Jade Goody is 27-year old British reality TV star who is dying from cervical cancer.
As part of an ongoing reality show, her last days will be filmed and broadcast.
In this day and age of the Pap smear, cervical cancer should be all but eradicated. And Ms. Goody did have Pap smears. Several, in fact. However, as gynecologist Margaret Polaneczky observes, she ignored ...
March 2009
All Stories
Waiting for the biopsy result is as stressful as being told you have cancer
Doctors should realize the stress that patients undergo while waiting for test results.
Surgeon Jeffrey Parks discusses a recent study examining the issue, showing that a woman's "stress hormone levels were just as high during the waiting period as levels determined in women who were told the biopsy was positive for cancer."
A needle breast biopsy should not take longer than two days for a result, although ...
The retail clinic era is over, and why pharmacy-based clinics are doomed to fail
Corporations are finding out what primary care doctors already know: it's hard to make money only doing office visits.
CVS has announced they are closing 90 of the 550 MinuteClinic locations until next fall's flu season.
As the WSJ Health Blog comments, "the clinics appear to be showing a pattern sort of like the dot-com bubble, in which some will go away while others survive."
That's ...
Will patients or doctors be the biggest obstacle impeding health care reform?
If both patients and doctors don't accept the changes required of their behavior, no amount of comparative effectiveness studies will cut health care spending.
Two prominent medical journalists write as much in their respective blogs.
First, the NY Times' Tara Parker-Pope notes that patients have to realize that, yes, they should demand the best care possible. However, that means, "we will have to accept that 'best' ...
Poll: Testosterone replacement therapy in men with prostate cancer
Men of any age can present with the symptoms of low testosterone - including erectile dysfunction, fatigue, difficulty concentrating, decreased muscle mass and bone density. Is it safe to treat these symptoms with testosterone replacement therapy?
There are several ways to treat men with low testosterone: the most common are gels, patches, and injections. These treatments are effective for relieving symptoms, and are generally safe.
There ...
What is a health coach, and why are they paid $121 an hour?
The movement of "health coaching" is gaining some traction in health care circles.
PookieMD explores the phenomenon, and finds that a health coach, among other duties, "help people clarify their health goals, and implement and sustain behaviors, lifestyles, and attitudes that are conducive to optimal health; guide people in their personal care and health-maintenance activities; and, assist people in reducing the negative impact made on their lives by chronic ...
Restricting resident work hours forces doctors to lie, and other unintended consequences of the 80-hour work week
To his credit, Dr. Thomas J. Nasca, chief executive of the Accreditation Council for Graduate Medical Education, is aware of the many problems in trying to limit work hours for physicians in training.
This topic has been frequently discussed on this blog, but some points bear repeating.
The first are the ethical quandaries that the cap often places on residents. In one example, a doctor ...
Don’t have a GI bleed on the weekend, and why you’re more likely to die on Saturday and Sunday
Patients don't choose the days they get sick.
There are several studies, specifically dealing with heart attacks, showing that the mortality rate increases when a patient visits the hospital during the weekend.
It appears that the same goes for upper GI bleeding. MedPage Today discusses a recent study showing that "patients with nonvariceal upper gastrointestinal hemorrhage had a 22% increased mortality risk on weekends, and those ...
Comparative effectiveness research in Newsweek, and parallels between real-life and NBC’s ‘ER’ in Variety
You can find some of my comments in recent magazine articles.
First, Newsweek's Sharon Begley talks comparative effectiveness research and mentions that, "a younger generation of doctors, perhaps more comfortable with science and clinical studies, is embracing CER. Dr. Kevin Pho, who practices internal medicine in Nashua, N.H., says that at least once a day he has a patient for whom there are numerous treatment options"”the ...
Did Medscape use CME to illegally promote off-label use of drugs for rheumatoid arthritis?
The controversy surrounding drug industry influence in continuing medical education continues to grow.
Merrill Goozer talks about a recent case where the Medscape, the physician internet portal site, is alleged to have illegally conspired with Amgen to promote the off-label use of Aranesp and Embrel. According the to complaint, "The scheme was to increase market share through the covert commercialization of CME programs."
I recently cited internal ...
How many proton beam therapy centers does Central Ohio need?
Despite the fact that proton beam therapy for the treatment of prostate cancer is expensive, and its efficacy questionable, that didn't stop local journalists from writing a puff piece touting its impending arrival in central Ohio.
Journalism professor Gary Schwitzer, however, takes them to task. He questions an advertisement in a local newspaper, and wonders why cost isn't mentioned, nor any discussion of the benefits versus risks.
Should doctors learn to become dentists?
There's such a shortage of dentists in Maine that primary care doctors are the ones pulling teeth.
Not only does the state have a severe shortage of dentists, poorer patients have trouble seeing one, since few accept those without insurance or with Medicaid.
So that leaves the primary care doctors to pick up the slack and learn to pull teeth, screen for tooth decay, or lance oral ...
Can a doctor sue a patient for a negative online review?
That's exactly what's happening in this case in San Francisco.
Angered by a billing dispute with his chiropractor, a patient posted a negative review on the online review site, Yelp. Now he has to defend his review in court, which is, even if the case is thrown out, not a chance many patients are willing to take.
Indeed, if the medical profession really wants to shut ...
The quality of CT and MRI scans vary, and how old machines can affect the treatment course
Medical imaging is one of the largest drivers of health care spending.
In a recent NY Times piece, Gina Kolata points to the fact 20 to 50 percent of scans ordered are not necessary. Indeed, as health reformers like to point out vis-a-vis the Dartmouth Atlas study, more care isn't necessarily better.
In fact, it can lead to worse outcomes, as these scans can point to ...
Why do I need a rectal exam, and what can doctors find with the gloved finger?
Have you ever wondered why doctors have to perform a digital rectal exam?
Well, look no further, as primary care doctor Rob Lamberts gives us the answers discerning readers demand.
Simply by looking at the rectum, which by the way, indeed "takes some getting used to," can lead to significant diagnostic findings. Furthermore, does tight sphincter tone matter? And should you be worried about the large hands ...
Doctors dealing with difficult patients, is it the fault of young physicians?
A study released last week reported doctors found that one in six patients were "difficult."
In addition, physicians who reported these difficult encounters tended to be young and female, leading to a 12-times increased risk of burnout.
Like any relationship, be it a marriage, job, or one between a physician and a patient, not all encounters are going to go smoothly. The editorial commenting on ...
When will doctors find it acceptable to deny medical services?
Will there ever be a scenario where doctors will accept a third-party entity restricting care to patients?
Pauline Chen talks about comparative effectiveness research, and finds that, when recommendations are transparent and based on solid evidence, some doctors will accept this more regulated paradigm.
Dr. Chen is completely right when she observes that there is a "sense that some of [a health insurer's] decisions are based not ...
Would you waive your right to sue a doctor to obtain free medical care?
What if a retired physician, Harvard-trained no less, wanted to give away medical care?
You'd think the huge demand would make it easier for him to accomplish this, but that's not the case.
When funding dried up for New York physician Lloyd Hamilton's free care clinic, he wanted to continue serving the same patients, even depriving himself of a salary. Unfortunately, it wasn't so easy, as ...
Relative value units, and how the RVU payment system doesn’t allow doctors to practice good medicine
For those who don't know, every piece of work that a doctor performs is quantified and measured.
The base unit of physician work is known as the relative value unit (RVU). Most physician salaries are determined by the amount of RVUs a doctor produces in a given year, and in most cases, can range between$35 and $45 per RVU in primary care, depending on geographic location and ...
Are academic physicians the next target on the inflated executive salary hit list?
First, Wall Street executives are vilified. Are academic physician-administrators next?
The WSJ Health Blog didn't do the profession any favors by highlighting the fact that 3 of the top 4 highest paid college employees were physicians at academic medical centers, pulling in $3 million to $4 million per year.
Needless to say, that statistic comes out at an inopportune time, only reinforcing the false public notion that ...
Kevin Pho, MD
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Why more primary care doctors are referring patients to specialists
According to a recent study from the Archives of Internal Medicine, primary care physicians are referring more patients to specialists than ever...
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Should Google censor anti-vaccine claims?
One of the reasons there is such a movement against vaccines is the democratization of information, perpetuated by search engines like Google....
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Radiologists who cheat on their board exams: Who’s to blame?
In a widely circulated CNN article, many radiologists have been found to cheat on their board exams: "Doctors around the country taking an...
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Doctors: Don’t be ashamed about going bankrupt
Are doctors really going broke? According to this piece from CNN Money, some are: "Doctors list shrinking insurance reimbursements, changing regulations, rising...
Physician
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Patients will understand an honest mistake if the doctor tells the truth
It was 1976 and I was a junior resident in urology at Baylor College of Medicine in Houston, Texas. I was assigned...
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Diagnosing an illness is an art
Diagnosis is the foundation on which all care and treatments rest. If the diagnosis is wrong, most probably so is the treatment. ...
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Physicians have a natural role as advocates
As physicians, we are often called upon to be advocates for our patients. Sometimes they have no other person to turn to....
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Our society expends huge sums on futile care
Mike was a runner, outdoors-man, and fitness nut. This was not so much as for health reasons as for "feeling good", but...
Patient
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How will the Baby Boomers age and die?
I love listening to life stories. As a hospice chaplain, I loved sitting with our patients and their loved ones engaging in...
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Patient engagement is the holy grail of health care
For health care professionals, patient engagement is the holy grail of health care. It is the key to patient adherence – a...
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Why do doctors delay hospice referrals?
This is a response to Deb Discenza's article requesting a one page informational sheet informing a patient about hospice or palliative care. This would...
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How touch can calm patients
So, Megen at Not Nurse Ratched wrote post recently about therapeutic presence. The following passage really caught my attention: "Question is: are...
Policy
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Improve patient safety to improve healthcare quality
It has taken 13 years for us to revisit the issues in To Err Is Human, the 1999 landmark government report that...
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A lack of incentive for medical schools to train primary care doctors
A social media movement is happening before our eyes with action starting to take shape. The #occupyhealthcare movement has begun within to...
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What should be the stated aim of health care in America?
The triple aim of health care, as defined by the Center for Medicare and Medicaid Services (CMS) is: improving the experience of care, bettering...
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How Moneyball applies to healthcare
The storyline is familiar. An organization is challenged to achieve better results without spending more money. An executive is committed to obtaining...
Tech
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New classes of devices to diet and exercise
For many celebrities, their livelihoods depend on their physical appearance and they rely on armies of personal assistants, schedulers, stylists, trainers and...
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Repetition is the curse of the doctor-patient engagement
How many times as a doctor do you ask the same questions over and over again as part of the routine process...
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Why the prognosis of patients is difficult
Many clinical decisions in older persons are dependent on life expectancy. For example, as life expectancy declines, cancer screening is likely to...
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Innovative technologies can markedly enhance safety
“To Err Is Human” is the title of the now famous book from the Institute of Medicine on patient safety published about...
Social Media
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The Internet is where patients go for pre-visit consultations
As a physician, technology cannot replace you, but it can make you more efficient and effective. This was the message from Richard...
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5 ways doctors can benefit from professional connections
Looking ahead to the next several months, I’ve found myself frequently wondering how many physicians will make this their year to take...
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Twitter Is my third office location
The physician’s decision to first dive into social media can be stress-inducing. Issues of time management, maintaining professionalism, and determining a return...
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The impact of social media on a physician assistant
The impact of social media on medicine could arguably be compared to the impact of the industrial revolution on the human condition....
