Coming soon {a London wedding}

Delia and Chris' wedding at All Saints Church Fulham and London Rowing Club on the Thames. 

London wedding at All Saints Fulham Church
London wedding on Putney Bridge, Thames


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Oregon PCMH Saved 240 Million But Spent Over 250 Million

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The latest headlines spout 250 million saved for Oregon in the movement to Primary Care Medical Home. Claims of savings often fail to consider the additional costs of an intervention or the supplemental government or foundation funding required. Based on $105,000 additional cost per primary care physician per year the following table demonstrates $250 million to 1 billion dollars more in cost for primary care medical home across Oregon. It is important to consider not just the savings, but also the higher costs of new models. Specifics are not given but the impact of the primary care medical home can be estimated across the number of clinics that could participate and the doctors per clinic over a 2 or 3 year period. The number of doctors may be small compared to actual. The high and low levels are shown along with a possible average cost. If studies involved less than 2 years they should not have gained print. The limitations in new studies with new measurements as measured and analy...
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Critical findings in Imaging – Policy and procedure

Imaging and Medical laboratory frequently come across critical results or finding of a patient’s diagnostic tests which requires immediate intervention from the doctor to bring the patient out of the criticality. Hence, a hospital must have a policy and procedure in place for identification and quick communication of such results. This posts describes critical findings in imaging (Check critical test results in laboratory –policy and procedure ). Critical findings in imaging are the findings from imaging examination of a patient, which indicates that condition of the patient may be critical or even life-threatening. Whenever such critical findings are made, it is necessary that the treating clinician of the patient is informed immediately so that required interventions can be carried out in time. To be able to do so, a hospital needs to have a well-developed process of ‘identification and urgent communication of critical findings in Imaging’. Such process should be able to achieve foll...
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Real Health Care Solutions, Not Value Focus

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The Value Based Movement lacks Value. It is important to understand how AAFP, Commonwealth, and others have arrived at their misguided focus about what is value.You will hear the various promotions constantly in journals, policy papers, and in the media. The following are more critical evaluations via Jha, Soumerai, Sullivan, CBO, Annals of IM, and others with my comments, critique, and assumptions regarding the real influences on outcomes. I still have hope for associations and foundations, but they need new leadership and a return to missions such as health access – real health access.Their staff need to be re-educated regarding the true value of family physicians and others serving in teams on the front lines despite that greater challenges of the value-based focus. Value, P4P, Performance Based Evidence Is Lacking Annals of IM 1/17 in a comprehensive review did not indicate value for performance based incentives. Only process was improved.   It is hard to stop a Bandwagon,...
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