April 2009

All Stories

Is the bipolar child and ADHD a purely American phenomenon?

in Meds | 7 responses

Bipolar disease and ADHD is becoming increasingly diagnosed in the United States, but isn't an issue in the rest of the world.

Investigative journalist Philip Dowdy has some strong reasons for that, and lays the blame squarely at the drug companies, along with child psychiatrists at Harvard.

"The pharma companies and the Harvard crew worked hand-in-hand to bring America a generation of ADHD kids and bipolar children," ...

Should hospitalists or intensivists manage ICU patients?

in Physician | 5 responses

Many hospitals prefer so-called "closed" intensive care units solely managed by intensive care specialists.

The reason being that specialists can supposedly better adhere to quality measures, and hence lower costs, which are goals that hospital administrators pine for.

The problem is, there aren't enough intensivists to staff closed-ICUs for many medical centers across the country.

So, hospitalsts are stepping in as a "stop-gap" measure, and ...

Do some doctors take on more risk than others?

in Physician | 10 responses

A neurosurgeon has higher malpractice premiums than an internal medicine physician, but do they really take on more risk?

The Happy Hospitalist says no.

That's a counter-intuitive take, as surgeons and proceduralists are perceived to take on more risk, and thus, pay higher malpractice rates.

"I don't think any physician, who is trained in their scope of practice, takes on anymore risk than any other physician, ...

ER visits and health care costs rise in Massachusetts due to lack of primary care access

in Physician | 7 responses

Color me unsurprised.

A Boston Globe article today confirmed what has been discussed on this blog during the past year. Universal care without primary care access is a recipe to increase both emergency department crowding and health care spending.

We now have more data to back up this expected conclusion.

Despite an individual mandate covering almost everyone in Massachusetts, the cost of emergency care ...

A pediatrician takes the anti-vaccine movement head on

in Patient | 13 responses

Would you rather have your kids get measles or autism?

That's the choice that anti-vaccine proponent Jenny McCarthy lays out on the talk show circuit. But in a LA Times column, pediatrician Rahul Parikh comments, "At best, that's a false choice; at worst, it's a sick, horrible wish for her or anybody else's child."

He further observes, rightly, that the anti-vaccine movement has done a much better ...

A major obstacle impeding universal coverage in the United States

in Policy | 5 responses

What's unique to the United States that's rare in the rest of the developed world?

According to respected economist Uwe Reinhardt, Americans want to have their cake and eat it too. This is why universal coverage is such a contentious issue.

Dr. Reinhardt explains the principle of social solidarity, which means that "health care should be financed by individuals on the basis of their ability to ...

Who is responsible for an abnormality on pre-operative testing, or, aren’t radiologists doctors too?

in Conditions | 14 responses

A few weeks ago, I cited a case where a urologist failed to follow-up on a deadly cancer found on a pre-operative chest x-ray.

Jeffrey Parks takes exception to my opinion, and instead, wonders why the radiologist shouldn't shoulder some of the follow-up responsibility.

"For some reason radiologists are immune to the usual expectations of physician responsibility," writes Dr. Parks. "It must be nice to just ...

Op-ed: Not all screening tests lead to early, better treatment

in Conditions | 4 responses

The following op-ed was published on April 23rd, 2009 in the USA Today.As a primary care doctor, it's heartening to hear President Obama call for "the largest investment ever in preventive care." That means more people, for one, will be undergoing tests to screen for various forms of cancer. But this might be one of those cases where what sounds like common sense is actually more ...

After a doctor is convicted, is telemedicine dead?

in Physician | 5 responses

A doctor is sentenced to 9-months in jail after prescribing Prozac to a teen who later committed suicide.

The contract physician, who had a restricted license in Colorado, prescribed generic Prozac for the patient after reading his questionnaire online. It's one of the first criminal convictions for a doctor practicing medicine over the phone or internet.

This is one of the dangers of prescribing drugs, sight ...

Professional athletes going half-speed, and the dangers of overtraining

in Patient | one response

With the NBA playoffs now upon us, do basketball players go all out, all the time?

Not necessarily.

Over at Better Health, Nick DeNubile, orthopedic consultant to the Philadelphia 76ers, says that there's "an important distinction between going half-speed and being tentative. If you're tentative "“ in any sport at any time "“ that's when you risk injury."

The key is staying relaxed, and Dr. DeNubile ...

Did social networks cause the FDA to rescind the ban on concentrated morphine?

in Social media | 2 responses

On April 1st, the FDA demanded that the production of concentrated liquid morphine, among others, be stopped.

9 days later, they changed their mind and rescinded the decision.

Had they gone through with the ban, shockwaves would have been sent through the palliative care community. As physician Christian Sinclair notes, with only the lower concentration available, "Giving a dying patient with dysphagia 5ml instead of 1ml ...

How injecting silicone for beauty can kill

in Meds | no responses

The price people are paying for beauty is getting higher.

Tough economic times are preventing people from obtaining plastic surgery, so they're resorting to more illicit means. Shady practitioners are offering silicone injections, administered in motel rooms or in so-called "pumping parties." Industrial grade silicone can be found in hardware stores, but sometimes, castor oil, mineral oil, petroleum jelly and even automobile transmission fluid are substituted.

Does consensual doctor-patient sex actually harm the public?

in Patient | 7 responses

When it comes to disciplinary action, Texas punishes doctors who engage in consensual sex with patients seriously.

Hospitalist Chris Rangel says they're going overboard.

Consider the cited case, where a doctor who had consensual sex was given a harsher penalty than physicians who were negligent and actually harmed patients.

"A sexual relationship, even a consensual one, between a doctor and their patient is certainly improper," writes Dr. ...

All doctors say they want to help people in pain, but how do you know for sure?

in Patient | 6 responses

How do you know which doctors are the ones who can appropriately comfort patients during times of suffering?

You don't.

Anesthesiologist Dr. T talks about how medical schools don't really screen which prospective physicians are "cavalry-ready," or not.

"People are either ready, willing, and able to be close to human suffering - to look at a weeping man, woman, or child in the eye, talk ...

The Craigslist Killer is a Boston University medical student

in Education | 25 responses

As an alum of Boston University Medical School, and having trained at Boston Medical Center, this is truly sad and disturbing news.

The so-called "Craigslist Killer," who was the target of a national manhunt, is apparently a 22-year old medical student at Boston University:

Boston police tonight arrested Philip Markoff, a 22-year-old Boston University medical student, in the murder of 26-year-old Julissa Brisman at the Copley Marriott last ...

How electronic medical records can lead to coding fraud, and get doctors into major trouble

in Tech | 2 responses

The perfect storm is coming.

So says a cautionary article shows the dangers of adopting the current generation of electronic medical records. Many of these systems are template-based, leading to easy "cut and paste" documentation. Given the time pressures doctors are increasingly facing, there is tremendous incentive to over-document and over-code.

The subsequent uptick in higher-coding visits, like 99214s and 99215s, is catching the attention ...

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