The following is part of a series of original guest columns by the American Medical Association.
by J. James Rohack, MD
Physicians in nearly every area of the country face a David and Goliath scenario when negotiating with entrenched health insurance companies. This is clearly illustrated by a new AMA study showing that competition in the health …
AMA: Health insurance consolidation can undermine physicians
There are certain actions we take even though we know that ultimately we will not be successful. Sometimes we do this out of hope for a better tomorrow (like playing the lottery) or because we are taking a moral stand (like supporting a candidate that has no chance of winning).
Supporting health care reform is probably a little of both.
Even if any of the currently proposed health care reform plans pass, …
Health care reform needs to pass now, and here’s why
Originally published in MedPage Today
by Chris Emery, MedPage Today Contributing Writer
The symptoms of autism tend to emerge in children after six months of age, with a loss of social and communications skills that is more common and more subtle than previously thought, according to a new study that questions previous assumptions about the progression of the condition.
At six months, …
Autism in children can be missed early in life
Anyone affiliated with a teaching hospital knows that the controversy regarding resident work hours is heating up again. It’s been over 5 years since the ACGME limited resident hours to 80 hours per week with a maximum of 30 consecutive hours. While this may not sound like ‘reform’, as someone who trained prior to these rules, it is definitely a change.
More recently, the Institute of Medicine issued a …
Patient handoffs limit residents work hour cap gains
Part four of a series. See also parts one, two, and three.
When dealing with your doctor’s biases, you have on your side a fact I firmly believe to be true: most doctors want to do a good job and help their patients as best they can. So what exactly can you do to maximize your doctor’s ability to help you?
1. Position your symptoms and requests carefully. Don’t demand medications …
Help doctors to best care for their patients
Originally published in MedPage Today
by Kristina Fiore, MedPage Today Staff Writer
Infants don’t learn a great deal from language-acquisition DVDs, and may in fact be hindered from learning vocabulary, researchers have found.
Tots who watched such DVDs over a six-week period didn’t have better language knowledge scores than youngsters who didn’t watch, and those who first tuned in at a younger …
DVDs don’t help infants learn language
I went to my physical therapist yesterday for knee treatment and we talked about the fact that Blue Cross is cutting their reimbursement to the point that the cost of providing care will not even be covered. All I could do was lament with him and listen.
One insurer even told him (the owner of the business) to just “make the sessions shorter and don’t give as much care.”
Clearly the insurance …
Primary care needs to be valued first before it can be saved
In the Tony award winning play God of Carnage two couples meet in an elegant living room for an ostensibly civilized conversation about the aggressive act of one couple’s child against the other’s. The meeting soon degenerates to reveal the underbelly of conflict in the two marriages. Husband and wife hurl insults, precious items and even themselves with escalating rage. We see, as they attempt in vain to focus on …
Aggressive behavior in children and the family dynamic
Originally published in MedPage Today
by Kristina Fiore, MedPage Today Staff Writer
Even though 90% of parents believe vaccines protect their children against disease, many are also concerned about potential adverse effects, a new survey found.
More than half of survey respondents said they were concerned about vaccine safety profiles, particularly for newer immunizations, Gary L. Freed, MD, MPH, of the University …
Vaccine safety still concerns parents
One of the joys of practicing at an academic center is that I get to do many different things in my job.
The foundation of my work is seeing my own patients in a large group (more than thirty doctors!) primary care practice.
Two months a year, I take my turn rotating on the hospital inpatient services, supervising teams of residents and students who are the primary caregivers for patients with illnesses …
Helping organ donation with donor advocate teams
Originally published in MedPage Today
by Michael Smith, MedPage Today North American Correspondent
Physicians are working fewer hours than they once did, the result of a decade-long decline that coincided with lower fees for their services, a study showed.
After two decades of stable hours, a steady decrease began in 1997, according to Douglas Staiger, PhD, of Dartmouth College, and colleagues.
The decline coincided …
Why physicians are working fewer hours
Remember the trial a couple of years ago that showed that group support participation was associated with prolonged survival among women with metastatic breast cancer?
I’ve thought a lot about that over the years. Isn’t it interesting that something as simple as a supportive environment can make a difference in what researchers consider to be the hardest endpoint there is: survival? In our dualistic view of the human organism, we think …
Evidence and the Eastern paradigm of medical treatment
Avandia continues to dominate cardiovascular-related news this week. Recently, the AHA and the ACC issued a highly detailed, thoughtful, though perhaps slightly over-diplomatic science advisory on TZDs and CV risk. Taking a completely opposite tack, GSK, in no mood to take prisoners, and apparently about to nominate itself for a Nobel Prize, issued a 30 page White Paper in response to the Senate report published on Saturday.
At the core …
Why rosiglitazone would not have been approved today
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During residency, there was always a case of misdiagnosed chest pain to discuss in conference. Incorrectly sending a patient home and missing the diagnosis of cardiac chest pain was an infrequent, but repetitively observed, phenomenon.
So as to tread carefully with words, it is sufficient to say that even now, chest pain triage remains a vexing problem.
Chest pain diagnosis is like appendicitis; there are always small numbers of unusual cases in …
Using CT scans to diagnose chest pain in the ER
Part three of a series. See also parts one and two.
Previously, I have suggested that patients should do their best to get their doctors as free from the influences of their biases as possible. In order to do that, patients (and doctors) need to recognize what forces are working against them.
Here’s what negatively influences a doctor’s decision making:
1. They fall behind in clinic. Your doctor may be naturally …
How doctors allow bias to affect patient care
I made a New Year’s resolution to become a vegetarian. Or a mostly vegetarian.
I’ve been thinking about it for a long time, but with young children who love meat and don’t have the broadest palates, I think it’s important to feed them protein any way I can get it in them.
Having passed 40, I’ve finally realized that I can no longer eat what I want with impunity. Further, as a …
Becoming vegetarian can help fight high cholesterol
Originally published in MedPage Today
by Charles Bankhead
From time to time, I hear a “mature” person lament the sad state of affairs of the “next generation.” Sometimes I wonder whether the same concern should apply to the next generation of doctors.
I was at a cardiology meeting, and my schedule included a breakfast program. As I headed toward the meeting, I …
Young doctors gathered around the beer machine
A recent story from the UK reported a school child who developed diarrhea and tested positive for C difficile.
The alarming thing is that there did not seem to be any explicit risk factors for this. The appalling thing is the mis-information by the story that, “children rarely become ill with C diff, which normally strikes elderly people in hospital.”
This is how things used to be, before the BI/NAP1/027 bug evolved …
C Diff and antibiotic resistance in kids
The Framingham Heart Study is perhaps the most famous long-term medical study. As every medical student learns, starting in 1948, the lifestyle habits of thousands of residents of Framingham, Massachusetts were followed to determine important risk factors for cardiovascular disease.
It is because of this study that your physician can, with a few keystrokes, predict with great accuracy your risk of having a heart attack within the next 10 years and …
Obesity treatment in family members should be contagious
Originally published in MedPage Today
by John Gever, MedPage Today Senior Editor
Many hospitals that spend relatively little per patient deliver good-quality care, researchers said.
Medicare data indicated that hospitals in the highest quartile of per-patient cost for initial treatment of pneumonia or congestive heart failure (CHF) did not have markedly lower readmission or risk-adjusted mortality rates than hospitals in the lowest …
Hospitals can deliver low cost, high quality care
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