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PostPosted: Sun Feb 19, 2006 4:28 pm 
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Joined: Sun Feb 11, 2001 6:01 am
Posts: 801
Location: Tallahassee, FL
deleted rantings of the ...... :) :( :wink: :roll:

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Last edited by Akil Todd Harvey on Sun Feb 19, 2006 6:52 pm, edited 1 time in total.

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PostPosted: Sun Feb 19, 2006 4:38 pm 
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Joined: Sun Feb 11, 2001 6:01 am
Posts: 801
Location: Tallahassee, FL
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Part of the reason that men seem so much less loving is that men's behavior is measured with a feminine ruler (Francesca M. Cancian)


Actually, among the issues of our schools, and in most of our institutions, imo, is that boys (and men's) behavior is measured according to a woman's behavioral norms..........and to the extent that women's and men's behavior patterns overlap, the gender normatization toward the female measure may be a handicap for some women as well, thus a broader problem than merely men or boys, versus women and girls, toward women and men, boys and girls.........

thus, we may be quick to judge male behavior (and some women) as being wrong and unacceptable.

how do we find a middle ground more acceptable to both genders?
8O :D :roll:

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PostPosted: Mon Feb 20, 2006 5:20 am 
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Joined: Wed Nov 27, 2002 1:16 am
Posts: 2758
Location: Boston
A quick comment on "pay for performance" in medicine:

1) It's often based on questionable "product.
--Get all your patients vaccinated for pneumonia when they get admitted for other reasons? Points for you! Sounds great until you look at the very poor data for pneumovax.
--Did you use the little stamp with your name and number and did you write out "daily" instead of "qd" even in a note and not in the orders? Points for you! Who cares if your name is perfectly legible without the stamp...

Sometimes there is slavish devotion to guidelines that can harm people. Populations need guidelines. Patients need doctors. For example, I don't follow the advice to treat all "healthcare associated pnuemonia" with two drugs, one of them an aminoglycoside--because some of the patients don't need that second drug and some can't tolerate it and some I can select a specific ideal antibiotic based on prior data. All of these actions are good for individuals but might COST me "performance" and money to boot. But some of the standards are basic and good:

--did you give all your heart attack patients aspirin and a betblocker OR DOCUMENT A REASON WHY NOT? That's basic and it correlates in my mind with quality and also nicely correlates with year of graduation from medicine.

2) Early studies suggest that pay for performance rewards people who were already doing their job well more than it elevates performance of everyone else.

Medicine is a tricky thing to standardize. I agree it must be done and any doc who claims to care about their patients should also support oversight and decision support (easily acessible info and advice that helps them make good choices). But we shouldn't fall in love with a "standard" just because.

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