May 6th, 2011 by BobDoherty in Health Policy, News
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Should the government be able to dictate to a doctor what he or she is allowed to discuss with a patient? Yes, says the National Rifle Association (NRA), which is pushing state legislation to prohibit physicians from asking patients about firearms in their homes.
An NRA-supported bill in Florida originally would have made it a criminal offense—punishable by fines and/or jail—if physicians asked a patient about firearms. The Florida Medical Association (FMA) fiercely opposed the bill as an intrusion on the physician-patient relationship. Now, a compromise has been reached between the NRA and the FMA that “allow doctors to ask questions about gun ownership, as long as the physician doesn’t ‘harass’ the patient, and doesn’t enter the information into the patient’s record without a good reason.” Violations would be policed by the state licensing board instead of being subject to criminal prosecution.
A long-standing ACP policy encourages physicians “to inform patients about the dangers of keeping firearms, particularly handguns, in the home and to advise them on ways to reduce the risk of injury.” But this issue is much bigger than guns, it is about whether the government should be allowed to tell physicians what they can and can’t say to patients. Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
May 6th, 2011 by Peggy Polaneczky, M.D. in Opinion
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A Rhode Island emergency room doc has been fired for posting about a trauma patient on her facebook page. While the post did not reveal patient name or personal identifiers, it had enough clinical info that a third party was able to recognize the patient.
I say if you’re going to write online about a patient, you had better disguise them so well they don’t even recognize themselves, and never post anywhere near the time of the event’s occurrence. Some bloggers I know change age, sex and other details, and post events long after they’ve happened, so no one one could ever know for sure who they’re talking about. Some doc bloggers go so far as to disguise themselves – preferring to remain anonymous both to protect themselves and their patients.
Some medical blogsites are rich with teaching cases, including x-rays and clinical information that, if disguised, would alter the diagnostic possibilities. As online venues begin to replace the time honored medical journal or local grand rounds, how do we keep our ability to teach one another with clinical cases and still respect patient privacy? In the past, the limited circulation of medical journals kept these cases amongst the medical community, but now with the internet (and the lay public’s interest in medicine), the audience for such case histories is limitless. Read more »
*This blog post was originally published at The Blog That Ate Manhattan*
May 6th, 2011 by StevenWilkinsMPH in True Stories
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I had a WOW experience yesterday when I accompanied my wife to interview a new doctor for her. As some reader may know she is being seen by specialists at MD Anderson Medical Center in Houston for Stage IV lung cancer. She has not had a local oncologist for the past 6 years…but she does now. And we both love this guy!
You need to understand that I have been very underwhelmed by the local oncologists I had met up till now. I am sure they were clinically proficient…but as a group not a one could muster a smile….or any sense of interest or curiosity in my wife’s medical condition. I held out little hope that this new doctor would be any different.
After being ushered into the exam room, a Physician’s Assistant came into the room to get smart about my wife’s history and records (which she brought). Three things surprised me about the PA. 1) She was incredibly thorough actually reading the radiology reports and reflecting with my wife on what she learned, 2) her empathy – as she read the reports she actually used terms like “bummer” when she read how my wife developed pneumonia during her treatment, and 3) she faithfully summarized the results of her review to the doctor before he came in. In other words – the PA listened and heard what my wife shared with her!
Now enters the doctor. He has a warm smile on his face while he extends a hand to my wife and me. He says just enough for us to know that he has talked to the PA. He asks my wife to sit on the exam table and does a physical exam (also a rare event these days). Read more »
*This blog post was originally published at Mind The Gap*
May 6th, 2011 by John Mandrola, M.D. in Health Tips
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The number of emails that come from fellow cyclists (and endurance athletes) with heart rhythm issues amazes me. I am more convinced than ever that our “hobby” predisposes us to electrical issues like atrial fibrillation (AF)—that the science is right.
Obviously, my pedaling “habit” creates an exposure bias. I hear from many of you because we cyclists understand each other. Like you, I consider not competing a lousy treatment option.
As a bike racer, I know things: that prancing on an elliptical trainer at a health club doesn’t cut it, and, that spin classes may look hard, but do not come close to simulating real competition. I know the extent of the inflammation required to close that gap, to avoid getting dropped when one of the local Cancellara-types have you in the gutter in a cross-wind, or the worst one of all, to turn yourself inside out to stay with a group of climbers over the crest of a seemingly endless hill—”ten more pedal strokes and I’m out”…Then ten turns to 20, then 40, and maybe you hang, and maybe not. The common denominator of all this: suffering.
It’s little wonder that we get AF.
With that as a backdrop, my goal for this post is to provide a modest amount of insight to the most common question asked by athletes with AF.
“Should I have an ablation, or not.”
Though my two episodes of heart chaos amount to only a mild case of AF, I think it’s fair to say that personal experience with a problem helps a doctor better understand your choice. I’ve thought to myself, on more than one occasion, what would I do if the watt-sucking irregularity persisted? Would I have an ablation; would I live with it; would I stop drinking so much coffee? Read more »
*This blog post was originally published at Dr John M*
May 5th, 2011 by Steven Roy Daviss, M.D. in Health Policy, Opinion
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The White House released its plan last week entitled “Epidemic: Responding to America’s Prescription Drug Abuse Crisis” [LINK to pdf of this 10-page plan]. Below are some of the elements in this plan that is part of the National Drug Control Strategy (like that has worked so well :-/).
The areas of this plan involve education of prescribers and users, monitoring programs, making it easy to dispose of controlled dangerous substances (CDS for short), and enhancing enforcement. The plan establishes thirteen goals for the next five years, and also creates a coordinating body, the Federal Council on Prescription Drug Abuse, to oversee and coordinate it all.
If any of our readers have comments on specific items (I’ve numbered them for ease of reference), including unintended (or even intended) consequences, please chime in.
- EDUCATION
- require training on responsible opiate prescribing
- require Pharma to develop education materials for providers and patients
- require professional schools and organizations to include instruction on balancing use of opiates for pain while reducing abuse
- require state licensing boards to include relevant ongoing education in their licensure requirements
- help ACEP develop guidelines for opiate prescribing in the Emergency Department [this should be a big help]
- increased use of written patient-provider agreements
- facilitate public education campaigns, especially targeting parents
- encourage research on low-abuse potential treatments, epidemiology of substance abuse, and abuse-deterrent formulations Read more »
*This blog post was originally published at Shrink Rap*
