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 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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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...
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The problem of insurance gaps in cancer patients
Why are cancer organizations waiting until it starts to rain before they suggest buying an umbrella? “Join my Medicare Advantage plan and...
Tech
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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...
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Google knows more about certain diseases than physicians ever will
Professor Gunter Dueck, is a calm and eloquent german mathematician who’s also the CTO of IBM Germany. He studied mathematics and philosophy...
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....
