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Chewable Birth Control

January 17th, 2011 by Toni Brayer, M.D. in Better Health Network, Opinion

Tags: Birth Control Pills, Chewable Contraceptive, Dr. Toni Brayer, Everything Health, FDA, Food and Drug Administration, Global Brands, Low-Dose Birth Control, Oral Contraceptive, Preventing Pregnancy, Reproductive Health, Watson Pharmaceuticals, Women's Health

Just in time for the new year, the FDA has approved the first low-dose chewable birth control contraceptive. 

The daily chew will be marketed by Watson Pharmaceuticals, Inc. Fred Wilkinson, executive vice president of Global Brands said: “We believe this product is an important addition to the oral contraceptive category, and that its characteristics will make it a desirable choice for women.”

I have to ask myself: “Why?”

Most birth control failures occur because the woman forgets to take the pill. Will a chewable be more reliant? Is it aimed at gals who just love chewing gum? I don’t get the concept.

Marketing for this breakthrough will begin the in the second quarter of 2011.

*This blog post was originally published at EverythingHealth*

Do Patients Have Clinical Judgment?

January 16th, 2011 by Bryan Vartabedian, M.D. in Better Health Network, Opinion

Tags: 33 Charts, Aristotle, Clinical Judgment, Decision-Making Ability, Doctor-Patient Communication, Doctors' Experience, Doctors' Judgment, Dr. Bryan Vartabedian, General Medicine, Good Medical Decision Making, Listening To A Patient, Medical Reasoning, Patient Intuition, Patient Phronesis, Patient-Physician Relationship, Personal Health Decisions, Practical Judgment, Shared Decision-Making

I used to think they didn’t, but they do.

Clinical judgment is the application of individual experience to the variables of a patient’s medical presentation. It’s the hard-worn skill of knowing what to do and how far to go in a particular situation. It’s having the confidence to do nothing. Clinical judgment is learned from seeing lots of sick people. Good clinical judgment is when the gifted capacity of reasoning intersects with experience. Some doctors have better judgment than others.

Aristotle called this phronesis — or practical judgment.

Patients have practical judgment. We often can tell when something’s amiss with our own body. Things feel different or look different. Taking action on these observations is how we exercise judgment as patients.

Parents of children with central venous lines, for example, can often identify the early signs of infection before fever has ever appeared. They know the subtleties of their child’s behavior. The same goes for children with epilepsy. People with diabetes increasingly have the latitude to apply judgment to the management of their disease. This tends to be quite defined, however, with fixed variables and limited options for intervention. Read more »

*This blog post was originally published at 33 Charts*

Medical Errors: Should Doctors Always Fess Up?

January 16th, 2011 by DavedeBronkart in Health Policy, Opinion

Tags: Dave deBronkart, Doctors' Mistakes, Dr. Margaret Moon, e-Patient Dave, e-Patients.net, General Medicine, Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University, Medical Errors, Medical Ethics, Medical Mistakes, Medscape, Mistakes In Patient Care, Patient Privacy, Physician Survey

From the Medscape Medical Ethics article entitled “‘Some Worms Are Best Left In The Can’: Should You Hide Medical Errors?“:

Consequences aside, from a strictly ethical perspective, if a patient doesn’t realize that his physician made a mistake, should the physician fess up?

Before you jump to conclusions (as I did), look at the article’s three parts. It’s about a survey. The title is on the inflammatory side; the article is a window into physicians’ views. The introduction continues:

Evidence of the complex prisms through which physicians view these issues was apparent in the replies to four questions asked in Medscape’s exclusive ethics survey. More than 10,000 physicians responded to the survey in 2010.

Subheads:

— Mistakes that don’t harm patients. “Are there times when it’s acceptable to cover up or avoid revealing a mistake if that mistake would not cause harm to the patient?” Sixty percent said “no;” the others split between “yes” and “it depends.”

• I personally can understand this note from a survey respondent: “If there is a mistake that would have no medical effect but would cause extreme, uncalled-for anxiety, then yes,” especially since I know people (some elders, some young) who would indeed freak out, out of proportion. But, that’s a big judgment call.
• I have a harder time accepting this comment: “Why shake the patient’s trust in the doctor for something that is irrelevant?” Irrelevant is a big judgment call, and I’d be really concerned about the natural human tendency to minimize the probable impact of a mistake — especially if a provider thinks it’s all about maintaining a patient’s trust, even when the topic is their own error.

— Mistakes that might harm patients. Ninety five percent said “no;” some still said “yes!” One commented: “If the mistake has not progressed to harmfulness, then it’s essentially a non-issue. Treatment correction takes place and you move on.” Another says if there hasn’t been harm yet, “I think a ‘wait and see’ approach is okay.” Read more »

*This blog post was originally published at e-Patients.net*

Psychiatric Diagnosis And The DSM-5 Controversy

January 16th, 2011 by Dinah Miller, M.D. in Better Health Network, Opinion

Tags: American Psychiatric Association, APA, Diagnostic and Statistical Manual, Dr. Dinah Miller, DSM-5, DSM-V, Gary Greenberg, Mental Health, Mental Illness, My Three Shrinks, Psychiatric Diagnosis, Psychiatry and Psychology, Science and Medicine, Scientific Certainty Of Diseases, Shrink Rap, Wired Magazine

I’ve followed in bits and pieces — sometimes for Shrink Rap, sometimes because the issues fill my email inbox, sometimes because there’s no escape. Oh, and lots of the players have familiar names.

In the December 27th issue of Wired magazine, Gary Greenberg writes a comprehensive article on the debates around the revision of the American Psychiatric Association’s (APA) upcoming revision of the Diagnostic and Statistical Manual (DSM) entitled “Inside the Battle to Define Mental Illness.” Do read it. Here’s an excerpt:

I recently asked a former president of the APA how he used the DSM in his daily work. He told me his secretary had just asked him for a diagnosis on a patient he’d been seeing for a couple of months so that she could bill the insurance company. “I hadn’t really formulated it,” he told me. He consulted the DSM-IV and concluded that the patient had obsessive-compulsive disorder.

“Did it change the way you treated her?” I asked, noting that he’d worked with her for quite a while without naming what she had.

“No.”

“So what would you say was the value of the diagnosis?”

“I got paid.” Read more »

*This blog post was originally published at Shrink Rap*

Five Dead Babies: A Lesson In Prenatal Politics

January 16th, 2011 by Linda Burke-Galloway, M.D. in Health Policy, Opinion

Tags: Dr. Linda Burke-Galloway, First Do No Harm, Government-run Healthcare, Government-Sponsored Healthcare, Healthcare Law, Healthcare Politics, Illegal Immigrants, Infant Deaths, Labor And Delivery, Lack of Health Services, medicaid, Nebraska, No Access To Healthcare, OB/GYN, Obstetrics And Gynecology, Patient Safety, Political Hostages, Pregnancy and Childbirth, Pregnant Women, Prenatal Care, U.S. Citizens, U.S. Healthcare System, Unborn Babies, Women's Health

When the Nebraska lawmakers voted to end Medicaid prenatal care for approximately 1,500 women, their unborn babies paid the ultimate price.

Any labor room hospitalist who is responsible for the care of unassigned pregnant women will tell you that it is far easier to take care of pregnant women who have had prenatal care than it is to take care of women who haven’t. The recent vigil of the Equality Nebraska Coalition in front of their state capitol to honor five dead babies whose death can be related to the lack of access to prenatal care speaks volumes.

On or about February of 2010, Nebraska expectant mothers received a “Dear John” letter from Nebraska’s Health and Human Services stating that their pregnancies were no longer covered under Medicaid. It appeared that the rationale for making such a drastic decision involved a resistance of state politicians to pay for medical services of “illegal immigrants.”

However, when one reads the comments on a popular website called Baby Center.com, the pregnant women who were affected were U.S. citizens who were college students, wives of husbands who had lost their medical insurance, and unemployed women. Eventually all the women were able to receive government-sponsored healthcare coverage, but the panic preceding their reinstatement was palpable. Read more »

*This blog post was originally published at Dr. Linda Burke-Galloway*