I have long been a fan of the “Case Records of the Massachusetts General Hospital,” which is published weekly in the New England Journal of Medicine. For many years, I made a point of recommending them to medical students and internal medicine residents as a model of concise yet comprehensive case presentations.No wasted words, no missing information, and none of the filler that trainees often added when they presented cases, such as “on heart exam….” or “the sodium was high at….” As I always reminded them (often not as gently as I should have), if they were reporting a heart murmur, I knew it part of their examination of the heart, and if the sodium was 149, I knew that was high. Continue reading Case of Caring
A recent study in the New England Journal of Medicine (N Engl J Med 2013;368:1713-22) has been getting a lot of press lately, and not because it reported on a new blockbuster drug. Rather, it reported the results of an unusual – and unintended – experiment about the utility of Medicaid.
A little background: one of the cornerstones of the affordable care act (aka “Obamacare”) is the expansion of Medicaid eligibility to include more low-income individuals. Since Medicaid is a state-run program partially financed with federal funds (as opposed to the “fully federal” Medicare program), eligibility has traditionally varied widely by state with much more generous eligibility and coverage in states like New York (read “blue states”) than say, Alabama. Continue reading The Oregon Medicaid Experiment: A Success or Failure?