October 28th, 2010 by Steve Novella, M.D. in Better Health Network, Health Policy, Opinion, Quackery Exposed, Research
Tags: Behavior of Pharmaceutical Companies, Dr. Steve Novella, Drug Prescribing By Physicians, Drug Rep Lunches, FDA, Food and Drug Administration, Ghostwriting Medical Articles, Ghostwriting White Papers, Overprescribing, Pharmaceutical Marketing, Pharmaceutical Sales Representatives, Pharmaceuticals, Physician Drug Prescribing Habits, SBM, Science Based Medicine, Underprescribing
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In my group practice, the Yale Medical Group, drug company-sponsored lunches and similar events have been banned. This is part of a trend, at least within academic medicine, to create some distance between physicians and pharmaceutical companies, or at least their marketing divisions. The justifications for this are several, and are all reasonable. One reason is the appearance of being too cozy, which compromises the role of academic physicians as independent experts.
But the primary reason is the belief that “detailing” by pharmaceutical sales representatives has a negative effect on the prescribing habits of physicians. There is reason to believe this may be the case because of cases of bad behavior on the part of pharmaceutical marketing divisions — ghost writing white papers, for example.
The concern, backed by evidence, is that pharmaceutical companies introduce spin and bias into the information they provide to physicians, whether though CME, detailing, literature, or sponsored lectures. Even when the information itself is not massaged, it is cherry picked, so in the end physicians are not getting a thorough and unbiased assessment of the facts. Read more »
*This blog post was originally published at Science-Based Medicine*
October 27th, 2010 by KevinMD in Better Health Network, Health Policy, News, Opinion, Research
Tags: Archives of Internal Medicine, Dr. Kevin Pho, Family Medicine, Fixing Primary Care, General Medicine, Health Reform, Healthcare reform, J Paul Leigh, KevinMD, Overcompensated Physicians, Overpaid Doctors, Physician Value, Physicians' Salaries, Primary Care, Primary Care Compensation, Primary Care Doctors' Pay, Specialty Doctors' Pay, Why Primary Care Suffers
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Authors of a recent study from the Archives of Internal Medicine are unlikely to endear themselves to specialists. As reported by Reuters, and provocatively titled, Do specialist doctors make too much money?, the study gives a per-hour breakdown of how much doctors make.
I think this is a good approach, since annual salary figures do not account for the number of hours doctors work — and in the case of primary care doctors, this includes uncompensated time doing paperwork and other bureaucratic chores.
Here’s what they found:
… the lowest wages — amounting to $60.48 an hour — [were] paid to primary care physicians.
In other broad categories of practice, surgeons took home the highest average hourly wage of $92. Internal medicine and pediatric docs earned about $85 an hour, the researchers report in the Archives of Internal Medicine.
Looking at salaries among 41 specific subspecialties, however, they found neurologic surgery and radiation oncology to be the most lucrative at $132 and $126 per hour, respectively. These were followed by medical oncologists and plastic surgeons, both making around $114 per hour; immunologists, orthopedic surgeons and dermatologists also took in more than $100 an hour. At the low end of specialist pay, child psychiatrists and infectious disease specialists made around $67 an hour.
Of course, regular readers of [this] blog know that healthcare reform will do little to decrease the disparity. The pay raises that will be coming to primary care will be far too little to change the perception that, in the United States, specialists are more valued by far. Read more »
*This blog post was originally published at KevinMD.com*
October 27th, 2010 by AnneHansonMD in Better Health Network, Health Policy, News, Opinion, Research
Tags: AAPL, American Academy of Psychiatry and Law, Dr. Anne Hanson, Medical Conference, My Three Shrinks, Practice Models, Shrink Rap
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For new readers, it’s my tradition to put up posts summarizing tidbits I picked up at the annual American Academy of Psychiatry and Law (AAPL) conference. It’s random, it’s not explained in detail, but it’s stuff I thought was interesting.
The conference started out with a keynote speech by AAPL President Stephen Billick. The title of his talk was “Be True To Psychiatry.” His point was that forensic psychiatrists are clinicians first, and that even a forensic evaluation can have therapeutic effects. He cited many examples in his practice in which a criminal or civil evaluation had potential beneficial “side effects” regardless of the forensic opinion. His main point: the forensic psychiatrist’s obligation to be neutral and objective does not preclude kindness. A point well taken, and appreciated.
A session on suicide risk assessment gave a very nice illustration of the basic problem inherent in these assessments: even assuming an “ideal” case situation with a “perfect” psychiatrist, a thorough suicide risk assessment would take four hours. Risk assessment is time consuming and inherently will be incomplete. We make the best decisions we can based on the limited data we have at the time. Read more »
*This blog post was originally published at Shrink Rap*
October 27th, 2010 by Happy Hospitalist in Better Health Network, Health Policy, Health Tips, Opinion
Tags: Disease By Choice, Happy Hospitalist, Health Insurance, Healthcare Costs, Hospitalist Medicine, Hypertension, Lifestyle Choices, Lifestyle Modifications, Medical Self-Care, Medicare, Out-Of-Pocket Healthcare Expenses, Patient Empowerment, Patient Motivation, Patient Self-Responsibility, Personal Choices, Personal Responsibility For Illness, When Patients Don't Take Their Pills
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“Why should I take my blood pressure medication,” you ask? The more I do this thing called hospitalist medicine, the more I appreciate the power of lifestyle choices we all make.
Every opportunity I get I give my patients my smoking lecture and charge their insurance a CPT 99406. Everybody knows that smoking is bad for you and it causes lung cancer. Nobody knows all the other stuff. They’re always shocked.
Maybe it’s time for me to start a blood pressure lecture. I often have patients who say: “Why should I take my blood pressure medication?” They always answer their own question with the same answer: “I was feeling fine. I didn’t see a reason to take my blood pressure medication.”
You see, these are people with insurance. These are people with the Medicare National Bank. These are people who don’t have to lift a finger or a dime to pay any out-of-pocket expenses for their healthcare. And yet, they still lack the motivation to care for themselves, even with incredible resources out there these days to help them — things like great online blood pressure chart sites for home monitoring.
Whatever the reason — whether it’s ignorance, laziness, lack of motivation, lack of remembering, or selfishness — people just don’t take care of themselves. Read more »
*This blog post was originally published at The Happy Hospitalist*
October 27th, 2010 by RamonaBatesMD in Better Health Network, Opinion, Research
Tags: Dr. James Bagian, Dr. Ramona Bates, JAMA, Journal of the American Medical Association, Medical Staff Communication, Medicine Is A Team Sport, NASA Astronaut, O.R., Operating Room Teams, Surgeons, Surgical Teams, Suture For A Living, Team Approach, Team-Based Patient Care, Teamwork In Medicine
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There’s an article in the Oct 20, 2010 issue of the Journal of the American Medical Association (JAMA) which discusses surgical team training and teamwork in the operating room.
Most surgeons have crews or individuals in the operating rooms they prefer to work along side. Things just go smoother. We work more as a team, more as one.
Why? Personalities. Communication styles that work well together. Skills that compliment. Each person knows and does their job, not trying to do someone else’s. Each knowing that even the smallest task is important to the whole.
Ideally, we could create teams like this at all times in the operating room. In reality, its not so easy. Change in personnel happens. Team members get sick, so there is great need for crosstraining and flexibility. Personnel (including surgeons) need to be able to work with these changes.
I know currently the comparison is to racecar teams that change the tires, etc. with great efficiency or the aviation industry with their checklists. While we should learn from these industries, we must not forget that medicine is far more diverse. Surgeries are not all the same. The cars are. Read more »
*This blog post was originally published at Suture for a Living*
