Patients and physicians should screen for cancer, but cautiously

Conditions and Diseases
October 6, 2010

To screen or not to screen? That is not the question.

The question is not whether to screen, it is why, what, where, when, how, and how much, how often, and at what cost for what benefit.

Patients and physicians must and do screen. The issue is cautious appropriateness. Self-screening by patients is easy, free, and fundamentally harmless. Look at your skin for potential melanomas, be alert to warning symptoms of a …

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Patients and physicians should screen for cancer, but cautiously

Catherine Zeta-Jones blames doctors for Michael Douglas’ throat cancer

Conditions and Diseases
October 6, 2010

Why is Catherine Zeta-Jones so mad?

It’s a facetious question. Her husband, Michael Douglas, was recently diagnosed with throat cancer he described at “stage 4.”

She was quoted by People magazine as saying, “It makes me furious they didn’t detect it earlier.” They have young children, and anyone who hasn’t personally been faced with this threat can only imagine her fear and anxiety. I suspect no number of large houses, expensive cars, …

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Catherine Zeta-Jones blames doctors for Michael Douglas’ throat cancer

Should CRNAs practice anesthesiology without physician supervision?

Physician
October 5, 2010

Interesting article recently from Health Affairs about the clinical equivalence between the care provided by anesthesiologists and CRNAs. The article concludes by advocating that CRNAs be given permission to practice anesthesiology without physician supervision. It’s more cost effective. And there is no compromise to the quality of care delivered to patients.

We recommend CMS return to its original intention of allowing nurse anesthetists to work independently of surgeon or …

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Should CRNAs practice anesthesiology without physician supervision?

Pfizer spending money to train journalists in how to cover cancer

Conditions and Diseases
October 5, 2010

The National Press Foundation is sponsoring a four-day, all expenses paid trip to Washington for 15 reporters to learn how to improve their coverage of cancer issues. Pfizer is funding the seminar.

Former University of Minnesota journalism professor Gary Schwitzer writes:

Even if National Press Foundation staff choose the speakers and set the agenda, even if the Pfizer “guy never even showed up” last year, even if one reporter doesn’t recall Pfizer …

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Pfizer spending money to train journalists in how to cover cancer

We’re not ready for do it yourself genetic analysis

Conditions and Diseases
October 5, 2010

You may be wondering why Stanford Medical School’s new genetic interpretation class – the one that offers medical students the opportunity to study their own genes – has made the news. After all, what better genes are there to study than your own? And if you were a medical student, wouldn’t you want to have your medical school subsidize 80% of an $800 test as part of your curriculum – …

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We’re not ready for do it yourself genetic analysis

Doctors should work weekends, and how reformers alienate physicians

Health Policy
October 5, 2010

Peter Orszag wants doctors to work weekends.

The former director of the White House Office of Management and Budget wrote as much in this past weekend’s New York Times:

Doctors, like most people, don’t love to work weekends, and they probably don’t enjoy being evaluated against their peers. But their industry can no longer afford to protect them from the inevitable. Imagine a drugstore open only five days a week, or …

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Doctors should work weekends, and how reformers alienate physicians

6 points every physician should consider about Medicare ACOs

Health Policy
October 5, 2010

by Asa Lockhart, MD

Doctors, that age-old business advice still applies: Take your time and read carefully, and evaluate what it might mean to your patients and your practice, before you sign a contract.

Specifically, the Patient Protection and Affordable Care Act (PPACA) paves the way for Medicare shared savings accountable care organizations (ACOs).

Conceptually, this type of ACO is a collaboration of physicians and health care providers …

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6 points every physician should consider about Medicare ACOs

Benefits of EMR outweigh the cost and learning curve

Health Technology
October 5, 2010

It’s hard to teach an old dog new tricks, but we can try.

To write or to type, that is the question. To boldly go (according to the latest statistics) where only a small few are going; that is the challenge. Actually, for everyone in the medical profession, the reality of the paper chart is slowly coming to a close.

The digital age is moving forward at lightning speed.

But can you teach …

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Benefits of EMR outweigh the cost and learning curve

Our love affair with technology holds primary care back

Physician
October 4, 2010

My wife and I were invited to dinner at the home of one of my daughter’s friends. My daughter is a graduate of the International Baccalaureate program of Murphy High and her friends tend to be interesting.

This particular friend is majoring in pre-med and has parents who immigrated from Vietnam following the fall of Saigon. As is usual when one has a physician dinner guest (and perhaps when one doesn’t) …

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Our love affair with technology holds primary care back

Cake with a terminal cancer patient

Conditions and Diseases
October 4, 2010

by Krupali Tejura, MD

A fellow physician called me with a consult this afternoon.

He described the case as a 60 year old who had stridor (difficulty breathing) for the past week and was admitted to the hospital recently. A CT scan showed lymph nodes in his neck which was compressing the trachea, and other scans didn’t show much better. A biopsy was done but the final results were …

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Cake with a terminal cancer patient

How academic physicians turn into drug company shills

Medications
October 4, 2010

An excerpt from White Coat, Black Hat.

by Carl Elliott

These days many thought leaders find themselves on shaky ground. The past few years have not been good for business. Some of the most prominent thought leaders have been exposed and censured by Grassley. Others have seen public opinion turning against them and gone underground. As more states institute Sunshine laws, anyone considering an industry …

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How academic physicians turn into drug company shills

POLST and the next generation of the “Do Not Resuscitate” order

Patient
October 4, 2010

POLST stands for “Physician Orders for Life-Sustaining Treatment”. It is a next generation replacement for an Advanced Directive and DNR (“Do Not Resuscitate”) order. Advanced planning documents turn out to be less than useful, especially in urgent care settings, and many patients receive more aggressive care than they might want because universal, transferable physician orders are unavailable or, simply, not applicable because a patient is in a different care setting.

The …

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POLST and the next generation of the “Do Not Resuscitate” order

The day that medicine broke her and destroyed her innocence

Patient
October 4, 2010

I was a third-year medical student in the first week of my obstetrics rotation. The obstetrics program was known to be high-pressure, its residents among the best. Mostly women, they were a hard-core group–smart, efficient, motivated–and they scared the heck out of us medical students.

I remember the day clearly: Not only was I on call, but I was assigned to the chief resident’s team. I felt petrified.

We’d started morning rounds …

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The day that medicine broke her and destroyed her innocence

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Why drug companies lavish doctors and how they price their drugs

Medications
October 3, 2010

An excerpt from Unhinged: The trouble with psychiatry- a doctor’s revelations about a profession in crisis. Copyright © 2010 Daniel Carlat. Excerpted with permission by Free Press, a Division of Simon & Schuster, Inc.

My own education in pharmaceutical marketing began during my second year of residency at Massachusetts General Hospital.

Suddenly, I noticed that Paxil bagels began appearing everywhere. I first saw them in the break room of …

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Why drug companies lavish doctors and how they price their drugs

Why doctors need an EHR, and why they should buy it now

Health Technology
October 3, 2010

The regulators have completed their work. CMS has defined how you should use technology in your practice or hospital (Meaningful Use) and technical requirements for EHRs have been finalized.

Centers for Medicare & Medicaid Services (CMS) and Office of the National Coordinator for Health IT (ONC) have removed all ambiguity regarding Government financial assistance to those purchasing EHRs, and ONC certified EHRs will start appearing shortly.

A national network of federally funded …

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Why doctors need an EHR, and why they should buy it now

Can accountable care organizations lower costs and improve quality?

Health Policy
October 3, 2010

Somewhere in the Obama Administration, there is an elitist central cabal that operates with the support of the highest organs of our central government. It conspires in windowless basement rooms to plot the gun control, mass vaccinations and the nationalization of key U.S. economic sectors like automobile and chardonnay manufacturing.

Healthcare, however, is its maximum target. Much like pieces on a chess board, and with the support of renegade organizations like …

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Can accountable care organizations lower costs and improve quality?

Children who are difficult may not be simply toxic

Conditions and Diseases
October 2, 2010

As a pediatrician I have listened to many parents speak of their child in very negative terms. Dr. Richard Friedman, in his New York Times article entitled Accepting That Good Parents May Plant Bad Seeds shares his patient’s description of her “rude and defiant” teenage son. Like the parents in his piece, the parents of my patients have other children with whom they have had no such …

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Children who are difficult may not be simply toxic

Heavy sleep debt extracts a price for patients

Patient
October 2, 2010

An excerpt from The Twenty-Four Hour Mind: The Role of Sleep and Dreaming in Our Emotional Lives.

by Rosalind D. Cartwright, PhD

We live in a culture that values speed; fast foods, fast cars, fast service, and fast decisions.

All of this takes a toll.  Fast food is blamed for the epidemic of obesity, fast cars for motor vehicle accidents, and the wish for fast service and decisions …

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Heavy sleep debt extracts a price for patients

The benefit of a drug cannot be measured by the law of averages

Medications
October 1, 2010

One of the topics that I have often thought about (especially in light of our seeming inability to develop zero-risk obesity drugs) is the problem of averages. Our entire medical philosophy of “evidence-based” medicine seems built on the “Gaussian” assumption that averages can reflect the true benefit (or risk) of a drug, when in real life (or medical practice) there is no such thing as the truly average patient.

Clearly, a …

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The benefit of a drug cannot be measured by the law of averages

Finding a doctor using ratings is a sound idea, but poorly executed

Physician
October 1, 2010

Let’s say you develop some heart problem and get sent to me for an evaluation. You show up to the office, check in, get ushered into an exam room, then you wait and wait and wait. When I finally come into the room I seem terse, impatient and rushed, and you end up visiting with me for less than 5 minutes. I provide you with a diagnosis, order a couple …

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Finding a doctor using ratings is a sound idea, but poorly executed

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