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 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....
