2010

April 7, 2010Apr 7, 2010

Now, as you know, I am a big fan of epidemiology. I do not believe that a randomized controlled trial is the be-all-and-end-all in evidence generation, and a well done observational study can add to our reservoir of knowledge much more efficiently. Of course, I, as many others, acknowledge certain limitations of epidemiologic design. However, many of them can be overcome with careful design and analysis.

I have to confess, though, …

Drugs and prescribing

Chronic pain patients may have been disobedient children

MedPage Today

April 7, 2010Apr 7, 201018

by Nancy Walsh Children who are irritable or disobedient, or who steal or bully others, are at risk for chronic pain in middle age, a large prospective study found. Youngsters who had persistent behavior problems at ages seven, 11, and…

by Nancy Walsh

Children who are irritable or disobedient, or who steal or bully others, are at risk for chronic pain in middle age, a large prospective study found.

Youngsters who had persistent behavior problems at ages seven, 11, and 16 years had more than twice the risk of widespread chronic pain at age 45 as other children (RR 2.14, 95% CI 1.43 to 3.21), according to Dong Pang, PhD, of the …

Physician voices

Patient advance directives are critical in the ICU

Shantanu Nundy, MD

April 6, 2010Apr 6, 20103

When someone dies at home we call it ‘going to a better place.’ When someone dies in the hospital we call it a ‘code.’ Recently, working in the cardiac ICU, I have been thinking a lot about code status. Code…

When someone dies at home we call it ‘going to a better place.’ When someone dies in the hospital we call it a ‘code.’

Recently, working in the cardiac ICU, I have been thinking a lot about code status. Code status is the medical term that describes what a patient’s wishes are should his or her heart stop or lungs fail. While code status is not a topic that typically …

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Physician voices

Hospital admissions may require watching and waiting

Edwin Leap, MD

April 6, 2010Apr 6, 20107

A sweet little lady came to the emergency department recently. She said she felt short of breath and sweaty at home. In the department, she looked like a rose! Normal oxygen levels, normal labs. Her chest x-ray had a faint area that ‘one might possibly imagine could perhaps be’ a pneumonia. It looked remarkably like her previous film.

But her history was concerning to me, and it was concerning to …

Health technology

iPad in the ER, a hands on physician review

Larry Nathanson, MD

April 6, 2010Apr 6, 20107

I had been anxiously awaiting the arrival of my iPad. This is the form factor I have been asking (begging) of all the vendors for years. I'm very happy to say that it appears to be living up to my…

I had been anxiously awaiting the arrival of my iPad. This is the form factor I have been asking (begging) of all the vendors for years. I’m very happy to say that it appears to be living up to my high expectations.

The screen is gorgeous. It’s very clear and bright, I had no trouble seeing the screen in bright outdoor light. The machine seems extremely responsive — it …

Health policy

Don Berwick to lead Medicare and Medicaid

Robert Wachter, MD

April 6, 2010Apr 6, 20102

While the health reform bill will have many effects, one of its most profound will be to unshackle the Centers for Medicare & Medicaid Services (CMS). Under the legislation, CMS is now far freer to undertake a variety of pilot…

While the health reform bill will have many effects, one of its most profound will be to unshackle the Centers for Medicare & Medicaid Services (CMS).

Under the legislation, CMS is now far freer to undertake a variety of pilot programs and demonstration projects designed to improve quality, safety and efficiency, and to convert the successful ones into policy. And, if that wasn’t enough for those who have long been praying …

Physician voices

Social work is key to quality patient care

Ken Covinsky, MD

April 5, 2010Apr 5, 20104

In 1927, Francis Peabody remarked that, "The secret of the care of the patient is in caring for the patient." Medicine has made much progress since those days, but some might argue that some of the humanitarian cornerstones of caring…

In 1927, Francis Peabody remarked that, “The secret of the care of the patient is in caring for the patient.”

Medicine has made much progress since those days, but some might argue that some of the humanitarian cornerstones of caring that concerned Peabody have been lost. Of course, there are many health professionals that still embody this caring ethic. And in today’s era, perhaps the group that best personifies this central …

Health policy

Medicare denies a brain tumor drug after a patient moves

John Fauber

April 5, 2010Apr 5, 201010

For nearly a decade, Paula Oertel's brain tumor was kept at bay by a drug that was not approved to treat her condition. Then Oertel did something she never imagined would jeopardize her health. She moved -- less than 30…

For nearly a decade, Paula Oertel’s brain tumor was kept at bay by a drug that was not approved to treat her condition. Then Oertel did something she never imagined would jeopardize her health.

She moved — less than 30 miles — from one county in Wisconsin to another.

That move triggered a review of her health insurance from Medicare, which eventually led to a loss of coverage, including the drug.

The …

Physician voices

Aortic dissection symptoms and current treatment options

Joseph Lombardi, MD

April 4, 2010Apr 4, 2010

by Joseph Lombardi, MD You probably remember the tragic death of actor John Ritter in 2003. Recently, his family partnered with the Thoracic Aortic Disease (TAD) Coalition to shed light on the condition that took his life: aortic dissection. In…

by Joseph Lombardi, MD

You probably remember the tragic death of actor John Ritter in 2003.

Recently, his family partnered with the Thoracic Aortic Disease (TAD) Coalition to shed light on the condition that took his life: aortic dissection.

In addition to TAD Coalition’s “Ritter Rules,” which focus on recognizing, treating and preventing the condition, the American Heart Association and American College of Cardiology also released new guidelines designed to prevent unnecessary …

Drugs and prescribing

Pain management depends too heavily on narcotics

Michael Kirsch, MD

April 4, 2010Apr 4, 201015

by Michael Kirsch, MD First, let me state unequivocally that I am against all varieties of pain, foreign and domestic. Indeed, I wish that we could snuff the varmint out every time and place it surfaces. Pain is a wily…

by Michael Kirsch, MD

First, let me state unequivocally that I am against all varieties of pain, foreign and domestic. Indeed, I wish that we could snuff the varmint out every time and place it surfaces. Pain is a wily opponent that can be difficult to vanquish. In recent years, physicians have been resorting to a ‘shock and awe’ strategy of using excessive force against it.

While this may be sound military …

Physician voices

Physicians increase revenue with better appointment analysis

Nikolaos I. Kakavoulis, MD

April 3, 2010Apr 3, 201010

by Nikolaos I. Kakavoulis, MD Physicians are working harder than ever to generate even a small increase in their income. Despite seeing more patients, average physicians net income between 1995 and 2003 has declined about 7% after adjusting for inflation,…

by Nikolaos I. Kakavoulis, MD

Physicians are working harder than ever to generate even a small increase in their income. Despite seeing more patients, average physicians net income between 1995 and 2003 has declined about 7% after adjusting for inflation, according to a national study from the Center for Studying Health System Change.

Why is this happening?

Now more than ever, physicians face an avalanche of complex rules, regulations, and administrative processes needed …

Health policy

The individual mandate may collapse health reform

Richard Reece, MD

April 3, 2010Apr 3, 201021

Obamacare faces a shaky future because of its call for an individual mandate. This mandate requires people to buy insurance or face income tax penalties, which the IRS would presumably enforce. As I write, attorney generals in 35 states are…

Obamacare faces a shaky future because of its call for an individual mandate. This mandate requires people to buy insurance or face income tax penalties, which the IRS would presumably enforce.

As I write, attorney generals in 35 states are in the process of challenging the individual mandate as unconstitutional.

The individual mandate issue is important. Kill it, and you kill Obamacare.

Why? Because the individual mandate is the political mechanism for controlling …

Physician voices

Peer review helps doctors improve medical care

John Mandrola, MD

April 2, 2010Apr 2, 20109

While typing words, the advertisement for yet another hospital is overheard from the TV. "Ignore it John," I think to myself, but, it is impossible to not look up and see. The head shakes with a smirk, like my grandfather…

While typing words, the advertisement for yet another hospital is overheard from the TV. “Ignore it John,” I think to myself, but, it is impossible to not look up and see. The head shakes with a smirk, like my grandfather did and without words displeasure was easily conveyed.

Do people really think the graphical professionalism of a TV spot is even remotely an accurate metric of quality of medical care?

At work, …

Physician voices

Physicians should be involved in health care decisions

Jeffrey Knuppel, MD

April 2, 2010Apr 2, 20103

As physicians progress through medical training and acquire new knowledge and skills, something interesting happens. They also develop a new and increasing awareness of not only how much they didn’t previously know but also how much they still don’t know. This process sounds paradoxical but has been consistent with my personal experience: The more I learn, the less I think I know.

Any seasoned clinician knows that in order for one …

Conditions and diseases

Children whose parents refuse vaccination may spread measles

MedPage Today

April 2, 2010Apr 2, 20109

by Todd Neale Children whose parents refuse vaccinations for them provide fertile ground for the spread of vaccine-preventable diseases, an investigation of a 2008 measles outbreak in San Diego demonstrated. Although the rate of two-dose immunization against measles was 95%…

by Todd Neale

Children whose parents refuse vaccinations for them provide fertile ground for the spread of vaccine-preventable diseases, an investigation of a 2008 measles outbreak in San Diego demonstrated.

Although the rate of two-dose immunization against measles was 95% in the area, a single case of measles from a 7-year-old child returning from overseas sparked an outbreak that exposed 839 people and sickened 11 other children, according to David Sugerman, …

Health policy

Medicare for all may be next for healthcare reform

George Lundberg, MD

April 2, 2010Apr 2, 201036

In the Journal of the American Medical Association on May 15, 1991, in our first of many theme issues dedicated to "Caring for the uninsured and underinsured," I wrote: "An aura of inevitability is upon us. It is no longer…

In the Journal of the American Medical Association on May 15, 1991, in our first of many theme issues dedicated to “Caring for the uninsured and underinsured,” I wrote: “An aura of inevitability is upon us. It is no longer acceptable morally, ethically, or economically for so many of our people to be medically uninsured or seriously underinsured. We can solve this problem. We have the knowledge and the resources, …

Medical education

Residency training is like James Cameron’s Avatar

Vineet Arora, MD

April 1, 2010Apr 1, 20102

Dr. Carolyn Clancy, head of the Agency of Healthcare Research and Quality, recently highlighted the definite need for enhanced patient safety and training on healthcare IT for residents who will be the practicing docs of the future. At the very…

At the very end, she compared the future of residency training to James Cameron’s Avatar – an epic battle followed by enlightenment.

Because I am a huge science fiction fan and working in graduate medical …

Health policy

Insurance companies fail at rating physicians on cost

MedPage Today

April 1, 2010Apr 1, 20105

by Emily P. Walker A physician profiling method used by private insurance companies to steer patients toward lower-cost physicians isn't reliable, researchers found. According to a study published in the March 18 issue of the New England Journal of Medicine,…

by Emily P. Walker

A physician profiling method used by private insurance companies to steer patients toward lower-cost physicians isn’t reliable, researchers found.

According to a study published in the March 18 issue of the New England Journal of Medicine, 43% of physicians who are ranked as “lower cost” doctors according to a common formula used by insurance companies are not actually treating patients for any less than physicians with …

2010

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