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A TV Physician Is Not Your “Doctor” Or “Coach”

A German physician wrote me about this, so while CNN may have an international reach, it’s not always with an adoring audience.

The physician was reacting to the weekend “Paging Dr. Gupta” program, which Dr. Gupta referred to once as “SG, MD.” The first thing that struck me was his introduction, in which he said:

“I’m your doctor. I’m also your coach.”

Later in the program he said:

“Think of this as your appointment. No waiting. No insurance necessary.”

I find this very troubling. He’s not my doctor. He’s not my coach. When I watch a “news” program, it’s NOT my medical appointment. It’s supposed to be news, not medical advice.

But that’s not what the German physician wrote to me about, so I kept watching (the segment in question appears about 5 minutes and 30 seconds deep, and after the 30-second commercial you have to watch to get there):

Gupta reacted to a viewer’s message on Twitter in which the tweep asked: “Does anyone know a ‘miracle’ treatment for ovarian cancer?”

Gupta’s answer began cautiously with a note about the word “miracle,” but he then transitioned into a description of a study described at the American Society of Clinical Oncology meeting last week about treatment of advanced ovarian cancer. Gupta said the results showed that adding the drug Avastin to standard chemotherapy “can slow the spread of this cancer pretty dramatically.” He also said that, “Cancer experts believe these results could change how doctors treat women with advanced ovarian cancer.”

Dramatically? Cancer experts believe this could change practice? Which cancer experts?

Not Dr. Len Lichtenfeld, who’s just across town from Gupta at the American Cancer Society, and who wrote about that same study, “Is It Right To Hype Ovarian Cancer Study?”:

“What appeared to be a very positive study in an abstract may not have been so positive after all. Patients, families and their physicians are now under the impression that a new advance has been made in this deadly disease, when that may not be the case. The positive press releases and news conferences were not balanced. Most of the media ignored the expert who raised legitimate concerns and cautions. But that information was only available to those who waited for the study to be presented and were in the audience at the time. Hopes have been falsely raised, when some caution is needed and appropriate.”

Lichtenfeld also pointed out the careful and cautious comments from a Canadian oncologist Dr. Elizabeth Eisenhauer:

“Given the cost issues, the side effect issues, and the unanswerable question as to why bevacizumab appeared to be beneficial as part of a maintenance program but not as a primary treatment, Dr. Eisenhauer concluded that more work needs to be done before this regimen can be considered as a standard treatment option for women with advanced ovarian cancer.”

Lichtenfeld himself concluded:

“…many experts and treating oncologists are going to be scratching their heads wondering what to do and whether or not to believe the results of the abstract, if they even know about the concerns such as those raised by Dr. Eisenhauer. More importantly, patients, families and friends are going to be wondering how a study that received such a positive response in the press could possibly not be the hope they had been waiting for, and had learned about through the media reports.”

Perhaps the news wasn’t as dramatic as Gupta announced, nor does it sound like cancer experts are poised to change their treatment immediately based on this abstract presented at a meeting. And it wasn’t just Lichtenfeld and Eisenhauer. I’ve already blogged about a Forbes piece that reported:

“Memorial Sloan-Kettering colon cancer specialist Leonard Saltz says that …new drugs like Avastin and Erbitux “have added very modest benefits. They increase survival a few months, but they increase the cost of care tremendously.”  …researchers revealed that ovarian cancer patients who got Roche’s Avastin in addition to standard chemo lived 14 months before their tumors progressed, vs. 10 months for those who got standard therapy. But to get this modest improvement, patients had to remain on the Avastin drug for 15 months, adding to the potential expense, hassle and side effects. So far, there is no statistically significant survival difference between the two groups; because most patients are alive it may be too early to measure this. “We may never know” whether it extends survival, admits lead researcher Robert Burger of the Fox Chase Cancer Center.”

This is balance. This is perspective. This is analysis. Not what we got from a TV MD-journalist telling you he’s your doctor and your coach.

ADDENDUM: See science writer Paul Raeburn’s analysis on this same topic on the Knight Science Journalism Tracker.

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.


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