May 21st, 2011 by DrWes in Opinion
Tags: Cardiology, Collegiality, Depression, Doctors Lounge, Fun, Health Care Reform, Lifestyle, Medical School, Psychiatry, Psychology
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I wonder if we’re in danger of stifling fun in medicine.
Certainly there are still fun things to do in medicine (ablating a pesky accessory pathway safely, for instance). But as I watch the newly-minted medical school graduates emerge from their long, sheltered educational cocoon, I wonder what their attrition rate will be from medicine once they see our new more-robotic form of health care community.
There is a social camaraderie in medicine when you train. Maybe it’s the “misery loves company” syndrome. In medical school you stick together through thick and thin because few others understand what you’re going through. You strive for the day when, collectively, you earn the designation of “doctor of medicine.” There’s a strength in numbers.
But as our work flows become regimented, our geographic coverage areas more dispersed, and our hours more fragmented, I’ve seen the loss of the collegiality of the doctor’s lounge being replaced with the coldness of e-mail blasts. I’ve seen the loss of summer picnics with my colleagues’ families replaced with “Doctor Appreciation Day.” After work get-togethers that included our spouses and kids are have long since gone – most of us just want to get back home to re-group for the next day ahead. Read more »
*This blog post was originally published at Dr. Wes*
May 19th, 2011 by Harriet Hall, M.D. in Health Tips, Opinion
Tags: Clinical Errors, Cognitive Traps, Critical Thinking, Errors, Errors In Thinking, Judgement, Objectivity, Psychiatry, Psychology, Science Based Medicine, The Way Doctors Think
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In my recent review of Peter Palmieri’s book Suffer the Children I said I would later try to cover some of the many other important issues he brings up. One of the themes in the book is the process of critical thinking and the various cognitive traps doctors fall into. I will address some of them here. This is not meant to be systematic or comprehensive, but rather a miscellany of things to think about. Some of these overlap.
Diagnostic fetishes
Everything is attributed to a pet diagnosis. Palmieri gives the example of a colleague of his who thinks everything from septic shock to behavior disorders are due to low levels of HDL, which he treats with high doses of niacin. There is a tendency to widen the criteria so that any collection of symptoms can be seen as evidence of the condition. If the hole is big enough, pegs of any shape will fit through. Some doctors attribute everything to food allergies, depression, environmental sensitivities, hormone imbalances, and other favorite diagnoses. CAM is notorious for claiming to have found the one true cause of all disease (subluxations, an imbalance of qi, etc.).
Favorite treatment.
One of his partners put dozens of infants on Cisapride to treat the spitting up that most normal babies do. Even after the manufacturer sent out a warning letter about babies who had died from irregular heart rhythms, she continued using it. Eventually the drug was recalled.
Another colleague prescribed cholestyramine for every patient with diarrhea: not only ineffective but highly illogical.
When I was an intern on the Internal Medicine rotation, the attending physician noticed one day that every single patient on our service was getting guaifenesin. We thought we had ordered it for valid reasons, but I doubt whether everyone benefited from it. Read more »
*This blog post was originally published at Science-Based Medicine*
May 19th, 2011 by VicenteBaosMD in Opinion, Research
Tags: Diario Medico, emotionally driven, Evidence Based Medicine, Irrational, medication choices, prescribing habits, prescription patterns, Spain
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I recently stumbled upon a very interesting editorial opinion in the ‘European Journal of Clinical Pharmacology’: ‘The use of drugs is not as rational as we believe…but it can’t be! The emotional roots of prescribing’, authored by Albert Figueras, from Fundació Institut Català de Farmacologia (Catalonia Institute of Pharmacology Foundation at Vall d’Hebron Hospital, in Barcelona).
Since more than 40 years ago when Archie Cochrane said that “there must be solid scientific evidence behind any statement, decision and prescription made by medical staff”, and all the way until today’s WHO promotion of rational medicine utilization, both developing and industrialised countries have been striving to increase sound knowledge about prescription and thus spread the kind of rational thinking necessary to foster evidence-based medicine in drug use.
Keeping your skills up to date has never been an easy task but nowadays we have newsletters and other Internet tools that can grant any MD state-of-the-art knowledge on any subject he or she may need, accessible anywhere and for any medical speciality. Nevertheless, drug use in the “real world” is far from this high quality. Not only in Spain: it has been noted in France, Greece and other countries that, despite widespread knowledge of risk factors that may cause gastrointestinal toxicity in patients under nonsteroidal anti-inflammatory drugs (NSAID) treatment, there is a massive use of proton-pump inhibitors in individuals that show no significant risk.
Changing well-established drugs for newer, less-known products is not consistent with the need of a well-grounded comparative evaluation. We are not raising concern on the influence of gifts or invitations from pharmaceutical companies. Many doctors really want to make rational decisions… but can’t. Read more »
*This blog post was originally published at Diario Medico*
May 18th, 2011 by Shadowfax in Health Policy, Opinion
Tags: Congress, Healthcare reform, Independent Payment Advisory Board, IPAB, Law, Legislation, Obamacare, Oversight Bodies, PPACA, Reigning In Health Costs
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I shouldn’t do this. It’s madness to try to delve into the minds of conspiracy theorists and try to make sense of their ravings. But I can’t help myself; I’m drawn like a moth to the flame. It never ends well. I only wind up with a horde of trolls in the comments telling me that I’m a glib supercilious idiot and should stick to medicine or go die in a fire or something.
Sometimes it’s too hard to stay away. Maybe it was the personal affront I felt in the false imputation of ill motives onto progressives. Maybe it was the gross errors in fact, sitting there ripe for the plucking. I don’t know, but I just can’t resist a rebuttal to Dr Rich at Covert Rationing, who weaves a technocratic cost control body into a paranoid web of fantasy, concluding that:
Progressives are dedicated to “progressing” to a perfect society, and they know just how to achieve it. … Specifically, the Progressive program requires individuals to subsume their own individual interests to the overriding interests of the collective – and human nature just doesn’t function that way. Thus, the Progressive program inevitably relies on a cadre of elites – those who have dedicated themselves to furthering the Progressive program – to set things up the right way for the rest of us, while manipulating we in the teeming masses to let them. And the rest of us, once the correct programs and systems are in place, will at last understand that it was all for our own good.
I suppose this paragraph tells you everything you need to know … about Dr Rich. Any supposition that he was approaching the view of policy with a fair mind or that he is willing to attribute anything but the worst motivations to those on the other side of the aisle is completely shredded by this paragraph. As rhetoric goes, it’s up there with “Conservatives want old people to die in pain.” So we can scratch Dr Rich off the list of people who are willing to discuss health care policy with a neutral mindset. He’s engaged in a holy war of ideology. Read more »
*This blog post was originally published at Movin' Meat*
May 18th, 2011 by DrRich in Health Policy, Opinion
Tags: Bad, Congress, Cost Control, Healthcare Law, Healthcare reform, Independent Payment Advisory Board, IPAB, Obamacare, Progressives
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In the speech President Obama gave responding to Congressman Ryan’s budget plan (the one in which he lured Ryan to sit in the front row in order to be publicly pilloried), the President did something DrRich did not think he would do before the next election. He openly invoked, and openly embraced, the Independent Payment Advisory Board (IPAB) as the chief mechanism by which Obamacare will control the cost of American healthcare.
“IPAB” might be a new term to many Americans, but DrRich pointed his readers to this entity, within a few weeks of the passage of Obamacare, as the lynchpin (and a very scary lynchpin at that) of the whole enterprise.
Until President Obama’s recent “outing” of IPAB, however, this new board has been almost entirely ignored by most commentators. Since the President’s speech, of course, many have written about it, either to celebrate it or to castigate it. (Of all these commentaries, DrRich most highly recommends the analysis provided by Doug Perednia at the Road to Hellth. In fact, DrRich recommends Perednia in general, as he is regularly producing some of the most insightful commentary, anywhere, on health policy.)
DrRich does not wish to simply repeat here all the observations that have lately been made by others regarding the IPAB. Rather, he will emphasize three particular features of the IPAB, features which are remarkable indeed, and which will tell us something very important about our Progressive leaders. Read more »
*This blog post was originally published at The Covert Rationing Blog*
