Kevin, M.D. - Medical Weblog

Same issues overseas

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).

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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.

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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 missed diagnoses). But the important point to emphasize is the increased false positives (i.e. decreased specificity) leading to more biopsies, as well as the impact on cost (MRIs cost 10 times as much as mammograms).

Clearly, more research is needed, as well as any impact on survival (still debatable with mammograms).

Edit: The link above has expired. Here is the same story from the NYT.

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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?

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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.

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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 of Family Medicine.

Moreover, 27 percent of the tests were done because the patients asked for them. Of these, almost 40 percent were inappropriate.

Like many other instances, more education is needed to prevent inappropriate patient demands of tests. Alternatively, one can shift the cost burden completely to the patients where the tests are not indicated.

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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.

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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.

In any case, Medicare is finally getting into the 21st century and moving its focus towards disease prevention. Better late than never.

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Shotgun lawsuits

Medpundit is guest blogging at Overlawyered, and posts this story about a potential casualty of shotgun lawsuits.

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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.

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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.

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There's something to be said . . .

. . . for continuity of care.

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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 staff to work the weekend, to give up time with their friends and family, would likely surpass any LOS savings that could be achieved.

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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 fear of being sued."

The Department of Health and Human Services found doctors order painful tests they consider unnecessary, for fear of being sued. And the majority of doctors say they recommended invasive procedures more often than they believed were medically necessary in an effort to prevent potential litigation . . .

. . . the fearful atmosphere that these kinds of lawsuits create has far-reaching consequences. Consider the minister who will no longer hug a grieving parishioner because of lawsuit concerns or the teachers who are told not to touch their students, or allow them to climb onto their lap for fear of lawsuit.

It makes it hard to trust job references. Employers can't tell the truth about their former employees, as the truth might have legal consequences. This threatens our safety, too. It's one reason a nurse who was killing patients kept getting jobs at new hospitals. The previous hospitals were too afraid of lawsuits to warn others that they suspected the nurse had harmed patients at their hospital.

This kind of fear doesn't make Americans safer. Give me a break.

The lawyers claim we order more tests because we make money off of this:

I asked Scruggs if he thought that was accurate, and he said, "That's probably true . . . but why do they do it? . . . They make more money, the more they do."

Such superficial and infantile thinking. Perhaps in the world of law, where it's about making every dollar, that's true. Trust me, it's not about the money. I would like nothing better than to practice medicine that advocates only for evidence-supported testing. Because this approach doesn't stand up well in court, I cannot - and thus must order more tests to protect myself. Getting sued has far-reaching consequences for the physician. It is an excruciating several years-long process where your professional livelihood hangs in the balance. Avoiding these situations is my number two priority (right after "first do no harm").

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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!

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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, as a general practitioner, to display posters, and disperse leaflets encouraging women to use the "carrot and stick" approach to "persuade your man to talk to his doctor about his prostate health." This campaign is different: it is for prostates, but for women. Sisters, we are being encouraged to "leave medical information leaflets lying around where he is likely to find them—ie, the bathroom, near the remote control or the car seat." . . .

. . . The idea that the only good citizen is one who has screening tests is, to me, abhorrent. I wonder what would happen if the situation was reversed. I would not enjoy being shepherded in to my local health centre by my husband for a cervical smear. No competent adult should be cajoled or manipulated into doing what someone else thinks is best for them. Adults are capable of making their own decisions about risk, but they need good, honest information to do that.

There is a danger to the culture of "awareness." While knowledge is power, it is only functional if harnessed to disperse and aid decision making properly. Otherwise, well meaning campaigns are in danger of worrying the well and failing to reach the very people who may be most likely to benefit . . .

. . . I agree with the Prostate Research Campaign that ignorance is not bliss. But ignorance of the implications of false positives, false negatives, potentially unnecessary invasive interventions, and the current lack of evidence to support PSA screening—that is not bliss either.

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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.

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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 time until procedure based upon the day of hospital admission.

Methods
We analyzed all acute care admissions from all 190 emergency departments in Ontario, Canada, between 1988 and 1997. We selected patients (n = 126,754) who underwent one of six prespecified procedures as their most responsible procedure: fiberoptic bronchoscopy, esophageal gastroduodenoscopy, magnetic resonance imaging, echocardiography, ventilation-perfusion scanning, or coronary angiography. We noted each patient's day of procedure and day of hospital admission. For waits of less than 8 days, we analyzed the time to procedure based upon the day of admission.

Results
Only 5% (n = 5903) of the urgent procedures were performed on the weekend. Of the six selected procedures, coronary angiography showed the most skewed pattern of performance (1.5% performed on the weekend) and esophageal gastroduodenoscopy showed the least skewed pattern (8% performed on the weekend). Patients admitted on Fridays or Saturdays had the longest waits for procedures. For all six procedures, patients with relatively longer waits had relatively longer total in-hospital stays (P <0.001).

Conclusion
Relatively few urgent procedures are performed in emergently hospitalized patients on the weekend, suggesting that greater attention to weekend care might result in more timely interventions and shorter lengths of stay.

The study was done by Dr. Chaim Bell (who incidentally went to the same high school that I did). He published an earlier study suggesting that mortality was increased on the weekend versus the weekdays. What was always suspected is now empirically studied. There are countless times where tests are delayed solely due to bureaucratic reasons (i.e. skeleton staffing). In addition to tests, simple things like discharge planning and social work are greatly slowed, if not impeded completely, during the weekend.

Disease and treatment does not stop and take a break on weekends. Treating weekends like any other day would be an easy way to decrease length of hospital stay and should offset any increase in staffing costs.

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"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 medicine are at odds. I don't think this is true. What is true is that practice under terms constrained by and defined by insurance companies is not in the interests of doctors, viability of medical practices, or good patient care. We need to see, and we need to make our patients see, that these are two separate entities. Part of the problem with American medical practice is that we have become bedfellows of insurers, making more and more accommodations to the insurers, while being persuaded, by our patients and their insurers, that these accommodations are necessary to good practice and good care. So we have allowed our practice overhead to become blown up by staffing and claims processing costs that were never part of a practice's operations in the past. Insurers have passed many of their own point of service administrative costs to the doctors while cutting reimbursement or practicing other payment denial techniques that have further added to their bottom line. And we have been bullied into believing that we must protect our patients from the harshness of medical expenditure by accepting payment from insurers rather than demanding the payment from the user of the services, the patient.

It has been a perfect strategy for the insurers and for Medicare and Medicaid. They are buffered from the patients when they fail to honor their coverage terms and the patients don't feel as accountable for costs when they leave the doctor to file claims and wait for payment. And the administrative burden on the practice, coding, filing and other paperwork, gives the perfect opportunity for insurers to use clerical discrepancy as a reason to delay payment. (Clean-claims payment laws have not worked as advertised--there are loopholes despite this legislation).

If internal medicine has become unmanageable, doctors have been unwitting participants in making it so.

If we are to participate with insurers, there are ways to even the playing field. One is to demand immediate payment for services, if not from the patient, then from the insurer: electronic funds transfer from the insurer to the doctor at the time of service, not ten, or thirty or sixty days later, and no pay means no play.

Let the insurance companies find some other source of income besides short-term lending at the expense of the doctors.

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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 verdict: 62% of the fault was directed against the hospital and radiologist who misread the UGI series, 38% of the fault directed against the PCP.

The risk-management principles eloquently speaks volumes and further cements the practice of defensive medicine today:

Politicians, employers, and insurance companies want inexpensive medical care. Patients and plaintiff lawyers expect complete and exhaustive care. Physicians are caught in the middle and need to adjust their level of caution to accommodate modern guidelines. Whereas insurance companies ask primary-care physicians to look after increasingly complex cases themselves, juries have more respect for a defendant who refers early and often, even if he or she takes the patient back for long-term care.

. . . Although in some instances, better medicine may mean cheaper medicine, physicians should be aware that jurors do not consider the cost of medical care in the liability equation. They expect physicians to recommend the most potent, not the most cost-effective, course of action.

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The exception comes back to bite

Here's a case where a physician and pharmacist were sued because they failed to warn about the risk of priapism when Trazodone was prescribed. Looking this up, it occurs in less than 1% of cases. Now, how many of you talk about the risk of priapism when prescribing Trazodone? Note the risk management principle:

Juries have been generally supportive of physicians in this respect and do not require them to explain every minor or uncommon side effect. This case is the exception.

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Boston becomes . . .

. . . the largest city in the nation thus far to endorse the importation of medications from Canada. Convenient timing of the announcement, one week before the DNC.

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Norvasc and the free clinics

A recent comment from my Caduet post stated this:

I'm amazed at how drug reps are taught to sneak in the information about putting patients on an unnecessary drug. I'm also always shocked to see how many free clinic patients at our student clinic are put on Norvasc right away.

This is a sad reality. The reason for this is that drug reps don't leave generic medications. There are a couple of problems with this scenario. First off, not all name-brand hypertensive medications are first-line medications (Norvasc comes to mind).

Secondly, there is the mistaken impression that giving free-care patients sample medication is saving them money. This is deleterious in the long-term, since they are then bound to a more expensive, name-brand medication. It would be more beneficial to start people off on a generic medication (a thiazide or beta-blocker) if cost-savings is truly a concern.

Thirdly, there really should not be a reason why generics cannot treat the majority of hypertension. There are generics in the majority of hypertensive medication classes. The cases where an angiotensin-receptor blocker (ARB) or a combined alpha/beta-blocker (Carvedilol) are needed would be exceptions to this.

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A nice summary . . .

. . . on the how Bush and Kerry will approach the various health-care issues. An excerpt:

. . . Kenneth E. Thorpe, an Emory University professor of health policy who has evaluated both plans, estimates that Kerry's would reduce the number of uninsured by nearly 27 million; Bush's would cut it by 2.4 million.

Besides the effect on insurance coverage, the proposals differ in two other ways. Kerry would pay for his plan by rolling back tax cuts for the wealthiest 2 percent of Americans, cuts that Bush firmly defends. Bush emphasizes the private sector to expand coverage, while Kerry would rely on a mix of government and private insurance.

"My reading of these two proposals," Thorpe said, "is that health care on the domestic side is likely to be the biggest area of policy difference between these two campaigns, both in terms of the impact the proposals would have, the structure of the proposals and the financing of the proposals." . . .

. . . Bush and Kerry have sharp differences over proposals to bring down health care costs. The president favors capping medical malpractice lawsuits; Kerry opposes such caps. Kerry wants to allow Americans to import low-cost prescription drugs from Canada; Bush has repeatedly rejected the idea . . .

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Banging on the drum

The National Coalition on Health Care called Tuesday for a rapid, sweeping reorganization of American health care. Without drastic changes, here are the resulting consequences:

Premiums for family coverage will exceed $14,500 in 2006, more than twice the cost of similar insurance in 2001.

Two million people a year will be priced out of the insurance market, with the number of uninsured growing to more than 51 million by 2006.

Patients could be injured or killed by uncoordinated, poor-quality care.

Nothing new here - but we need more action, less talk.

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Talkback on the Florida war . . .

. . . between physicians vs. lawyers.  Blogborygmi,  RangelMD and Galen all chime in with interesting and reflective analysis. 

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More on good business vs good medicine

Here's a cynical letter from an internal medicine physician found on Internal Medicine News:

The headline, “Internal Medicine Seen as Unmanageable Career Choice,” hit home.  One of the last sentences, however, demonstrated that someone missed the boat:
“The initial results suggest that students respond to a structured curriculum, which gives them the sense that internal medicine is a manageable career.”
 
Ouch.
 
As a solo internist since 1985, I have seen my modest income from the mid-90s drop like a stone at a time when I need to be most productive, as I look to educate my four children.  The fact is, internal medicine is not a manageable career choice. We are forced to see too many patients, many adults with chronic diseases, and we get paid too little to do this.  In addition, we must either give up hospital care to hospitalists (and see a decline in income) or continue to provide in-hospital care at a time when inpatients are sicker, residency coverage is more limited, paperwork is more burdensome, and risks are much higher.

When on call, because we have so many patients (often around 3,000 for a busy doctor), we are usually peppered with calls, making lifestyle issues a major concern.  The result is burnt out internists telling medical students and residents not to choose internal medicine (primary care) as a career.

The solution is very simple: better compensation for internists. Since that will never happen, internal medicine as a career choice will fall right off the chart in the next 5 years.  So really, the goal should not be to fool seniors into making silly choices.  The reality is, primary care internal medicine is a silly choice for a career.

It is just that simple.

A bleak prediction on the future from someone on the front lines. For someone like me who has only recently been in practice, it isn't encouraging. The sad thing is, I can't argue with anything that has been said.  I think your outlook depends on how you approach primary care.  As I have stated before, you have two spectrums - good business on one end and good medicine on the other.  If you think you can practice purely good medicine in today's environment, you're sadly mistaken.  If you accept a little bit of good business when you practice (granted, that's a big if for some physicians), then one can thrive and survive.   

The key point - it's impossible to practice purely good business with purely good medicine.  The decision is where on the spectrum you choose to fit in. 

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Why physicians need a true jury of peers

This case illustrates why a physician needs a true jury of peers in malpractice cases - people who at least have some medical background.  In this case, a cardiologist was sued for giving Retavase (presumably for an ST-elevation myocardial infarction).  Unfortunately, the patient died from cerebral hemorrhage - a well-known complication.  The jury found him liable.  Here's what the independent counsel found:

A four-person state medical malpractice screening panel that met after the lawsuit was filed found that neither the hospital nor Dr. Hymanson was negligent in treating Healy. The decision by two physicians, a judge and a lawyer was unanimous. But that decision is not binding, and lawyers can continue to pursue their lawsuit, as happened in this case.

The hospital is publicly backing up the cardiologist, disagreeing with the jury's verdict.

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The battle lines . . .

. . . have been drawn in Florida.  Lawyers vs physicians.  The people will decide in November.

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Time is money

Interesting study from Vanderbilt University.  Paying physicians to take more time with patients.  I guess it would make sense if there was a correlation between improved patient outcomes and the length of the visit.  

A small number of physicians at Vanderbilt University Medical Center, Nashville, are taking part in a study to find out if it's more cost effective in the long run to pay doctors to take more time with each patient. Since the introduction of managed care, providers have felt financial pressure to fill their daily schedules, and industry reports have shown the average primary care physician spends about six minutes with each patient. The new study is investigating if doctors who see patients with high blood pressure, congestive heart failure or diabetes could offset long-term costs to insurance companies and employers by spending more time with the patients, who might stay healthier as a result and need fewer medical visits.

Six minutes sounds about right.  Conveyor-belt medicine.

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A recent conversation . . .

. . . with a Pfizer rep yesterday led to their new medication, Caduet.  This is simply a combination of Pfizer's best-selling medications, Norvasc and Lipitor.  I was commenting on how this medication is convenient for those concurrently taking the two medications separately.  Then, to my surprise the rep suggested that I use this first-line for hypertension, saying that "people with hypertension have high cholesterol anyways". 
 
Pretty dangerous thinking.  First off, Norvasc (amlodipine) isn't even a first-line hypertensive medication.  From UptoDate:

As previously mentioned, the ALLHAT trial showed that, although there were no differences in the rate of coronary death and nonfatal myocardial infarction, amlodipine increased the risk of heart failure compared to chlorthalidone (10.2 versus 7.7 percent for chlorthalidone, relative risk 1.38).
 
Thus, a calcium channel blocker should not be used as routine first line treatment of hypertension.

It would have made much more sense to combine Lipitor with Pfizer's ace-inhibitor, Accupril instead.  An ace-inhibitor/statin combination would have been a perfect drug for diabetics.  I suspect that money was behind the decision to combine Lipitor with Norvasc instead.   
 
Secondly, despite the recent hype on the revised NCEP recommendations, not all hypertensives need to be on Lipitor.  Blindly adding Lipitor so caverlierly is simply a blatant revenue-builder for Pfizer.

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Folks, this is nothing new . . .

So not everyone's happy about the new NCEP cholesterol guidelines.  Drug companies funding studies is absolutely nothing new.  In this case, the data is sound and peer-reviewed.  True, it's not a completely ideal source of funds, but the money's got to come from somewhere.  

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Surgeon goes crazy and amputates penis

So, I was browsing the headlines and caught this story from Romania.  A bad time and place for your surgeon to lose it.

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Posting health care costs on the web

As health plans trend towards a deductible-type insurance, more patients will have to shoulder the cost. To that end, some health plans in Massachusetts are posting costs of various tests on the web.

Patients being more aware of the cost of care, and being able to talk about cost with doctors, is generally "a good thing and desirable," said James F.X. Kenealy, MD, an otolaryngologist in Framingham, Mass.

"We tend to assume price is no object, and that really is unsustainable," he said.

This is an idea long overdue. It's about time that patients take more responsibility for health care costs. Educating the public by giving them the numbers is the first step. I think it will also cut down on patients who come in and demand tests.

Have a headache and want a non-contrast CT scan? $248-$482.

How about that patient who demanded the transvaginal ultrasound for ovarian cancer screening. It's against every recommendation, but if you insist on one, it's $101-$135.

And finally, how about the patient with back pain who insists on a stat MRI? Guidelines recommend anti-inflammatories and physical therapy, but if you demand the MRI, it's $545-$678.

Health insurance will soon be like auto insurance. With costs spirling out of control, deductible plans will be increasing in popularity. That means patients having to know more about health care costs. Whether they want to or not.

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Changes at Medlogs and new Blogger editor

As many may know, Medlogs is an indispensible aggregator of medical blogs. Lately, there was concern about how many non-medical blogs were included in the physician section. Let me say that I completely agree and applaud the recent editorial changes at the site. Thanks Nick for saying what has been on everyone's minds. Medlogs is now much cleaner and more medically relevant.

As an aside, I'm using this new Blogger editor. Fantastic is all I can say - finally brings the editor up to acceptable standards.

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Innocent

Everyone was acquitted in the local case against TAP Pharmaceuticals, charging that the drug reps were bribing physicians to prescribe their drugs (Lupron and Prevacid). Although certainly in a moral gray zone, tough to say that it was criminal.

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An interesting story . . .

. . . on a fertility case gone wrong due to a medical mix-up.

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Thinking about my schedule

Some big changes in the coming months. First we're switching to an EMR. After that, there's the increasing pressure by management to see more patients - not to mention having our compensation structure more directly correlate with our productivity RVUs. I'm thinking of changing my schedule structure - currently it's the standard 15-minute blocks with 30-minute physicals. Many advocate the modified-wave structure. Looks good on paper. The other option I'm looking at is switching over to a 10-minute increment schedule (i.e. 10-minute appointments, 20-minute physicals - with blocked, 10-minute catch-up time hourly). Any thoughts?

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New cholesterol guidelines

As you may have heard, the new NCEP cholesterol guidelines were released yesterday. The biggest change is a goal LDL of < 70 in the very high risk group. Now, what classifies as very high risk? They are the following:

Established CAD plus:
i) multiple major risk factors (esp. diabetes)
ii) severe and poorly controlled risk factors (i.e. continued smoking)
iii) multiple risk factors of the metabolic syndrome (esp. triglycerides >200, non-HDL >130 with low HDL <40)
iv) acute coronary syndrome

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On sudden wealth syndrome

As you may heard, in Lowell, MA this lady recently won the $294 million MegaMillions jackpot. Some psychologists say that the so-called sudden wealth syndrome often leads to impulse buying and social isolation.

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Two views . . .

. . . on medical malpractice. One from the insurers' perspective, the other from the lawyers. These articles are from the state of Wyoming, where 1 of the 3 medical malpractice insurers withdraws from the state later this year.

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The option of binding arbitration . . .

. . . as a solution to alleviate the malpractice crisis. Some practices claim up to 80% of patients agree to the terms - namely waiving their right to a jury trial. Read more about it in Medical Economics.

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Response to recent articles

Medrants and RangelMD have chimed in with their opinions on the piece regarding the patient who demanded ovarian-cancer screening. Each makes fantastic points.

Also, in response to BMC hiring a managment consultant, symtym supports the idea, while Blogborygmi takes a more cautious take.

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A balanced view on screening

Medpundit links to an excellent article detailing how more cancer screening isn't necessarily better. There certainly should be further public education on taking a more balanced, evidence-influenced view - or else more physicians would be subjected to this.

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Lawsuit against Massachusetts General Hospital

This story is getting a lot of play here. Here are the basics:

In short, the unsupervised pharmacy technician, in her second week on the job, wrongly added insulin to an undisclosed number of intravenous nutrient bags prescribed to sick infants.

The feeding bags contained no indication of insulin on their labels. They apparently were not checked by the pharmacist before delivery to the neonatal intensive care unit. They were then administered to the tiny patients by nurses unaware of the insulin within.

Almost immediately, several of the children around the unit hit a dangerous state of hypoglycemia . . .

. . . Four years later, the family copes with what they believe is the tragic outcome. Nicholas suffers from cerebral palsy. He is moderately deaf. His vision is dismal. He can't stand and needs a walker to toddle around. His intellectual development has been impaired. Meanwhile, his sister, who didn't receive a tainted feeding bag, is a normal, healthy little girl.

Now, the parents are suing the hospital as well as the pharmacy. The columnist slams MGH for not disclosing the names of the other infants involved. Tough call for MGH - no way I can see them disclosing patient information to the public. The lawsuit was on all the local channels here.

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Good business vs good medicine

Medrants has recently ranted about going to back to basics:

We need to return to first principles. The reason we became physicians was to care for people, not patients! By that I mean, caring for the patient, rather than the disease.

We need a revolution in our thinking. This revolution actually is occuring in retainer practices and cash only practices. Patients will, I believe, be willing to pay a reasonable amount to get personalized health care.

Right now, I practice in a world of "productivity". RVUs and CPT codes have as much a place in my daily life as diabetes and hypertension. Trust me, I would love nothing more than to go back to basics, and to take my time with each patient. However, there needs to be radical change in our system before that happens. As one of my colleagues recently stated, good business does not equate to good medicine. Unfortunately in today's environment, the business side is winning.

Unless there is radical change, good medicine will always be the square peg trying to fit into the round hole of today's medical environment.

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