Since 1997 the number of US medical students choosing to go into primary care has decreased by more than 50%.
It seems that sources as diverse as the Obama Administration and the Wall Street Journal think that we should find a way to encourage medical students to choose primary care specialties in order to allow Americans to have the best and most cost effective care. This is very problematic when primary …
Pay specialists less to save primary care
A recent article in the New England Journal of Medicine touched off another salvo about how non-clinicians have no problems judging the abilities of clinicians in the world of medicine.
The article begins by presenting the case of a woman who awoke with facial paralysis and then went to the emergency department. On arrival, she received CT scans and MRI scans of her brain. When those were normal, she was diagnosed …
The difficulty of regulating x-ray radiation in the ER
by Michael Smith
Clinicians treating dying patients did well in managing pain but fell short on communicating with patients and their loved ones, researchers said.
The findings, from a single-institution study, suggest that those who care for terminal patients also often failed to assess shortness of breath in a dying patient whose mechanical ventilation was withdrawn, according to Anne Walling, MD, of the University of California Los Angeles, and colleagues.
But overall those …
Caring for dying patients needs better physician communication
I was visiting with my physician colleague Debbie the other day, which is always a pleasure. She is, by far, one of the best dermatologists I know. She had purchased an electronic medical record (EMR or EHR) a year or two ago and I asked her how it was going.
“Pretty well,” she said, “but I’ve had to start using a scribe. It’s just too inefficient any other way. I was …
Doctors hiring scribes because of electronic medical records
An excerpt from Stroke Diaries.
by Olajide Williams, MD
The man who did not take his medicine
Pedro was lying on the bathroom floor next to the toilet bowl. Water was still running from rusty faucet, overflowing the sink, and pooling around his body as he lay limp on wet porcelain tiles. Lucy was standing over him and whining. The young black Labrador retriever had not left …
What does a TIA feel like? A Stroke Diaries excerpt
by Joyce Frieden
An estimated 30 million women will be helped by the new health reform law over the next 10 years, according to a report from The Commonwealth Fund.
“While women are just as likely as men to be uninsured, they are more likely [than men] to have trouble buying coverage on the individual market,” Karen Davis, PhD, president of the fund, said in a teleconference announcing the report’s release. “This …
How healthcare reform affects women
by Nancy Walsh
Both maternal and paternal cigarette smoking can contribute to adverse chronic conditions — physical and psychological — in children, two large studies found.
Writing in the July issue of Pediatrics, Marie-Jo Brion, PhD, of the University of Bristol in England, and colleagues reported that children in two cohorts whose mothers smoked were more likely to have conduct/externalizing behavior problems than were those who had no prenatal tobacco exposure:
* British …
How adult smoking affects behavior in children
Most people enter the healing arts with a genuine desire to serve others.
The long educational journey and the realities of both the workaday world and the various business models of health care often strain our abilities to act in an empathic manner.
We have to pay the bills, after all.
“No money, no mission,” is a refrain I’ve often heard in the non-profit corners of the health care world, justifying business decisions …
Empathy is needed for better relationships with patients
Childhood is full of self-limited illnesses. Kids get sick and kids get better. The majority of childhood illnesses will get better on their own. Because of this, observation and “watchful waiting” is often the most useful diagnostic test at the pediatrician’s disposal.
Parents are often confused about the need for testing. Their experiences with adult medicine is typically full of lab tests and imaging studies. Unfortunately some parents equate the quantity …
Watchful waiting is a powerful diagnostic tool
by Nancy Walsh
Planned early initiation of dialysis in patients with chronic kidney disease did not improve survival or other clinical outcomes, a multicenter randomized trial conducted in Australia and New Zealand found.
The hazard ratio for death among patients who had an early start of dialysis, when the estimated glomerular filtration rate (GFR) was 10 to 14 mL/min, was 1.04 (95% CI 0.83 to 1.30, P=0.75), according to Bruce A. Cooper, …
Early dialysis may not improve kidney failure outcomes
Gordon Gekko is wrong. Greed is not good. Not when it comes to health care providers.
The socioeconomic study of what motivates people is a fascinating field of study, not the least of which is because of how counter-intuitive it is. For example, it seems normal to assume that the more someone is rewarded for their efforts, the more effort they will put forth toward those rewards.
These rewards (increasing salary, bonuses, …
Greed is not good when it comes to doctors, patients and medicine
Pathologists and radiologists don’t have the luxury of spending time with actual patients so they have to render professional judgments and determinations based on indirect data (radiographs, a mashed up slice of breast tissue, etc.).
I don’t envy them; the utter detachment from patient care would make me miserable. But they do have a tough job. They get one shot at getting it right. There’s no patient follow up. They never …
When a biopsy cannot completely rule out cancer
by Scott Cowsill
A third or more of scans may be unnecessary or repetitive, studies show, and in scans that are medically appropriate, radiation doses could be dramatically reduced without hurting the quality of images.
As pointed out by Robert Centor, MD, “one cannot easily develop rules for testing because the presentations that we see vary so greatly.” That being said, guidelines for diagnostic …
Decision support can help doctors order scans
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by Kristina Fiore
More than one in 10 heart disease deaths may be attributable to diabetes, researchers say.
In a meta-analysis of more than 100 studies, diabetes was associated with a twofold increased risk of the disease and was estimated to be accountable for 11% of vascular deaths, according to Nadeem Sarwar, MD, of the University of Cambridge in England, and colleagues.
They reported their findings online in The Lancet and will present …
Diabetes is responsible for many heart disease deaths
What are entry-level non-clinical physician job salaries?
Let me clarify what I mean by “entry-level” here: I’m referring to non-clinical jobs that physicians may find if they leave clinical medicine to pursue a non-clinical job in a company (such as a medical communications company, a health IT company, pharmaceutical, biotechnology, or a consulting company).
So, let’s look at several examples:
* A primary care physician who’s making $120k/year leaves clinical medicine and begins …
Non-clinical physician job starting salaries
Three years ago, the Department of Justice took stock of the orthopedic medical device industry–represented by the five big makers of orthopedic implants–and concluded that it was rampantly violating federal anti-kickback laws with the bribes and favors it was offering to surgeons. Such bribes often came in the form of training grants for those just starting out in the profession, or as lucrative consulting contracts for influential academic orthopedists.
The …
How industry money continues to influence orthopedics
The news that Dr. Marcus Conant has quit practicing medicine is a blow to healthcare here in the Bay Area.
And a sad symbol of all that is wrong with healthcare – and in particularly, the way we treat primary care practitioners – in America today. It would be hard to find a doctor more symbolic of the best of medicine than Marcus Conant – a man willing to devote …
What to do if your doctor quits and leaves medicine
Is the Patient Centered Medical Home (PCMH) the panacea for all that ails health care?
Have we exhausted all the allegories related to the term “home?” The answer to both questions apparently is no, thanks to this American Journal of Managed Care article by Timothy Hoff titled The Shaky Foundation of the Patient Centered Medical Home.
Dr. Hoff appropriately shelves PCMH policy and looks at the topic with a market-based perspective. From …
Let consumers decide if they want the patient centered medical home
Celebrities are powerful role models and are important to consumers concerned with their health because of the perception that famous people have access to the best health practices and medical care. The public looks to celebrities for hope and inspiration as they struggle with their own health issues and fight disease. However the health practices that celebrities promote are often questionable and misleading.
One currently popular folk remedy, kombucha tea, is …
Kombucha tea can be dangerous to your health
by Crystal Phend
Homocysteine-lowering supplements do not help prevent further cardiovascular events in heart attack survivors, a large randomized trial affirmed.
The trial, which followed more than 12,000 heart attack survivors over nearly seven years, found that folic acid plus vitamin B12 effectively reduced homocysteine levels, but did not reduce major vascular events overall nor any other individual endpoint compared with placebo, reported Jane M. Armitage, BM BChBSc, MBBS, of the University …
Homocysteine lowering does not reduce heart attack risk
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