The strain of screening

As screening modalities emerge and grow more expensive (i.e. take the recent studies on screening MRIs for breast cancer in high-risk patients), can our health system handle the strain?

Consider the colorectal cancer screening. We all know that a colonoscopy is one option for colon cancer screening. However, there is no direct data that screening colonoscopies reduce mortality:

The USPSTF found good evidence that …

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Same issues overseas

Looks like resident physician hours are also an issue in Britain – except their limit is 58 hours a week (way under the 80 hour per week limit in the United States).

On vacation

I’ll be taking a much-anticipated vacation the next 2 weeks. My forums at Med Help International will be closed until August 14th. I’ll continue to blog as interesting things come up, but will be sporadic during the first two weeks of August.

MRIs for breast cancer screening

I was going to talk about it, but Bard-Parker beat me to it. I guess that’s what headlines are for, but people simply read the headline (“Study Finds MRIs Better on Breast Cancer”) and jump to a conclusion. Already had someone ask me for a screening MRI of her breasts this morning. It comes as no surprise that the MRI has the higher sensitivity (i.e. less …

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Med-mal in Canada

PointofLaw.com writes several interesting articles on medical malpractice, pain and suffering caps, and liability in Canada. A stark contrast to what’s happening here, eh?

I can see the Pfizer reps . . .

. . . whipping this study out when I see them next. The study suggests a 10% improvement in osteoarthritis pain scores over acetominophen (Tylenol). Of course, no mention is made of cost – 30 caps of Celebrex 200mg is $74.99. 250 caps of acetominophen 650mg at CVS is $7.49.

Lyme test overused

A report says that the serologic test for Lyme disease is overused.

“We found that a good number of Lyme disease blood tests are ordered inappropriately, primarily for patients who come in without symptoms,” . . .

. . . In more than 50 percent of the inappropriate tests, the patients didn’t have symptoms of Lyme disease, according to the article in the July/August issue of the Annals …

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A trio of articles . . .

. . . from Medpundit on Overlawyered. The first, discussing a lawsuit based on a 1 in 1.09 quintillian chance. The second on the benefits of non-economic damage caps. The last on the effects of lawsuits going out-of-control: obstetricians are leaving Pennsylvania, and some hospitals are closing their OB departments entirely.

It’s about time

Medicare will now cover a “comprehensive physical” and the appropriate screening tests that accompany it.

The “welcome to Medicare physical” for new beneficiaries includes influenza and hepatitis B vaccines, mammograms, Pap smears and pelvic examinations and screening tests for prostate cancer, colon cancer, glaucoma and osteoporosis, among other conditions.

It will even cover things like a routine EKG, which is not even recommended by the USPSTF.

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Shotgun lawsuits

Medpundit is guest blogging at Overlawyered, and posts this story about a potential casualty of shotgun lawsuits.

An unfortunate case . . .

. . . of someone who does not have insurance and doesn’t speak the language, getting lost in the maze of our broken health care system.

Brace yourselves for Michael Moore

His next project will turn his attention to the world of HMOs. Should be fascinating when it comes out:

With “Fahrenheit 9/11” becoming the first documentary to cross the $100 million mark at the domestic box office, director Moore expects a smooth path on raising money to make “Sicko,” his critique of health-maintenance organizations.

There’s something to be said . . .

. . . for continuity of care.

Talkback on weekend vs weekday care

Our surgical colleague on A Chance to Cut . . . responds to the piece on delayed weekend testing. He disagrees with my hypothesis that the savings from shortened length of stay would offset the increased staffing costs of treating a weekend like a weekday. Perhaps this should be studied next.

Given the current nursing shortage and the premium that would have to be paid to …

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20/20 on personal injury lawyers

John Stossel did a fantastic piece on 20/20’s “Give me a break” segment regarding John Edwards and personal injury lawyers (found via Galen’s Log). Some excerpts:

In hospitals, the lawyers have bred so much fear that patients now suffer more pain, and may be less safe because doctors are concerned about being sued.

“That fear is always there,” said obstetrics professor Dr. Edgar Mandeville. “Everybody walks in mortal …

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New scutmonkey comics

For those who haven’t been following Michelle Au’s Scutmonkey Comics, they are witty and hilarious – I can certainly relate to many of the experiences. A new batch were released today, dealing with her surgery rotation. Check it out!

Women in the UK . . .

. . . are now encouraged to use stealth to bring their husbands in for screening tests. In this view from BMJ USA, a general practitioner warns against blindly advocating screening tests. This harkens back to a previous article advocating a balanced view on screening tests.

The “Ignorance Isn’t Bliss” campaign—launched this week and run by the Prostate Research Campaign UK with support from AstraZeneca—wants me, …

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Interesting study . . .

. . . from Finland. It is suggested that the rate of stroke was lowest on Sunday, and highest on Monday. I wonder if the next step would be to see if the same applies to heart attacks.

Weekday versus weekend hospital care

A new study was released saying that tests are delayed on the weekends versus the weekdays.

In the study, published in the August edition of the American Journal of Medicine, researchers analyzed six procedures commonly used in emergency situations:

Purpose

Many hospital departments tend to have lower staffing levels on weekends. We evaluated the use of selected urgent procedures for emergently hospitalized patients and measured the time …

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"Bedfellows of the insurers"

A thoughtful response to my piece on good business vs good medicine. The commenter argues that the fundamental problem is our dependence on the insurance system. Consequently, our health-care system is slanted against good medicine. It is the insurance companies that forces good business on our medical practice, and the physicians are unwitting pawns. Take a read:

The assumption is that somehow good business and good …

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