Informed consent is missing from Pap smears and cervical cancer screening

Conditions and Diseases
November 23, 2009

The American College of Obstetrics and Gynecology (ACOG) has just revised their guidelines for Pap smears under some pressure. This resulted from an Annals of Internal Medicine article which documented that only 16.4% of gynecologists followed the College’s prior guidelines. Most did more screenings than indicated, the worst record of the specialties tested. But the ACOG still recommends that nearly all women obtain regular screening at intervals of 1-3 years.

The …

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Informed consent is missing from Pap smears and cervical cancer screening

What is the death toll for the H1N1 flu pandemic?

Conditions and Diseases
November 23, 2009

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

In the first six months of the H1N1 flu pandemic, 22 million Americans fell ill from the virus, the CDC now estimates.

Of those, about 98,000 needed inpatient care, and 3,900 died, according to Anne Schuchat, MD, director of the CDC’s National Center for Immunization and Respiratory Diseases.

The estimates …

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What is the death toll for the H1N1 flu pandemic?

How does Zetia and niacin affect the carotid intima-media thickness (CIMT)?

Medications
November 22, 2009

Originally published in MedPage Today

by Peggy Peck, MedPage Today Executive Editor

By a margin of 0.014 mm in carotid intima-media thickness (CIMT), extended-release niacin (Niaspan) demonstrated superiority over ezetimibe (Zetia) as an add-on for high risk patients on long term statin therapy.

But is a difference of 0.014 mm clinically significant?

The niacin versus ezetimibe findings come from the ARBITER 6-HALTS trial, …

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How does Zetia and niacin affect the carotid intima-media thickness (CIMT)?

How training to become a doctor in France differs from the United States

Medical Education
November 22, 2009

Among the many differences between the U.S. and the French health-care systems is the approach to medical training. While U.S. medical school graduates in 2008 had an average debt of $154,000, French medical students receive their training virtually for free. For example, first-year medical students at the Faculte de Medecine Pierre et Marie Curie in Paris have only one mandatory cost for this year: an enrollment fee of $264.

The amount …

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How training to become a doctor in France differs from the United States

Op-ed: Humor can be healing for both doctors and patients

Physician
November 21, 2009

A version of this op-ed, co-written with Doug Farrago, was published on October 26th, 2009 in Medscape.

It’s tough to be a doctor these days. Whether it’s listening to the difficulties of our medical colleagues as they try to best care for their patients, or engaging other health professionals about the uncertainties surrounding health reform, we’ve noticed a tense, sometimes gloomy, atmosphere among physicians.

A recent survey from the Annals of Internal …

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Op-ed: Humor can be healing for both doctors and patients

When women should have their first Pap smear; the new cervical cancer screening guidelines

Conditions and Diseases
November 20, 2009

Originally published in MedPage Today

by Charles Bankhead, MedPage Today Staff Writer

Women can wait longer for their first Pap smear and then repeat the test less frequently, according to recommendations from the American College of Obstetricians and Gynecologists (ACOG).

The organization now says women should begin cervical cancer screening with a Pap test at age 21. Subsequent tests should occur at …

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When women should have their first Pap smear; the new cervical cancer screening guidelines

Discharged from the hospital without answers; the death of Jane Q. Patient

Patient
November 20, 2009

We found out that her real name was Cindy Chapman, and that she died alone and afraid.

Cindy was a paralegal, an activist and a fighter of lost causes who lived in Worcester, Massachusetts. She was part of an online community called RATEMDs, where she had many soul mates. Her posts on health care were funny and cynical and wise. Her screen name was Jane Q. Patient.

My wife, Pam, was especially …

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Discharged from the hospital without answers; the death of Jane Q. Patient

Are older nurses being forced out of the profession?

Patient
November 20, 2009

Originally published in HCPLive.com

by Colleen O’Leary, RN, MSN, AOCNS

Last time I talked about how I had never really experienced the concept of nurses eating their young in action.

However, I have seen the opposite begin to evolve. I see this as a bigger issue in nursing these days. The “putting out to pasture” of seasoned, experienced nurses is happening more often …

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Are older nurses being forced out of the profession?

How should the FDA regulate the social media advertising of drugs?

Medications
November 20, 2009

Originally published in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

Drug and device makers are urging the FDA to establish clear guidelines that will allow the industry to discuss and promote products in the unsettled world of online social media.

The FDA is hearing testimony from drug and device companies, online marketing experts, and consumer groups about what steps the …

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How should the FDA regulate the social media advertising of drugs?

Can less aggressive cancer screening recommendations be better for patients?

Conditions and Diseases
November 19, 2009

Doctors have understood for some time that it was inevitable. The American Cancer Society has acknowledged that cancer screening has been oversold.

It seems like every day you read in the newspaper that what was standard medical care yesterday is now no longer recommended. Don’t doctors know anything? Well, actually they do. And what seems like paradoxical behavior, no longer recommending aggressive screening for certain cancers, actually represents a more sophisticated …

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Can less aggressive cancer screening recommendations be better for patients?

How to choose the right electronic health record (EHR) consultant

Health Technology
November 19, 2009

Originally published in HCPLive.com

by Jonathan Bertman, MD

You may have seen advertisements, or may already have been contacted by people who’ve promised to help you figure it all out so you can get your share of the stimulus money. Be wary. The truth is that the Obama administration is still defining many essential elements of the Health Information Technology for Economic and Clinical Health Act (HITECH), and full details about the …

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How to choose the right electronic health record (EHR) consultant

Why health reformers should be worried about the breast cancer screening backlash

Conditions and Diseases
November 19, 2009

What if a non-partisan, authoritative entity wrote a robust, evidence-based guideline, but nobody followed it?

That is precisely what’s happening with the USPSTF’s recent revision of their breast cancer screening recommendations. The change most find problematic is their recommendation that women younger than 50 not undergo any breast cancer screening, such as with a mammogram.

Here are their reasons explaining why:

The harms resulting from screening for breast cancer include psychological harms, …

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Why health reformers should be worried about the breast cancer screening backlash

Senate health reform plan analysis

Health Policy
November 19, 2009

Originally published in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

After weeks of closed-door meetings, the Senate leaders released their $849 billion healthcare reform bill on Wednesday evening, paving the way for a procedural floor vote soon.

The bill, combining versions approved by the Finance Committee and the Senate Health, Education, Labor and Pensions (HELP) Committee, would create a …

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Senate health reform plan analysis

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How a personal injury lawyer views the medical malpractice system

Physician
November 18, 2009

Personal injury lawyer Eric Turkewitz responds to my recent USA Today piece on fixing the medical malpractice system.

In a USA Today op-ed, Kevin Pho tackles the medical malpractice liability system. Some stuff I agree with, but suggestions regarding improvement of the current system are unlikely to work.

Kevin correctly states that malpractice legal fights often go on for years. In New York, it could easily take three years to get …

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How a personal injury lawyer views the medical malpractice system

Can family doctors do safe first trimester abortions?

Conditions and Diseases
November 18, 2009

Originally published in MedPage Today

by Chris Emery, MedPage Today Contributing Writer

Complications from first trimester abortions performed by family practitioners are rare, and family doctors could help address abortion provider shortages across the U.S., a new study found.

Among more than 2,500 abortions performed by family physicians, abortion was successful without complications in 96.5% of patients using medications (95% CI 95.5% …

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Can family doctors do safe first trimester abortions?

Why doctors are doing so many unnecessary Pap smears

Conditions and Diseases
November 17, 2009

The Wall Street Journal and other sources reported on a study from the Annals of Internal Medicine that showed that most US doctors don’t know the guidelines of how often women should get a pap smear. More importantly, doctors were doing a lot of pap smears on women who didn’t need them. In all the talk about health care reform, reducing costs by eliminating unnecessary testing has been mentioned multiple …

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Why doctors are doing so many unnecessary Pap smears

Learn how to conduct a family meeting by using a structured approach

Patient
November 16, 2009

On my last day of ward attending, I handed out an EKG that resembled the Dow Jones industrial average over the last 10 years (not pictured). The normal pattern of an EKG was completely disrupted: ST segments were markedly elevated, P waves were hidden, and beats were grouped in odd patterns. My medical team laughed and shook their heads.

I asked why.

A brave intern responded that he was completely at a …

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Learn how to conduct a family meeting by using a structured approach

Why you should stop taking Vytorin for high cholesterol

Medications
November 16, 2009

At the American Heart Association meeting in Orlando, the results of the ARBITER 6-HALTS study were released. No Vytorin was used in the study, but I am sure that all the headlines will mention Vytorin.

The actual study published ahead of press online in the New England Journal of Medicine. Essentially, they enrolled over 200 patients from Walter Reed and Washington Adventist who had known heart disease or were at …

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Why you should stop taking Vytorin for high cholesterol

Niacin beats Zetia in the ARBITER 6-HALTS trial, and what this means for ezetimibe

Medications
November 16, 2009

Originally published in MedPage Today

by Peggy Peck, MedPage Today Executive Editor

Boosting HDL cholesterol with extended-release niacin (Niaspan) is a more effective way of slowing atherosclerosis in high-risk patients on long-term statin therapy than seeking additional LDL cholesterol reductions by adding ezetimibe (Zetia), researchers here reported.

Compared with ezetimibe, 2 grams of niacin led to significant reductions in both the mean …

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Niacin beats Zetia in the ARBITER 6-HALTS trial, and what this means for ezetimibe

Who’s dying from the H1N1 flu pandemic?

Conditions and Diseases
November 15, 2009

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

Although the pandemic H1N1 flu tends to strike younger people, it can be life-threatening when older people are infected, California researchers said.

In the first four months of the pandemic, 1,088 people in the state needed inpatient care or died of the pandemic flu strain, according to Janice Louie, …

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Who’s dying from the H1N1 flu pandemic?

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