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Insurance Or Not, The Patients Nobody Wants To See

In the practice of medicine, as in any human endeavor, we encounter a wide variety of human beings. While thinking about this recently, in light of the passage of the healthcare reform act, I realized something startling that supporters of the bill may not realize: There are some patients that nobody wants to see.

This uncomfortable truth exists irrespective of the presence or absence of insurance. Sometimes physicians are accused of dismissing or avoiding certain patients on the basis of their finances alone. While that problem exists (and I have seen it), a great many of the patients who can’t find (or keep) a doctor simply aren’t much fun to be around, much less to treat. Read more »

*This blog post was originally published at edwinleap.com*

Until Patient Behaviors Change, “I Do The Damn Test”

Congress controls the nation’s purse strings. It can tell the Executive Branch how to spend money. It can regulate all commerce, and by the way, to Congress everything is “commerce.”

Congressional legislation can incent economic behavior–pay for this, but not for that–but it can’t change personal decisions. A case in point is Dr. Robert Cantor, ACP Member, of Boca Raton, Fla., who says he authorizes the tests that his patients demand. His opinion? “I do the damn test.”

He says there’s little incentive not to order tests and little in healthcare reform to make him and others change their habits. More likely is the idea that, once new medical technology is invented, it will find a use.

Another article compiles a wide spectrum of ideas on how to reduce healthcare spending. Tort reform was one, sure, but many doctors focused on changing patient behavior first.

*This blog post was originally published at ACP Internist*

The “No Viagra For Sex Offenders” Amendment

There’s been some buzz on Twitter that the Democrats in the Senate have killed an amendment which would have prohibited federal funding for erectile dysfunction (ED) medications for sex offenders, which means in the upside-down logic of Washington D.C. that the Democrats favor giving Viagra to pedophiles. Right? Well, not exactly.

First, just a point of procedure: Remember, healthcare reform (HCR) is now a law, on the books, signed by the President. But there was this reconciliation sidecar bill which was meant to fix the HCR law as originally passed—it was passed in the House pretty much as soon as the Senate bill was passed. But it had to pass the Senate in the identical form, word for word, in order to go directly to Obama’s desk for signing. If the Senate mucked things up by tacking on amendments, it would have to go back to the House for approval, and given the razor-thin margin in the House, Democrats very much wanted to avoid that. Read more »

*This blog post was originally published at Movin' Meat*

No End In Sight For Prostate Cancer Screening

Is the tide finally turning on PSA screening for prostate cancer? There’s no definitive data that PSA screening saves lives from prostate cancer, and it indeed can lead to further, invasive, tests that can cause men significant discomfort. Medical societies are divided on the issue. Primary care groups like the U.S. Preventive Services Task Force (USPSTF) recommend against it for older men, while the American Urological Association (AUA) continues to recommend screening.

In a strongly worded op-ed in the New York Times, Richard Ablin, also known as the founder of the PSA test, bemoans how our healthcare system has twisted its use. “The test’s popularity has led to a hugely expensive public health disaster,” he writes. Read more »

*This blog post was originally published at KevinMD.com*

All About Skin Cancer

The entire March issue of Archives of Dermatology appears to be dedicated to skin cancer — melanoma and non-melanoma. 

Basal cell carcinoma (BCC) represents 65% to 75% of all skin cancers. Most occur on sun-exposed parts of the face, ears, scalp, shoulders, and back. Intense short-term UVB exposure is important in the formation of BCC. Clinical features include pearly translucent flesh-colored papules or nodules with superficial telangiectasias (broken blood vessels). More active lesions may have rolled edges or ulcerated centers.

Squamous cell carcinoma (SCC) represent 30% to 65% of all cutaneous malignancies.  SCCs are most attributable to UVB exposure, long-term or accumulative exposure over years. Clinical features include crusted papules and plaques that may become indurated, nodular, or ulcerated. SCC may arise in chronic wounds, scars, and leg ulcers. Recurrent SCC development within 3 years is 18%, a 10-fold higher incidence compared with initial SCC diagnosis in the general population.

Malignant melanoma (MM) represents the most serious of all cutaneous malignancies. It is estimated that approximately 65% to 90% are caused by UV exposure, predominantly UVA. Roughly 10% of all melanoma cases are strictly hereditary. Read more »

*This blog post was originally published at Suture for a Living*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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