February 18th, 2011 by Michael Kirsch, M.D. in Book Reviews, Opinion
Tags: Dr. Michael Kirsch, Healthcare reform, MD Whistleblower, Overtreated, Overtreatment, Shannon Brownlee, Too Much Medicine, U.S. Healthcare System
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My daughter, Elana, home from college on winter break, offered me a book to peruse from one of her classes. She correctly suspected that her father, the MD Whistleblower, would enjoy reading a book authored by a whistleblower pro.
The book, “Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer” by Shannon Brownlee should be required reading for first year medical students, who have not yet acquired views and habits that promulgate excessive medical care and treatment. For those of us already in practice, this book should be a required element of board recertification.
Brownlee understands the medical system well and describes a culture of excess, conflicts of interests, absence of universal quality control mechanisms and fractured and disorganized care with no one in charge of a particular patient. She presents some chilling anecdotes of medical tragedies that have occurred at our most prestigious medical institutions. And she introduces us to reform leaders who understand the system’s inherent deficiencies and their proposals to remedy them.
Brownlee states that explanations for waste in the healthcare system include:
- Cost of a gargantuan bureaucracy
- Medical malpractice fear and defensive medicine
- Incentives for patients with medical insurance to overutilize care
- Rising medical costs
The most important cause, she argues, is unnecessary medical care, which costs the nations hundreds of billions of dollars and exposes patients to the risk of harm from medical complications. She writes, “If overtreatment were a disease, there would be a patient advocacy group out there raising money for a cure.” Read more »
*This blog post was originally published at MD Whistleblower*
February 16th, 2011 by DrWes in Better Health Network, Opinion
Tags: Becker's Hospital Review, Dr. Wes Fisher, Employment Contracts, Healthcare Economics, Hospital Business, Independent Cardiology Groups, Medicine and Money, Opt-Out, Outpatient Cardiology Services, Physician Productivity
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It’s no surprise that hospitals are acquiring cardiology and primary care groups groups in droves lately. It seems there’s a signficant financial incentive to do so for now, but doctors (and especially cardiologists) should read the tea leaves ahead. From Becker’s Hospital Review:
While hospitals are limited to paying fair market value for practices, they can gain an edge over competing hospitals by offering longer employment contract terms or better electronic medical record systems and management services. If hospitals move forward with a transaction, Ms. Kaplan suggests they limit employment contracts to no more than two years if possible and rebase compensation annually based on productivity.
“In healthcare you shouldn’t assume anything is permanent,” says Ms. Kaplan. She cautions that the revenue increases that are currently available to hospitals through expanding outpatient cardiology services may not last forever, which is why she urges hospitals to limit employment contracts and other agreements to only a few years. Doing so will afford an “out” for the hospital if the service line goes from a money-maker to a money pit.
-WesMusings of a cardiologist and cardiac electrophysiologist.
*This blog post was originally published at Dr. Wes*
February 16th, 2011 by Dinah Miller, M.D. in Health Policy, Opinion
Tags: Dr. Dinah Miller, ECT, Electroconvulsive Therapy, FDA, Food and Drug Administration, Medical Device Safety, My Three Shrinks, Neurological Devices Committee, Neuroscience, Psychiatry and Psychology, Shock Therapy, Shrink Rap, Treating Depression
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Electroconvulsive therapy (ECT) is considered to be a highly effective treatment for depression. The story goes that roughly 90 percent of patients respond. The downside is that it requires general anesthesia with all its attendant risks, and patients may suffer from headaches and memory loss. The memory loss is often mild, but there are cases where it is profound and very troubling.
As with any psychiatric treatment — or so it seems — there are those who say it saved them and those who say it destroyed them. Because the risks aren’t minor, the procedure is expensive and often done on an inpatient unit, and people generally don’t like the idea of having an IV line placed, being put under, then shocked through their brain until they seize, only to wake up groggy and perhaps disoriented with an aching head, it’s often considered to be the treatment of last resort, when all else has failed. This makes the 90 percent response rate even more powerful.
I’m no expert on ECT. I haven’t administered it since I was a resident and I don’t work with inpatients where I see people before and after. I’ve rarely recommended it, and then I’ve been met with a resounding, “NO.” My memory of it was that it worked, and that most people didn’t complain of problems. One woman read a novel during her inpatient stay. I asked if she had trouble following the plot (ECT in the morning, novel reading in the afternoon), and she said no.
The Food and Drug Administration (FDA) has been looking at the safety and efficacy of the machines used to perform ECT. It’s a fairly complex story where the FDA advisory panel was considering whether to keep ECT machines categorized as “Class III” machines, which would now require machine manufacturers to prove their efficacy and safety. A reclassification as Class II (and therefore lower risk) would not require this stringent proof. Read more »
*This blog post was originally published at Shrink Rap*
February 16th, 2011 by Linda Burke-Galloway, M.D. in News, Opinion
Tags: Andres Luis Marrero, Devin Nickels, Dr. Linda Burke-Galloway, Early Pregnancy Loss, Ending A Pregnancy, Florida State University, Forced Miscarriage, Patient Safety, Physical Assault, Pregnancy and Domestic Violence, Pregnancy and Murder, Pregnancy-Related Deaths, Pregnant Women Beaten, Reproductive Health, Risk of Pregnancy, Sexual Health, teen pregnancy, Terminated Pregnancies, Unintended Pregnancy, University of Tampa, Unplanned Pregnancy, Violence Against Pregnant Women
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In less than six months after I wrote “Seven Reasons Why Pregnancy Becomes a Deadly Affair,” the public outrage is faint and inaudible regarding domestic violence committed against pregnant women. The subject therefore needs to be revisited again.
On a college campus less than 90 minutes away from my home, a 17-year-old woman was kicked and punched in her abdomen for no apparent reason other than that she carried life within her womb. The alleged father of her baby, Devin Nickels, a college student at Florida State University (FSU), was apparently not happy about his new prospective role. He purportedly contacted a high school buddy, Andres Luis Marrero, who now attended the University of Tampa, and asked him to beat his girlfriend until she had a miscarriage for $200.00. Marrero, instead, offered to assault the girl for free.
According to the University of Tampa’s newspaper, The Minaret, Nickels drove his girlfriend to a secluded wooded area near an apartment complex and Marrero allegedly assaulted her despite her pleas that she was pregnant. The woman was treated at a local hospital and her pregnancy was still viable. Hours later, Marrero allegedly wrote about the attack on his Facebook wall describing it as “fun.” He was subsequently arrested for armed kidnapping and aggravated assault on a pregnant woman. His father made a statement that his son was an “outstanding kid all his life” and he had no idea “where this was coming from.” Nickels was also arrested on the FSU campus.
Unfortunately these travesties continue. The Oakland Press reported the story of a 17-year-old Ypsilanti, Michigan high schooler who allegedly stabbed a classmate (with whom he’d had sex) in the back of the head 12 times because she told him she “might be pregnant.” She ultimately had surgery that resulted in an intensive care unit admission. The classmate lived because she “played dead.” Read more »
*This blog post was originally published at Dr. Linda Burke-Galloway*
February 16th, 2011 by Elaine Schattner, M.D. in Better Health Network, Opinion
Tags: Cigarettes, Difficulty With Speech, Doctor Patient Relationship, Doctor-Patient Communication, Doctor-Patient Trust, Epilepsy, King George VI, King of England, Medical Credentials, Medicine and History, Medicine and Movies, Prince Albert, smoking, Speech Impediment, Speech Therapy, Stuttering, The King's Speech, Tobacco Use
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Over the weekend I went to see “The King’s Speech.” So far the film, featuring Colin Firth as a soon-to-be-king-of-England with a speech impediment, and Geoffrey Rush as his ill-credentialed but trusted speech therapist, has earned top critics’ awards and 12 Oscar nominations. This is a movie that’s hard not to like for one reason or another, at least most of the way through. It uplifts, it draws on history, it depends on solid acting.
What I liked best, though, is the work’s rare depiction of a complex relationship between two imperfect, brave, and dedicated men. At some level, this is a movie about guys who communicate without fixating on cars, football (either kind), or women’s physical features. Great! (Dear Hollywood moguls: Can we have more like this, please?)
The film’s medical aspects are four, at least: The stuttering, the attitude of physicians toward smoking, a closeted sibling who had epilepsy and died at an early age (just mentioned in passing), and the king’s trusted practitioner’s lack of credentials.
At the start, Prince Albert (young King George VI) has a severe speech impediment. It’s said that he stutters, and on film Firth does so in an embarrassingly, seemingly extreme and compromising degree. He’s the second of George V’s sons, and might or might not succeed to the throne depending on events in history, his older brother’s behavior, and his capacity to serve the Empire at the brink of war. Being effective as the king of England in 1936, and especially at the start of war in 1939, entails speaking confidently.
Prince Albert’s been through the mill with doctors who’ve tried to help him talk. Some recommend he smoke cigarettes — these, they advise, would help him to relax because they’re good for the nerves, they say. One asks him to speak with a mouthful of marbles, on which this doctor watching the film worried he might choke. Eventually Albert’s wife, Elizabeth (Queen Mother to be), finds a speech therapist in London, Lionel Logue, who uses unorthodox approaches with, by rumor, exceptional results. Eventually Prince Albert — or “Bertie” as the therapist insists on calling him — trusts and accepts help from this peculiar Australian who, it turns out, developed his methods of assisting stutterers through his work with shell-shocked soldiers in WWI. Read more »
*This blog post was originally published at Medical Lessons*
