July 19th, 2011 by DrRich in Health Policy, Opinion
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In his last post, DrRich pointed out to his PCP friends that their chosen profession of primary care medicine is dead and buried – with an official obituary and everything – and that it is pointless for PCPs to waste their time worrying about “secret shoppers” and other petty annoyances.
It is time for you PCPs to abandon “primary care” altogether. It is time to move on.
Walking away from primary care should not be a loss, because actually, primary care has long since abandoned you. Whatever “primary care” may have once been, it has now been reduced to strict adherence to “guidelines,” 7.5 minutes per patient “encounter,” placing chits on various “Pay for Performance” checklists, striving to induce high-and-mighty healthcare bureaucrats (who wouldn’t know a sphygmomanometer from a sphincter) to smile benignly at your humble compliance with their dictates, and most recently, competing for business with nurses.
This is not really primary care medicine. It’s not medicine at all. It’s something else. But whatever it is, it’s what has now been designated by law as “primary care,” and anyone the government unleashes to do it (whether doctors, nurses, or high-school graduates with a checklist of questions) now are all officially Primary Care Practitioners.
What generalist physicians (heretofore known as primary care physicians) need to realize is that “primary care” has been dumbed-down to the point where abandoning it is no loss; indeed, it ought to be liberating to walk away from it.
The beauty is that Read more »
*This blog post was originally published at The Covert Rationing Blog*
July 16th, 2011 by Michael Sevilla, M.D. in Health Policy, Opinion
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Every day in the news, you hear about the United States federal budget and the potential political complications if something is done or if nothing is done. And every day in the news you hear about possible cuts in Medicare. What you don’t know is that some cuts in Medicare can significantly impact the training of future Family Physicians. What do I mean by this? Well, did you know that residency programs are paid Medicare funds (called Graduate Medical Education funds) going to hospitals? Check out this great article about how residency programs are funded.
So, let’s play this out with its potential complications for Family Medicine. If GME funds are cut as they are proposed, then many hospitals with only one residency program (usually a Family Medicine program), may be forced to close the program – thereby decreasing the number of Family Physicians being trained. In those hospitals with multispecialty programs (like large university hospitals), cuts in GME funding would force hospitals to cut their Family Medicine residency slots in favor of more specialty residency slots, which are more lucrative for hospitals. Again, this would decrease the number of Family Physicians being trained.
With GME funding being cut, there are two other disturbing possibilities that may happen. First, Read more »
*This blog post was originally published at Family Medicine Rocks Blog - Mike Sevilla, MD*
July 13th, 2011 by Matthew Mintz, M.D. in Opinion
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Both Germany and France have now suspended the marketing of Actos (pioglitazone) due to concerns of a link between Actos and bladder cancer. Though we have known about bladder cancer concerns for some time, these recent concerns about the bladder cancer link stem from a recent report analyzing the FDA’s Adverse Event Reporting System (AERS), which found that 93 cases of cancer were recorded between 2004 and 2009 in patients treated with antidiabetic drugs, of which 31 patients were treated with pioglitazone, representing a statistically significant increased risk of bladder cancer (ROR 4.30, 95% confidence interval, 2.82-6.52; P less than 0.0001).
Interestingly, the FDA announced that it was going to look into the link between Actos and bladder cancer only a few days before it made its final decision on what to do with Avandia (as if they didn’t know about the Actos cancer risk before the July 2010 advisory board).
Despite the many things you have heard about Avandia, back in July 2010, the FDA decided to severely restrict the use of Avandia for three reasons: Read more »
*This blog post was originally published at ACP Internist*
July 12th, 2011 by admin in Health Tips
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Feeling tired? If so, it’s not surprising. Fatigue is one of the most common problems people report to their doctors. The Health and Retirement Study of more than 17 million older people ages 51 and up reported recently that 31% said they feel fatigued.
Fatigue is a symptom, not a disease. Different people experience it in different ways. The tiredness you feel at the end of a long day or after a time zone change might feel similar to that resulting from an illness. But fatigue from stress or lack of sleep usually subsides after a good night’s rest, while disease-related lethargy is more persistent and may be debilitating even after restful sleep.
Finding the cause. How do you know if your low-energy is caused by an underlying illness or is the result of stress, poor diet, or lack of sleep? For example, could you have chronic fatigue syndrome? That is an unusual illness and an uncommon cause of persistent fatigue, says Anthony Komaroff, M.D., professor of medicine at Harvard, world-renowned expert on chronic fatigue syndrome, and medical editor of a new Harvard Special Health Report, Boosting Your Energy. About 4 to 8 of every 1,000 adults in the United States suffer from chronic fatigue syndrome, which is about twice as common in women as in men. The causes of chronic fatigue syndrome are still unknown, and there is no accurate diagnostic test. However, scientists have found abnormalities in the brain and peripheral nervous system, in the immune system, and in energy metabolism in people with this syndrome. Read more »
*This blog post was originally published at Harvard Health Blog*
July 7th, 2011 by Peggy Polaneczky, M.D. in Health Tips
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A friend of mine had a hard time getting in to see her doctor for an urgent visit last week. Reeling from an unexpected and sudden family upset, she was depressed and anxious, unable to sleep or function, and her therapist was advising an antidepressant. She called her family doc, who works at a large hospital-based multispecialty group, and told the woman at the call center that she wanted to see the doctor on an urgent matter. She was given an appointment 6 weeks in the future.
Summoning her courage, my friend told the woman her story – and that she was really worried about herself and did not think she could wait that long.
“Sorry, that is the best I can do” was the reply.
Increasingly upset, my friend told the woman that if she had to wait that long, she just might kill herself in the interim. Read more »
*This blog post was originally published at The Blog That Ate Manhattan*
