Friday, May 16, 2008
MedBlog Power 8
5/13/2008 - 5/20/2008Next revision: 5/20/2008
(Key: Rank, Blog name, Last week's rank, Post of note)
1) Health Beat (3), Health Care Reform Via Focus Group
2) WSJ Health Blog (2), Doctor Shortage is ‘Coming On Like A Freight Train’
3) The Happy Hospitalist (1), Doctoring From The Back Seat
4) Musings of a Dinosaur (7), Managing Risk
5) DB's Medical Rants (4), Reasons to become a doctor
6) Dr. Wes (5), MacGyver Moments in Medicine
7) Buckeye Surgeon (-), Surgeon Tryouts
8) Not Totally Rad (-), The Radiologic Appearance of Acute Kindle-itis
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 mid-week and will be published every 1-2 days on Kevin, M.D. If you want me to consider your exceptional week of blogging, you can contact me.
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Reader Takes
Reader Takes is a regular feature where selected op-ed style pieces from the audience at Kevin, M.D. will be published on the blog.Posts are between 500 and 600 words in length, and can argue any opinion related to medicine and health care.
Original articles that are provocative, well-written, free of grammatical or spelling errors, and generally follow these guidelines are preferred.
Once a reader take is published, it will remain at the top of the blog above the fold for one day. A link to the author's book, blog, or website will be included.
Kevin, M.D. receives in excess of 10,000 visits daily, and is regularly read by major media outlets.
The piece will remain exclusive to Kevin, M.D. and may not be republished elsewhere.
If you are interested in submitting a take for consideration, please contact me.
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Panda leaves us
An eloquent writer who was in your face and told it like it was. One of my favorite blogs will be missed.
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More medicine isn't better
Predictable:New techniques for detecting breast cancer may be leading more women to have their entire breast removed . . .Don't want to say I told you so, but:
. . . one possible explanation is that magnetic resonance imaging, which is relatively new, detects more possibly cancerous growths than does mammography. That could be causing patients and doctors to conclude that a lumpectomy, which removes just the part of the breast containing the primary tumor, may not be sufficient.
Every test has the risk of a "false positive," which is a positive test in the absence of disease. Doctors generally act on every abnormal result, so a simple X-ray finding could lead to further tests, such as an advanced imaging scan or biopsy. When you consider that a CT scan can expose patients to radiation equivalent to several hundred X-rays, and a biopsy might have serious complications such as bleeding or infection,there comes a point where increasing the frequency and degree of diagnostic studies could lead to harm.More tests lead to more procedures, which doesn't always help patients.
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Weight loss surgery
Buckeye Surgeon encounters a complication from a Roux-en-Y.
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The "silver tsunami"
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How to videotape surgeries with a camcorder
Tips from a professional videographer.
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Quashing PTSD
TheA psychologist who helps lead the post-traumatic stress disorder program at a medical facility for veterans in Texas told staff members to refrain from diagnosing PTSD because so many veterans were seeking government disability payments for the condition.
"Given that we are having more and more compensation seeking veterans, I'd like to suggest that you refrain from giving a diagnosis of PTSD straight out," Norma Perez wrote in a March 20 e-mail to mental-health specialists and social workers at the Department of Veterans Affairs' Olin E. Teague Veterans' Center in Temple, Tex. Instead, she recommended that they "consider a diagnosis of Adjustment Disorder."
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"Good doctors are the ones who don't take insurance"
Really?The theory is that if a doctor is skilled enough, he or she can fill up their practice with private-pay patients without having to rely on an insurance panel.
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Physician ratings
Like 'em or not, they're here to stay. Reviews of these sites are being index by Google, so physicians should pay attention to them:The “electronic medical grapevine,” to coin a term, is growing in importance. In 2001, the American Medical Association issued a press release suggesting that patients make a New Year’s resolution to “trust your physician, not a chat room.” As with much other New Year’s advice, this proffered piece of wisdom went unheeded. Today, online doctor ratings have become an integral part of an effort to intensify the interactivity of health care sites and thereby make them more attractive to users.(via Our Own System)
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Of course, you can always subscribe using a variety of newsreaders.
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Insidermedicine: In the Clinic - Radioembolization
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| In the Clinic - Dr. John Louie, MD, discusses radioembolization |
Thanks to Insidermedicine for their continuing sponsorship at Kevin, M.D.
Insidermedicine (www.insidermedicine.com) is a physician-led news organization that brings daily evidence-based updates to patients, doctors and medical students. Also available in Chinese and Spanish.
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Thursday, May 15, 2008
My take: Night float, free medical school, triage and disease management
1) After the resident work-hour restrictions were implemented in 2002, there has been more supervision during night float.My take: Good for patient safety, bad for training. Being independent on the overnight cross-coverage team provided one of the best learning opportunities during residency.
2) The Cleveland Clinic's medical school is going tuition free.
My take: Brilliant. These students will have substantially less debt burden than the average medical student. Hopefully their choice of specialty will have less of a financial motive, increasingly the likelihood they would choose a generalist field.
If this trend spreads, top-tier students will find medical school attractive again.
3) A reader writes: "I was reading the WSJ saw a full page color ad showing a father and his 3-year-old daughter, saying something like 'when my daughter had a fever of 103 last night, I'm glad I got to speak to nurse instead of an answering machine' . . .
. . . These kinds of programs, along with 'disease management' programs for e.g. asthma and diabetes, are bunch of crap. If anything, they only serve to further fracture care . . .
. . . I think these programs are really designed to avoid trips to the ER, and ultimately save insurers money."
My take: Couple of points here.
Not all physician offices use answering machines off-hours. Patients in my practice can reach a doctor 24 hours a day.
I agree that one goal of telephone triage is to reduce ED visits, and thus costs. Liability however, becomes an obstacle, as it is impossible to diagnose accurately over the phone. Can you be 100% sure that the child with the 103 degree fever didn't have meningitis? If the health insurer is willing to accept all malpractice liability for their off-hours telephone triage service, I have no problems with it.
Disease management programs certainly have their place. Working in conjunction with a primary care physician, they can be helpful adjuncts to ensure that patients are up to date with lab tests and are taking their medications.
Problems arise when they intervene with therapeutic decisions independent of the physician. Having a clear, centralized decision maker is a necessity when multiple providers and nurses are caring for the patient.
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Want my take?
This is a periodic open thread to solicit issues people want me to blog about, or to simply ask me a question. Suggest topics and links in the comments of this post, or you can e-mail me.I'll choose a few to put into my regular "My take" feature.
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Congrats to Dr. Rich
The Covert Rationing Blog turns one year old. See some of his best posts.
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"Trial and error is part of the healing process"
People sometimes forget to realize that medicine is an inexact science.
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John Ritter defendants: "They just lost less"
EM News: "In the Ritter case, the jury agreed with the defendant physicians and exonerated them of any liability. They were lucky. How lucky? They were able to spend four years with attorneys worrying about their future, including the potential that they would be ordered to pay tens of millions of dollars and be left penniless.So, they didn't really win. They just lost less."
(via Dr. RW)
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MedBlog Power 8
5/13/2008 - 5/20/2008Next revision: 5/20/2008
(Key: Rank, Blog name, Last week's rank, Post of note)
1) Health Beat (3), Health Care Reform Via Focus Group
2) WSJ Health Blog (2), Doctor Shortage is ‘Coming On Like A Freight Train’
3) The Happy Hospitalist (1), Doctoring From The Back Seat
4) Musings of a Dinosaur (7), Managing Risk
5) DB's Medical Rants (4), Reasons to become a doctor
6) Dr. Wes (5), MacGyver Moments in Medicine
7) Buckeye Surgeon (-), Surgeon Tryouts
8) Not Totally Rad (-), The Radiologic Appearance of Acute Kindle-itis
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 mid-week and will be published every 1-2 days on Kevin, M.D. If you want me to consider your exceptional week of blogging, you can contact me.
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Why is the government continuing to fund chelation trials?
Dr. RW: "This tops any example you can trot out about the corrupting influence of Big Pharma. What I didn’t cover in my posts was the extent of the pseudoscientific agenda and conflicts of interest that prevailed throughout the planning and implementation of the study. If you think government funding is the answer to Pharma involvement in research this article will give you pause."
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Dr. Anonymous Show, LIVE tonight at 9pm EST
Dr. A takes your calls and talks about his recent Vegas trip.Here's how to listen.
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A disease that needs advertising
How generic Requip may lead to the extinction of restless legs syndrome:Last week, the drug agency approved the first generic versions of ropinirole tablets for four manufacturers. The move is likely to send Requip sales and advertising plummeting, industry experts predicted.
At least one sleep disorder specialist expects the focus on restless legs syndrome to fade as rapidly as the Requip television commercials — which have already been pulled from the airwaves.
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Surgeons operating on more than one patient at a time
Should they?
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CBO: Prevention does not save money
Merrill Goozner: "On a down note, he added his voice to the growing conventional wisdom that prevention measures will not generate savings for the health care system. All candidates for president have made prevention promotion a central motif in their health care plans, claiming that it will save the health care system money in the long run by promoting healthier lifestyles and arresting ill-health before it progresses to chronic disease."
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The candidates aren't addressing the physician shortage
Well, it's actually the generalist physician shortage.That's a profoundly troubling oversight, as any attempt to cover the uninsured will stretch the already strained primary care system.
This survey suggests that some physicians may quit if universal coverage is enacted:
Some 20 percent of doctors say they will quit practicing medicine if universal health-care insurance coverage is implemented under the next president . . .
. . . Among nearly 1,400 doctors who answered the survey, 63 percent said they would 'continue practicing like they do today,' 11 percent would change occupations and 9 percent said they would retire.
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Eavesdropping
A drug-seeker listens in on a physician conversation. Mayhem ensues.
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Maybe lawyers need some anti-kickback rules
Lawyers apparently receive referral fees, and can be a third of the award that is won during a case.Pete Stark needs to look into that.
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"Compared to working in the fields, it was easy"
An illegal immigrant becomes a neurosurgeon.
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Should hospitals be fully staffed 24 hours a day?
Joe Wright: "The hospital is a constant production process. But it's in transition: it inherits many of the features of its pre-industrial roots. A truly efficient production process never stops, but the hospital slows down considerably at night. I think there would be a lot to be said for a truly 24-hour hospital. But that would require more health care workers, more money to pay people extra to work overnight, and a completely different way of arranging care."
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Placebo Television
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Insidermedicine
I would like to thank Insidermedicine for their continuing sponsorship at Kevin, M.D.
Insidermedicine (www.insidermedicine.com) is a physician-led news organization that allows you to keep on top of the latest medical information by watching unique videos that are created each and every weekday by Insidermedicine's team of medical experts. Their goal is to reach patients, medical doctors and students around the world to ensure that each is receiving a daily 'evidence based' health and medical update.
Given their wide and diverse audience, Insidermedicine offers health and medical content that is unique for their viewers. Here is a sample of some of their regular programs, which are also available in Chinese and Spanish.
Their videos are highly recommended, and I am excited to include them as a regular feature of this blog.
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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Wednesday, May 14, 2008
MedBlog Power 8
5/13/2008 - 5/20/2008Next revision: 5/20/2008
(Key: Rank, Blog name, Last week's rank, Post of note)
1) Health Beat (3), Health Care Reform Via Focus Group
2) WSJ Health Blog (2), Doctor Shortage is ‘Coming On Like A Freight Train’
3) The Happy Hospitalist (1), Doctoring From The Back Seat
4) Musings of a Dinosaur (7), Managing Risk
5) DB's Medical Rants (4), Reasons to become a doctor
6) Dr. Wes (5), MacGyver Moments in Medicine
7) Buckeye Surgeon (-), Surgeon Tryouts
8) Not Totally Rad (-), The Radiologic Appearance of Acute Kindle-itis
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 mid-week and will be published every 1-2 days on Kevin, M.D. If you want me to consider your exceptional week of blogging, you can contact me.
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"Isn't it time we had a health system run by doctors?"
Ezra Klein makes some sense in analyzing a potentially politically feasible approach to reform.
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The bias against physicians leading health IT
Health Care Renewal: "I believe this and related stereotypes about physicians are a driver and an enabler (either through genuine belief or through disingenuous opportunism) of much that ails medicine today through the interference of non-medical outsiders. The fundamental message is that physicians are children who cannot do anything more than medicine, and require 'a village' of paternalistic non-medical outsiders to manage their affairs."
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The public's confusion
This makes some sense as to why reform is so difficult in America:Lake is not interested in explaining reform; her goal is to market reform. And how do you market a product? By appealing to prejudices, and playing on the ignorance of your audience. If they think a yellow box make it a friendlier product, then put it in a yellow box.
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Amazon Kindle and radiology
How's the screen for viewing plain films?The results? Not too shabby. Although it wouldn't fly for diagnostic purposes, the lace-like pattern of sarcoid in the distal phalanx can still be seen well enough for educational purposes. Of the two dithering modes, I think I prefer the Atkinson algorithm. Also, I have found that an image looks a lot better when it is sized large enough to completely fill the Kindle screen.
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The ACP launches a blog
It's about time. (via Clinical Cases)
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Will P4P kill off public hospitals?
Another possible unintended consequence:In an analysis of three years' worth of key performance measures, these hospitals fared worse at baseline than hospitals with fewer Medicaid patients, and they had significantly smaller improvements thereafter, suggesting a grim reimbursement fate if the model becomes more widespread.
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iMedExchange
I would like to thank iMedExchange for their continuing Premium Sponsorship at Kevin M.D.
If physicians want it, iMedExchange is building it...
It's rare when a company actually listens to their customers. Even more rare when a company has enough insight into their market that they can anticipate their customer needs.
iMedExchange is accomplishing both. A seasoned team of Web 2.0/social networking gurus, along with a team of several hundred physician advisers, is quietly building a new model for physician social networking.
Not satisfied to merely provide clinical information and resources, the iMedExchange model takes into account the additional pressures and challenges facing today's physician. Not only are they providing the forums and clinical information physicians want, word on the street is that they are using Web 2.0 technology to help physicians in their business -- like help with finances and healthcare technology -- and even for leisure, like sharing great wine tips.
Most recently, they built a tool that lets its members create their own groups, giving physicians the opportunity to have private conversations with other physicians who share their specific interests and issues.
iMedExchange technically hasn't launched yet, but physicians can still join the site as they build it. Almost every time you log in there is a new tool or feature. Log in at www.imedexchange.com (they verify that you are a physician before you can enter the site) and start using their forums and groups.
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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Tuesday, May 13, 2008
Business and medicine
I have long contended that some sort of business education or degree should be mandatory for every practicing physician.Skills like running a business and the art of negotiation are just as important as clinical aptitude. The medical profession's lack of business skills is a major reason why physicians have lost control of their profession, and why doctors have so little influence in the health care debate.
Those who don't think so are sorely naive and will be in for a harsh wake-up call when faced with post-graduation reality.
I'm happy to see that others agree:
A common fallacy shared by many medical students and pre-meds is that doctors are isolated from business practices such as marketing, management, and finance. A rude awakening is applied to anyone upon graduating residency when he discovers that the laws of economics apply to medicine just as easily as they apply to any other employment field. Many doctors are woefully unprepared for running a hospital or clinic.
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The inhaler switch
Matthew Mintz blogs about the impending switch to HFA Albuterol inhalers.
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Maybe we should throw money at the doctor shortage problem
Bingo:"Until we make it financially advantageous to do that kind of [general] practice, then you’re going to see a continued growth of the shortage. Just throwing money at it won’t solve it completely, but it would sure go a long way toward making a huge difference."
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