Thursday, March 31, 2005
11 percent of patients leave the ER because the waits were too long (8 to 9 hours in Ontario). A case in point was a 24-year old with meningitis. After waiting 8 hours without being seen, she went home and later died.
These problems are not confined to Canada, but reflective of a larger problem.
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One instrument you want to be sure is disinfected properly would be a colonoscope.
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"Eric Neuberger, 31, contends his pre-operation libido let him 'engage in intercourse approximately 30 to 50 times a month.'
But his sexual appetite was destroyed by Dr. Rodney Barron's work, Neuberger said."
Not sure that phalloplasty commonly causes a decreased libido. Any urologists care to comment?
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PML is a rare demylinating disease that occurs in 6 per 10 million patients. This is the third case that is associated with Tysabri. Investors are not happy.
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Wednesday, March 30, 2005
"A South Carolina doctor accused of writing steroid prescriptions for three players on the Carolina Panthers says he prescribes the drugs only when medically necessary.
Dr. James Shortt, an alternative practitioner under investigation by federal and state officials, said in Wednesday's editions of The Charlotte Observer that he prescribes steroids only in low doses and monitors patients to ensure their steroid levels are within 'their upper limit of normal.'
'People come to me often because they're worn down, they're exhausted, or something has happened to them and they haven't recovered fully,' Shortt said during an interview with the newspaper at his office Tuesday."
There doesn't seem to be a lot of evidence to support what he's doing.
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The malpractice situation is affecting new graduates as they become more attuned to the current crisis.
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"* The first Doctors Day observance was March 30, 1933, in Winder, Ga. The idea came from Eudora Brown Almond, wife of Dr. Cha Almond, and the date was the anniversary of the first use of general anesthetic in surgery. (On March 30, 1842, Dr. Crawford Long of Barrow County, Ga., used ether to remove a tumor from a patient's neck.)
* The Barrow County Medical Society Auxiliary proclaimed the day "Doctors Day," which was celebrated by mailing cards to physicians and their wives, and placing flowers on the graves of deceased doctors, including Dr. Long.
* The United States House of Representatives adopted a resolution commemorating Doctors Day on March 30, 1958. In 1990, legislation was introduced into the United States House of Representatives and United States Senate to establish a National Doctors Day. Following overwhelming approval by the House and Senate, then-President George Bush signed a resolution designating March 30 as National Doctors Day. The first National Doctors Day was celebrated in 1991."
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The response of a physician in South Africa who refused to treat a patient with HIV.
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"He's called some doctors who disagree with him 'pro-life fanatics,' and others quacks and charlatans.
No legitimate neurologist in the world, he says, would look at the evidence in this case and dispute that Terri Schiavo is in a permanent vegetative state."
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"In addition, having a long-term relationship with a doctor resulted in fewer hospitalizations and other reductions in health-care costs, the researchers found."
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Tuesday, March 29, 2005
The New Yorker writes about the intersection between money and medicine. (via kottke.org)
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"Direct-to-consumer advertising of prescription drugs had come under intense scrutiny in the wake of the recent Vioxx debacle. Experts across many fields felt that the huge advertising effort behind Vioxx and other cox-2 inhibitors contributed to an over-prescribing of the drugs, and the subsequent heart-related problems experienced by some users.
Ads by medical centers are a more recent phenomenon, another product of an increasingly competitive health-care market, but they have not been analyzed so closely."
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Get all the scoop from the best of the medical blogs.
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"Rather than release Chidiac [the OB] at that point, Lilliston [the officer] drove him to the hospital and marched the doctor to the maternity ward with his motorcycle helmet still on and his hands cuffed behind his back.
A nurse urged the doctor to hurry, because the baby's head was showing."
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"The law limits an award for noneconomic damages in medical liability cases to $350,000, down from $500,000; regardless of the number of defendants in a case, and there is no inflation adjustment on the cap."
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Monday, March 28, 2005
"Among other findings about physicians from the Pilot Pen/Graphology Consulting Group handwriting report are the characteristics of medical specialists:
* Cardiologists -- fast thinkers, open-minded, positive high energy.
* Neurologists -- forward thinkers, quick, interested, intuitive and "elegant."
* Orthopedic surgeons -- Surprisingly, only 15% display handwriting signs that indicate manual dexterity.
* Male OB/GYNs -- the most depressed, stressed and disheartened among all specialties. When asked why, many pointed to greedy, ungrateful families and aggressive malpractice lawyers.
* Female OB/GYNs -- Optimistic, energetic.
* Anesthesiologists -- Clear thinking, objective, not impulsive -- good traits for the operating room."
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"But it is aiming to reverse the trend with the introduction of a new GP post, called a referrals GP, which will give patients access to a second family doctor if they are not convinced by their own."
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Did I mention she was also pregnant?
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As doctors, lawyers, and insurance companies battle for reform, it's the patient that often loses.
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Sunday, March 27, 2005
A doctor yearns for medicine as it was practiced 30 years ago. Best of luck to him - a doctor who doesn't accept business being a part of medicine cannot survive in today's world.
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"In order to accommodate Haley's medical condition, her priest substituted the wheat wafer with one made of rice. But little did they know, they'd just broken a church doctrine . . .
The local diocese ruled that Haley's first communion didn't count, and reprimanded the priest who gave her that rice wafer."
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"The four familiar words physicians always dread come when the office visit is ending, doctor's pen clipped back onto the white coat pocket and hand reaching for the door. "Oh, by the way," the patient says. What comes next could be as innocuous as a harmless freckle or a bombshell. Doctors call it 'the doorknob phenomenon.' . . .
. . . Charon teaches a method she has adopted with her own new patients, whom she tells: 'I'm going to be your doctor and I need to know a lot about your health and your body and your life' and then I stop talking.'"
One of those solutions that is easy to implement in medical school, hard to execute in real life. An easy way to spend more time with patients? Stop the conveyor-belt practice of medicine, seeing patients every 15 minutes. Get insurance companies to reimburse appropriately. In other words, take the business out of medicine.
Of course, that would never happen - unless I change to a concierge practice.
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Friday, March 25, 2005
In reference to commentators who have "compared Ms. Schiavo's situation to that of starving children in Africa and abandoned animals in shelters."
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"Sen. Bill Frist last week watched a videotape of Terri Schiavo made by her parents in 2001. He did this in his capacity as Senate majority leader and as a renowned physician. In both roles, he performed miserably. As a senator, he showed himself to be an unscrupulous opportunist. As a physician, he was guilty of practicing medicine without a brain."
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"The MEDI Binder is an organizational tool to allow patients to keep track of the important' aspects of their medical record."
This is the brainchild of Dr. Benjamin England, a fellow medblogger at Galen's Log.
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Thursday, March 24, 2005
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"The House Judiciary Committee [in New Hampshire] is poised to recommend a compromise which would create a method for malpractice cases to be screened before going to trial in the hopes both sides can reach a settlement . . . It is a system based on one in Massachusetts, however, that state uses a panel comprised of a judge, lawyer and doctor to decide if a malpractice case has merit.
'We tried to get a swift, simple system that will work,' said Rep. Robert Rowe, R-Amherst, a retired attorney. 'Who better than a judge to screen these cases?'"
Hmm, someone with medical training probably would be better - but maybe that's just me. How is this different from a doctor deciding on legal malpractice cases?
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This gastroenterologist seems to think so: "Any physician who would knowingly starve a patient to death, court order or not, is in my opinion violating the Hippocratic Oath and is in effect guilty of malpractice."
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"They cared about 'exciting the base,' as an internal GOP memo circulated on Capitol Hill boasted."
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"This is absurd beyond imagination - not every drug is Vioxx; and the enormous evidence that was presented to the FDA demonstrated the safety of these [drugs]."
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Wednesday, March 23, 2005
A 10-year old boy was arrested for attempting to bring a glass of water to Terri Schiavo
(via Drudge Report)
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Like universal health care, the United States is one step behind the rest of the world.
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"The makers of all products and the providers of all services are obliged to warn the public of possible mishaps: the medical profession should follow suit. Surgeons should protect themselves against being sued by making patients sign a consent form in which it is clearly stated that the patient understands, along with the other risks, that the operation may be unnecessary and could be poorly performed.
Similarly, doctors would be well advised to mount placards in their waiting rooms: 'In medical practice errors of omission as well as commission are common and unavoidable. Sometimes the consequences lead to permanent disability, if not death. Patients who seek treatment here are assumed to have waived all claims.'"
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"There are 12 medical doctors, 3 dentists, and 3 nurses in Congress, and most did not publicly invoke their medical experience during the Schiavo debate. Among them was Senator Tom Coburn, Republican of Oklahoma and a family practice doctor, who said in an interview, 'I don't think you have to examine her. All you have to do is look at her on TV. Any doctor with any conscience can look at her and know that she does not have a terminal disease and know that she has some function.'"
I'm a doctor, and there is no way I can look at her image on a TV screen and come up with any informed medical opinion. I'm not sure how they can either.
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Come see what other blogs have to offer outside the medical blogosphere.
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Tuesday, March 22, 2005
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"The 2004 figure broke the previous record, which had been set in 2001."
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"You do things to avoid being sued and it so affects what you charge. You order tests even when there is only a marginal chance that something will be found, and the cost is unbelievable. Some malpractice premiums are $100,000 a year. That has to come out of what the patients pay.'' (via Common Good)
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Certainly getting dangerous in the medical workplace. This story from my old stomping grounds hit home.
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"'I liken this with taking an aspirin for bringing a fever down,' said Evan Jenkins, executive director of the West Virginia State Medical Assn. and a state senator. 'Trial lawyers want you to think when you take the medicine, you'll see the effects immediately, but it takes a little time.'"
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Come get your weekly best of the medical blogosphere.
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Monday, March 21, 2005
A cautionary tale showing that a transition to EHR is easier said than done.
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Sunday, March 20, 2005
"Dr. Gustave Kreh is doctor at Pediatric Associates of Savannah. He's treated kids like Gabrielle for almost 30 years. He used to think nothing of calling in a prescription for something minor, but not any more.
'It has to be a case-by-case basis, but we will be very hesitant to call in a prescription without seeing a child at this point,' he said.
That's going to cost parents more time. 'Especially being a working mom,' said New. 'It's difficult to take off and bring them to the doctor, so it would be hard and irritating to not be able to do that.'
Doctors will not only actually see more children, they will also be referring many of their patients to specialist as an added safeguard. That will cost parents more money." (via Common Good)
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"Advanced Cardiac Specialists, a statewide physicians practice with offices in the East Valley, bought two pacemakers on eBay for $411, according to Sacramento, Calif., police and medical board records. The devices are worth about $6,000 each."
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"In the doctor's office, you always have to wait your turn. So you learn to make the best of the time in a quiet corner of captivity."
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"If the U.S. House and Senate agree on a law which President Bush signs tomorrow which will permit the family of Terri Schiavo to attempt to overturn 7 years of detailed and consistent judgments in the Florida courts by starting the whole process in the federal courts, does everyone realize what the consequences of this action would be?"
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Saturday, March 19, 2005
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"While I knew it was taking a toll on my life and affecting my practice style, I had no idea how much until I got out here. Using my clinical judgment without the threat of second-guessing and Monday-morning quarterbacking not only improves care, but also drastically cuts down on CYA testing. It's great to be a doctor rather than a fearful technician wondering from where the next hit is coming." (via PointofLaw.com)
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"Shafer was using an electrocauterizing tool to seal off small blood vessels in Corrado's eyelids when the device generated a spark that caused a flash fire over Corrado's face.
The fire spread to surgical draping around Corrado's head and along a plastic tube that had been run up her neck, taped to her chin and inserted into her nose. The fire also burned hair on her face and head."
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"Republican lawmakers have unveiled their own notion of medical-malpractice-insurance reform, a package they have named Plan A.
Like Plan B, announced Monday by Democratic leaders from the House and Senate, it is meant to be an alternative on the fall ballot to initiatives 330 and 336, the doctors' and lawyers' proposals, respectively, for changing the medical-malpractice system."
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"A new study suggests that medical malpractice jury awards are not significantly lower in states that already limit compensation for a patient's pain and suffering. Instead, lawyers are finding clever ways around the limits, either by emphasizing their clients' medical expenses or by placing a dollar value on domestic services, such as housekeeping."
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"The process of starving to death seems very barbaric but in actuality is very peaceful."
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The letter added: "If the person named on this computer-generated letter is deceased, please accept our sincere apologies."
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Friday, March 18, 2005
Attention grabbing
A billboard in Australia promoting the use of sunscreen to prevent skin cancer.
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Thursday, March 17, 2005
"'I think there's a regrouping going on. They're going to be terribly, terribly careful,' says Frank Ginsberg, CEO of advertising agency Avrett Free Ginsberg.
He and others expect fewer ads in the future that name a prescription drug — and thus usually have to include potential side effects — and more general ads that describe medical conditions and then direct consumers to doctors, Web sites and 800-numbers for specific product and risk information."
It's not a ban on DTC ads, but a reasonable compromise. Too bad it had to take the Vioxx and Celebrex debacles to realize their folly.
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"In general, it costs about $45 to purchase and perform the test. But Medicaid and Medicare reimburse doctors only $8 for the test.
'You can see that a doctor who might want to use this test would actually lose money every time he tries to accurately and rapidly diagnose the flu,' Grover said."
Dr. Grover is sadly misguided, suggesting that money is a motivating factor. Influenza is largely a clinical diagnosis, and the rapid flu test really isn't needed during flu season:
A decision analysis performed before the availability of PCR based testing assessed the value of rapid diagnostic testing prior to the use of neuraminidase inhibitors versus empiric use of these antiviral agents. This analysis concluded that rapid diagnostic testing was appropriate first except during influenza epidemics. When the probability of a case being due to influenza reached 42 percent, the two strategies were equivalent.So once again the media misleads, as not everyone warrants a rapid flu test.
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"The British Association of Plastic Surgeons even said some people saw them in a similar vein as hairdressers."
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Wednesday, March 16, 2005
Dr. Judson Lively will return in two weeks as Dr. Judy Lively.
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"Imagine you are the only doctor in a small, isolated northern community. You're single. The law says you're not allowed to have sex with your patients. Since everyone in the community is your patient, that means you're not allowed to have sex. Period."
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"What happens if he says I need a back operation and I have to go on the waiting list for that?"
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It has been written before that there is poor data supporting the use of vitamin E for the prevention of cancer and heart disease. Now comes a study suggesting an association with heart failure. An editorial asks, Is there hope for vitamin E? I say no.
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"Richard Cupp, a Pepperdine University law professor, says that if courts routinely start to award emotional damages to pet owners, veterinary care will cost more, leading to 'more suffering' among pets because 'fewer pets will get sent to the vet.'"
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