April 23rd, 2011 by RyanDuBosar in Quackery Exposed
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A handful of physicians are collaborating to take Mehmet Oz, MD, to task on what they’re calling outlandish claims and bad medical advice. Their suggestion is to no longer pay attention to that man behind the curtain.
David H. Gorski, MD, PhD, at the blog Science-Based Medicine went after Dr. Oz for hosting segments about faith healing and consulting psychics. Dr. Gorski pulls no punches, saying, “Dr. Oz has in some ways imitated Oprah and in some ways gone her one better (one worse, really) in promoting the Oprah-fication of medicine. And this season has been a particularly bad one for science-based medicine on The Dr. Oz Show.”
(Dr. Mehmet Oz may be using his “Degree in Thinkology” to come up with some of his show topics.)
Val Jones, MD, the woman behind the curtain at GetBetterHealth.com, joined the crusade against Dr. Oz, saying that he’d descended from “competent and caring cardiothoracic surgeon whose research interest was reducing preoperative stress” to “America’s chief snake oil salesman.” She is organizing a campaign to drown out the bad information with better messages. (As a disclosure, ACP Internist‘s blog contributes to and draws posts from GetBetterHealth.com.)
ACP Member Peter A. Lipson, MD, also wanted to clear the air about primary and secondary prevention of heart attacks, “one of an internist’s most important tasks, given that heart disease is one of the three top killers of North Americans.” Read more »
*This blog post was originally published at ACP Internist*
April 19th, 2011 by Harriet Hall, M.D. in Opinion
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Before we had EBM (evidence-based medicine) we had another kind of EBM: experience-based medicine. Mark Crislip has said that the three most dangerous words in medicine are “In my experience.” I agree wholeheartedly. On the other hand, it would be a mistake to discount experience entirely. Dynamite is dangerous too, but when handled with proper safety precautions it can be very useful in mining, road-building, and other endeavors.
When I was in med school, the professor would say “In my experience, drug A works better than drug B.” and we would take careful notes, follow his lead, and prescribe drug A unquestioningly. That is no longer acceptable. Today we ask for controlled studies that objectively compare drug A to drug B. That doesn’t mean the professor’s observations were entirely useless: experience, like anecdotes, can draw attention to things that are worth evaluating with the scientific method.
We don’t always have the pertinent scientific studies needed to make a clinical decision. When there is no hard evidence, a clinician’s experience may be all we have to go on. Knowing that a patient with disease X got better following treatment Y is a step above having no knowledge at all about X or Y. A small step, but arguably better than no step at all.
Experience is valuable in other ways. First, there’s the “been there, done that” phenomenon. Older doctors have seen more: they may recognize a diagnosis that less experienced doctors simply have never encountered. My dermatology professor in med school told us about a patient who had stumped him: she had an unusual dermatitis of her hands that was worst on her thumb and index finger. His father, also a doctor, asked her if she had geraniums at home. She did. She had been plucking off the dead leaves and was reacting to a chemical in the leaves. The older doctor had seen it before; his son hadn’t. Read more »
*This blog post was originally published at Science-Based Medicine*
April 2nd, 2011 by Jessie Gruman, Ph.D. in Opinion
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Members of the American public are frequently surveyed about their trust in various professionals. Doctors and nurses usually wind up near the top of the list, especially when compared to lawyers, hairdressers and politicians. Trust in professionals is important to us: they possess expertise we lack but need, to solve problems ranging from the serious (illness) to the relatively trivial (appearance).
How much professionals trust us seems irrelevant: our reciprocity is expressed in the form of payment for services rendered or promised, our recommendations to friends and families and repeat appearances.
So I was surprised to read an article in the Annals of Family Medicine describing a new scale to measure doctors’ trust in their patients. This scale, based on input from focus groups and validation surveys of physicians, was developed for research purposes on the grounds that trust is a “feature of the clinician-patient relationship that resonates with both patients and clinicians.” Read more »
*This blog post was originally published at CFAH PPF Blog*
March 24th, 2011 by GarySchwitzer in Opinion
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Maggie Mahar’s Health Beat blog tipped me off about a Bloomberg opinion piece by an Oregon urologist that begins by stating:
“The decision to opt for medical care that relies on the most costly technology is often based on blind faith that newer, elaborate and expensive must be better.”
Later, he focuses specifically on robotic surgery devices:
“They are costly and require significant re-training for surgeons. Yet consumers hungrily seek out surgeons versed in their use. If a surgeon recommends an older, less expensive technology, many patients will shop for a surgeon willing to use the newest and costliest devices, even if the added benefits are unproven and the risks may be greater.
Hospitals do nothing to discourage this and engage in the kind of tawdry marketing more familiar on late-night infomercials by using patient testimonials. “I cannot believe how quickly I recovered,” a vigorous-looking patient is quoted as saying.
As a surgeon I have to ask: Where is the data? Was the recovery any quicker than in a procedure done without a robot? Would another surgical approach have served the patient as well? And cost a lot less?
…
We are all keepers of the health-care system treasury. In making treatment choices, physicians and patients alike would do well to ask: “If I were paying for this out of my own pocket would I choose this treatment, or am I just being wowed by the cool factor at someone else’s expense?”
In the first decade of practice I was enthralled with the amazing new technology. Moving into my second decade I hope to temper some of that enthusiasm with a bit of good old-fashioned fiscal responsibility.”
It should be noted that the urologist/author discloses in the editorial that he is is founder of a medical device company with its own surgical system.
*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*
March 16th, 2011 by StevenWilkinsMPH in Opinion, Research
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Is anyone else tired of hearing about how important empathy is in the doctor-patient relationship? Every other day it seems a new study is talking about the therapeutic value of empathy. Enough already!
It’s not that I don’t believe that empathy is important — I do. I also believe the data that links physician empathy with improved patient outcomes, increased satisfaction, and better patient experiences.
A recent study released in Academic Medicine reported that “patients of physicians with high empathy scores were significantly more likely to have good control over their blood sugar as well as cholesterol, while the inverse was true for patients of physicians with low scores.”
Findings from this study by Hojat, et al. are consistent with a 2009 study by Rakel, et al. which found that among patients with the common cold, those with physicians displaying high empathy had a significantly shorter duration of illness and trend toward lesser severity of illness and higher levels of immune response compared to those patients whose physician displayed less empathy. Read more »
*This blog post was originally published at Mind The Gap*
