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Treating vitamin D deficiency requires caution

Conditions and Diseases

August 27, 2010

Vitamin D seems to be all the rage in medicine these days. A family physician colleague commented to me recently that the laboratory test for vitamin D deficiency is becoming the most frequently ordered test in his practice.

This clinical bandwagon is likely a response to data from multiple recent studies that found low vitamin D levels in the majority of children and adults of all ages. While vitamin D has …

Statins for heart disease and stroke, and debunking statin myths

Eric Van De Graaff, MD

Medications

August 27, 2010

There is no class of medications in the history of the world that has been better studied that statins.

This class of drugs is more properly termed HMG CoA reductase (3-hydroxy-3-methyl-glutaryl co-enzyme A reductase) inhibitors, but with a name like that a terser nickname is almost mandatory (the name statin comes from the suffix of the members of this class: lovastatin, pravastatin, etc.).

Simply …

For women with endometriosis, motherhood is elusive

Kevin

Conditions and Diseases

August 27, 2010

by Lone Hummelshoj

Earlier this year, we finished a month dedicated to women and mothers. In the U.S., we celebrated “National Women’s Health Week” and before it Mother’s Day. One study suggested Americans would spend a total of $14.6 billion in May alone to honor our mothers. And we should honor our mothers!

However, for millions of women with endometriosis, motherhood is elusive. In fact, an estimated …

Assumptions in medicine can inhibit care

Patrick W. Hisel, MD

Patient

August 27, 2010

Assumptions are ubiquitous. Neither patients nor physicians are exempt. Sometimes they are justified, other times entirely misguided.

Webster’s defines “assume” as “to take as granted or true.” The cliché’s have probably always existed: Doctors are greedy and paid too much, and are uncaring. Some patients believe doctors do care and that their doctor actually likes them. That’s an assumption too. Some assumptions are newer. Patients assume doctors will substitute their prescription …

How drug companies sell psychiatrists on their drugs

Daniel J. Carlat, MD

Medications

August 26, 2010

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.

In 1993, the FDA approved Neurontin for the treatment of epilepsy. This should have been a cause for celebration at Warner-Lambert, the drug company that introduced it, but the celebration was muted. The FDA had …

Checks and balances in health reform

Richard Reece, MD

Health Policy

August 26, 2010

What follows are ten thoughts on checks and balances in health reform.

I am writing from Oak Ridge, Tennessee, where I am attending a high school class reunion. My son Spencer, a nationally known poet and a candidate for the Episcopal priesthood, is with me. He is checking on my past, and I am trying to provide balance so he can understand his father’s legacy.

There …

Read more…

Checks and balances in health reform

Converting from paper chart to an EMR: Keep daily use in mind

Rosemarie Nelson

Health Technology

August 26, 2010

Maybe you’ve been assuming that when it comes time to go live on your EMR, you’ll simply scan each patient’s old paper chart into the electronic system.

Maybe you haven’t given it much thought because you’re focusing on the change in your work flow when you start to use the EMR to document patient encounters.

Well, it’s time to pay attention to the transfer, because the conversion of the paper chart can …

The medical system Donald Berwick prefers in the United States

Kevin

Health Policy

August 26, 2010

by James Gaulte, MD

Apart from some apparently radically contradictory expressed views on patient “centeredness” and patients being in control, the newly appointed head of CMS, Dr. Donald Berwick, has made it clear what sort of medical system he would have for the United States.

What he wants is well explained in this commentary from National Review Online as is the authors’ reasoning of why …

Fix the July Effect for incoming interns and residents

a medical resident, MD

Medical Education

August 25, 2010

According to an article published in the Journal of General Internal Medicine, counties with teaching medical hospitals experienced a 10% increase in fatal medication errors as compared to counties without teaching medical hospitals.

First, what is the July Effect? It represents an entire transition in the hospital, during which medical students become interns, interns become senior residents, and second or third-year residents become chief residents. …

Tamoxifen for breast cancer prevention is not routinely used

Shantanu Nundy, MD

Conditions and Diseases

August 25, 2010

Cancer prevention is built around screening. In screening, the hope is to catch cancer at an earlier stage than it would be found otherwise and increase options for treatment and chances of cure. In some cases, screening prevents cancer — for example, when a precancerous polyp is removed from the colon during colonoscopy — but generally it is aimed at early detection.

What if instead we could prevent cancer from developing …

Burnout in doctors and stressed physicians hurt patients

Kevin Pho, MD

Physician

August 25, 2010

The following op-ed was published on July 18th, 2010 in USA Today.

A new patient recently said he was referred to me after his last doctor had left medicine. His old doctor always looked unhappy and burned out, he noted.

Burnout affects more than half of doctors, according to researchers at the University of Rochester School of Medicine. Beyond mere job dissatisfaction, these doctors are emotionally exhausted to the …

Doctors are often preferred to market a drug to other physicians

Kevin

Medications

August 25, 2010

An excerpt from White Coat, Black Hat.

by Carl Elliott

A few years ago a small group of first-year medical students at the University of Minnesota spoke to me about a lecture on erectile dysfunction that had just been given by a member of the urology department.

The doctor’s PowerPoint slides had a large, watermarked logo in the corner. At one point during the lecture a …

Implementing patient centered medical home pilot projects

Kevin

Physician

August 25, 2010

by Robert Graham, MD

As the nation works to reinvigorate primary care, a lot is riding on the medical home.

Some see it as an answer to a fragmented health care system that is not responsive to patients’ needs for coordinated, comprehensive care. Others have invested in it as a vehicle to improve both the quality of care and control costs. While we work to address …

Applying the minimally invasive concept to patient management

Ralph Gordon, MD

Patient

August 24, 2010

Every time you subject the patient to an invasive procedure you take the risk of causing complication. I have done hundreds if not thousands of procedures which makes me even more aware of the risk I take every time I stick a needle or cut into the patient. We can do everything possible to enhance the safety, yet we cannot completely eradicate the risk of adverse events.

With the recent progress …

Positive reinforcement can motivate preventive behaviors

Alex Lickerman, MD

Physician

August 24, 2010

Eating right, exercising, avoiding the sun or using sunscreen, moderating alcohol consumption, abstaining from tobacco use, getting mammograms, Pap smears, colonoscopies—almost every measure we’re asked to take to safeguard our future health is difficult. It’s a strange paradox that we have to work in some way, to expend energy, and experience discomfort of some kind in order to gain benefit in life.

Wouldn’t it be nice if the most pleasurable things …

Why OpenNotes and access to the medical chart is important

Wendy S. Harpham, MD

Patient

August 24, 2010

Have you ever read what your physicians and nurses have written in your medical chart? If not, would you want to?

The OpenNotes project is a recently launched observational research study that involves 100 primary care doctors and about 25,000 patients. Lead author Dr. Tom Delbacoa, a primary care physician at the Beth Israel Deaconess Medical Center, poses the research question succinctly: “After a year, will the patients and doctors still want to continue sharing notes?”

In the study, …

Adults living with dementia and disability need research funding

Alex Smith, MD

Patient

August 23, 2010

I heard a prominent speaker talk about studies at the National Institute of Aging. The speaker described several new large and well funded trials aimed at preventing illnesses associated with aging, such as dementia and disability. These studies are terrific, and worthy of funding.

I was disappointed, however, that little was said about funding for studies of older adults already living with dementia and disability. Research in prevention will not help these patients. I asked: where is the …

How patients can stop doctors from blaming them for their health

WarmSocks

Patient

August 23, 2010

If doctors need to listen to patients to figure out what’s going on, patients need to tell doctors what’s going on. Why is that so hard sometimes? It’s hard to speak up when you feel rushed, but have doctors ever done other things that made it harder for me to talk to them?

Sometimes doctors blame the patient

Years ago I got a terrible abdominal pain. I could only explain that it felt like …

Insurance does not have incentives to lower costs or improve quality

Stephen C. Schimpff, MD

Health Policy

August 23, 2010

Whether we have commercial insurance through our employer or Medicare, the incentives are poorly aligned to lower costs and improve quality.

In fact, they actually encourage greater and greater expenditures. In most instances, our insurance covers everything from prevention to basic routine care to complex care of serious illness. Coverage may not be all that good for some things like preventive care and our primary care …

Is placebo a therapy, like surgery or medication?

PalMD

Conditions and Diseases

August 23, 2010

The New England Journal of Medicine recently published a troubling article on acupuncture, which was ably deconstructed by Dr. Mark Crislip. This incident has reignited a discussion of what, exactly, “placebo” is.

A common argument is that placebo is like any other intervention, something that can be intentionally harnessed for the benefit of patients. This is both true and overly simplistic.

First, we must review what “placebo” …

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