April 10th, 2011 by Elaine Schattner, M.D. in Opinion
Tags: Cancer, Education, Expertise, Medical Specialties, Policy, Primary Care, Subspecialists, Telemedicine
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An article in the March 24 NEJM called Specialization, Subspecialization, and Subsubspecialization in Internal Medicine might have some heads shaking: Isn’t there a shortage of primary care physicians? The sounding-board piece considers the recent decision of the American Board of Internal Medicine to issue certificates in two new fields: (1) hospice and palliative care and (2) advanced heart failure and plans in-the-works for official credentialing in other, relatively narrow fields like addiction and obesity.
The essay caught my attention because I do think it’s true that we need more well-trained specialists, as much as we need capable general physicians. Ultimately both are essential for delivery of high-quality care, and both are essential for reducing health care errors and costs.
Primary care physicians are invaluable. It’s these doctors who most-often establish rapport with patients over long periods of time, who earn their trust and, in case they should become very ill, hold their confidence on important decisions — like when and where to see a specialist and whether or not to seek more, or less, aggressive care. A well-educated, thoughtful family doctor or internist typically handles most common conditions: prophylactic care including vaccinations, weight management, high blood pressure, diabetes, straightforward infections – like bacterial pneumonia or UTIs, gout and other routine sorts of problems. Read more »
*This blog post was originally published at Medical Lessons*
April 9th, 2011 by Edwin Leap, M.D. in Opinion
Tags: Emergency Medicine, Post-Traumatic Stress Disorder, Psychiatry, Psychology, PTSD
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I sometimes see men and women who come to the emergency department and tell me about their PTSD, caused by service in Iraq or Afghanistan. I believe some of them; others I doubt, since their PTSD seems directly connected to a desire for Percocet, Lortab, MS-Contin or other prescriptions for back pain. Sadly, the VA system does not lend itself to inquiry by outside physicians, so in many instances I am treating them in an information vacuum.
However, as I contemplate their allegations of PTSD, I wonder how many physicians and nurses from emergency departments have the disorder. I’m no psychiatrist, but it just seems probable that the years of cummulative stress, the years of sleeplessness and snap decisions, the untold shifts filled with unpredictable chaos, pain, threats, death and anxiety would add up to significant emotional turmoil for providers who work in that environment.
It is appropriate that we are attentive to the needs of those who serve in combat zones. And yet, they may spend only spend one or two years there. Granted, that can be terrible enough. Read more »
*This blog post was originally published at edwinleap.com*
April 9th, 2011 by Happy Hospitalist in Health Tips, Opinion
Tags: Clean Catch, Diagnosis, Internal Medicine, Straight Catheterization, Urinalysis, UTI
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After eight years of hospitalist medicine and seeing inaccurate urinalysis results day after day, year after year, I’ve come to the conclusion that the straight cath vs clean catch debate is not a debate. If the urine didn’t come from a straight cath, I have zero faith in the accuracy of the results.
I know, I know. It takes time and effort for a nurse to perform the straight cath. It’s not comfortable for the patient to have a catheter inserted into their urethra. Plus, with bad nursing technique, one could introduce bacteria into the bladder when performing a straight cath urinalysis.
All that aside, if I’m a physician trying to make medical decisions based on accurate data, then having bad urine results that don’t represent the true picture is worse than not having any data at all. For example, here’s a classic case of what I have to deal with day in and day out when trying to make medical decisions on my patients. Below is a snap shot of three UA results obtained from Happy’s ER over two visits. I’m sure it’s the same no matter where you get your care in this country. The first two urinalysis results came from a clean catch sample of a horribly weak 89 year old female who presented with family complaints of “fever and weakness”, both days. Read more »
*This blog post was originally published at The Happy Hospitalist*
April 8th, 2011 by GarySchwitzer in Opinion, Research
Tags: Drug Sales, Marketing, Off-Label Drug Use, Pharma
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There’s an important paper in PLoS Medicine, “Strategies and Practices in Off-Label Marketing of Pharmaceuticals: A Retrospective Analysis of Whistleblower Complaints.” The authors provide this background on off-label marketing:
“An important part of the (drug) approval process is the creation of the “drug label,” a detailed report that specifies the exact diseases and patient groups in which the drug can be used and the approved doses of the drug.
Physicians can, however, legally use FDA-approved drugs ‘off-label.’ That is, they can prescribe drugs for a different disease, in a different group of patients, or at a different dose to that specified in the drug’s label. However, because drugs’ manufacturers stand to benefit financially from off-label use through increased drugs sales, the FDA prohibits them from directly promoting unapproved uses. The fear is that such marketing would encourage the widespread use of drugs in settings where their efficacy and safety has not been rigorously tested, exposing patients to uncertain benefits and possible adverse effects.”
The authors conclude: Read more »
*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*
April 8th, 2011 by Glenn Laffel, M.D., Ph.D. in Health Policy, Opinion
Tags: Autism, Cerebral Palsy, Costs, Cuts, Essential Services, Habilitative Services, Health Insurance, Institute of Medicine, IOM, Wall Street Journal
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One of the great challenges facing the folks who have been tasked to implement the Big O’s health care law is defining “essential benefits,” the core medical services that insurers must cover.
Despite its voluminous nature, the law is remarkably vague in this regard. It does identify 10 care categories that health plans must provide to consumers who use federally-funded health insurance exchanges to select a plan, but the categories and associated lists aren’t comprehensive or specific (the categories appear at the end of this post).
The Institute of Medicine has been tasked to flesh out the lists of required services. It has begun work amid a frenzy of lobbying by private insurers and consumer groups. Habilitative services are one contentious area, and they illustrate the challenges faced by the IOM. Unlike rehabilitative services which help people recover lost skills, habilitative services help them acquire new ones.
Habilitative services can help autistic children improve language skills, or those with cerebral palsy learn to walk. They can also help a person with schizophrenia improve his social skills. Read more »
*This blog post was originally published at Pizaazz*
