Interesting article from the NY Times investigating communication between physicians and patients. Here are some excerpts:
. . . Two decades ago, in 1984, researchers showed that on average, patients were interrupted 18 seconds into explaining their problems. Fewer than 2 percent got to finish their explanations.
. . . Research shows that only 15 percent of patients fully understand what their doctors tell them, and that ...
May 2004
All Stories
Why Harvard Medical School is opening a medical campus in the United Arab Emirates
Harvard Medical School is planning a medical campus in the United Arab Emirates. Some interesting points:
. . . there are enormous hurdles to fostering US-style health care in a region where medicine is so spotty that the 100 million Persian Gulf residents spend $25 billion a year getting treatment elsewhere, according to Dubai Healthcare City officials. Many medical school students enroll straight out of high school and ...
Behind the scenes at a Canadian mail-order pharmacy
Here is a nice article from the Boston Globe that investigates some of the issues of importing medications from Canada.
Slow start for medicare cards
As a follow-up to what I wrote last week, it seems like the new Medicare cards are slow to take off. And why not? On one hand, you have a dizzying, confusing array of Medicare cards - on the other, you have Canada, which gives you better savings. The choice seems pretty clear. It confounds me how the government can so poorly implement a ...
Speaking english a disease?
Here's a nice joke from the BMJ:
For those of you who watch what you eat and drink, and worry about heart disease, here is the truth"”according to a joke currently doing the rounds. The Japanese eat very little fat, while people in Mexico eat lots. Both groups suffer fewer heart attacks than the British or Americans. Africans drink very little red wine, while the Italians drink large ...
Physicians are punished for missing the rare diagnosis
In the article, Why do doctors use treatments that do not work?, several interesting points were made. It is making a case that we need to continually rely on the evidence, and less on empiricism. This is why it is so frustrating when I hear stories where EBM is tossed around like a "dirty word" and when physicians are making treatment decisions that are evidence-bereft.
Is Paxil associated with irritable bowel syndrome?
IBS is one of the more frustrating diseases to treat. Increased fiber intake, antispasmodic agents, and Zelnorm (for constipation predominant disease) are among the treament choices. However, in many cases, these treatments aren't enough and many patients unfortunately remain symptommatic. In the GI forum that I moderate, there are many who report refractory IBS symptoms.
Today comes a study from the American ...
A slice on rising health costs
We all know that one reason for rising health costs is that newer technologies are more expensive. For one small example, consider the evolution from sigmoidoscopies to colonoscopies. The medical director Patient Care writes that sigmoidoscopies have virtually ceased once colonoscopies became a covered benefit under both Medicare and private insurance. Consider the charge for a sigmoidoscopy is several hundred dollars compared to over $3000 for a ...
Inevitable
It was only a matter of time that this would happen.
AP:
A businessman has sued the promoters of the Atkins Diet, saying the low-carb, high-fat meal plan clogged his arteries and nearly killed him.
Scutmonkey comics
I got a good laugh from Michelle Au's scutmonkey comics. Very funny, very true. I particularly like the 12 types of med students.
More on prostate cancer screening
Medpundit and DB has chimed in on the mainstream coverage of the deficiencies of PSA screening for prostate cancer that was discussed here on Tuesday and Wednesday.
Medpundit writes:
Beware of organizations made up of hospitals and urologists who call for lower thresholds for treatment. They have much to gain from the increased number of biopsies such lower thresholds would produce. Unfortunately, it's far from clear ...
Rifaximin for traveller’s diarrhea
The FDA approved rifaximin, a non-absorbed antibiotic that remains within the body's gastrointestinal system, for traveller's diarrhea. This is in contrast to most other antibiotics which are spread throughout the body. Cipro or Bactrim are medications that are currently used.
A review article has suggested that this therapy may become the treatment of choice once routinely available.
Apology after a medical error
We're always told that a sincere apology after a medical error reduces the risk of an impending lawsuit. Here is a story of that theory in practice.
A normal PSA can miss prostate cancer
The mainstream press has caught wind of the NEJM study that was discussed here yesterday. Here are some quotes from the article:
. . . "This study adds to information that perhaps the PSA threshold may be dropped to 2.5 or so," said Gomella, the Philadelphia urologist. "The number 4 may not be the, quote, normal that we look at anymore."
. . . Some ...
Cash for prescribing drugs
In today's environment where drug companies are being monitored closely (take TAP's recent lawsuit in the Boston area for instance) for physician kickbacks for prescribing drugs, comes this story from Italy:
A two-year investigation by the financial brigade found that the Italian subsidiary of Glaxo had mounted an illegal incentives scheme involving 4,713 people, including 4,440 doctors.
Glaxo clearly wasn't subtle in their efforts to influence physicians:
Prostate biopsies with a normal PSA
In the May 27th issue of the NEJM, a study was released that concluded that biopsy-detected prostate cancer was not rare among men with PSA levels of 4 or less. Prostate cancer was diagnosed in 15 percent of cases in the group with PSAs of less than 4, and of those cases, 15 percent were high grade.
This begs the question - should the threshold ...
Hiccups
Medpundit wrote about hiccups today. It reminded me about one of my patients who had protracted hiccups for 5 years - you could only imagine how frustrating this was. He was a 70-yo male who started having hiccups after surgery. Multiple medications were not successful: PPIs, H2 blockers, Thorazine, Reglan, Compazine, Neurontin and Dilantin were given without success. Endless GI and neurology consults were not ...
Medicare drug discount cards – still not enough
AMNews compared two Medicare discount cards with Drugstore.com and a Canadian mail-order pharmacy. As you can see, the discounts still aren't enough. There is also pretty wide variability between the two Medicare cards:
Medication / Card 1 / Card 2 / Drugstore.com / Canada
Celebrex $105.64 / $162.87 / $76.99 / $38.69
Lipitor $60.85 / $66.82 / $62.99 / $49.85
Nexium $109.39 ...
Earlier treatment for osteopenia
From the Archives of Internal Medicine, comes a study that suggests that the majority (82 percent) of osteoporotic and hip fractures occured in women with T-scores greater than 2.5 (i.e. at osteopenic, not osteoporotic levels). This suggests that treatment at an earlier stage (i.e. with T-scores between 1 and 2.5) may be considered.
Remember that the USPSTF recommends that women aged 65 and older be screened ...
Toxic neckties?
This story caught my eye - guess I'll think about dry-cleaning my ties from now on:
A small study of neckties worn by doctors at a Queens hospital found almost half the 42 ties tested harbored microorganisms that can cause illness.
Of the 42 physician neckties sampled, 20 contained one or more microorganisms known to cause disease, including 12 that carried Staphylococcus aureus, five a gram negative ...
Kevin Pho, MD
-
How I approach ovarian cancer screening with patients
Ovarian cancer screening clearly touches a nerve. No one doubts that ovarian cancer is a devastating diagnosis, often found when the disease...
-
Why more primary care doctors are referring patients to specialists
According to a recent study from the Archives of Internal Medicine, primary care physicians are referring more patients to specialists than ever...
-
Should Google censor anti-vaccine claims?
One of the reasons there is such a movement against vaccines is the democratization of information, perpetuated by search engines like Google....
-
Radiologists who cheat on their board exams: Who’s to blame?
In a widely circulated CNN article, many radiologists have been found to cheat on their board exams: "Doctors around the country taking an...
Physician
-
Why an anesthesiologist would be needed for organ donation
I've only had to declare death a couple of times. Once in a three-year-old and once in an adult. In each case...
-
5 ways to avoid a misdiagnosis
Billionaire Teddy Forstmann had been diagnosed with a serious form of brain cancer. There’s a tragic twist to the story: according to...
-
Benefits of the Medicare Adult Wellness Visit
One of the things I love about family medicine is that I get to care for people of all ages. I almost...
-
Cancer has a way of teaching us poignant life lessons
I just finished reading George’s recent post on Evelyn Lauder, who recently passed away from ovarian cancer, and am still stirred by...
Patient
-
In love there is a life giving force
Here is a toast to the miracle of love. Not to the romantic, chocolate, dance club nightlife type of love. Not warm...
-
How to get ready for death
No one wants to die. Even people who want to go to heaven don't want to die to get there. And yet...
-
The long term cost of a pain in the neck
One morning this May, I woke up with a stiff neck. I applied hot and cold therapy all day and took an...
-
Preparing for your visit with someone in hospice care
Visiting someone who is dying or critically ill is an experience many of us will have in the course of our lives....
Policy
-
AMA: Advocating for Medicare, military and fiscal responsibility
A guest column by the American Medical Association, exclusive to KevinMD.com. This week, I’m joining hundreds of physicians and medical students in Washington, DC...
-
A critical look at value driven health care
Everyone in the world is talking about “value-driven health care.” Or so it might seem if you pick up a medical journal...
-
Surviving the new landscape of physician reimbursement
CNN recently posted an article titled "Doctors Going Broke." It described several cases of independent physicians who are near bankruptcy although they once...
-
Doctors lobby Congress to repeal the SGR
One of the things that I like most about my job is engaging with ACP’s physician leadership—the internal medicine doctors who dedicate...
Tech
-
There is a patient attached to that implantable defibrillator
As a follow-up to my post on why patients with implantable defibrillators should have access to their device’s data, I am going...
-
The pitfalls of email communication with patients
A recent article in the Wall Street Journal reviewed the emerging role of email in healthcare, arguing that doctors should more aggressively...
-
Why adoption of EHRs is a transformational event for physicians
Paul Conslato, MD, director of clinical affairs for Lancaster General Medical Group, recently was quoted in the PAMED Better Health Network eZine...
-
Why EMR is a dirty word to many doctors
Don’t get me wrong, EMRs (electronic medical records) are inevitable. Over the long-run they are almost certainly good for physicians, patients and...
Social Media
-
Using Twitter to deliver health improvement messages
I have decided to spam for public health. Phone calls, text messaging, and even apps have been shown to help improve health...
-
Addressing comments on your medical practice’s Facebook page
Does your medical practice allow anybody to post links and comments on your Facebook page? The short answer is yes. We do....
-
The Internet is where patients go for pre-visit consultations
As a physician, technology cannot replace you, but it can make you more efficient and effective. This was the message from Richard...
-
5 ways doctors can benefit from professional connections
Looking ahead to the next several months, I’ve found myself frequently wondering how many physicians will make this their year to take...
