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Latest Posts

Oncologist Considers Heat-Based Cancer Treatment

There’s so much weird and exciting cancer news this week, it’s hard to keep up!

Double-kudos to Andrew Pollack on his front-page and careful coverage in the New York Times of the hyperthermic intraperitoneal chemotherapy (Hipec) technique that’s being used at some name-brand health care facilities to treat colon cancer.

First, he spares no detail in the Times describing the seemingly primitive, crude method:

….For hours on a recent morning at the University of California, San Diego, Dr. Andrew Lowy painstakingly performed the therapy on a patient.

After slicing the man’s belly wide open, Read more »

*This blog post was originally published at Medical Lessons*

Pharma Discloses Physician Relationships – Now What?

This was the year that Pharma disclosed the names and payments of their physician consultants.  Look here for physicians speaking and consulting with Merck, GlaxoSmithKline, Lilly, and Pfizer.

Physician disclosure of conflict is important.  It helps put a physician’s opinion and point of view into a context. Disclosure has long been the standard in the academic world.  This represents the first time that such information has been made available to the general public.

But how will patients use this information and how will it affect care and outcomes?  Should patients flatly avoid physicians or others who have a relationship with a pharmaceutical company?  And should patients routinely screen physicians for conflict?

I don’t know the answer to these questions.  I’m not sure patients know the answer to these questions.  I suspect patients may not like the idea but would be willing to overlook a pharma connection when the reputation of the physician is impeccable.

Transparency is all the rage.  Expect more. But I’m wondering how the average health consumer will practically process the information.

*This blog post was originally published at 33 Charts*

Should Doctors Disclose How Many Procedures They’ve Done?

Recently the WSJ Health Blog posted “Should Doctors Say How Often They’ve Performed a Procedure?” written by Jacob Goldstein.   It references another guest post by Adam Wolfberg, M.D — “Test Poses Challenge for OB-GYNs

Dr. Wolfberg writes:

None of the published studies of CVS pitted seasoned physicians against novices; what patient would agree to be randomly assigned to an inexperienced doctor holding a long needle? But several reports from individual hospitals demonstrate that the miscarriage rate declined over time as the hospital’s staff became more experienced.

These reports point to a dilemma: CVS mavens got that way by practicing, so their present-day patients benefit at the expense of previous patients.

When I first began my solo practice 19 years ago, patients often asked how long I had been in practice.  They ask less often these days.  I have never failed to answer.

Patients sometimes ask how many times I have done a procedure, but not often.  Early in my practice, and sometimes even now, if it is a procedure I feel a bit uneasy with or haven’t done in a while I will bring the subject up without being asked.  After all, some procedures you just don’t do every day or even every month.  Some diseases you don’t see every month or even every year.

In my mind, many of the procedures I do are built on basic surgical principles.  I withdrew my privileges for microvascular procedures more than 10 years ago.  I didn’t get enough patients referred to me to feel that my skills were kept sharp.  In private practice, unlike at a university, there are no labs to go do practice work in to maintain those rarely used skills.  I have no doubt that I could regain them given the chance, but at what cost (financially or complications).

Because I gave up my privileges for microvascular procedures, it means I have limited my repertoire of reconstructive procedures important in hand, breast, and other work.  I tell my patients about them.  If a breast reconstruction patient wants a free TRAM flap, then she is referred to someone who does it.  If she  wants to keep me as her surgeon, is there the possibility she is short changing herself on the outcome?  I suppose, but I try (TRY) to be upfront and fair to each patient.

The question asked “should doctors say how often they’ve performed a procedure?” may seem an easy one to answer.   If asked, yes.  If not asked, should it be part of the consent form?  I’m not sure it should for most procedures, but for extremely complex ones, maybe.

What if I did 100 of one type of procedure, but my last one was over a year ago?  What if I have done 50 of a second procedure that is closely related in skill-set?  What if that number is only 15? What if I have never done one and don’t wish to now, but the patient needs the procedure and is not willing to travel to another hospital?  Is it okay that I have “informed” them, but they want to take the risk?  How do I define that risk for them?

How many of which procedure is enough to become proficient?  How often does it need to be done to remain proficient?  Who gets to define proficient?  Who gets to define the “magic” number of how many is enough to be proficient?  Who get to define how often the procedure needs to be done to remain “proficient”?

As Dr Wolfberg noted

What patient would agree to be randomly assigned to an inexperienced doctor holding a long needle?

So how will these questions be answered?

*This blog post was originally published at Suture for a Living*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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