February 25th, 2011 by DrRich in News, Opinion
Tags: Civil Disobedience, Covert Rationing Blog, DrRich, Fake Doctors' Excuses, Fake Sick Excuses, Madison, Medical Ethics, Medical Profession, Social Justice, University of Wisconsin School of Medicine, University of Wisconsin-Madison, Wisconsin Doctors
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A minor firestorm has erupted regarding those doctors in Wisconsin this week who were handing out fake “sick excuses” to demonstrating teachers, Fox news producers, Andrew Breitbart, and, apparently, anyone else who had some use for one.
Indeed, there has been more outrage about this episode than DrRich would have thought. Conservative commentators, of course, were predictably apoplectic about the sight of these callow youths, preening in their white coats, abusing and debasing the sacred trust which has been granted to them by virtue of their profession. There’s nothing surprising about that. But even most of the more mainstream commentators expressed at least a slight bit of discomfort about the actions these doctors were taking, even if they were doing it for a very good and noble cause.
Only a very few seemed to endorse their actions completely, explaining that these doctors are engaging in classic civil disobedience, and that, by standing on street corners in their white coats repeatedly committing felonies with the cameras whirring, their behavior is every bit as deserving of our approbation as the actions we admire so much of Thoreau or Gandhi. DrRich is open to this explanation.
Civil disobedience, of course, is to a) openly and non-violently disobey a certain law that you consider unjust, b) to admit to the operative authority, upon apprehension, that you intentionally broke the law specifically because you consider it unjust, and finally c) to passively accept whatever punishment the authority hands out to you. These doctors have executed step “a” flawlessly, and DrRich waits with interest to see whether they will successfully complete steps “b” and “c.” Read more »
*This blog post was originally published at The Covert Rationing Blog*
February 25th, 2011 by Peggy Polaneczky, M.D. in Opinion, True Stories
Tags: Accuracy in Diagnosis, Diagnostic Tool, Dr. Gizabeth Shyner, Dr. Peggy Polaneczky, Electronic Medical Records, EMR, Healthcare Outcomes, Medical Diagnosis, Methodical Madness, Mothers in Medicine, Pathology, Quality Improvement, TBTAM, The Blog That Ate Manhattan
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A pathologist uses the EMR to find out just a little more about the patient whose cerebro-spinal fluid she has under her microscope — and changes her diagnosis:
This patient had a diagnosis of plasma cell myeloma with recent acute mental status changes. So the lone plasma cell or two I was seeing, among the lymphs and monos, could indicate leptomeningeal spread of the patient’s disease process. I reversed the tech diagnosis to atypical and added a lengthy comment – unfortunately there weren’t enough cells to attempt flow cytometry to assess for clonality of the plasma cells to cinch the diagnosis. But with the information in the EMR I was able to get a more holistic picture on a couple of cells and provide better care for the patient. I cringe to wonder if I might have blown them off as lymphs without my crutch.
The much-hoped-for improvement in quality due to the adoption of EMRs has been elusive to date, so anecdotal experiences like this will be important evidence to consider in judging the impact of the EMR on healthcare outcomes.
Kudos to pathologist Gizabeth Shyner, who writes over at Mothers in Medicine and her own blog, Methodical Madness, for “thinking outside the box.”
*This blog post was originally published at The Blog That Ate Manhattan*
February 24th, 2011 by Dr. Val Jones in Book Reviews, Opinion
Tags: Dr. Robert Goldberg, Dr. Val Jones, Evidence Based Medicine, Health Information on the Web, Informed Medical Decision Making, Internet-Based Health Information, Medical Manufactroversy, Medical Science, Online Health Information, Patient Empowerment, Personalized Medicine, Precautionary Principle, Science and Medicine, Science Based Medicine, Scientific American, Tabloid Medicine
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This was the Guest Blog at Scientific American on February 23rd, 2011.
In his new book, “Tabloid Medicine: How The Internet Is Being Used to Hijack Medical Science for Fear and Profit,” Robert Goldberg, PhD, explains why the Internet is a double-edged sword when it comes to health information. On the one hand, the Web can empower people with quality medical information that can help them make informed decisions. On the other hand, the Web is an unfiltered breeding ground for urban legends, fear-mongering and snake oil salesmen.
Goldberg uses case studies to expose the sinister side of health misinformation. Perhaps the most compelling example of a medical “manufactroversy” (defined as a manufactured controversy that is motivated by profit or extreme ideology to intentionally create public confusion about an issue that is not in dispute) is the anti-vaccine movement. Thanks to the efforts of corrupt scientists, personal injury lawyers, self-proclaimed medical experts, and Hollywood starlets, a false link between vaccines and autism has been promoted on a global scale via the Internet. The resulting panic, legal feeding frenzy, money-making alternative medicine sales, and reduction in childhood vaccination rates (causing countless preventable deaths), are sickening and tragic.
As Goldberg continues to explore the hyperbole behind specific “health threats,” a fascinating pattern emerges. Behind the most powerful manufactroversies, lies a predictable formula: First, a new problem is generated by redefining terminology. For example, an autism “epidemic” suddenly exists when a wide range of childhood mental health diagnoses are all reclassified as part of an autism spectrum. The reclassification creates the appearance of a surge in autism cases, and that sets the stage for cause-seeking.
Second, “instant experts” immediately proclaim that they have special insight into the cause. They enjoy the authority and attention that their unique “expertise” brings them and begin to position themselves as a “little guy” crusader against injustice. They also are likely to spin conspiracy theories about government cover-ups or pharmaceutical malfeasance to make their case more appealing to the media. In many cases the experts have a financial incentive in promoting their point of view (they sell treatments or promote their books, for example).
Third, because mainstream media craves David and Goliath stories and always wants to be the first to break news, they often report the information without thorough fact-checking. This results in the phenomenon of “Tabloid Medicine.” Read more »
February 23rd, 2011 by Davis Liu, M.D. in Health Policy, Opinion
Tags: 401(k) Plans, America's Health Insurance Plans, Baby-Boom Generation, Consumer-Driven Health Plans, Consumer-Driven Healthcare, Dr. Davis Liu, Financially Able To Retire, General Medicine, Health Savings Accounts, Healthcare reform, Kaiser Family Foundation Employer Benefits Survey, National Healthcare Costs, New U.S. Healthcare System, Pension Plans, Pension Protection Act, Primary Care, Retirement Income, Retiring Baby Boomers, Saving Money and Surviving the Healthcare Crisis, Wall Street Journal
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With the creation of consumer-driven health plans and health insurance policies with high deductibles linked to a savings option, more financial responsibility shouldered by patients and employees and less by employers was completely inevitable. The American public likes to have everything, whether consumer electronics or other services, as cheap as possible. With escalating healthcare expenses rising far more rapidly than wages or inflation, it’s not surprising employers needed a way to manage this increasingly-costly business expense.
In the past, companies faced a similar dilemma. It wasn’t about medical costs, but managing increasingly expensive retirement and pension plan obligations. Years ago, companies moved from these defined benefit plans to defined contribution plans like 401(k)s. After all, much like healthcare, the reasoning by many was that employees were best able to manage retirement planning because they would have far more financial incentive, responsibility, and self-motivation to make the right choices to ensure a successful outcome.
How did that assumption turn out anyway? Disastrous, according to a recent Wall Street Journal article entitled “Retiring Boomers Find 401(k) Plans Fall Short.” An excerpt:
The median household headed by a person aged 60 to 62 with a 401(k) account has less than one-quarter of what is needed in that account to maintain its standard of living in retirement, according to data compiled by the Federal Reserve and analyzed by the Center for Retirement Research at Boston College for The Wall Street Journal. Even counting Social Security and any pensions or other savings, most 401(k) participants appear to have insufficient savings. Data from other sources also show big gaps between savings and what people need, and the financial crisis has made things worse.
In others words, a lot of people don’t have enough money to retire. The options they have are simply “postponing retirement, moving to cheaper housing, buying less-expensive food, cutting back on travel, taking bigger risks with their investments, and making other sacrifices they never imagined…In general, people facing problems today got too little advice, or bad advice.” Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
February 23rd, 2011 by KevinMD in Health Policy, Opinion
Tags: ACA, Affordable Care Act, Choosing Primary Care, Dr. Kevin Pho, Family Medicine, Financial Incentive, General Medicine, Healthcare reform, Internal Medicine, KevinMD, Medical Residency, Medical School, Medscape, New Doctors, PCP&S, Physician Burnout, Physician Satisfaction, Physicians' Salaries, Primary Care Physicians, Professional Dissatisfaction, Robert Centor, U.S. Medical Students
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There are plenty of reasons why medical students aren’t choosing primary care as careers. Lack of role models. Perception of professional dissatisfaction. High burnout rate among generalist doctors. Long, uncontrollable hours.
But what about salary? Until now, the wage disparity between primary care doctors and specialists has only been an assumed reason; the evidence was largely circumstantial. After all, the average medical school debt exceeds $160,000, so why not go into a specialty that pays several times more, with better hours?
Thanks to Robert Centor, there’s a study published in Medscape that shows how money affects career choice among medical students. Here’s what they found:
Sixty-six percent of students did not apply for a primary care residency. Of these, 30 percent would have applied for primary care if they had been given a median bonus of $27,500 before and after residency. Forty-one percent of students would have considered applying for primary care for a median military annual salary after residency of $175,000.
And in conclusion:
U.S. medical students, particularly those considering primary care but selecting controllable lifestyle specialties, are more likely to consider applying for a primary care specialty if provided a financial incentive.
Money matters. There should be no shame for new doctors to admit that. After all, they’re human too, and respond to financial incentives just like anyone else. And when most medical students graduate with mortgage-sized school loans, salary should be a factor when considering a career. Read more »
*This blog post was originally published at KevinMD.com*
