June 25th, 2009 by KevinMD in Better Health Network, Health Policy
Tags: Anti-Physician, Doctors, Hate, Health Policy Experts, Physician, Wonks
No Comments »
Health policy experts have never been shy about their antagonism towards doctors.
The focus now appears to be on physician pay, with the Washington Post’s Steven Pearlstein, for one, continuing his anti-physician columns. Derek Thompson, over at The Atlantic (via @AllergyNotes), continues the assault, with a recent blog entry wondering if doctors deserve to be paid less.
I touched upon this topic last year, in a USA Today op-ed, Doctors’ pay cuts save little in health care costs, and paraphrased prominent Princeton economist Uwe Reinhardt saying that cutting physician pay 20 percent will only result in 2 percent of health care savings. And besides, if the current system stays in place, doctors whose pay is cut will simply respond by doing more procedures.
Furthermore, many health policy experts bring out the tired statistic comparing American physician salaries with those abroad. The problem is that these are not apples-to-apples comparisons. Both the cost of medical school and malpractice insurance are exponentially higher Stateside. Fully subsidize medical school and bring malpractice premiums down to the levels of other countries first, before talking about tackling doctors’ pay.
Until then, comparing physician salaries with those in Europe is a largely meaningless exercise, and only serves to expose many health wonks’ innate contempt for the medical profession.
*This blog post was originally published at KevinMD.com*
June 24th, 2009 by Emergiblog in Better Health Network, True Stories
Tags: Emergency Medicine, Nursing, Patient Care, Shifts
No Comments »
Well, somebody likes their job, I must say.
Although I can’t figure out why she is smiling.
Her cap looks like conjoined coffee filters!
Conjoined coffee filters that somebody sat on!
Maybe she doesn’t realize it’s squished, and would die of embarrassment if she knew!
********************
The emergency department “regular”.
Every emergency department has them.
A patient can become a “regular” for many reasons. Maybe they are a recurrent cardiac patient. Perhaps they suffer from chronic pain. Sometimes, they become a “regular” because they utilize the ER as a clinic and bring the whole family in over the course of a month. Some regulars are drug seekers. Others are homeless and know they can find respite in the department for at least a couple of hours and maybe get something to eat.
If you work in an emergency department long enough, you will know who they are.
And you will get to know them.
*****
Recently, it dawned on me just how well you get to know them.
I work in a community hospital. It’s one of those hospitals that patients actually request to go to from all over the county. We have our shifts from hell, but it is far from the county-trauma-eight-hour-wait-time environment of the huge medical centers. There is time to talk to the patients, find out more about them than what hurts, what is swollen or what prescription they have lost.
Over time, the conversation stops being scripted and “starts getting real”, as they say.
*****
This particular shift was steady, but not crazy. And almost all the patients I cared for were “regulars”. Easily 90%. For some, it was their usual health issue. For others, something different.
I found out a lot that night over the course of that shift
Someone’s youngest would be starting kindergarten in September; someone’s oldest had just graduated from high school. Someone had gotten into a recovery program and had been clean for a month. Someone had just welcomed their first grandchild, another was mourning the loss of their mom the week before. Someone had lost their job earlier in the week. Someone had gotten married since their last visit. A baby sister was on the way for one of my patients. Another patient had enrolled in the local junior college.
We saw them, treated them and sent them on their way with a wave and a prescription.
Hopefully they left in better shape then they arrived, even if all they needed was reassurance.
All I know is that I thoroughly enjoyed that shift.
*****
I had done all the usual things. Saline locks, blood draws. Medications and re-evaluations. IVs and education.
But I had also congratulated success, commiserated over frustrations and offered consolation over losses. We covered birth and death, struggles and successes, dropping old lifestyles and starting new beginnings.
That shift, I saw my patients in a different light.
*****
The best part of nursing has nothing to do with disease or diagnoses or procedures or prescriptions.
The best part of nursing is the patients themselves.
I thoroughly enjoyed catching up with my “regulars”.
I hope I was therapeutic for them.
They were most certainly therapeutic for me.
*This blog post was originally published at Emergiblog*
June 24th, 2009 by Mark Crislip, M.D. in Better Health Network, Quackery Exposed
Tags: Complementary And Alternative Medicine, Naturopathy, Oregon, Prescription Drugs
6 Comments »
I am a terrible Oregon chauvinist. I think there is no better place to live on the planet. Period. Great natural beauty, not a lot of people, best beer ever and no pro football team. Oregon is both casual and tolerant. It is safe to say that dressing up in the Pacific NW means tucking your t shirt into your jeans. And the citizens of the NW, especially in the Portland metro area, are tolerant of a diverse number of alternative life styles. What more could you want?
No good deed goes unpunished. The downside of toleration is the proliferation of alternative medicine. Portland has a school of chiropractic, a college of oriental medicine and the country’s oldest school of naturopathy, established in 1956. It is a year older than me. There are about 850 ND’s in Oregon. To judge from the number of alternative practitioner offices around my hospital, most of the graduates stay in Portland.
There are five health care systems in Portland. Three of the five have hired naturopaths as part of their complementary medicine programs. My system, as of yet, does not have a scam practitioner on staff, a fact of which I am most proud. Yet, I suppose it will come some day. However, if you wonder if a hospital practices evidence and science based medicine, see if they have a naturopath, a chiropractor or an acupuncturist on staff. If they do, they may be interested in issues other than providing quality health care.
Oregon has had a Board of Naturopathic physicians since 1929 to oversee naturopathic practice. There has been a long tradition of legislative oversight of naturopathy in Oregon, but they have been able, until recently, to only prescribe medications that are naturally derived. None of that synthetic nonsense for naturopaths. Natural products only. Until this month.
In Oregon, naturopaths are no longer limited to natural, herbal and homeopathic concoctions, they can also prescribe substances that actually work. Recently House Bill 327 was passed by the Oregon legislature to expand the prescriptive privileges of naturopaths. Drugs can now be added to the naturopathic formulary just by asking. The bill was passed by the Senate 22-7 and the House unanimously. Bummer. If you live in Oregon and want to pester your representative on their profound stupidity, a list is at http://gov.oregonlive.com/bill/SB327/. Send them a link to this post.
As a “shill for big pharma and a tool of the medical-industrial complex,” I suggest this may not be such a good idea. Naturopaths do not have the training, experience or understanding of medicine to safely prescribe medications. Their understanding of disease and the various therapies taught at naturopathic schools are antithetical to what is required to safely and knowledgeably prescribe modern medications.
To give prescription medications correctly and safely, one needs to understand anatomy, physiology, pharmacology and the pathophysiology of diseases. Real medical providers (MD’s, DO’s, NP’s and PA’s) have to have not only years of education in school, but a residency or other training to be able to appropriately use these medications.
What is a naturopath and what is their education?
First the Philosophy of Naturopathy. Read more »
*This blog post was originally published at Science-Based Medicine*
June 24th, 2009 by Paul Auerbach, M.D. in Better Health Network
Tags: Amber Jack, Ciguatera, Food Poisoning, Painful Intercourse, Poisoning, sex, Toxicology
No Comments »
Ciguatera fish poisoning involves a large number of tropical and semitropical bottom-feeding fish that dine on plants or smaller fish that have accumulated toxins from certain microscopic dinoflagellates. Therefore, the larger the fish, the greater the toxicity. The ciguatoxin-carrying fish most commonly ingested include the barracuda, jack, grouper, and snapper. Symptoms, which usually begin 15 to 30 minutes after the victim eats the contaminated fish, include abdominal pain, nausea, vomiting, diarrhea, tongue and throat numbness, tooth pain, difficulty walking, blurred vision, skin rash, itching, tearing of the eyes, weakness, twitching muscles, incoordination, difficulty sleeping, and occasional difficulty in breathing. A classic sign of ciguatera intoxication is the reversal of hot and cold sensation (hot liquids seem cold and vice versa), which may reflect general hypersensitivity to temperature. Unfortunately, the symptoms persist in varying severity for weeks to months. Victims can become severely ill, with heart problems, low blood pressure, deficiencies of the central and peripheral nervous systems, and generalized collapse. Anyone who displays symptoms of ciguatera fish poisoning should be seen promptly by a physician.
It was reported this spring that ciguatera fish poisoning has been linked to pain during sexual intercourse. Despite the sensational coverage that this announcement received by the press, the phenomenon has been known for quite some time. It is indeed a fact that a person affected by ciguatera fish poisoning may suffer symptoms of pain during sex. These symptoms include painful ejaculation in men, and a burning sensation during and after (for up to 3 hours) intercourse. What was interesting about this most recent report, which was generated by observations made in North Carolina, was quantification of the duration of the uncomfortable symptoms. One male reported that his symptoms lasted a week, and two of the women said that they were affected for a month. The fish implicated in this particular cluster of cases was amberjack.
Treatment for ciguatera fish poisoning is for the most part supportive, although certain drugs are beginning to prove useful for aspects of the syndrome. An example is intravenous mannitol for abnormal nervous system behavior or abnormal heart rhythms. These therapies must be undertaken by a physician. Prochlorperazine may be useful for vomiting; hydroxyzine or cool showers may be useful for itching. There are chemical tests (such as Cigua-Check® Fish Poison Test Kit) to determine the presence of ciguatoxins in fish, but there is not yet a specific antidote.
This post, Ciguatera Poisoning and Sex, was originally published on
Healthine.com by Paul Auerbach, M.D..
June 24th, 2009 by KevinMD in Better Health Network, Health Policy
Tags: Government Health Insurance, Health Insurance, Healthcare reform, Public Plan
No Comments »
It’s not because of what you think.
The common thought is that health insurers will quiver at the sight of a government plan, with the public option offering lower premiums to patients due to leaner administrative burdens.
But Charlie Baker, CEO of Massachusetts’ Harvard Pilgrim Health Care, isn’t so worried about that. Instead, he first wonders about the government’s competence in handling another large bureaucratic program:
I worry less about the impact of having the federal government writing the rules and competing directly with plans like Harvard Pilgrim for business, and more about the federal government’s ability to do this at all, much less do it well. Merely coordinating basic demographic information between Social Security, Medicare and Medicaid – three big federal programs that millions of Americans belong to – can be a chore for beneficiaries, their children, and their health plans. It’s not unusual for our members to spend six months or so trying to get this stuff corrected before they call us and ask us to step in on their behalf.
And next, he has zero confidence that the government will be fiscally disciplined administering such a plan. With how it handled the General Motors fiasco as an example, Mr. Baker wonders how any proposed public plan “will negotiate with providers for a mutually agreeable fee . . . will balance its books every year . . . will have to cover its costs of doing business – just like the private plans do – [but] won’t add to the federal deficit.”
Is that even possible?
*This blog post was originally published at KevinMD.com*
