Friday, August 31, 2007

Placebo Television #5

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'Nuff said



(via Dr. Wes)

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Why physicians get irked by "suits"

Like Billy Walsh on Entourage, doctors have disdain for "suits". Here's why:
But now the intrepid blogger of Over My Med Body may be getting an inkling why doctors who have had years of training like this can get so upset when their dedication, knowledge, or work habits are questioned by some "suit" with a six-, seven-, or eight-figure income, a "suit" who is comfortably in bed every night of the week, and who never has to handle an emergency, much less a patient throwing up blood, hallucinating, and febrile at three in the morning.

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Medicare error P4P

Dr. RW looks further at the unintended adverse consequences, saying it will outweigh any benefits.

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Evidence-based medicine

Pallimed looks at several recent articles discussing EBM.

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Doctors treating themselves

As common saying goes, "A physician who treats him(her)self has a fool for a patient."

So, what to make of these numbers?
. . . a survey conducted of Michigan psychiatrists regarding their opinions toward self-prescribing. A survey of more than 500 Michigan psychiatrists showed that more than 40% would medicate themselves for mild to moderate depression and that 15% had actually done so in the past. Seven percent of psychiatrists said they would treat themselves for severe depression or depression involving suicidal ideation.

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Zero percent financing

Coming soon to a doctor's or dentist's office near you:
For $3,500 laser eye surgery, $6,000 ceramic tooth implants or other procedures not typically covered by insurance, millions of consumers have arranged financing through more than 100,000 doctors and dentists that offer a year or more of interest-free monthly payments.
Richard Reece comments on the practice.

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Resident work hours: An alternative view

Zagreus Ammon with a somewhat different take:
I don't think working forty eight hours straight is the problem. More likely the fact that those 48 hours have become as grueling and punishing as an ultra-marathon. The fact is that medical interventions have become much more intense than ever before and no patient lounges around the hospital waiting to get better. The cost-containment pressures on the health care system have made the job insane. I would rather residents spent the hours, but sharply reduced the number of patients they followed. At least they would realize some of the original benefits of spending long hours in the hospital.

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WSJ: Medical records as a "credit score"

Any errors in medical records can hinder the chance of obtaining insurance.

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Big Pharma's Wikipedia editors

Abbott Labs has an in-house employee editing various Wikipedia entries pertaining to their drugs:
As other observers have noted since the Wikipedia tool was released, other companies have edited their Wikipedia entries — sometimes making small changes, sometimes making their entries sound more promotional — but the Abbott case was particularly striking because it involved the deletion of a reference to safety study published in a major medical journal (albeit a reference that may have been added to Abbott’s entry by an industry critic, and without a link to the study itself).

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Job board



The latest jobs on the Kevin, M.D. Job Board:


Together with The Health Care Blog, your job post will be viewed by readers of two prominent health care blogs, with a targeted audience of physicians, nurses, health IT, and other health professionals.

Post your job listing now.

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MedBlog Power 8

8/22/2007-8/29/2007
Next revision: 8/29/2007



(Key: Rank, Blog name, Last week's rank, Post of note)

1) Surgeonsblog (5), Fast Relief, and Simple

2) The Physician Executive (6), The Utlilization of Evidence: A Dangerous Problem with Regulation

3) RangelMD.com (1), The WHO's World Health Care System Rankings

4) Musings of a Distractable Mind (3), Why Google Healthcare is Scary

5) Musings of a Dinosaur (7), An Inexact Science

6) Notes from Dr. RW (-), Criticize Sicko, face the Thought Police

7) Medpundit (4), Big Dr. Brother

8) Emergiblog (-), Pearls of Wisdom for Perioperative Purveyors

The MedBlog Power 8 is a list of medical blogs that have had an exceptional week of blogging, based purely on my subjective measures. Factors I consider are how provocative the posts are, the amount of discussion it generates, and posting frequency.

The list is revised every Wednesday and will be published every 2-3 days on Kevin, M.D. If you want me to consider your exceptional week of blogging, you can contact me.

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Thursday, August 30, 2007

Is it wise to use a "wide stance" when you go to the bathroom?

Slate with the answer:
No. When you're sitting on the toilet, spreading your feet and leaning forward tightens the levator ani muscles that control defecation. If you're having trouble passing stools, you should take the opposite of a wide stance, and lean back. Doctors recommend this technique to relax the bowel muscles.

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"Doctors do best when they treat their patients by the numbers"

McArdle on Groopman's How Doctors Think. I agree with her, and continue to advocate global, evidence-based measures (which also would help the medical malpractice/defensive medicine problem) to guide clinical decision making:
Every profession resists being told that there is a standard way to do things, that a cookie cutter can cut better than their skilled hand. Journalists famously hate the "inverted U" style of writing a news story, even though it really does seem to work better than anything else; it's boring to write, and leaves no room for individual style. Teachers don't like "teaching to the test" or rigidly programmed phonics curricula, even though the latter produces measurably better results than all but the very best teachers. Unfortunately, for many of us, it may be time to welcome our new robot overlords.

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Labor day and resident physicians

Dr. Val thinks about the hardworking residents working this upcoming Labor Day weekend:
Physicians work for 3-7 years after graduating from medical school, and are paid (on average) about the equivalent of a home health aide or a medical secretary but work about twice the hours during residency. In fact, if you calculate out the salary by the hours they work, resident physicians are paid about $9 -$10/hour which is roughly $1.50 more than minimum wage.

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"Dr. 10/10 puts in his own chest tubes"

Don't tempt the medicine gods.

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First night on call

Graham's first night on call during his medicine sub-i: "Man it sucked."

Don't worry, it gets better. An attending once told me to always look at the orders first, then the note. When it comes to things getting done, the note means nothing. This is especially true out of academic medical settings when you have several consultants and cross-covering physicians writing orders on your patient.

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Are opiate contracts "absurd"?

This anesthesiologist thinks so:
How do you protect yourself? An opiate contract! These things, for which there is no evidence of any effect whatsoever, are proliferating at a terrific rate (9). To sum it up: you compel the patient to sign a contract which states: Honestly, I’m not lying, I’m in pain. It’s like asking a used car salesman if he’s telling you the truth; it’s not only pointless, it’s absurd. Opiate contracts are supposed to shift the burden for patient’s malfeasance onto them. I wouldn’t count on it. The entire notion is surreal if you think about it.

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About that amputated finger in Sicko

A hand surgeon comments on this vignette in the movie:
As a hand surgeon who treats many traumatic injuries, Moore's portrayal of a patient who amputated his middle fingertip captured my interest. He depicted this uninsured man as required to pay $23,000 to have his finger "saved." Moore lost considerable credibility here. Most hand surgeons would never consider micro-surgically replanting this table saw injury at the finger nail base. Rather, this unfortunate injury would have been comfortably and safely treated -- without reattachment of the severed bit of finger -- in an office procedure room for $1,000 or less.

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Doctor shortage hits Japan

It's not only here that there's a critical shortage of physicians:
Japan's health minister promised to try to resolve a shortage of doctors after a pregnant woman miscarried in an ambulance during a frantic three-hour search for a hospital that would accept her.

Eight hospitals turned down the 38-year-old woman, who was six months pregnant, and the ambulance carrying her collided with a minivan on its way to the ninth, said a fire department official in Nara, western Japan.

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A man loses the top of his head

Apparently, it was argued that the replacement was better:
Doctors removed the top of the man's head and put it in cold storage while they operated on his brain, the court in the western city of Koblenz said Tuesday.

Because the refrigerator was defective, the section of skull was not kept cool enough and could not be reattached. Doctors replaced the bone with a plastic prosthesis.
(via Medgadget)

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Exubera: "Another blow for the bong"

The punching bag of new medications takes another hit:
Analysts were forecasting blockbuster annual sales of $2bn (£1.01bn, E1.49bn) for the insulin spray. It delivered just $4m in the second quarter of 2007 – the first time Pfizer disclosed sales of the product.

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Mickey Mouse sign



(via Radiology Picture of the Day)

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More on Botox vs mole checks

More on the no-brainer study suggesting it's easier to see a dermatologist for Botox:
This can be spun in two ways. #1. Dermatologists are greedy and make patients with a potentially cancerous skin lesion wait weeks while cosmetic patients get through to the front of the line. #2. Health Insurance is willing to pay a professional with 12 or more years of advanced training as little as $20 to evaluate a potentially fatal condition. Take your pick.

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Exception to the rule

Sometimes urgent care visits do go right:
He listened, and expressed understanding. Then he said "doctor, I don't care how it looks when you're done...and I don't care if I have to deal with complications; as long as you do your best, I will be happy. Please try, I don't want to go to the ER...especially if you can fix it." (hmmm...can I get that in writing? Does that count as informed consent? Will that hold up in court?).

So, the doctor in me...that part who doesn't want to base every medical decision I make on what's defensible in court, but rather do what's best (and within my capacity) for people...over took me.
(via Scalpel)

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Health care reform

Despite the attention the issue is getting, don't expect too much to change.

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Physician salaries are not keeping up with inflation

Nonphysician providers are reporting healthier pay increases:
Doctors are increasingly squeezed by soaring costs and declining payments from insurers and Medicare. The slipping salaries came as primary-care physicians reported a 3.7 percent increase in gross charges, while specialists charged 2.3 percent more.

"Patients can expect to feel the pinch right along with practices as physicians in some specialties see more patients each day for incongruous pay," said William Jessee, president and CEO of Arapahoe County-based MGMA.

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Tennis player versus urologist

It's US Open time, and The Independent Urologist compares income potential, threats, lifestyle and overhead for these two professions.

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Hysterectomy, the ovaries and dementia

A link between removing the ovaries and dementia?
Researchers at the Mayo Clinic compared a group of women who had their ovaries out before menopause for reasons other than cancer with a group of similar women who didn’t have their ovaries out. The women who’d had their ovaries out had a higher risk of developing several neurological problems — including dementia, cognitive impairment and parkinsonism, which is related to Parkinson’s disease — than women who hadn’t had their ovaries out.

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Why don't we call doctors by their first name?

Code Blog wonders aloud:
Why don't we call doctors by their first names? Is it a sign of respect to say "Dr. Jones" instead of "Fred?" Or is it a throwback to the era when nurses used to scramble to give up our seats when a physician walked onto the unit? These days, nurses work more closely with physicians than ever. We call ourselves the "healthcare team." Do teammates have to address other members with a title?

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Healia



I would like to thank Healia for their continuing sponsorship at Kevin, M.D.

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To learn more about Healia, visit The Healia Health Blog and the About Healia page.

Sponsorship opportunities continue to be available. This can be via a Standard Blogad or a customized package. Please visit the advertising information page for further details.

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MedBlog Power 8

8/22/2007-8/29/2007
Next revision: 8/29/2007



(Key: Rank, Blog name, Last week's rank, Post of note)

1) Surgeonsblog (5), Fast Relief, and Simple

2) The Physician Executive (6), The Utlilization of Evidence: A Dangerous Problem with Regulation

3) RangelMD.com (1), The WHO's World Health Care System Rankings

4) Musings of a Distractable Mind (3), Why Google Healthcare is Scary

5) Musings of a Dinosaur (7), An Inexact Science

6) Notes from Dr. RW (-), Criticize Sicko, face the Thought Police

7) Medpundit (4), Big Dr. Brother

8) Emergiblog (-), Pearls of Wisdom for Perioperative Purveyors

The MedBlog Power 8 is a list of medical blogs that have had an exceptional week of blogging, based purely on my subjective measures. Factors I consider are how provocative the posts are, the amount of discussion it generates, and posting frequency.

The list is revised every Wednesday and will be published every 2-3 days on Kevin, M.D. If you want me to consider your exceptional week of blogging, you can contact me.

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Wednesday, August 29, 2007

Primary care crisis in northern New York

What's the point of enjoying the scenic living if you're on call all the time?
Typical was what one primary care doctor who recently left for an out-of-state job and a 50 percent salary hike told Mundy: "I came here knowing I'd make less money, but I did it for the rural lifestyle. I never had time to enjoy the mountains. I'll leave, make a lot more more money and bring my family back to the Adirondacks on vacation."
It's probably time to stop thinking that physicians are more altruistic than others:
"This nation's set of values has not extolled the social worker model of the physician of old," Fein said. "Making the most money has become the way we've come to assess things. I don't expect doctors to be better than the rest of us."

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Plastic surgeon to the stars

A profile of "one of the most famous plastic surgeons in history", and the trail of lawsuits against him:
Few doctors can boast a résumé quite as impressive as Jacobs's. After growing up in Queens and Long Island, Jacobs attended SUNY Albany and got his medical degree from McGill University. He did his residency at St. Luke's Roosevelt Hospital Center, where he says he'd already amassed a large patient following before setting up a private practice in 1995. With aggressive use of Internet marketing, his patient list grew worldwide by the late '90s, and he became particularly renowned among Austrian women. He's done work on four Playboy Playmates and countless Playboy models, who have autographed copies of their covers for him to display at his Upper East Side office. Before he sold it to cover his legal expenses, his old Porsche boasted the license plate "BUNNYMAKR."

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How much does a medical transcriptionist edit dictations?

There can be various degrees of editing involved:
Physician dictates: No tenderness present over chest
Transcribed: No tenderness is present over the chest.

Physician dictates: Came in with chest pain
Transcribed: The patient came in with chest pain.

. . . I was instructed to type exactly what the physician dictated. I only changed or edited sentences such as when doctor dictates throughout the report he or she performed surgery on the left leg, and then suddenly changed it over to the right leg before the report was finished. And when I made such a change, I carefully read previous dictations and diagnosis of patient to be certain which leg the doctor actually performed surgery upon!

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Man gouges out his own eyes, gets a $2.2 million hospital bill

The patient was a schizophrenic who was supposed to be restrained during the incident.

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Doctors in executions

Great lengths go to shielding physician identities:
At all Florida lethal injections, a man in a purple moon suit leans over the dying inmate to listen for a heartbeat and feel for a pulse. After a few seconds, he nods, and the witnesses are informed that the death sentence has been duly carried out.

The man is a doctor and the gear shields his identity — not just from the prisoner’s family and friends, but from the American Medical Association, whose code of ethics bars members from participating in executions.

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Fired for not providing care to illegal immigrants

The story of Gene Rogers:
As the medical director for Sacramento County's Indigent Services program for the better part of the past decade, Dr. Rogers has waged a long fight against the central California county's practice of providing non-emergency medical care to illegal immigrants — a policy he says violates federal law and results in the poorest American citizens being denied the care they deserve.

That fight cost Dr. Rogers his job.

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Studies of the obvious: It's easier to get a dermatologist for cosmetic procedures

Physicians will respond to financial incentives. So clearly, this makes sense:
Patients seeking an appointment with a dermatologist to ask about a potentially cancerous mole have to wait substantially longer than those seeking Botox for wrinkles, says a study published online today by The Journal of the American Academy of Dermatology.

Researchers reported that dermatologists in 12 cities offered a typical wait of eight days for a cosmetic patient wanting Botox to smooth wrinkles, compared to a typical wait of 26 days for a patient requesting evaluation of a changing mole, a possible indicator of skin cancer.
If someone really wanted to solve the primary care crisis, it can be easily done - simply increase compensation and doctors will respond.

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Defibrillators in schools

Cardiologist Dr. Wes with his thoughts.

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Job board



The latest jobs on the Kevin, M.D. Job Board:


Together with The Health Care Blog, your job post will be viewed by readers of two prominent health care blogs, with a targeted audience of physicians, nurses, health IT, and other health professionals.

Post your job listing now.

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Patient poaching

Lose a patient to a hospital-owned practice? It's not an uncommon occurrence.

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Pleasing medical terms to the ear

Dr. Rob with a list of the best medical terms to say aloud. With audio goodness.

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Black market isoniazid?

This medication is relatively cheap, and I'm not sure people would go out of their way to take this. But that doesn't stop the spammers.

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EMT complaints

Tom Reynolds writes about some complaints he sees against EMTs:
As you can see some people are quick to complain, or just don't understand the job that we do. Remember that I was complained against for saying that a patient hits like a girl after he assaulted me - and the complaint was fully investigated. I wonder if that is in a Trust report somewhere...

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Drug-seekers, again

Scalpel and ER Nursey with more ways to detect drug-seeking behavior.

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What killed Beethoven?

Lead poisoning is the common answer. However, new analysis (found in the Beethoven Journal - which I never knew existed) sheds new light:
Christian Reiter has conducted months of painstaking work applying CSI-like methods to strands of Beethoven's hair.

He says his analysis, published last week in the Beethoven Journal, found that in the final months of the composer's life, lead concentrations in his body spiked every time he was treated by his doctor, Andreas Wawruch, for fluid inside the abdomen. Those lethal doses permeated Beethoven's ailing liver, ultimately killing him, Reiter said.

"His death was due to the treatments by Dr. Wawruch," said Reiter, head of the Department of Forensic Medicine at Vienna's Medical University. "Although you cannot blame Dr. Wawruch -- how was he to know that Beethoven already had a serious liver ailment?"

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"Free" EMR

What's the catch?

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MedBlog Power 8

8/22/2007-8/29/2007
Next revision: 8/29/2007



(Key: Rank, Blog name, Last week's rank, Post of note)

1) Surgeonsblog (5), Fast Relief, and Simple

2) The Physician Executive (6), The Utlilization of Evidence: A Dangerous Problem with Regulation

3) RangelMD.com (1), The WHO's World Health Care System Rankings

4) Musings of a Distractable Mind (3), Why Google Healthcare is Scary

5) Musings of a Dinosaur (7), An Inexact Science

6) Notes from Dr. RW (-), Criticize Sicko, face the Thought Police

7) Medpundit (4), Big Dr. Brother

8) Emergiblog (-), Pearls of Wisdom for Perioperative Purveyors

The MedBlog Power 8 is a list of medical blogs that have had an exceptional week of blogging, based purely on my subjective measures. Factors I consider are how provocative the posts are, the amount of discussion it generates, and posting frequency.

The list is revised every Wednesday and will be published every 2-3 days on Kevin, M.D. If you want me to consider your exceptional week of blogging, you can contact me.

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EMR Experts