What libraries and community centers have to do with health care

Health Policy
July 19, 2010

Our grandparents used to tell us, “if it ain’t broke, don’t fix it”.

Management gurus, in their race to the finish line have turned this sentiment on its head by telling us that, if it ain’t broke now, it will be soon, and if you do not fix it before it breaks, you will be behind the competition. This sentiment drives the annual corporate reorganization at every corporation that I or …

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What libraries and community centers have to do with health care

Watchful waiting may be appropriate for most prostate cancer cases

Conditions and Diseases
July 19, 2010

by Crystal Phend

Deferring curative treatment for low-risk prostate cancer may be a good option for many men ages 70 and younger, a population-based observational study affirmed.

In the national Swedish prostate cancer registry, the cumulative 10-year prostate cancer-specific mortality rate was only 2.4% for men at low risk who opted for watchful waiting or active surveillance, according to Pär Stattin, MD, PhD, of Umeå University Hospital in Umeå, Sweden, and colleagues.

This …

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Watchful waiting may be appropriate for most prostate cancer cases

What bored doctors can do after they retire

Potpourri
July 19, 2010

As the baby boom generation nears retirement, there will be a flood of doctors left wondering what to do with their time. Some doctors will continue to work in practice and, although it is certainly rewarding to work hands-on with patients and new staff, after 30, 40, or 50 years in the business many start to explore other options.

The motivation that drives one to medicine often stays with them for …

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What bored doctors can do after they retire

Prior authorization required by health insurers impedes primary care

Physician
July 19, 2010

by Charles R. D’Agostino, MD

It strikes fear in the hearts of doctors across the country; it is not the deadly Ebola virus or a new strain of cancer, but its malignancy is equally apparent.

It is the dreaded “PA”, which is insurance-speak for “prior authorization” and it seems that no matter which way we turn it appears, standing between our patients and the care they need.

To their credit, PAs are truly …

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Prior authorization required by health insurers impedes primary care

Cancer patients need compassion and balanced information

Patient
July 18, 2010

If you have to ask what jazz is, you will never know.
– Louis Armstrong

The stillness in the meeting room was electric.

First, one panelist addressed the audience members who have never experienced a malignancy. She described the unique and powerful bond that exists between cancer survivors. She described how the brush with mortality forces each survivor to renegotiate terms with Life itself. She reminded everyone that the cancer care system too often lets …

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Cancer patients need compassion and balanced information

A new primary care payment model with health savings accounts

Health Policy
July 18, 2010

by Charles Smith, MD

Everybody seems to be dissatisfied with the current model of primary care.

Concierge and retainer practices are all the rage, but they serve too few patients. While some highly integrated systems (Mayo Clinic, maybe Kaiser Permanente) may be thriving, they are difficult to replicate. Most primary care physicians are demoralized by a system that overburdens them with administrative hassles and liability while providing insufficient revenue to improve …

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A new primary care payment model with health savings accounts

How doctors can discuss advance directives with patients

Patient
July 17, 2010

A recent blog post and series of responses on KevinMD.com aroused my interest.

Dr. Kevin Pho posed the question: Why are doctors so reluctant to discuss end-of-life care? Responders, including patients, doctors, nurses, and even a veterinarian highlighted the stress inherent in this discussion for patients and for medical professionals alike.

To me, the real issue is not whether the discussion should occur, because clearly it should, but when and how? …

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How doctors can discuss advance directives with patients

ER visits rise because of prescription drug abuse

Medications
July 17, 2010

by Michael Smith

The number of emergency room visits for nonmedical use of prescription painkillers more than doubled between 2004 and 2008, according to a CDC estimate.

The increase was part of a trend that saw emergency room visits for nonmedical use of all prescription and over-the-counter medications reach the same level as those for abuse of illicit drugs, the agency said in the June 18 issue of Morbidity and Mortality Weekly …

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ER visits rise because of prescription drug abuse

Unnecessary testing needs more than tort reform to cure

Conditions and Diseases
July 17, 2010

Recently, while covering for one of my partners on a weekend, I was consulted by a physician to do a procedure.

The doctor wanted his patient to undergo an EGD, which is a scope test that examines the esophagus, stomach and first portion of the small intestine called the duodenum. We gastroenterologists do this test routinely to search for an explanation for a patient’s symptoms, or to determine if these organs …

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Unnecessary testing needs more than tort reform to cure

Why general internists are quitting clinical medicine

Health Policy
July 16, 2010

The Association of American Medical Colleges predicts that by 2025, the US health system will have 46,000 fewer primary care physicians than it needs.

If the prediction proves correct and we fail to develop effective mitigation strategies, the manpower shortage will create quite a mess. Ironically, the health reform law signed by President Obama in March will exacerbate the problem by increasing demand for services provided by primary care physicians.

The American …

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Why general internists are quitting clinical medicine

Facebook friend issues between doctor and patient

Social Media in Medicine
July 16, 2010

My friend and colleague Katherine Chretien has a provocative op-ed in USA Today entitled, “A doctor’s request: Please don’t ‘friend’ me,” which asks the question whether doctors and patients should interact in social networking sites such as Facebook.

Social networking has huge potential in health care regarding the sharing of information and ideas, and could possibly even enhance communication between doctors and patients. However, as Dr. Chretien points out, many …

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Facebook friend issues between doctor and patient

Echocardiogram reading by cardiologists needs to improve

Conditions and Diseases
July 16, 2010

by Crystal Phend

Insufficient training among cardiologists in reading echocardiography results is wasting healthcare dollars and subjecting patients to unnecessary procedures, researchers said.

A review by sonographers of cardiologist-interpreted echocardiography findings at a Milwaukee medical center during a period of just over a year indicated major discrepancies in 29% of cases, leading to unnecessary further diagnostic testing or treatments for the wrong indication, according to a study presented here at the American …

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Echocardiogram reading by cardiologists needs to improve

Poliomyelitis doesn’t make the health reform cut

Health Policy
July 16, 2010

Early in paralytic poliomyelitis, the patient exhibits weakness; hyperesthesia; muscular pain, frequently quite severe; antalgic (reflexive) immobilization (spasm) of involved muscles; and normal or accentuated tendon reflexes.

This phase is rapidly followed by loss of motor function, which is usually asymmetric and noncontiguous: one or both legs in 60 percent of the cases; one or both arms in 25 percent. Involvement of the diaphragm and intercostal muscles reduces ventilatory capacity. Cranial …

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Poliomyelitis doesn’t make the health reform cut

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Why doctors run late and how patients can help

Physician
July 15, 2010

A friend recently asked me in great frustration after her visit to her doctor why doctors “always run late.”

Why do doctors make their patients “dance around” the office, getting moved around to different spots in the clinic, but still having to wait and wait at each location? Instead of explaining what really goes on at the doctor’s office, I ended up emailing her a couple of links to some of …

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Why doctors run late and how patients can help

Stents to treat blocked heart arteries are not an easy fix

Conditions and Diseases
July 15, 2010

Cardiologist Richard Fogoros — aka DrRich — has put out an incredibly timely and pertinent piece of advice concerning the common practice of stenting blockages in the coronary arteries.

He succinctly summarizes a small retrospective study that showed an increased risk of cardiac events after non-cardiac surgery in patients who have recently undergone either a bare metal or drug-eluting coronary stent.

On a website clearly designed to educate patients, DrRich rightly points …

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Stents to treat blocked heart arteries are not an easy fix

Why having a primary care physician is important

Physician
July 15, 2010

by Chrysalis

I read a post that disturbed me the other day. It was discussing the value of primary care physicians (PCPs). I was stunned by some of the comments. Surprised that people’s perceptions of what a PCP does would be viewed in such a poor light.

Well, I do value the primary care physician and I’ll tell you why. I am just simply going to state some of …

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Why having a primary care physician is important

Is the PAP test for cervical cancer screening being overused?

Conditions and Diseases
July 15, 2010

by Kristina Fiore

Physicians do not appear likely to reduce the frequency of cervical cancer screening — not even with the availability of the sensitive human papillomavirus (HPV) DNA test, researchers say.

When given a clinical vignette of a 35-year-old woman with a normal Pap test and a negative HPV test, only 19% of the more than 1,200 physicians surveyed said they would wait three years before conducting another Pap test, Mona …

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Is the PAP test for cervical cancer screening being overused?

Why this doctor felt compelled to go to Haiti

Physician
July 15, 2010

by David Chong, MD

As the world watched the greatest athletes gather to compete in Vancouver, I was on a plane to Haiti. Just getting on the plane was quite a feat.

After I received an urgent e-mail for volunteer doctors from the University of Miami’s Project Medishare field hospital in Port-au-Prince, Haiti during an overnight shift at New York’s Presbyterian hospital, I began to send frantic requests for coverage for …

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Why this doctor felt compelled to go to Haiti

Rosiglitazone (Avandia) stays on the market, with stronger warnings

Medications
July 14, 2010

by Emily P. Walker

An advisory panel voted 20-12 to recommend that the FDA allow rosiglitazone (Avandia) to stay on the market, but most panelists want to see the controversial diabetes drug carry tougher warnings on its label.

Wednesday’s vote marks the second time an FDA advisory panel has essentially endorsed rosiglitazone. In 2007, a panel voted that while the drug appears to …

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Rosiglitazone (Avandia) stays on the market, with stronger warnings

Treating intellectual disabilities in patients who can’t talk

Conditions and Diseases
July 14, 2010

Psychiatrists treating patients who can’t talk. Sounds fishy, doesn’t it?

Well, I do it 2-3 days per week, and as strange as it may sound, it makes perfect sense.

Let me explain.

I provide psychiatric consultation services in a facility for people with intellectual and developmental disabilities. (Intellectual disability is the newer term for mental retardation). Some of my patients are short-term admissions from the community, and others are long-term residents of the …

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Treating intellectual disabilities in patients who can’t talk

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