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A low salt diet for high blood pressure: Where’s the evidence?

Conditions and Diseases

July 9, 2013

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We know that people with high cholesterol have a higher risk for strokes and heart attacks than people with low cholesterol. So if a medicine lowers cholesterol it should also lower the frequency of strokes and heart attacks too. Right? Not necessarily.

Estrogen lowers cholesterol and doesn’t lower stroke or heart attack risk. We also know that people with high blood pressure have …

Does HIPAA really protect our privacy?

Wes Fisher, MD

Health Policy

July 9, 2013

As my head reels at the implications of the IRS scandal mushrooming in Washington, the IRS’s recently disclosed ability to access emails without warrant, the intricacy of the NSA PRISM wiretap techniques that includes their ability to acquire tech firms’ digital data, and even the Justice Department’s ability to secretly acquire telephone toll records from the Associated Press, I wonder (as a doctor) what all this means for the privacy protections afforded …

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Does HIPAA really protect our privacy?

Choosing a hospital: What is most important to you?

Leana Wen, MD

Physician

July 9, 2013

Here’s a thought experiment presented a recent conference on healthcare consumer advocacy. Let’s say that you’re told you need surgery of your knee. It’s an elective surgery to repair a torn knee ligament, the ACL. Your insurance covers part, but not all, of the cost. How do you choose which hospital to go to?

At the moment, there is very little information for you to make such a decision. Many people will choose …

Quality is a word that lacks universal meaning

Hans Duvefelt, MD

Health Policy

July 9, 2013

In 2009 I wrote a post titled “Quality or Conformity,” where I pointed out that many of the quality measures in primary care have more to do with whether doctors follow guidelines than if they deliver care that helps patients live long and well. There is a tendency to focus quality efforts on measuring what is easy to measure, rather than what matters the most.

That phenomenon is called …

When does a teen girl need a pelvic exam?

Wendy Sue Swanson, MD

Conditions and Diseases

July 8, 2013

Typically, teen girls do not need a pelvic exam until they are 21. Most parents are surprised to hear this, especially if they know their teen is sexually active.

About 1/2 of teen girls are sexually active during high school which puts them at risk for sexually transmitted infections (STI) and unwanted pregnancy. However, for routine prevention and care, girls rarely need an internal pelvic or speculum exam during high school. …

Should the Sunshine Act be celebrated?

Dr. Charles

Health Policy

July 8, 2013

Do you want to know if your doctor has been eating pizza for lunch that was purchased by Pfizer as she listened to a drug rep describe a new medication? Do you want to know if your endocrinologist has been paid $1,500 to give a brief talk about a new injectable diabetes medication to his colleagues as they gobble down filet mignon? If the answer is “yes,” then you are …

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Should the Sunshine Act be celebrated?

How Katie Couric continues to influence the colonoscopy debate

Sophie M. Balzora, MD

Conditions and Diseases

July 8, 2013

In 2003, the Archives of Internal Medicine published an observational study assessing the impact of Katie Couric’s March 2000 Today Show colorectal cancer awareness campaign, including the well-known colonoscopy she underwent live on air. The data was compelling, showing a sizeable spike in colonoscopy rates across the U.S. of more than 20%, thanks to this very likeable, personable, and …

We allow the legal system to contaminate evidence based guidelines

Jennifer Gunter, MD

Physician

July 8, 2013

The American Congress of Obstetricians and Gynecologists (ACOG) issued a recently regarding legislative interference and health care decisions. Specifically, the release states that: “Government should not interfere with the patient-physician relationship without a substantial public health justification.”

The full Statement of Policy was approved by ACOG’s Executive Board. Some recent examples of government interference include mandatory age requirements for Plan B, transvaginal ultrasounds before abortion, prohibiting doctors from asking about firearms, …

Declining board exam pass rates: Blame millennial doctors?

John Schumann, MD

Medical Education

July 8, 2013

An interesting conversation recently took place among residency program directors in my field of internal medicine.

At issue was the declining pass rate of first-time test takers of the ABIM Certification Exam.

It’s a mouthful to say, but the ABIM exam is the ultimate accolade for internists. One is only eligible to take the exam after having successfully completed a three-year residency training period (the part that includes “internship,” right after medical …

I failed to appease pain during her life, so she died terribly

James C. Salwitz, MD

Physician

July 8, 2013

Ellen died a clockwork machine, restrained by Versed, fed by nasal tube, secretions in bags, and as her blood pressure dropped intravenous pressors accelerated in dose until blood squeezed from her extremities left fingertips dry and black as coal. Death occurred on the 41st hospital day, after 27 minutes of scripted, six rib fracturing, 360-joule electric shock CPR. A brutal case by any measure, worse because advanced cancer …

It’s hard to grasp the experience of being a patient

Madeline Sterling, MD

Medical Education

July 7, 2013

My time as a medical student has quickly come to an end. This past winter, with nearly four years of arduous study, countless examinations and numerous clinical rotations under my belt, I couldn’t help but think, Yes, I’m ready to be a doctor.

And then I became a patient.

I’d always thought I knew what it’s like to be the patient. For much of my childhood, my father suffered from chronic fatigue syndrome, …

Either we are suckers, or we think health sucks

David L. Katz, MD

Health Policy

July 7, 2013

Ralph Cramden was the quintessential sucker. I suppose only people of a certain age — my age, for instance — will remember Ralph. If you have fewer gray hairs than that, perhaps you will remember the next incarnation of Ralph, Fred Flintstone. The Honeymooners character, brought indelibly to life by Jackie Gleason, was the inspiration for Fred, just …

Death with dignity: Issues states need to consider

Jim deMaine, MD

Physician

July 7, 2013

Vermont became the first state to enact a law authorizing physician-assisted suicide through the legislative process. As the governor signed the bill, Jean Mallary watched carefully over his shoulder. She’s the widow of the late Dick Mallary, a former speaker of the House and U.S. Congressman. Mallary was in pain and suffered from terminal cancer when he chose to end his life over a year ago. Jean Mallary’s story …

Bad data: When everyone breathes at the same rate

Deep Ramachandran, MD

Physician

July 7, 2013

It was my second day of residency, and something was afoot. As I made my way around my first rotation on the cardiac floor, my medical senses were tingling. There was something strange happening to all of my patients, I saw. As I peaked over my cohort’s shoulders, I secretly saw that it was happening to their patients too, though they hadn’t seemed to notice.

Only I did, and I was …

The July effect: Welcome to the summer of supervision

Vineet Arora, MD

Medical Education

July 7, 2013

While everyone has heard the old adage about not getting sick in July because of new interns, the truth is that new interns nationwide have started already. Yet, you don’t hear much about the “late June effect?”

So is the July effect overblown or true? Well, there have been many studies – so many so there was a recent systematic review co-authored by one of my own co-interns a long time ago. …

When the weight of illness suddenly descends on an individual

Miranda Fielding, MD

Physician

July 7, 2013

The sudden illness of a colleague is always a shocking surprise. As physicians, we are trained from an early age to ignore our own infirmities in the service of others. Apart from my three C-sections, I have been extremely fortunate in terms of my own health—I can count the number of sick days I’ve taken in the last thirty years on one hand and I am thankful every day for …

Respect diagnostic radiation, but don’t have an irrational fear of it

Christopher Johnson, MD

Physician

July 6, 2013

I’ve written before about the increased risk for future cancer, if any, of diagnostic radiation. These posts have generated a large number of comments and questions from parents. Most take the form of fear they have needlessly increased their child’s future cancer risk by agreeing to a CT scan. A new research study give us some important new information about …

Anyone can fall prey to addiction and substance abuse

Michael Kirsch, MD

Conditions and Diseases

July 6, 2013

Over the course of a year, I have an alternating pattern of caffeinated coffee ingestion. As readers should know, I will not swallow Starbucks coffee as I do not think that I have sufficient stomach acid and other bodily defenses to successful prevail against this corrosive elixir. Of course, everything has a benefit if one is resourceful enough to discover it. For instance, I have found their coffee to be …

Dr. Wachter reflects after completing his term at the ABIM

Robert Wachter, MD

Medical Education

July 6, 2013

I recently completed my last day as chair of the ABIM, and ended my eight-year tenure on the Board. In this blog – a bookend to the one I wrote at the start of the year, which went near-viral – I’ll describe some of our accomplishments this year and a few of the challenges that I leave my talented successors to grapple with.

I had two very tangible tasks to …

Physicians: Learn to pick up the proverbial poop

Neil Baum, MD

Physician

July 6, 2013

As a little boy I had a dream that I have always wanted to join the circus. I thought for sure I could be a clown or even the ringmaster. At age 34 a friend who did public relations for Ringling Brothers and Barnum & Bailey Circus gave me the opportunity to make my dream come true and I was invited to be a clown in the circus.

The show was to …

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