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Working with industry requires building a culture of trust

Health Policy

September 9, 2010

Howard Brody, a family physician, recently wrote an article in the Annals of Family Medicine discussing, “Professional Medical Organizations and Commercial Conflicts of Interest: Ethical Issues.”

The article focused on how AAFP has “recently been criticized for accepting a large corporate donation from Coca-Cola to fund patient education and materials on obesity prevention,” and how this money has been called a “conflict of interest.” To that effect, Dr. Brody defines such …

Physician resistance to EMR and why CPT should be replaced

Mike Koriwchak, MD

Health Technology

September 9, 2010

After 5 successful years with electronic medical records (EMR), I am convinced that the promise of EMR to improve physician practices and to improve the health care system is real.

If that is true, why is adoption of EMR currently limited to only 5-10% of medical practices? Why is there so much resistance? As folks who work in heath care IT so often ask, why don’t doctors “get it?” I don’t …

Why are most physicians writing their prescriptions by hand?

Bob Doherty

Health Policy

September 8, 2010

Is the pen mightier than the PC?

When it comes to prescribing, it appears so. A new report from the Center for Studying Health System Change finds that most physicians write their RX scripts by hand, despite financial incentives for physicians to adopt electronic prescribing. Even those who have e-RX systems do not always use them, and when they do, they may not to use the features that were …

Alzheimer’s disease needs better preventive strategies and treatments

William R. Yates, MD

Conditions and Diseases

September 8, 2010

The Alzheimer’s Association sponsors a journal titled Alzheimer’s & Dementia. In the March 2010 issue, they provide a report on facts and figures related to Alzheimer’s disease (AD).

I’m a sucker for data so I spent some time going through the manuscript and here are some of the things that stood out to me:

Ninety (90) drugs are under investigation using human volunteers in the U.S. to slow or stop …

Forgiveness shaped by the stories of people’s lives

Jeffrey Knuppel, MD

Patient

September 8, 2010

If you had asked me what I thought forgiveness was when I was a young adult, I probably would have said that it is something you do for others—others who have wronged you in some way, to give them a break and let them know that you are no longer angry or upset with them.

As I’ve matured emotionally over the years, my view of forgiveness has evolved significantly. Some of …

Anecdotal accounts of patient experiences with local physicians

Kevin

Patient

September 8, 2010

by Liz O’Brien

A long time ago — when managed care-style employee healthcare benefits were a new thing — we worker bees learned we might have to throw our old family doc under the bus.

We were given a booklet of providers on the network panel, and if the faithful retainer who had served our family for years wasn’t on that list, it was sayonara — unless we …

Improve patient safety and cut costs with clinical pharmacists

Kevin

Patient

September 8, 2010

by Emmanuel King, MD

What if you could improve patient safety, cut costs, broaden your medical knowledge and find 20% more time in your workday? On October 1, 2010, that is just what we can expect when clinical pharmacists move from the back room to the bedside in ten general medical units at the Hospital of the University of Pennsylvania.

As we all know, medications play an intensely complex and ever-growing …

Empathy is still at the heart of medicine

Dr. Chris Nickson

Physician

September 7, 2010

Treat the patient, not the disease.

Care more particularly for the individual patient than for the especial features of the disease.
— William Osler

We enter medical school eager to help the sick and the dying. Over the years this golden objective is transmuted into the base lead of disease-specific diagnostics and therapeutics. Our absorption in the strangeness of the manifestations of a remarkable pathophysiological process may distract us from its impact on …

Why are hearing aids so expensive, and reading glasses so cheap?

Randall S. Bock, MD

Conditions and Diseases

September 7, 2010

I am currently 53 years old, but I recently found an imperfection in my near-vision. I was probably laboring for a year or so before caving in: purchasing reading glasses. I am using them right now and they have made all the difference.

In the space of a few months, I went from no reading glasses to seven pairs. I bought all seven online together as a package recently, for the …

Some MRI places have good quality machines, others are obsolete

Doctor Grumpy, MD

Conditions and Diseases

September 7, 2010

“Dave” showed up at my office last week with neck pain, worsening weakness in his arms and legs, and changes in his bladder control. All signs pointed to something gone bad in his neck.

His internist had already thought of this, because he’d ordered the appropriate MRIs. And they’d all been read as normal, leaving me without a cause.

Here is where the problem began. Everything about Dave’s exam and story pointed …

Cosmetic foot surgery can have serious downsides

Howard Luks, MD

Physician

September 7, 2010

How far will some women go to fit into high heels? The menu of services at Beverly Hills Aesthetic Foot Surgery in Studio City, Calif., provides a clue.

There’s the trademarked “Cinderella Procedure”—a preventive bunion correction that makes feet narrower. The clinic also offers the “Perfect 10! Aesthetic Toe Shortening” that invisibly trims toes that hang over the end of sandals or have to be crushed into tight shoes. There’s also …

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Cosmetic foot surgery can have serious downsides

Defensive medicine costs less money than physicians think

Kevin Pho, MD

Physician

September 7, 2010

Nothing polarizes the heath care debate more than defensive medicine. A recent study from Health Affairs will only add more fuel to the fire.

Here’s what I wrote a couple of years ago in USA Today: “When you consider that rampant testing is a major driver of escalating health care dollars, addressing defensive medicine should be a primary goal of cost containment.”

Is that still true?

Well, yes and no.

MedPage Today summarizes …

How to use your CPAP machine when traveling

Steven Y. Park, MD

Conditions and Diseases

September 6, 2010

One of the most common excuses for not wanting to use CPAP is that “I travel a lot.” Even after I explain that many people travel just fine with their CPAP machines, some people are stll reluctant.

With advances in technology and increased awareness by the lay public, government officials and medical professionals about the importance of using CPAP for obstructive sleep apnea, traveling with CPAP, although initially a challenge, can be …

Insurance companies affect patients with paperwork for tests

Jeoffry B. Gordon, MD, MPH

Health Policy

September 6, 2010

by Jeoffry B. Gordon, MD, MPH

I have always considered it to be my professional responsibility and ethical imperative to fight for my patients with the insurance companies to get approval for every test and medication that I think is medically necessary.

My batting average is close to 100% Lately, the insurance companies have been trying to draw the noose tighter and make the task of getting …

Multiple assessments are needed in the face of repeated testing

Jerome Groopman, MD and Pamela Hartzband, MD

Conditions and Diseases

September 6, 2010

At a recent weekly case conference at our hospital, we heard about a young woman with an elevated testosterone level. The patient was evaluated by James Hennessey, FACP, prior ACP governor from Rhode Island and currently director of clinical endocrinology at Beth Israel Deaconess Medical Center, along with an endocrine fellow, Laura Sweeney, MD.

Case study: Polycystic ovarian syndrome suspected

The patient was a 19-year-old art student at a local university. She …

Moments of internal struggle in the ER

StorytellERdoc, MD

Patient

September 5, 2010

I walked into Room 22 to find a very interesting patient who presented to our ER with complaints of abdominal pain and associated nausea and vomiting.

The patient sat on her cot with her pant legs rolled up above her knees, refusing, according to her nurse, Gwen, to put on a treatment gown. Her left leg hung in the air, her ankle crossed over the knee of her right leg. Her …

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Moments of internal struggle in the ER

Acute gonorrhea in Congo

Yann Meunier, MD

Conditions and Diseases

September 5, 2010

Year: 1984

Setting: Ouesso, Congo
Position: Timber consortium medical expert

We landed in Brazzaville and took a private jet to Pointe Noire where we spent the night. The next day, the group is assigned six 4×4 Toyotas to take through the Mayombe Mountains, Brazzaville and the plateau to reach Ouesso near the Cameroon border.

The journey is eventful, particularly when I drove the pickup truck into a river from a bridge to avoid children …

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Acute gonorrhea in Congo

Wound infections and the Surgical Care Improvement Project (SCIP)

Skeptical Scalpel, MD

Physician

September 5, 2010

The Surgical Care Improvement Project (SCIP) and its antecedent, the Surgical Infection Prevention project, have been around for several years.

In short, these consist of several rules issued by various self-appointed agencies with important-sounding names and the Centers for Medicare and Medicaid Services (CMS), a federal agency. The main rules are 1) administer the correct prophylactic antibiotic before surgery, 2) give the antibiotic within one hour before the skin is incised …

Are physicians today active in the arts?

Jan Henderson, PhD

Physician

September 4, 2010

Physician/poets such as William Carlos Williams are an honorable tradition in the history of medicine, following in the footsteps of Keats, Schiller, and Oliver Wendell Holmes (of “Chambered Nautilus” fame). Physicians have also been writers, painters, musicians, philosophers, and – at least in more recent times –photographers.

Yet in 1980 the historian G.S. Rousseau expressed concern that modern physicians no longer embodied the humanist tradition of their predecessors. Now that medicine …

Are opioids any less safe or effective in non cancer patients?

Kevin

Medications

September 4, 2010

by Drew Rosielle, MD

Recently, the New York Times reported of the movement in Washington State to officially do something about prescription opioid abuse, coming on the heels of course of the FDA rejecting the current risk evaluation and mitigation strategy plan as, essentially, not going far enough.

The article basically discusses the discussion in Washington about what to do; no formal new plans have been …