The following is part of a series of original guest columns by the American College of Physicians. by Steven Weinberger, MD, FACPThe unfettered debate about ideas that characterizes the democratic process in the United States operates best when there is a truthful presentation of the issues, and when the process is civil and respectful. Unfortunately, the debate about health care reform has evolved to the point that it ...
August 2009
All Stories
Will the spread of swine flu be affected by the uninsured?
By now, we're aware of the sobering predictions for this fall's spread of H1N1 influenza.But, as the Washington Post's Ezra Klein points out, our health system is ill-suited to deal with the situation:
It's simply too fractured to do anything different. Almost 50 million Americans have no insurance. Many more are underinsured. Many don't have a particular doctor or even medical center where they feel comfortable receiving care. Many are ...
Are more patients leaving the hospital against medical advice?
by Michael Smith, North American Correspondent, MedPage TodayThe number of people who check out of hospitals against medical advice has grown dramatically, according to the Agency for Healthcare Research and Quality.
In 2007, the agency said, inpatient care ended that way 368,000 times, accounting for 1.2% of all hospital stays, compared with only 264,000 such discharges a decade earlier.That ...
How a wealth of information takes attention away from the patient
by Abraham Verghese, MDThis month I am the attending physician overseeing an internal medicine team, one of four such teams that admit patients to my teaching hospital. It's a great time to be an attending physician. I have seasoned interns who in just a few weeks will be junior residents, and I have even more seasoned senior residents on their way to entering practice or entering subspecialty training. The team ...
Poll: How should doctors make patients responsible for their own health?
The current health reform proposals do not make enough of an effort to encourage patients to take care of themselves. After all, the frequency of two leading causes of death, diabetes and heart disease, can be markedly reduced with lifestyle changes.What is the best way to encourage patients to take responsibility for their own health?Rewards or penalties can indeed motivate change. Several years ago, West Virginia's Medicaid program asked ...
A designer IV bag makes a hospital fashion statement
Concept photos imagines what hospital life would be like if IV bags were trendy.
Reminds me of the custom teddy bear blood transfusion bag that I saw earlier this year.
(via Better Health and Medgadget)
Health care as a futures exchange
by Susan HIt seems that health insurers are serving as exchange and clearing firm for "health futures" traders. Traders of "health futures" are potential patients, and health care providers. Patients are synthetic buyers of futures on health care provision, doctors and providers of medical goods and services are short sellers of those futures. The exchange and clearing firm (health insurer) represents that it serves to stand as guarantor in the ...
Why following a delayed vaccine schedule may be dangerous
by Steve Perry, MDI recently read a post by Dr. Bob Sears which listed several “Vaccine Friendly Doctors” in Colorado and across the nation.As a pediatrician and vaccine advocate, I thought I’d be on this list. I am “vaccine-friendly doctor” who works with moms and dads to find the best health care plan for their babies. I read the information on both sides of the issue and weighed the science ...
Are relationships being lost in medicine, and are hospitalists partly responsible?
An emergency physician, like me, may be the worst possible person to discuss relationships with patients. I mean, one of the reasons I chose this specialty was that I didn’t want long-term relationships with my patients. I see, now, that God has a great sense of humor.See, the county I landed in after residency is small enough that I do know many of my patients, and I do see them ...
Do drug companies and the pharma industry deserve to be villains?
by Michael Kirsch, MDDemonizing the pharmaceutical industry has become a parlor game for many who enjoy the challenge of shooting at an oversized target. Scapegoating Big Pharma? Now, that takes guts.Never mind the gazillions they spend on research and development to create tomorrow’s treatments for cancer, arthritis, depression, infectious diseases, heart attacks and strokes. I know that drug industry executives are not all eagle scouts whose mission ...
Are network morning news shows an emerging public health threat?
Journalism professor Gary Schwitzer is the foremost health media watchdog, with his organization rigorously monitoring the health content of major media.During the past year, he notes a disturbing trend. According to his analysis, the health segments on network television morning shows, "unquestioningly promote new drugs and new technologies, feed the 'worried well' by raising unrealistic expectations of unproven technologies that may produce more harm than good, fail to ...
Increasing radiation exposure to patients from CT scans and other imaging tests
by Kristina Fiore, Staff Writer, MedPage TodayImaging procedures can expose patients to high cumulative doses of radiation, researchers say. In a large study, 193.8 people per 1,000 were exposed to moderate doses of radiation each year, while 18.6 per 1,000 were exposed to high doses, and 1.9 per 1,000 received very high doses, according to Reza Fazel, MD, of ...
Should consumer prescription drug ads be reined in?
I've previously written that direct to consumer drug advertising should be banned, similar to the rest of the world, except for New Zealand.The main reason reason is that many of the advertised products are for expensive, brand name drugs that have little advantage over their generic counterparts.In a New York Times' Room for Debate post on the issue, various viewpoints are presented. I find myself agreeing with internist ...
Will medical malpractice reform be included in the final health bill?
by Jeffrey Segal, MD, JDBelieve it or not, some element of federal tort reform is not only possible, but likely.Sounds counterintuitive? We all know that Congress has a strong majority with Democrats. We know the President is also a Democrat. We know the plaintiff’s bar strongly supports the Democratic Party. We know that Democrats have traditionally shied away from specific reforms, such as caps on pain on suffering. So, this ...
New troponin tests to better diagnose a heart attack
by Crystal Phend, Senior Staff Writer, MedPage TodayA generation of new, more sensitive troponin assays has improved hospitals' ability to diagnose a heart attack to a point as early as the time of emergency department presentation, two separate studies affirmed. In one multicenter study, a sensitive troponin I assay had an early diagnostic accuracy of 96%, compared with conventional ...
How did Mozart die, and was a strep infection involved?
There have been various theories about the sudden death of Wolfgang Amadeus Mozart, including, poisoning, syphilis, kidney failure, and even Henoch–Schönlein purpura.
But, in a fascinating article from the Annals of Internal Medicine, researchers have suggested a simpler explanation: streptococcal infection.Deaths in Vienna during the winter of 1791 were analyzed, and it was found that, "Tuberculosis and related conditions ...
Treating Fournier gangrene, or necrotizing fasciitis of the male genitals
Fournier gangrene one of the nastiest infections you'll ever see.General surgeon Jeffery Parks details a case, complete with a vivid CT scan:
Dr. Parks takes us behind the scenes in treating the condition, which requires rapid surgical debridement. "There's nothing fancy about this surgery," he writes. "You cut and debride until all the necrotic fat and skin and muscle ...
Drug company ethics and the pharmaceutical industry’s pursuit of profit
Ghostwritten clinical papers. Off-label marketing. Channel-stuffing. Hiding of negative data.Pharma companies have earned a hefty percentage of the opprobrium heaped on them by a skeptical public. And it's mainly because of a failure to heed the Golden Rule. We all know the "classical" Golden Rule: Treat others the way you’d wish to be treated. But in so many cases, drug manufacturers seem to adhere to a different version: the Gold-in ...
Is Caster Semenya a woman, and the issues surrounding androgen insensitivity syndrome
Caster Semenya is the South African track and field star who recently was engulfed in controversy at the recently concluded World Track and Field Championships.
Turns out, there are some who are questioning her gender, and subsequently, tests are being conducted to see if she is really a woman.It's not as cut and dry as it appears.Consider the possibility of ...
Would you rather have an older or younger trauma surgeon?
Turns out, it may not matter.According to a recent study from the Archives of Surgery, when it comes to trauma surgery, the mortality rate of trauma causes handled by "novice" surgeons - those just out of residency - did not differ appreciably from those handled by more experienced doctors.As reported by ABC News (under the somewhat melodramatic headline, "In the ER, Baby-Faced Doc Is No Death Sentence"), whether the ...
Kevin Pho, MD
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Why Priscilla Chan may become the country’s most influential doctor
Who has the potential to be the most influential physician of our generation? It's Priscilla Chan, who not only recently graduated from...
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Confused about prostate cancer screening? Make a shared decision
In a widely anticipated move, the USPSTF officially recommended against prostate cancer screening in healthy men. Case closed, right? Hardly. The prostate...
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When it comes to doctors and social media, hospitals fail miserably
When it comes to medicine and social media, much of the attention is negative. Doctors losing their hospital privileges because of Facebook....
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Warren Buffett’s prostate cancer choices aren’t right for every man
A version of this column was published on April 24, 2012 in USA Today. There has been a recent uptick of elderly men...
Physician
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Why test recalls should not be considered cheating
I was appalled recently by the coverage of radiology “test recalls” by CNN, amplified by Dr. Gary Becker of the American Board...
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Why physicians are susceptible to hardball tactics
I was invited to a medical staff leadership conference sponsored by our hospital. A company specializing in training physician leaders ran the...
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How we deliver bad news is critical to how families deal with grief
As a cardiac electrophysiologist, I have had to discuss bad news with patients and families more times than I would like during...
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His father’s suffering had already been too great
He looked dead. The paramedics brought him down the hall toward one of my critical care beds, and for a moment I...
Patient
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How death can be a beautiful experience
I was honored to be part of a beautiful experience in late January of 2011. It was the death of my mother-in-law...
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What meaningful encouragement can be given to someone who is dying?
Theirs is a lonely journey; to be moving towards the separation and end of all things known and loved. Being with a...
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Health care journalists have tendencies similar to those of doctors
As a patient who was asked to speak at the Association of Health Care Journalists 2012 conference, I felt a bit covert....
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Adaptation can be painful, but it can also be a gift
Nothing will force you to live life on your own terms faster than almost losing it. In 2008, I was on fire....
Policy
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What should America’s health care vision be?
America has this paradox of excellent biomedical science, innovative drug manufacturers and entrepreneurial device developers along with outstanding providers but at the...
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Hospitals around the world aim to remain relevant to patients
"It was the best of times, it was the worst of times ..." So begins a story called A Tale of Two...
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Repairing the tear in health care’s safety net with social media
The nation’s “safety net” hospitals are designed to ensure that uninsured, lower income and indigent populations receive adequate medical care – a...
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Look to technology to reduce health costs
Technology to lower costs rather than accelerate them. Smart phones to increase physician and other providers’ productivity. Fewer primary care physicians but...
Tech
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When patient care becomes secondary to filling out the medical record
The policeman was two cars in front of me. I meandered down the road cautiously adjusting my speed a few ticks above...
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Doctors, use Google to get more patients in less than 7 minutes
Every month, hundreds of thousands of people look for a doctor on Google. As an amazing practitioner, your site deserves to be...
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The user interface for EHRs should be uniform
The first thing I noticed when I walked into the physician’s office were the tall cabinets filled with manila folders, tabbed with...
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EMR liability needs to go further than just the physician
This example of a disaster waiting to happen, in the form of an error-promoting CPOE, is a poster example of why the...
Social Media
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We need to see the potential harm of social media
Prior to 1794, farms across the world could only pick cotton as fast as humanly possible. In the late 18th century, Eli Whitney...
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Why social media may not be worth it for doctors
Social media in healthcare is all the rage these days. You can’t visit even one physician-oriented website without someone breathlessly advising you...
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Transparency defines social media success for doctors
Want to understand social media? Physicians wanting to learn about social media must learn transparency. We must learn transparency on a personal...
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How Twitter was used in a potential mass casualty scenario
It was my first ER shift in charge of the resuscitation area. Needless to say, my adrenaline and nerves were firing like...
