Looks like resident physician hours are also an issue in Britain - except their limit is 58 hours a week (way under the 80 hour per week limit in the United States).
July 2004
All Stories
On vacation
I'll be taking a much-anticipated vacation the next 2 weeks. My forums at Med Help International will be closed until August 14th. I'll continue to blog as interesting things come up, but will be sporadic during the first two weeks of August.
MRIs for breast cancer screening
I was going to talk about it, but Bard-Parker beat me to it. I guess that's what headlines are for, but people simply read the headline ("Study Finds MRIs Better on Breast Cancer") and jump to a conclusion. Already had someone ask me for a screening MRI of her breasts this morning. It comes as no surprise that the MRI has the higher sensitivity (i.e. less ...
Med-mal in Canada
PointofLaw.com writes several interesting articles on medical malpractice, pain and suffering caps, and liability in Canada. A stark contrast to what's happening here, eh?
I can see the Pfizer reps . . .
. . . whipping this study out when I see them next. The study suggests a 10% improvement in osteoarthritis pain scores over acetominophen (Tylenol). Of course, no mention is made of cost - 30 caps of Celebrex 200mg is $74.99. 250 caps of acetominophen 650mg at CVS is $7.49.
Lyme test overused
A report says that the serologic test for Lyme disease is overused.
"We found that a good number of Lyme disease blood tests are ordered inappropriately, primarily for patients who come in without symptoms," . . .
. . . In more than 50 percent of the inappropriate tests, the patients didn't have symptoms of Lyme disease, according to the article in the July/August issue of the Annals ...
A trio of articles . . .
. . . from Medpundit on Overlawyered. The first, discussing a lawsuit based on a 1 in 1.09 quintillian chance. The second on the benefits of non-economic damage caps. The last on the effects of lawsuits going out-of-control: obstetricians are leaving Pennsylvania, and some hospitals are closing their OB departments entirely.
It’s about time
Medicare will now cover a "comprehensive physical" and the appropriate screening tests that accompany it.
The "welcome to Medicare physical'' for new beneficiaries includes influenza and hepatitis B vaccines, mammograms, Pap smears and pelvic examinations and screening tests for prostate cancer, colon cancer, glaucoma and osteoporosis, among other conditions.
It will even cover things like a routine EKG, which is not even recommended by the USPSTF. ...
Shotgun lawsuits
Medpundit is guest blogging at Overlawyered, and posts this story about a potential casualty of shotgun lawsuits.
An unfortunate case . . .
. . . of someone who does not have insurance and doesn't speak the language, getting lost in the maze of our broken health care system.
Brace yourselves for Michael Moore
His next project will turn his attention to the world of HMOs. Should be fascinating when it comes out:
With "Fahrenheit 9/11" becoming the first documentary to cross the $100 million mark at the domestic box office, director Moore expects a smooth path on raising money to make "Sicko," his critique of health-maintenance organizations.
There’s something to be said . . .
. . . for continuity of care.
Talkback on weekend vs weekday care
Our surgical colleague on A Chance to Cut . . . responds to the piece on delayed weekend testing. He disagrees with my hypothesis that the savings from shortened length of stay would offset the increased staffing costs of treating a weekend like a weekday. Perhaps this should be studied next.
Given the current nursing shortage and the premium that would have to be paid to ...
20/20 on personal injury lawyers
John Stossel did a fantastic piece on 20/20's "Give me a break" segment regarding John Edwards and personal injury lawyers (found via Galen's Log). Some excerpts:
In hospitals, the lawyers have bred so much fear that patients now suffer more pain, and may be less safe because doctors are concerned about being sued.
"That fear is always there," said obstetrics professor Dr. Edgar Mandeville. "Everybody walks in mortal ...
New scutmonkey comics
For those who haven't been following Michelle Au's Scutmonkey Comics, they are witty and hilarious - I can certainly relate to many of the experiences. A new batch were released today, dealing with her surgery rotation. Check it out!
Women in the UK . . .
. . . are now encouraged to use stealth to bring their husbands in for screening tests. In this view from BMJ USA, a general practitioner warns against blindly advocating screening tests. This harkens back to a previous article advocating a balanced view on screening tests.
The "Ignorance Isn't Bliss" campaign—launched this week and run by the Prostate Research Campaign UK with support from AstraZeneca—wants me, ...
Interesting study . . .
. . . from Finland. It is suggested that the rate of stroke was lowest on Sunday, and highest on Monday. I wonder if the next step would be to see if the same applies to heart attacks.
Weekday versus weekend hospital care
A new study was released saying that tests are delayed on the weekends versus the weekdays.
In the study, published in the August edition of the American Journal of Medicine, researchers analyzed six procedures commonly used in emergency situations:
Purpose
Many hospital departments tend to have lower staffing levels on weekends. We evaluated the use of selected urgent procedures for emergently hospitalized patients and measured the ...
"Bedfellows of the insurers"
A thoughtful response to my piece on good business vs good medicine. The commenter argues that the fundamental problem is our dependence on the insurance system. Consequently, our health-care system is slanted against good medicine. It is the insurance companies that forces good business on our medical practice, and the physicians are unwitting pawns. Take a read:
The assumption is that somehow good business and good ...
More support for defensive medicine
I regularly receive the Cortlandt Forum and only recently realized they're on the web. It's an eclectic magazine, but has interesting malpractice cases. Here's another one.
Basically, it's a patient who came in with dyspepsia. The PCP ordered an upper GI series and it was read as normal. However months later, the symptoms continued, and an EGD found terminal stomach cancer. The ...
Kevin Pho, MD
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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...
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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...
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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....
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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
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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...
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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...
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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...
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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
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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...
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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...
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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...
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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
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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...
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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...
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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...
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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
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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...
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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...
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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...
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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
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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...
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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....
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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...
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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...
