Go ahead, let patients buy prescription drugs over the counter

Meds
May 14, 2012

The FDA is deciding whether to allow patients to purchase prescription medications over the counter for many common ailments.

This idea is controversial.

On one hand, deregulation would remove one of the largest barriers to receiving treatment for some conditions – the doctor’s visit. If no doctor’s visit is necessary to receive necessary blood pressure medications or diabetes medications, then patients don’t have to wait for an appointment and the patient/government …

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Tips to improve your patient satisfaction scores

Physician
May 14, 2012

Recently I was asked, “How can I improve my Press Ganey scores?”  Presently this question applies mostly to hospitals as CMS is requiring hospitals to use the HCAHPS as a part of their quality reporting. Press Ganey can manage the HCAHPS for hospitals.  Few physicians or physician groups presently survey patients for satisfaction; they should begin thinking about doing so in the near future as it seems likely that CMS …

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Are smokers to blame for the damage they do to their bodies?

Conditions
May 12, 2012

He had yellow nails, leather neck, stained teeth and a deep cough. He wheezed slightly, breathed too quickly and occasionally sprinkled the white handkerchief red. No surprise his ticket to my office was a lung mass to match. We talked about tests, treatment and prognosis.  About the future, probably short.  Devastated, he was not surprised.  He was reaping the reward of 30 smoking years.  He sadly admitted, “I knew better, …

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The unholy alliance between Big Pharma and the medical profession

Meds
May 12, 2012

An excerpt from The Truth About Statins.

Like all physicians, I’ve had interactions with pharmaceutical companies. Shortly after I went into private practice in Rhode Island in 1977, I received a telephone call from a drug company representative. He offered me an all-expense-paid weeklong trip to Germany to attend a medical conference. I was taken aback, knowing that the cost of such a trip would run to thousands of dollars. I …

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Primary care requires more than knowledge

Physician
May 11, 2012

“You are too smart to do primary care.”

I have heard this far too many times, directed at me and at others seeking career advice.  There are many reasons for the shortage of primary care doctors in the U.S., but at least part of it is this.  Smart, capable, successful trainees are discouraged from choosing primary care.  It is perceived as a less prestigious pathway than specializing.

The knowledge base of primary …

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Tips for adjusting to life after residency

Education
May 11, 2012

The more I talk to new physicians who are transitioning into practice, the more I realize how many substantial life and career shifts occur post-residency.

I experienced these changes myself several years ago, but it’s taken me a while to fully process them and realize how they’ve affected my life.

In fact, it would be safe to say that I experienced a complete 180 after graduating from residency. I know other new …

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No one told me that getting on with life after cancer would be so hard

Physician
May 7, 2012

I met with a young patient recently, a woman who has been done with chemotherapy for lymphoma for close to a year. She was feeling well, and she had no symptoms of cancer, nothing that made her suspicious of a recurrence. After I examined her and reviewed her most recent CT scan and labs, I agreed. No recurrence. I wrote in my note, “NED,” the acronym for no evidence of …

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How money influences our decisions as doctors

Physician
April 30, 2012

When you ask young medical students why they want to be doctors, you will probably get all sorts of answers. Some may say they like people and want to interact with them and offer them help.  Some students will believe this is their calling. Others still may state they are intrigued by the scientific mysteries the human body is filled with. From my experience, not many medical students just starting …

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When doctors are forced to accept malpractice case settlements

Physician
April 27, 2012

Suppose your malpractice insurance company wants to settle a medical malpractice case against you – even though the case has no merit.

In many cases, insurance policy language may allow the insurance company to do just that.

In the 2011 case of Mohan Papudesu, MD v. Medical Malpractice Joint Underwriting Assn. of Rhode Island, the Rhode Island Supreme Court allowed an insurer to settle a case on behalf of the defendant physician …

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Medical residents are abused more than Chinese factory workers

Physician
April 23, 2012

Medical residents have fewer labor protections than Chinese factory workers. While labor abuses at Apple’s factories make headlines, few people are as concerned about the lack of protections for doctors and medical students here in the United States. As a resident, I was subject to some of the worst abuses – intentionally misreported time sheets and gender-based discrimination – and after I complained, I was fired, so I sued the …

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Healthcare reimbursement will change dramatically in the future

Policy
April 22, 2012

Based upon the past and the current state of affairs in healthcare, healthcare reimbursement will change dramatically in the future.  I believe that reimbursement based upon fee-for-service will gradually disappear and be replaced by models based upon the ability to better manage patient diseases and conditions.  That is, reimbursement will be based upon the quality of service delivered by the provider.  For insurers, whether private or governmental, I believe that …

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What separates a developed and a developing country?

Physician
April 22, 2012

How can you determine whether you are in a “developed” or a “developing” country? We used to call these latter “un- or underdeveloped” or “3rd world” countries, but those terms are no longer politically acceptable, considering the tinderbox of feelings about this topic.

If one objectively examines all 20 dozen or so of the world’s countries, a geographer would divide them into either north or south of the Equator. And if, …

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When doctors are incorrect in their prognosis of terminal illness

Physician
April 18, 2012

In January, when my close friend’s lymph node biopsy came back as a rare form of T-cell lymphoma, I scoured the scientific literature. What was his prognosis?He was 56, a little overweight but otherwise healthy. He had helped us move into our home more than a decade ago, and I was like an uncle to his son and daughter.

In the literature I found jagged graphs plunging downward, indicating that my …

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Tips for successful home blood pressure monitoring

Conditions
April 18, 2012

Sometimes, the simplest tools in medicine are the ones that give us the most useful information.

Take the humble blood pressure machine, for example. It’s been around for years, and it’s cheap, compared with a lot of other medical devices. It’s simple to use, and it doesn’t require a medical or a nursing degree to operate. But the numbers it reports are valuable in helping predict a person’s risk of a …

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Bullies are not born, they are raised

Physician
April 17, 2012

People often wonder what causes children to bully.  Why is it that some children feel the need to hurt and humiliate other children?  What do they really stand to gain from this cruel behavior?

Some studies indicate that some (not all) bullies have naturally aggressive and/or hyperactive personalities from the start. Some.  But that doesn’t mean that all “spirited” kids will bully while all “mellow” kids will be perfectly empathic and …

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CME limitations and how we can improve Continuing Medical Education

Education
April 16, 2012

Some people critique Continuing Medical Education (CME) programs as spoon-feeding. As a young physician struggling to learn a lot of material, I actually appreciate a bit of ready-to-consume content that I can learn quickly and effectively. The American College of Cardiology (ACC) and other reputable institutions provide CME programs that, overall, help to keep physicians up on the literature and integrate new findings with existing knowledge. However, despite the basic …

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Tips to fight depression during medical residency

Physician
April 15, 2012

Even though I love my job, I’ve been feeling a little burned out lately. I think it comes from being stretched too thin, which is something I’ve coped with off an on ever since med school.

As the saying goes, there are never enough hours in the day, and sometimes that really gets to me. While my practice is incredibly important, I also place a lot of value on my family. …

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The implications of provider versus doctor

Physician
April 13, 2012

I am used to being called a “medical provider” instead of a doctor or a physician these days, but it makes me think about the implications of our choices of words. The word “provider” was first used in non-medical contexts over 500 years ago. It is derived from the Latin providere, which means look ahead, prepare, supply.

“Medical provider” is part of the Newspeak of America’s industrialized medical machine. …

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End stage colon cancer becomes even more tragic without hospice

Physician
April 11, 2012

Mike was a runner, outdoors-man, and fitness nut. This was not so much as for health reasons as for “feeling good”, but he did hope that it would help him avoid illness. It was worrisome when he started with some belly cramping and noticed some blood streaks in his stools. It took about a month until he could be scheduled for a colonoscopy. The news was shocking. “There’s a cancer …

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The future of medicine for aspiring young doctors

Physician
April 11, 2012

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March 29, 2012

Calhoun Lecture Series
Strom Thurmond Institute, Clemson University

Thank you for the invitation to speak tonight. I’m very humbled to stand before you. And what a delight to speak to people who are neither bleeding, intoxicated nor asking for Percocet! And in a setting where no one will burst through the back door on a stretcher!

As you know, I’m an emergency physician …

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