March 2009

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The JAMA versus Jonathan Leo debacle worsens, should Catherine DeAngelis apologize?

in Social media | 11 responses

JAMA forcefully responded to the recent allegations of a small university professor going behind their back to mainstream media outlets.

As MedPage Today reports, JAMA sought to preempt any form of criticism, saying, "The person bringing the allegation will be specifically informed that he/she should not reveal this information to third parties or the media while the investigation is under way."

I'm not sure how enforceable that ...

Will the benefits of digital medical records only be seen in large, integrated health systems?

in Tech | 7 responses

I'm afraid the answer is yes.

An op-ed in the Washingon Post criticizes the influx of federal dollars to fund the spread of the current generation of electronic medical records.

Much of the data supporting the improvements in patient safety and the supposed cost-savings were done in large, integrated health systems, such as the VA, Kaiser Permanente in California, or the Mayo Clinic.

Unfortunately, ...

Are family physicians better suited to practice primary care?

in Physician | 8 responses

And if so, is this the best time to start a turf war?

The ACP's Bob Doherty highlights a study from the research arm of the American Academy of Family Physicians suggesting that, "Medicare spending by general internists and subspecialists is significantly higher than for family physicians."

I haven't seen the study myself, but if this is correct, is it really the time to release a study that ...

Is the focus on patient safety creating a generation of indecisive doctors who practice without confidence?

in Physician | 7 responses

Is medical training taking a turn for the worse?

We are so focused on reducing medical errors, as we should, that doctors in training have no leeway to make a mistake. Often times, giving them that space is the only way to give them the confidence to become a competent physician.

Psychiatrist Richard Friedman is noticing that more of his residents are asking him for help, for ...

Is loan forgiveness enough to convince students to choose primary care?

in Education | 20 responses

I've often said that forgiving medical school loans, often exceeding $140,000, can help more students choose primary care.

Students at Harvard Medical School were the lucky recipients of an offer by an anonymous donor, offering $60,000 to students who entered, and completed, a primary care residency.

Salary is one consideration that students have when choosing a specialty. The other is lifestyle. As they train, they ...

Should the MCAT grant extra time for students with learning disabilities?

in Education | 18 responses

A recent California court denied extra time for aspiring medical students with dyslexia and attention deficit disorder when taking the MCAT.

The body that administers the test has to straddle a delicate line, in granting extra time to a broadening definition of the disabled student versus maintaining the overall fairness and integrity of the high stakes test.

Despite the ruling, three of the four plaintiffs have ...

Does a breast MRI have any benefit for patients with breast cancer?

in Conditions | one response

Ah, a perfect question for comparative effectiveness research.

Surgeon Jeffrey Parks takes a look at a study looking at breast MRIs during the pre-operative workup of patients with breast cancer.

Essentially, surgical outcomes were not improved, and worse, "leads to a higher rate of unnecessary mastectomy, and is extremely expensive (about $1600 a pop, out of pocket)."

Although there are specific cases where a breast MRI ...

Why does my new asthma inhaler suck? Questions surrounding the CFC to HFA inhaler transition

in Meds | 16 responses

Beginning this year, inhaled beta-agonist asthma medications had to switch to a more environmentally friendly form.

MedPage Today has a special report on the issue, one where most primary care doctors were not well educated on.

Apparently, the new inhalers, which use hydrofluoroalkane (HFA) as a propellant, have been attracting a litany of patient complaints, including that the medicine tastes funny, the propellant isn't as strong, it's ...

Making up drug studies, and is the pressure for results too intense for clinician-scientists?

in Meds | one response

You may have heard the story of anesthesiologist Scott Reuben, who allegedly fabricated the results of 21 medical studies.

Orac, over at his blog Respectful Insolence, provides some perspective of the issue, saying, "Dr. Reuben's fraud appears to eclipse even that of Andrew Wakefield [the disgraced researcher who wrongly linked autism to the MMR vaccine]."

Apparently, the pressure for academic physicians to generate results is intense, often ...

Can Wal-Mart help doctors implement electronic medical records?

in Tech | 7 responses

Well, they're going to give it a try.

In a somewhat audacious initiative, Wal-Mart is entering the digital medical records fray. They're proposing to bundle computers and equipment, along with a popular EMR program, to sell to doctors at an attractive price. They're probably hoping that bulk purchases with help with the pricing.

Will it work? It depends.

David Williams, although cautiously optimistic, ...

Do patients trust doctors to bring about health reform?

in Policy | 4 responses

Patients still trust their doctors, despite what you may read in the newspapers and blogs.

Bob Doherty points to a recent survey, showing broad public support for comparative effectiveness research, indicating that voters "trust their doctors and consistently support changes to help their doctors do their jobs."

Mr. Doherty interprets the findings to mean that organizations like his, namely, the American College of Physicians, still has significant ...

Match Day comes and goes, and did medical students continue to avoid primary care?

in Education | no responses

Match Day in March often marks the climax of the years of training a medical student endures.

This year, we apparently have more focus from the national media on the issue, thanks to the proliferation of health blogs that every newspaper seems to have.

Pauline Chen writes about her experience with the rite (complete with a photo taken from my alma mater, Boston University), writing how students ...

Did the Canadian health system fail Natasha Richardson?

in Physician | 20 responses

Would Natasha Richardson be alive today if she had gone skiing in the United States instead?

I don't think it would have made a difference.

To recap the tragedy, Ms. Richardson died from an epidural bleed, after she fell while skiing. Her presentation was somewhat classic, with the well-described "lucid" period before she deteriorated.

According to Canada's Globe and Mail, "ambulance workers were ...

Doctors leaving private practice, and where to go next

in Physician | 2 responses

It's becoming apparent that the solo and private practice model of primary care is dying a slow death.

PookieMD interviewed me, as well as retainer physician Kevin Lutz, about the divergent paths that one can take after leaving private practice.

I represent the hospital-owned practice route, and here's my take:

He opines that, "primary care is the loss leader for the hospital," explaining that primary care brings business ...

Are doctors doing too much cancer screening?

in Conditions | 2 responses

Screening for certain cancers, such as breast, colon, or cervical cancer, have been shown to save lives.

However, the same can't be said for a multitude of others, including lung, pancreatic, or ovarian cancer.

Major media outlets, like NBC's Today Show, have in the past, irresponsibly trumpeted recommendations that have no basis in evidence.

To their credit, journalism professor Gary Schwitzer says they are ...

Medical students lobby Congress for lower medical school tuition

in Education | 5 responses

Medical students graduate, on average, with $140,000 in debt, with many having loans in excess of $200,000.

The majority who enter school wishing to practice primary care often change their minds when greeted with this fiscal reality. Combined with the fact that primary care role models are overburdened in a practice environment so toxic towards generalist practice, it is no wonder that most students change their minds, and gravitate ...

Should I get a PSA test for prostate cancer? A new study shows that screening for prostate cancer doesn’t necessarily save lives

in Conditions | 5 responses

Prostate cancer screening is about to get a whole lot cloudier.

Published this morning in the NEJM, the results of the study by the National Cancer Institute showed that, for men who were screened with both a PSA and digital rectal exam, there was no difference when compared to men who received "usual care."

The results confirm the suspicions that many physicians already had, namely, that screening ...

Is Natasha Richardson brain dead? Was an epidural bleed, or “talk and die” syndrome, to blame after her ski accident?

in Physician | 6 responses

Tragic news this morning regarding actress Natasha Richardson, who reportedly, suffered a head injury during a ski lesson in Canada.

According to reports, she fell on a beginner's ski hill, and did not hit anyone or anything during the fall. There was no obvious sign of injury, and in fact, she was "was walking around and feeling fine for an hour after her accident."

Things then ...

Do not resuscitate or Allow natural death, does it make a difference?

in Patient | one response

Do words matter, or is it just semantics?

A recent article in the USA Today highlights a study showing that nurses, student nurses and people with no health care backgrounds all "reported a greater likeliness to forgo resuscitation if 'allow natural death' was used."

Palliative care physician Christian Sinclair sheds more light on the topic, noting the ambiguity of "Allow natural death."

"What did it ...

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