An article and editorial have appeared in the Annals of Internal Medicine demonstrating that primary care physicians do not understand simple statistical data presented to them regarding screening tests for cancer. The consequences, as outlined in an editorial written by a former chairperson of the much maligned Institute of Medicine, is that primary care doctors are over-using cancer screening tests because they do not understand the statistical ramifications and conclusions ...

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One fine fall morning last year my wife turned to me and said: "I want a tummy tuck. There are no rules against you doing that for me are there?" We had talked about tummy tuck surgery for her several times over the years. She had had a gastric bypass a decade before we had met and was a pretty good candidate. No cigarettes. Well she did have a few surgical ...

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I had a patient once.  Her name was Alice (not her real name).  Alice was in her mid-thirties, diabetic, had chronic pain, high blood pressure and was an alcoholic.  She lived on Kuper Island which was just a short ferry ride from the small pharmacy I managed in Chemainus, British Columbia.  Alice would come in every month or so to see me for her medication, go over her blood sugar results, take her blood pressure. ...

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A recent Health Affairs article casts doubt on the cost-saving prospects of health information technology despite the significant investments made by hospitals, physicians, and the federal government to promote electronic records. Reduced ordering of imaging and other diagnostic studies by physicians is often cited as a likely mechanism for estimated cost savings due to health information technology. Possible mechanisms include reduction in redundant (duplicated) tests secondary to better access to ...

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Full code is the universal default status for patients who haven’t chosen otherwise, but I suspect most physicians believe this policy is wrong. We know in our hearts we’re doing harm when we perform CPR on poor souls at the natural end of their lives, whose bodies can do nothing more than suffer. Appropriately timed end-of-life discussions are the supposed answer, but for doctors they are emotionally draining, interpersonally complex, and ...

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As citizens of the 21st century, we seem to have adapted personal technology for every conceivable use -- Siri, the iPhone’s newest darling, can literally remind us to call a proctologist. But as physicians, we may be missing some of the best opportunities to derive “meaningful use” from technology. I am an emergency physician, and a few nights ago I worked a shift in the ER. It was a typical, ...

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Last June the American Academy of Family Physicians (AAFP) sent a letter to the AMA’s Relative Value Scale Update Committee (RUC) demanding specific changes to the ways that the RUC conducts its business. Primary care has been severely compromised by the RUC’s recommendations, and there was an implicit threat that the nation’s largest medical society would withdraw if the demands were ignored. I co-authored a Kaiser Health News article ...

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"It is getting worse everyday." "Medicare fix at the last moment." "Too much paperwork not enough time with patients." "ACO’s and bundling." The headlines scream at us everyday. If we have one word that underlies the medical community it is fear. The looming uncertainties of reimbursement, insurance changes, electronic medical records and new regulations form the main topic of doctor worry talk. The country’s health system remains in perpetual flux and catching ...

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I have worked in continuing medical education for 12 years and the argument over industry support of CME has grown tired and wearisome. Truth be told, I’m sick of it. I have always been a staunch defender of industry support of CME – and still am, for the most part – but listening to the same old arguments on both sides of the issue has become akin to the Elmo ...

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Where is the physician outrage? Right. Here. I’m speaking, of course, about the required-transvaginal-ultrasound thing that seems to be the flavor-of-the-month in politics. I do not care what your personal politics are. I think we can all agree that my right to swing my fist ends where your face begins. I do not feel that it is reactionary or even inaccurate to describe an unwanted, non-indicated transvaginal ultrasound as "rape." If I insert any ...

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Up until now, I hadn’t considered to write an article on healthcare reform simply because of the divisiveness and the complexity of the issue. But after listening to the Supreme Court session and the arguments made on both sides, I can’t help but comment on one popular argument that continuously resurfaces. Yes, it’s the infamous "broccoli argument." In short, the argument states that if government were given the power to force individuals to ...

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As a traveling consultant, I eat at a lot of restaurants on the road and am frequently short on time when I do. I have had to learn to live with the very inefficient current model of business in restaurants. Wait to be seated, order your beverage, wait again, hear the specials, order my meal, wait some more, eat my meal, wait for the check, pay the bill, wait again, you ...

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Have you ever been in a negotiation with a health plan for a network participation contract and had the impression that the plan knew all the rates that you had agreed to in confidential negotiations with other health plans?  Allow me to reassure you:  you are not being paranoid.  It is quite likely that the plan you are negotiating with knows exactly what rates and terms you have agreed to ...

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With all the debate about how to best implement coordinated care that benefits patients while being feasible for providers and economical for the government, it’s ironic that little attention has been given to a decades-old managed care model that does all this. But as Medicaid reform progresses in New York and elsewhere, that may be about to change. The program is called PACE, or the Program of All-inclusive Care for the Elderly, ...

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As an OB/GYN resident, I tried to reconcile quality and cost of care every day. This is the story of one patient who cost the system a lot of money, but I don’t know to this day if it was too much. Cheryl (name changed) had HIV, a history of cervical cancer, and 3 kids. At age 35, she had been cured from cervical cancer after surgery and radiation therapy. However, ...

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Recently there was a lovely story in the New York Times about a young couple struggling to navigate the complexities of a romantic relationship.   Both in their early 20’s, dating is a relatively new experience for them.  She likes physical affection; he prefers sitting alone on the couch.  She wants a pet; he is allergic.  They are learning to negotiate the small things while clinging to their common affection for ...

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And progressives should want health reform to fail. No, you read that right. Counter-intuitive?  Let me explain.  As the fate of the Affordable Care Act hangs in the balance in the Supreme Court, both progressive and conservative pundits have been working overtime to discern the future of health reform. The traditional thinking is that progressives direly want health reform to move forward, and ...

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A response to Why isn’t everyone excited about robotic assisted surgery? by Kelly Wright. Yes, it’s cool.  The surgical robot is every gamer-cum-surgeon’s dream. However, I, too, was a skeptic regarding incorporating robotic surgery into my practice.  I have been practicing minimally-invasive surgery for over 20 years, including residency.  I became convinced of the value of minimally invasive surgery after observing patients postoperatively.  I have laparoscopically repaired an obturator nerve transection, ...

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I recently came across two articles in the press concerning doctor-patient relationships and communication. I began to reflect on what makes communication between doctor and patient most successful and many questions surfaced. In the New York Times, a new study published in Annals of Internal Medicine was referenced. In this study, the way in which doctors communicate non-verbally was examined. Non-verbal communication was often discordant to the message being relayed, particularly ...

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Studies, medical societies and position papers are unanimous in their condemnation of inappropriate antibiotic prescriptions for an uncomplicated URI ... but not a single voice tells us how to do that. Let me give you a three part structure you can use in your patient conversations in the future - and some exact words to try out.  This structure is adapted from the Parenting literature, another role where boundaries and inappropriate ...

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