Sunday, July 31, 2005
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"Even patients who decide on a concierge practice may find themselves back in managed care, as those of Dr. Enrico J. Versace, in West Yarmouth, Mass., discovered recently. Dr. Versace said he spent $100,000 on consultant fees and marketing to establish a practice charging $3,000 a patient two years ago. There were complications from the beginning. Although he wanted 40- to 60-year-olds, he said almost half his patients were over 75. Many demanded house calls, often leaving his office unused. Although he told his patients that he was available at all hours, he said he felt that some patients abused the system. "They'd call on weekends, telling me they were feeling better," he said. He sent out a reminder notice that after-hours contacts were only for emergency care.
After two years, as their contracts ran out, he referred patients to other doctors. He closed his practice in March and is now on the staff of Cape Cod Hospital, in Hyannis."
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"As the number of organ donors doubled to 14,154 between 1992 and 2004, the number of patients on the waiting list tripled to more than 89,110, according to the United Network for Organ Sharing. Last year, about one in 12 of them died before receiving an organ.
Desperate to avoid the same fate, more and more patients are pleading for donations in classifieds and on the Internet. There are now hundreds of Web sites, with names like helpmygrandpa.com, and jimneedsakidney.com."
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Saturday, July 30, 2005
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I think this just shows the amount of distrust that people have for scientific studies. Even when a respected journal like NEJM reports this, it doesn't really matter. And who can blame them? Patients have been back and forth about Vioxx and hormone replacement therapy with conflicting studies. All one can do is present the (lack of) evidence, make your recommendations, and leave the ultimate decision up to the patient.
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"'This is a triumph of the model of medicine that has abandoned the idea of personal interaction and providing comfort in favor of a model of the patient-physician interaction as essentially an exchange of information,' said David Magnus, a Stanford University bioethicist. 'You can see a face, but there's no touch, no laying on of hands, no personal contact. We're increasingly isolating people in a sea of technology.'"
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Friday, July 29, 2005
"Featuring news, commentary and legislative action about the medical liability crisis, which impacts both physicians and patients by limiting access to quality medical care." (via PointofLaw.com)
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After his embarrassing, lemming-like Schiavo debacle, he breaks from Bush in stem-cell research.
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"Dr. Thomas Hurley, president-elect of the Illinois State Neurosurgical Society, told the Chicago Sun-Times his case illustrates the problem of allowing big awards that raise doctors' insurance rates.
He said his annual malpractice insurance premium would probably increase from the current $245,000 to $300,000 or more.
The legal action was by Richard McCorry, a Chicago factory worker who went into surgery with a bad back and came out paralyzed, the Sun-Times said.
The surgery occurred in 1994, Hurley's second year of practice.
Hurley said he warned McCorry, as he does all of his patients, that spinal surgery is risky and can result in paralysis. He told the newspaper in 12 years of practice, performing 150 surgeries annually, that was the only such incident."
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"The bill, approved by a vote of 230-194, would cap awards for pain and suffering at $250,000. There would be no limit on economic damages, which provide reimbursement for such expenses as medical bills and lost wages. Finally, the bill would in many cases cap punitive damages at $250,000."
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"Colvin is a professional patient, trained to role-play specific medical conditions to train nursing students, emergency medical personnel, police, medical students and residents at the Center for Studies of Clinical Performance at the Northeastern Ohio Universities College of Medicine.
Officially, Colvin is known as a 'standardized patient.'"
The toughest standardized patients to be would be the ones where medical students would practice pelvic exams on.
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"Despite suffering a heart attack days before his 100th birthday, Tom
Soulby, a former engineer, says he is still fit to drive his
24-year-old Austin Metro, which has only 24,387 miles on the clock."
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"After discovering 73 fake packets, the MHRA decided to recall all that remains of a 120,000-packet batch, each containing 28 x 20mg Lipitor pills, marked 004405K1 and imported into the country in February. The alarm was raised last week after customs officers confirmed that they had intercepted fakes in the Dutch port of Rotterdam in late May."
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I suspect the same is true in the US. No wonder so many physicians take the easy way out and just prescribe a sedative medication for insomnia.
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Thursday, July 28, 2005
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Would they have published the study if the answer was no? (via Blogborygmi)
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"In evaluating patients who have chest pain, some emergency room physicians too often order unnecessary tests and hospitalizations out of fear of malpractice lawsuits, according to a new study. 'Concern about malpractice has a formidable effect on physician decision making,' particularly in the scenario of a possible heart attack or unstable angina, collectively referred to as acute coronary syndrome, Dr. David A. Katz told Reuters Health.
Katz, from University of Iowa, Iowa City, and colleagues developed a malpractice fear scale and used it to evaluate the association between emergency physicians' fear of malpractice and the evaluation and treatment of patients with symptoms suggestive of an acute coronary syndrome.
The findings are reported in the online issue of Annals of Emergency Medicine.
Patients seen by ER doctors with the highest scores on the malpractice fear scale were significantly less likely to be discharged from the emergency room than were patients seen by ER doctors with the lowest scores, the authors report. The trend persisted when only low-risk patients were included in the analysis.
Physicians with the highest malpractice fear scores were also more likely to admit patients to monitored beds and to order laboratory tests and chest X-rays in the emergency room, the report indicates . . .
. . . 'Our findings that high-fear physicians are more likely to admit patients with symptoms of possible acute coronary syndrome (including low-risk patients) and to obtain more diagnostic tests in these patients suggest that the initial costs of care are quite a bit higher for this group of physicians.'"
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Seems like a potential new indication is cropping up every day: "In the latest research to suggest that the popular cholesterol-lowering drugs known as statins are good for more than the heart, a new study hints that the medications may help curb the spread of HIV throughout the body.
In the study of nearly 4,000 HIV-infected people, those taking statins tended to have lower levels of the virus in their blood compared with those not taking the medications, says researcher Homayoon Khanlou, MD, of the AIDS Healthcare Foundation in Sherman Oaks, Calif."
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"The patient, Spencer Sullivan, entered UCSF Medical Center on Dec. 26, 2001, for routine elective neck surgery, which was successful, according to a June 20 legal brief summarizing the plaintiff's case. Following the surgery, however, Sullivan "was grossly overmedicated and then grossly underobserved," leading to irreversible brain damage, according to the brief, which argued that a lack of coordinated care and oversight led to a narcotic overdose. As a result, Sullivan, now 44 and in a chronic vegetative state, will need medical care for the rest of his life."
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"However, there is a reason why the cyber doctor may be getting such a foothold in our society - cost.
While an accident which puts a victim into the emergency department followed by six months recovering in a ward is all courtesy of the taxpayer, a one-minute visit to a GP to have him give a few reassuring words about a funny looking mole or a worrying lump results in a $40 bill.
There are issues with online consultations and self-diagnosis, but it is wrong to blame the internet; the problem lies with how our health system is funded and the distortion caused by the fact that some services are charged for while other, much more expensive ones, are completely free."
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"The rare surgical feat of removing a 16.5kg malignant bone tumour -- so far the largest of its kind -- from the right femur (thighbone) of a patient has earned for an Indian doctor a place in the latest edition of Guinness Book of world records.
Dr. B K S Sanjay, Director of the Dehra Dun-based Doon Paramedical Hospital in Uttaranchal, carried out a 10-hour surgery on 35-year-old Naresh Kumar.at the Himalayan Institute of Medical Sciences, Dehra Dun on June 10, 2002. The tumour (chondrosarcoma) had a maximum length of 45 cm and was 30 cm wide."
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"Financial pressures have made house calls difficult to impossible for most physicians in recent years. Today's typical doctor feels compelled to see as many patients as possible in the doctor's office. Patients who can't get there on their own may find themselves scrambling for a ride - or just getting sicker.
But house calls are making a small but noteworthy comeback, fueled by growing numbers of homebound elderly, mobile medical technologies and physicians who want to connect more with patients. Although house calls aren't for everyone, and only a small fraction of doctors currently offer the service, it is a trend that is gaining traction."
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"The General Medical Council has won its appeal against a ruling which gave a seriously-ill patient the right to stop doctors withdrawing food and drink.
Leslie Burke, 45, who has a degenerative brain condition, fears artificial nutrition could be stopped against his wishes when he cannot talk.
Mr Burke, from Lancaster, had won a landmark ruling, supporting his right to artificial nutrition and hydration.
But the GMC appealed, saying doctors could be put in an impossible position."
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Wednesday, July 27, 2005
A new study - 4 different headlines
A study about perioperative beta-blockers came out in the NEJM. Here are some articles showing divergent headlines:Study: Beta Blockers Don't Help All
Beta blockers don't help people with low heart risk after surgery
Beta blockers and surgery not a good mix?
Cardio Drugs May Prevent Surgery-Linked Heart Attack
Here is the real conclusion:
Perioperative beta-blocker therapy is associated with a reduced risk of in-hospital death among high-risk, but not low-risk, patients undergoing major noncardiac surgery. Patient safety may be enhanced by increasing the use of beta-blockers in high-risk patients.
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"The recommendation rates for additional testing after a screening mammogram are much higher in the United States than in other countries. However, Dr. Elmore said previous studies have shown that a higher recall rate does not necessarily result in higher cancer detection rates."
No surprise given the risk of reading mammograms. (via Common Good)
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"BreathQuant Medical Systems, Inc. is pleased to announce the worldwide launch of its revolutionary PREtest Consult product. The product utilizes a large database of patients with known outcomes to determine the likelihood that a patient presenting to an emergency department or clinic has a life threatening disease.
The risk score generated by this test aids physicians in their decision to pursue further testing and hospitalization.
If the physician discharges the patient without further workup, the physician has mitigated malpractice risk by documenting his/her quantitative basis for decision making. At the same time, this quantitative basis also helps in reducing unnecessary testing, which is a known contributor to the overcrowding epidemic that affects hospitals across the country."
Certainly defensive admissions have been recently discussed as a problem. Will the results from quantitative software such as these stand up in court?
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Tuesday, July 26, 2005
That's impressively current.
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Congrats to all that were included. My new blog, Straightfromthedoc, was also mentioned. (via A Chance to Cut . . .)
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"Mr. Romney's decision will probably have little effect on the measure itself, which passed by veto-proof margins in both houses of the legislature. But it could affect how he is viewed by voters outside Massachusetts should he run for president in 2008, a course he is considering.
Indeed, national conservative groups, which play a critical role in races for the Republican presidential nomination, had been awaiting Mr. Romney's decision as a way to gauge whether the governor of this liberal state was conservative enough." (via Follow Me Here...)
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"And finally, why has the AMA not gotten involved? This is a national medical disgrace (so much so that my venerable surgeon father has sent money to William Hurwitz MD's appeal fund)." (via DB's Medical Rants)
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Come get the weekly best of the medical blogosphere.
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The latest interesting case from the NY Times.
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"Our study lays to rest the myth that expensive care for immigrants is responsible for our nation's high health costs . . . The truth is that immigrants get far less care than other Americans. Further restricting their eligibility for care would save little money and place many immigrants-particularly children-at grave risk. Already, many immigrant children fail to get regular checkups, and as a result more end up needing emergency care, or get no care at all."
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"The only hospital in Nashville is teetering on bankruptcy largely because, some say, it picked a fight with the wrong man: a popular local doctor, who now is referring his patients to hospitals in St. Louis and elsewhere.
Like many small-town hospitals, Washington County Hospital scrapes for every dime, and the grudge match with Dr. Thomas Coy has drained it of both revenue and credibility, officials say.
They say the drop in patients from Coy has contributed to financial shortfalls that could ultimately shutter the hospital, forcing Nashville's 3,200 residents to travel 20 miles or more for even basic medical care."
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Monday, July 25, 2005
"A California woman is suing a hospital for wrongful death because her husband fainted and suffered a fatal injury after helping delivery room staff give her a pain-killing injection.
Jeanette Passalaqua, 32, filed the suit against Kaiser Foundation Hospitals and Southern California Permanente Medical Group Inc. in San Bernardino County state court last week.
In June 2004, Passalaqua’s husband, Steven Passalaqua, was asked by Kaiser staff to hold and steady his wife while an employee inserted an epidural needle into her back, court papers said.
The sight of the needle caused Steven Passalaqua, 33, to faint and he fell backward, striking his head on an aluminum cap molding at the base of the wall.
Jeanette Passalaqua delivered the couple’s second child, a boy, later that day. Steven Passalaqua, however, suffered a brain hemorrhage as a result of his fall and died two days later, the lawsuit said.
The suit seeks unspecified damages related to Steven Passalaqua’s death and to Jeanette Passalaqua’s emotional distress at being widowed with two young children."
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"In Medicare's upside-down reimbursement system, hospitals and doctors who order unnecessary tests, provide poor care or even injure patients often receive higher payments than those who provide efficient, high-quality medicine.
'It's the exact opposite of what you would expect,' said Mary Brainerd, chief executive officer of HealthPartners, a nonprofit health plan based in Bloomington, Minn. Her Medicare HMO ranked among the top 10 in the nation last year for quality but was paid thousands of dollars less per patient by Medicare than lower-performing plans.
'The way Medicare is set up,' Brainerd said, 'it actually punishes you for being good.'"
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"Canada's other big selling point is its national health insurance system, which saves auto manufacturers large sums in benefit payments compared with their costs in the United States." (via CuriousJD)
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"Research by the Mental Health Foundation (UK) today revealed that male GPs are far more likely to prescribe antidepressants as a first treatment response to patients with mild or moderate depression than female GPs (61 per cent, compared to 37 per cent), and are twice as likely to think them effective (43 per cent, compared to 17 per cent)."
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"Hollywood is into crazy. Mental illness, madness, obsessive behavior, multiple personalities, schizophrenia — you name it, it's been depicted by nearly every big star, including Robert DeNiro, Sally Field, Leonardo DiCaprio, Anthony Hopkins and Barbra Streisand."
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"A big spike in insurance premiums could prompt some physicians in high-risk specialties such as obstetrics, neurosurgery or trauma care to stop accepting some patients or move to a state with lower malpractice premiums, health industry officials said.
Early physician retirements are another concern, as is 'defensive medicine,' which is the ordering of unnecessary medical tests to guard against misdiagnoses and potential litigation down the road.
At the very least, increased malpractice insurance costs will be passed on to patients in the form of larger medical bills, said Steve Brenton, president of the Wisconsin Hospital Association, Fitchburg."
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"For the procedure, the maggots -- about 2 millimeters each in size -- are placed on the wound, then surrounded by an adhesive foam, clear tape, and a gauze bandage.
By July 8, the maggots had swelled to twice their normal size and eaten away part of the infection. When Dowling removed the bandages two days later, Enser's foot was looking better. Healthy, pink skin was replacing the dead tissue, and the swelling was down in her foot and ankle.
The maggots do more than just clean a wound. They also dissolve the infected tissue, kill bacteria and leave an enzyme behind that stimulates healing. They will only eat the infected tissue, leaving healthy tissue alone."
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Sunday, July 24, 2005
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"A woman who won breast implants at a nightclub contest ignored gospel singers protesting the event, saying she has a right to do what she wants with her body."
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"The lower number of generic alternatives available in the USA compared to those available worldwide is one of the main reasons that health care costs in the United States are the highest in the world per capita. The reason for the greater number of generic drugs available outside of the United States is that US patent laws are generally not recognized worldwide."
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"Harvard Medical School's major teaching hospitals are considering adopting a sweeping disclosure policy that would establish detailed procedures for physicians to openly acknowledge medical errors and other bad results to their patients, and provide for training in apologizing."
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Saturday, July 23, 2005
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"As quarry for D.E.A. agents, doctors offered several advantages over crack dealers. They were not armed. They were listed in the phone book. They kept office hours and records of their transactions. And unlike the typical crack dealer living with his mother, they had valuable assets that could be seized and shared by the federal, state and local agencies fighting the drug war."
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"Lots of well-meaning, cheery people tell me everything is going to be fine because breast cancer turned out fine for their Aunt Louise or their cousin Helga.
But when my doctor discusses the possibility of whacking off part of my body, frying me with radiation and pumping me full of toxic chemicals that will make me vomit and lose my hair, it does not sound fine to me. In the eloquent words of my teenagers' friends, it sounds like it sucks."
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"But Ellington added that the current malpractice system deprives most injured patients of access to the courts, funnels as much as half an award to lawyers and experts, generates millions of dollars in defense costs, and can prolong awards for years.
The cost of that system is driving up the costs of medical care and limiting patient access to doctors, especially in rural areas, doctors contend.
The health court proposal drew an immediate rebuke from state trial lawyers, who said the possibility of negligence cases being decided by someone other than a jury raises strong constitutional questions.
'If juries are able to be trusted to make life and death decisions in criminal cases, they are certainly able to be trusted to make decisions in medical malpractice cases,' Jack Harris, executive director of the Virginia Trial Lawyers Association, said in an e-mail response.
Ellington and others said juries wouldn't necessarily be stricken but they noted that special courts exist in worker injury cases and maritime and tax law."
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"It will likely make me a better doctor for having experienced all of this."
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"A MELBOURNE doctor risks prosecution after confessing he has helped a terminally ill man who wants to die.
Voluntary euthanasia activist Rodney Syme yesterday revealed he had supplied information to Steve Guest, a former state government media adviser, who has appealed for the right to die with dignity.
Mr Guest, who has inoperable cancer of the oesophagus, was interviewed in The Weekend Australian and has been heard on Melbourne's ABC radio begging for a compassionate release from his suffering. Dr Syme visited Mr Guest in his Point Lonsdale home this week."
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"They stood one by one, more than a dozen people, heaping praise on their beloved former family physician Dr. Denis Deonarine.
They lauded the 60-year-old Jupiter doctor for being an old-fashioned practitioner who gave patients his home phone number and spent a lot of time with them during office visits."
Another reason not to do chronic pain management. All it takes is one bad outcome, and you're toast.
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Friday, July 22, 2005
"I've been in practice for 23 years, and my experience as a cancer patient has taught me a few things, and confirmed things I suspected all along."
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"Heymann had called Iraci in to help him find the needle, and the two doctors spent hours searching for it, eventually closing up Faas' abdomen without locating it."
Those must have been anxious hours trying the find that needle.
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"However, plaintiffs attorney Mark Lanier argues that the sudden death left no time for Ernst's heart to show damage. During Santanello's earlier testimony, Lanier pointed out that Merck's medical manual says arrhythmia in some form occurs in more than 90 percent of heart attack patients."
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"Nine healthcare workers at the hospital who tested positive for TB in recent weeks also probably contracted their infections from the physician, said Dr. Anita Barry, top disease tracker at the Boston Public Health Commission."
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Thursday, July 21, 2005
"Now, however, Medicare, which says the lack of electronic records is one of the biggest impediments to improving health care, has decided to step in. In an unprecedented move, it said it planned to announce that it would give doctors - free of charge - software to computerize their medical practices. An office with five doctors could save more than $100,000 by choosing the Medicare software rather than buying software from a private company, officials say.
The program begins next month, and the software is a version of a well-proven electronic health record system, called Vista, that has been used for two decades by hospitals, doctors and clinics with the Department of Veterans Affairs. Medicare will also provide a list of companies that have been trained to install and maintain the system."
A wonderful move by the government. Vista is a fantastic program that is robust and continually updated. No reason now not to have an EHR.