On the Defensive

Mike Gibbons — Thu, 08 May 2008 15:40:00 GMT

Covering the 2008 NAMDRC conference in San Francisco recently, I was re-introduced to a term I hadn't heard or thought about in many years.

Chatting with members of NAMDRC after-hours always bears ripe journalistic fruit. This group, composed of medical directors of respiratory care departments, includes many of the "top dogs" in cardiopulmonary medicine and clinical research.

During the opening night reception inside the elegant marbled confines of the 93-year-old Flood Mansion, I posed my perennial question to many NAMDRC delegates: what articles would you like to see in ADVANCE?

One physician mentioned the forever-lurking threat of drug-resistant TB. Another wanted a story on the many ways therapist-driven protocols save hospitals money. Then I pulled up a chair next to Randall M. Fulchiero, MD, medical director of the respiratory care department at Miami Valley Hospital, in Dayton, Ohio.

"The cost of defensive medicine is the most significant (cost-driving) item in medicine," he said emphatically. "It's mind-boggling that this hasn't been written about...Talk to doctors off the record and they'll confirm it."

Yes...defensive medicine, that compulsion felt by physicians-out of self-preservation-to run every test in the book on every patient, lest some hawk-eyed prosecuting attorney seize on a bad patient outcome and haul them into court. I had lost sight of this problem.

Minus defensive medicine, health care costs in this country would decrease by "at least 50 percent," Dr. Fulchiero insisted. But the need to practice defensive medicine "is so ingrained in people they don't question it," he said with a shrug.

"Rational, intense oversight" of medicine, rather than the looming threat of litigation and financial ruin, would properly incentivize medicine to improve itself, Dr. Fulchiero concluded. "My fear should be practicing poor medicine," he said. "Doctors will respond to threats to their reputations."

What are your thoughts on defensive medicine? How great a factor is it in health care inflation? Is it a "sleeper" issue in the debate on how to lower America's runaway health care costs?

by Michael Gibbons

Networking Made Easy

Shawn Proctor — Thu, 17 Apr 2008 13:15:00 GMT

When I earn my master's degree in writing next May, I'll finally be able to cross off a biggie from my list of long-term goals. Even though I'm still waiting to graduate, I can already confirm that the greatest lessons were not merely gained in class.

Certainly anyone can deepen understanding of a subject with additional formal education.Yet the greatest opportunity for growth comes by networking with others who work in the same occupation. They confront the same issues. They share in one another's successes.

On ADVANCE's Web site, respiratory care practitioners from so many backgrounds and dots on the map have the same chance to network as I do (minus the hefty tuition bill). They can post topics in the forum and start a conversation. Or respond to a question someone else has posted. They can interact with our expert bloggers by leaving a comment or simply learn from their insights.

Our community Web site, in short, provides an ideal way to connect that new graduate in Tampa, Fla., with the long-time manager from San Diego. A smoking cessation expert from Minnesota can swap tips with a pulmonary rehab guru from Hawaii. ADVANCE's staff will even have a voice on this blog.

So while we hope our readers take every opportunity to further their education, whether in school or at a conference, we invite you discover a community of experts together on this site.

ADVANCE Perspective: Respiratory Therapy

On the Defensive

Networking Made Easy