2010

October 6, 2010Oct 6, 20106

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…

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 …

Conditions and diseases

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

Richard Young, MD

October 6, 2010Oct 6, 201042

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…

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, …

Physician voices

Should CRNAs practice anesthesiology without physician supervision?

Jeffrey Parks, MD

October 5, 2010Oct 5, 201032

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…

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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Conditions and diseases

Pfizer spending money to train journalists in how to cover cancer

Merrill Goozner

October 5, 2010Oct 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…

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

…

Conditions and diseases

We’re not ready for do it yourself genetic analysis

Jan Gurley, MD

October 5, 2010Oct 5, 20106

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 – …

Health policy

Doctors should work weekends, and how reformers alienate physicians

Kevin Pho, MD

October 5, 2010Oct 5, 201058

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…

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

…

Health policy

6 points every physician should consider about Medicare ACOs

Asa Lockhart, MD

October 5, 2010Oct 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…

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 …

Health technology

Benefits of EMR outweigh the cost and learning curve

Adam Alpers, DO

October 5, 2010Oct 5, 201011

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…

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 …

Physician voices

Our love affair with technology holds primary care back

Allen Perkins, MD

October 4, 2010Oct 4, 20107

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…

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) …

Conditions and diseases

Cake with a terminal cancer patient

Krupali Tejura, MD

October 4, 2010Oct 4, 201010

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…

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 pending. It was …

Read more…

Cake with a terminal cancer patient

Drugs and prescribing

How academic physicians turn into drug company shills

Carl Elliott, MD, PhD

October 4, 2010Oct 4, 20107

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…

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 …

Patient voices

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

Jeffrey Hall Dobken, MD, MPH

October 4, 2010Oct 4, 201013

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…

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 …

Patient voices

The day that medicine broke her and destroyed her innocence

Jordan Grumet, MD

October 4, 2010Oct 4, 201010

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…

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 …

Drugs and prescribing

Why drug companies lavish doctors and how they price their drugs

Daniel J. Carlat, MD

October 3, 2010Oct 3, 201015

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…

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 …

Health technology

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

Margalit Gur-Arie

October 3, 2010Oct 3, 201023

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…

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 …

Health policy

Can accountable care organizations lower costs and improve quality?

Jaan Sidorov, MD

October 3, 2010Oct 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…

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

Conditions and diseases

Children who are difficult may not be simply toxic

Claudia M. Gold, MD

October 2, 2010Oct 2, 20107

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…

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 …

Patient voices

Heavy sleep debt extracts a price for patients

Kevin

October 2, 2010Oct 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…

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

…

Drugs and prescribing

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

Arya M. Sharma, MD

October 1, 2010Oct 1, 201014

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 …

Physician voices

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

Eric Van De Graaff, MD

October 1, 2010Oct 1, 201018

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 …

2010

Real physician voices, twice a week

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