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Waiting is a part of surgery, and how a surgeon perceives time

Physician

May 30, 2010

People like us, who believe in physics, know that the distinction between past, present, and future is only a stubbornly persistent illusion.
– Albert Einstein

The surgical case is delayed for ten minutes and I am getting restless. I anticipate a very difficult dissection. The cancer has returned after extensive prior treatment with surgery, chemotherapy and radiation. I have enlisted additional help to make certain that everything goes as smoothly as possible. …

Virtual colonoscopy access may not reduce lower endoscopy rates

MedPage Today

Conditions and Diseases

May 29, 2010

by John Gever

Easy access to CT colonoscopy may not reduce the number of conventional colonoscopies performed.

After the University of Wisconsin’s (UW) health system persuaded local insurers to cover the imaging-based screens in 2004, there was little sign that patients preferred them to standard endoscopic exams, according to Patrick Pfau, MD, the university’s director of clinical gastroenterology.

Mean quarterly counts of optical colonoscopies performed at UW rose from 1,104 in 2003 to …

HSA-compatible high deductible health plan advantages

Kevin

Health Policy

May 29, 2010

by Ray Carlson

With so many health insurance consumers familiar with standard “PPO” or Preferred Provider Organization health plans that feature lower annual deductibles, the HSA-compatible health plan might be getting overlooked.

These same consumers who – because of the downturn in the economy and subsequent job loss – are now shopping for, or considering shopping for, a new individual or family health plan might gravitate towards a PPO that features the …

Your asthma or COPD inhaler is not available, and what to do

Matthew Mintz, MD

Medications

May 28, 2010

As reported in MedPage Today, the FDA announced the end for CFC-propelled inhalers. Of the seven inhalers with deadlines for removal, only three are still being made:

Flunisolide (Aerobid Inhaler System) on June 30, 2011
Albuterol and ipratropium combination (Combivent Inhalation Aerosol) on Dec. 31, 2013
Pirbuterol (Maxair Autohaler) on Dec. 31, 2013

The reason for this is because CFC’s are harmful for the environment, and the newer inhalers have to be replaced with …

How doctors choose which specialists they refer to

Michael Kirsch, MD

Physician

May 28, 2010

There is an aspect of professional sports that I greatly admire. This transcends the athleticism and skill of the athletes, the work ethic, coaching expertise, teamwork and the thrill of the game. This is one of the only institutions that is a pure meritocracy. The philosophy is simple and not blurred by arguments for diversity or massaging the qualifications for admission to serve another agenda. Coaches, managers and owners want …

How primary care should manage chronic pain patients

Juliet K. Mavromatis, MD

Medications

May 28, 2010

In April 2010 the American Society of Anesthesiologists (ASA) published updated guidelines for the management of chronic pain. The guidelines were based on a review of recent scientific evidence as well as a survey of expert opinion. As I read through the guidelines, summarizing the efficacy of various therapies for chronic pain ranging from epidural injection to medication management, some of my most challenging clinical cases involving pain management …

Female sexual dysfunction treatment options

Jill of All Trades, MD

Conditions and Diseases

May 27, 2010

Female sexual dysfunction has been reported in up to 40% of women, and described as causing actual distress in approximately 12% of women.

Therefore, it is an important topic to familiarize with and screen for as a primary care physician, as many patients may not report these symptoms unless they are elicited during the history taking process of the patient encounter. Female sexual dysfunction is often multifactorial and complex; it is …

Healthcare needs to be simpler and more like real economics

John Mandrola, MD

Health Policy

May 27, 2010

A middle aged patient whom I have seen in the past for benign palpitations called today because of atypical chest pain. Although I have criticized the overuse of nuclear imaging studies, and probably order the fewest of any cardiologist in the city, there are times when they are appropriate –this was one of those occasions. Symptoms did not rise to the level of an invasive angiogram, but could not be …

EMR use may not save money but can save lives

MedPage Today

Health Technology

May 27, 2010

by Joyce Frieden

Two new studies of electronic medical records (EMRs) have come to different conclusions: one found that they don’t save money or staffing time, but the other suggested that at least one part of EMR — electronic prescribing — does save lives.

In the electronic prescribing study, at a single California hospital, the mean monthly adjusted mortality rate decreased by 20% …

Patient relationships with their doctors over time

Kevin

Patient

May 27, 2010

by Sandeep Grewal, MD

We as doctors and patients as well as medicine as a whole have evolved over time. What used to be a simple conversation of between a doctor and a patient has turned into a melee of medical issues, legal issues, insurance and financial issues and not to mention the complicated ICD 9 and CPT code system.

Conversation between a doctor and patient in 1960s:

Patient: Sir, I am …

Treating patients in prison for murder

Jeffrey Knuppel, MD

Patient

May 26, 2010

Correctional psychiatrists inevitably treat patients who have been convicted of a broad array of crimes. There is a correlation between the security level of the institutions in which one works and the severity of the crimes of the inmates being housed there.

Since I’ve treated inmates of minimum, medium, and maximum custody levels, I’ve had the opportunity to work with people who have been convicted of everything from drug possession to …

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Treating patients in prison for murder

Hospitalists are killing primary care, and other myths debunked

Vineet Arora, MD

Physician

May 26, 2010

Those who hate hospitalists believe that students and residents are choosing hospital medicine over primary care so hospitalists are to be blamed for the primary care shortage. They also believe that the rise of hospital medicine has made primary care less attractive. Then, there is the salient argument that care transitions are more inherent and vulnerable due to hospitalists.

Of course this hatred is not new. As a …

Few receive the shingles vaccine because of cost to doctors

MedPage Today

Medications

May 26, 2010

by Michael Smith

It’s a classic good-news, bad-news story.

The vaccine against shingles, already shown to be effective, is both safe and well-tolerated, researchers found after following more than 38,000 participants in the randomized trial that led to the 2006 approval of the vaccine.

On the other hand, few people are getting the vaccine, and for a variety of reasons — including its cost — researchers noted in a separate study. Both analyses …

Waterbirth dangers to newly born babies

Amy Tuteur, MD

Conditions and Diseases

May 26, 2010

Waterbirth has become a central component of “natural” childbirth dogma, despite the fact that for primates giving birth underwater is entirely unnatural. You don’t need a medical degree to appreciate the idiocy of birth in water. The most critical task for the newborn is to take its first breath.

Inhaling a mouthful of fecally contaminated water instead of air is profoundly dangerous. Not surprisingly, as the popularity of waterbirth has grown, …

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Waterbirth dangers to newly born babies

A medical student chooses dermatology because of family

Kevin

Medical Education

May 25, 2010

by an anonymous medical student

As of today, I am one month from adding those long sought-after and hard-earned initials to my name, M.D. I matched at my number one choice in a very competitive “lifestyle specialty,” have a fabulous husband who has helped me through the emotional turmoil that is medical school, and two young boys who make me laugh and smile every day. I sit here, where …

Standardizing claims can save billions of dollars

MedPage Today

Health Policy

May 25, 2010

by Joyce Frieden

A standardized claim form and a single set of submission and payment rules for all health plans could save the U.S. healthcare system $7 billion annually, a study has found.

“Although not all costs of excessive administrative complexity have been captured in our study, both real costs in billing operations and opportunity costs in physicians’ practices are significant,” Bonnie B. Blanchfield, ScD, of Massachusetts General Hospital in Boston, and …

Rental housing can worsen your health

Erin Marcus, MD

Conditions and Diseases

May 25, 2010

Whenever I diagnose a person with asthma or allergies, I usually ask a few questions about his or her living environment. Is there shag carpeting in the bedroom? Is the air conditioning filter changed every month? Is there evidence of roaches and other vermin? I ask these questions because mold, dust mites, animal saliva and insect droppings can worsen the symptoms of asthma and other illnesses.

But some of my patients …

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Rental housing can worsen your health

When will cost effectiveness ever be acceptable in US healthcare?

David Williams

Health Policy

May 24, 2010

Cancer. The Big C. No one wants money to stand in the way of curing a patient.

But real life is messier. Many new treatments for cancer are pricey yet provide only marginal gains over existing therapies in life expectancy and/or quality of life. Forty thousand dollars for a cure is not a real dilemma for policymakers — the same spend for an extra six weeks of life is another story.

In …

Voluntary simplicity can ease the stress of American life

Aldebra Schroll, MD

Patient

May 24, 2010

Who hasn’t heard the story of a friend or acquaintance who retires only to become seriously ill or die soon after?

Are we working ourselves to death? For anyone who has ever wondered “is this worth it?” a move is afoot to question the concept of the American work ethic. We are currently the most overworked society on the globe. The United States has surpassed Japan as the nation with the …

Definition of health includes social well-being

Emily P. Walker

Physician

May 24, 2010

by Emily P. Walker

I was covering an FDA tobacco meeting a while back when I heard a Howard Koh, MD, assistant secretary of health at the Department of Health and Human Services (HHS) start his speech with the World Health Organization’s definition of health.

“Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or …