs only if they affect the amount of healthcare services provided.
Sorry, you must not work in health care.
This is just the malpractice part. What's not in the "1-2%" is what I'll call defensive medicine.
I have a colleague who is an orthopedic surgeon. He will not perform surgery on you unless you had an MRI or CT performed the day before. Many, many surgeons do this. And blood work. Update a complete panel. CBC, SMA, drug panel--the whole smash.
It does not matter if you had an MRI last week or your blood tests are two days old.
Why?
He does not want to get sued. You are paying for his defensive medicine.
You might ask "what does having an MRI prevent being sued?" There is a type of patient and a type of lawyer who look for clerical errors and then sue over them--not a negligence outcome. Not having an MRI the day before could be argued as not being the best care.
So what does it really mean? My colleague makes good money being a surgeon and would make less if he had a mark on his insurance record--just or unjust. With the surge in amateur ranking systems this means a lot to a practice.
Do I have a solution? Yes. Make it easier to become a physician or primary provider in the US. An ortho makes between $320K and $550K. That's in large part because of the amount of schooling (4 + 4 years after high school) , residency (4-5 years), fellowship (2 years), working for nearly free (a couple of years).
Make the PA an attractive choice in patients seeking care. Make a Family practice hospitalist specialty that requires 2 years grad school and 2 of residency.
Here's the last one: Make a non-profit hospital standards higher to keep non profit. Non-profit does not mean minimal bureaucratic excess.
years of sitting through Rev Wright's sermons even though he severely disagreed
I would believe he would have attended a king makers church for a couple of years. Three tops. But 20 years? And Rev Wright married them? And baptized their kids?
No brown nosing there. Obama was a willing attending member and I doubt he disagreed.
Yawn. GPU's are good for CT because you have a medium amount of data and a lot of processing to compensate for crap detectors and low ionizing radiation levels. You're staking the future of your CT on AMD? Good luck with that. I had people from one of the big 3 CT vendors evangelizing to me about the GPU and AMD. My group chose not to work with them because they were being stubborn on their religious choices of product and not on solving the problems. That and stealing some of our IP.
For an array, and people panicking over FFTs, a CPU today can keep up with 1D FFT data on a PCIe bus and some 2D FFTs. So using a GPU for a 1D FFTs is not necessary. But what about the gigantic 3D FFT? A GPU can't fit the 3D data set in memory without non-commercial hardware. So the GPU needs to pull data in through the bus. Multiple times. That is hardly efficient use of the GPU.
Someday, maybe a GPU will be available with a huge amount of memory but I'm just not seeing it. Even with a fully rendered lighting model, forward projected, there's just not much memory that will be needed for a commercial product. GPU's have an end-life trajectory. We're not that far away from it.
So what about a custom GPU for this project? If you're going to go custom, there's probably a lot better compute-memory-interconnect choices you can make than using a GPU.
Because I vote for the people who do make the valid arguments and grant them the authority to make those arguments.
Climate scientists have no authority to submit to as a teacher might.
Quite simply, they oppose the idea of teaching kids to think for themselves instead of blindly following what their parents or other authority figures tell them.
So we should teach children to challenge authority. How wonderful! I look forward to another generation of children who believe every one of their arguments actually means something. Just make sure to teach kids to challenge all authority. Starting with yours.
Someday maybe the Japanese can figure out how to build a bullet train in an earthquake zone.
The biggest difference between time and space is that you can't reuse time. -- Merrick Furst
