Childhood is full of self-limited illnesses. Kids get sick and kids get better. The majority of childhood illnesses will get better on their own. Because of this, observation and "watchful waiting" is often the most useful diagnostic test at the pediatrician's disposal.Parents are often confused about the need for testing. Their experiences with adult medicine is typically full of lab tests and imaging studies. Unfortunately some parents equate the quantity ...
July 2010
All Stories
Early dialysis may not improve kidney failure outcomes
by Nancy WalshPlanned early initiation of dialysis in patients with chronic kidney disease did not improve survival or other clinical outcomes, a multicenter randomized trial conducted in Australia and New Zealand found.The hazard ratio for death among patients who had an early start of dialysis, when the estimated glomerular filtration rate (GFR) was 10 to 14 mL/min, was 1.04 (95% CI 0.83 to 1.30, P=0.75), according to Bruce A. Cooper, ...
Greed is not good when it comes to doctors, patients and medicine
Gordon Gekko is wrong. Greed is not good. Not when it comes to health care providers.The socioeconomic study of what motivates people is a fascinating field of study, not the least of which is because of how counter-intuitive it is. For example, it seems normal to assume that the more someone is rewarded for their efforts, the more effort they will put forth toward those rewards.These rewards (increasing salary, bonuses, ...
When a biopsy cannot completely rule out cancer
Pathologists and radiologists don't have the luxury of spending time with actual patients so they have to render professional judgments and determinations based on indirect data (radiographs, a mashed up slice of breast tissue, etc.).I don't envy them; the utter detachment from patient care would make me miserable. But they do have a tough job. They get one shot at getting it right. There's no patient follow up. They never ...
Why comparative effectiveness won’t matter to Avastin and Lucentis
The Center for Medicare and Medicaid Services could save a half billion dollars a year by switching its beneficiaries with macular degeneration to Genetench's Avastin instead of Genentech's Lucentis, the Wall Street Journal reported recently. The two drugs are variations of the same molecule.
Many eye doctors across the country have been switching to the less expensive Avastin ($42 a dose compared to $1593 for Lucentis) to save their ...
Decision support can help doctors order scans
by Scott CowsillA third or more of scans may be unnecessary or repetitive, studies show, and in scans that are medically appropriate, radiation doses could be dramatically reduced without hurting the quality of images.As pointed out by Robert Centor, MD, “one cannot easily develop rules for testing because the presentations that we see vary so greatly.” That being said, guidelines for diagnostic ...
Diabetes is responsible for many heart disease deaths
by Kristina FioreMore than one in 10 heart disease deaths may be attributable to diabetes, researchers say.In a meta-analysis of more than 100 studies, diabetes was associated with a twofold increased risk of the disease and was estimated to be accountable for 11% of vascular deaths, according to Nadeem Sarwar, MD, of the University of Cambridge in England, and colleagues.They reported their findings online in The Lancet and will present ...
Non-clinical physician job starting salaries
What are entry-level non-clinical physician job salaries?Let me clarify what I mean by "entry-level" here: I'm referring to non-clinical jobs that physicians may find if they leave clinical medicine to pursue a non-clinical job in a company (such as a medical communications company, a health IT company, pharmaceutical, biotechnology, or a consulting company).So, let's look at several examples:* A primary care physician who's making $120k/year leaves clinical medicine and begins ...
How industry money continues to influence orthopedics
Three years ago, the Department of Justice took stock of the orthopedic medical device industry--represented by the five big makers of orthopedic implants--and concluded that it was rampantly violating federal anti-kickback laws with the bribes and favors it was offering to surgeons. Such bribes often came in the form of training grants for those just starting out in the profession, or as lucrative consulting contracts for influential academic orthopedists.The ...
What to do if your doctor quits and leaves medicine
The news that Dr. Marcus Conant has quit practicing medicine is a blow to healthcare here in the Bay Area.And a sad symbol of all that is wrong with healthcare – and in particularly, the way we treat primary care practitioners – in America today. It would be hard to find a doctor more symbolic of the best of medicine than Marcus Conant – a man willing to devote ...
Let consumers decide if they want the patient centered medical home
Is the Patient Centered Medical Home (PCMH) the panacea for all that ails health care?Have we exhausted all the allegories related to the term “home?” The answer to both questions apparently is no, thanks to this American Journal of Managed Care article by Timothy Hoff titled The Shaky Foundation of the Patient Centered Medical Home.Dr. Hoff appropriately shelves PCMH policy and looks at the topic with a market-based perspective. ...
Kombucha tea can be dangerous to your health
Celebrities are powerful role models and are important to consumers concerned with their health because of the perception that famous people have access to the best health practices and medical care. The public looks to celebrities for hope and inspiration as they struggle with their own health issues and fight disease. However the health practices that celebrities promote are often questionable and misleading.One currently popular folk remedy, kombucha tea, is ...
Homocysteine lowering does not reduce heart attack risk
by Crystal PhendHomocysteine-lowering supplements do not help prevent further cardiovascular events in heart attack survivors, a large randomized trial affirmed.The trial, which followed more than 12,000 heart attack survivors over nearly seven years, found that folic acid plus vitamin B12 effectively reduced homocysteine levels, but did not reduce major vascular events overall nor any other individual endpoint compared with placebo, reported Jane M. Armitage, BM BChBSc, MBBS, of the University ...
Why patients are wary of the primary care medical home
Say the words, "Patient-centered medical home," and you're bound to get a variety of opinions.On this blog alone, there are a variety of guest pieces critical of the effort, saying it does not increase patient satisfaction, nor does it save money.And that's not good news for its advocates, who are pinning primary care's last hopes on the model.Medical homes hit the mainstream media recently, ...
How essential is industry funding for university CME?
As originally reported in a New York Times article recently, with more coverage in MedPage Today, the University of Michigan School of Medicine has decided to end all industry support of CME as of January 1, 2011.According to the dean of the medical school, "the decision was based on a review of literature about the influence on clinical faculty of industry-funded CME." Apparently the decision was made after a ...
How the Massachusetts gift ban hurts primary care doctors
by Kate Atkinson, MDSix years ago, I organized a group of female healthcare practitioners for a women’s medical journal club. A multidisciplinary team of doctors and NPs from primary care and sub-specialties regularly attended monthly dinners. Invited speakers presented on a variety of topics and over the course of a meeting we exchanged insights while challenging each other on how best to manage our challenging patients.Our group grew ...
Should we worry about physician privacy in the EHR era?
As we move to electronic health records (EHR), the debates over security and privacy are becoming more frequent and more poignant.We of course have HIPAA laws on the books and Office of the National Coordinator for Health Information Technology (ONC) has a Tiger team assembled to recommend privacy and security policies to Secretary Sebelius.CIOs and entire IT departments are all focused on protecting the privacy of patients and their Personal ...
ADHD and how drugs impede meaningful help for children
I recently received a call from a mother that made me both want to cry and scream out in frustration.Several months ago I wrote a post entitled Drugs for Children May Silence Stories, in which I described a young boy who had suffered severe neglect as an infant. His adoptive parents had sought help from me when he was four, but when I recommended intervention for the whole family ...
Can Twitter and Facebook help prospective medical students?
As more students participate in social media, like Twitter, Facebook, and blogs, Bryan Vartabedian asks, "Does Twitter Belong on Your Medical School Application?"Great question.I'd say that the majority of doctors and medical schools fail to see the utility of social media, and are generally behind the curve. Indeed, as Dr. Vartabedian writes, "some academics, after all, see social media as a waste of time."But that's going to change. With ...
Cell towers do not increase childhood cancer risk
by Crystal PhendMobile phone base station towers boost cell reception, not childhood cancer risk, a British population-based study showed.Children whose mothers lived near a high-output cell phone antenna mast while pregnant were no more likely to develop childhood cancer than those who lived farther away, found Paul Elliott, MBBS, PhD, of Imperial College London, and colleagues.Exposure to an intermediate level of cell tower power output was associated with an adjusted ...
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...
