October 2nd, 2011 by John Mandrola, M.D. in Opinion
No Comments »
You have probably read that experience makes for better doctors.
And of course this would be true–in the obvious ways, like with the hand-eye coordination required to do complex procedures, or more importantly, with the judgment of when to do them.
There’s no news here: everyone knows you want a doctor that’s been out of training awhile, but not so long that they have become weary, close-minded or physically diminished. Just the right amount of experience please.
But there’s also potential downsides and struggles that come with experience. Tonight I would like to dwell on three ways in which experience is causing me angst.
But first, as background…
It was the very esteemed physician-turned-authors, Dr. Groopman and his wife, Dr. Hartzland, who wrote this thought-provoking WSJ essay–on how hidden influences may sway our medical decisions–that got me thinking about how I have evolved as a doctor. They were writing from the perspective of the patient. But in the exam room, there are two parties: patient and doctor.
# 1) The sobering view that experience brings: Read more »
*This blog post was originally published at Dr John M*
September 6th, 2011 by HarvardHealth in Health Tips, Research
No Comments »
Low-fat diets, move over. When it comes to lowering cholesterol, a “portfolio” diet that includes cholesterol-lowering foods such as oatmeal, nuts, and soy products is better.
Several years ago, researchers at St. Michael’s Hospital and the University of Toronto created what they called a “dietary portfolio of cholesterol-lowering foods.” It went after cholesterol by adding to a heart-healthy diet specific foods known to lower cholesterol: margarine enriched with plant sterols; oats, barley, psyllium, okra, and eggplant, all rich in soluble fiber; soy protein; and whole almonds.
In a head-to-head test against the low-fat diet traditionally recommended by the American Heart Association, the portfolio approach was the clear winner. (You can see the makeup of the test diet here.) After 24 weeks, it lowered harmful LDL cholesterol by 13%, while the low-fat diet lowered LDL by only 3%. As an added benefit, the portfolio approach also lowered triglycerides and blood pressure, and did not depress the level of beneficial HDL cholesterol. The results were published in the Journal of the American Medical Association.
What I appreciate about this study is that it Read more »
*This blog post was originally published at Harvard Health Blog*
September 2nd, 2011 by Paul Auerbach, M.D. in Research
No Comments »
I am often asked by elder persons whether or not they should take the herpes zoster (“shingles”) vaccine. Up until this point, I have been answering “yes” based on my own experience, but now there is some data to support this recommendation.
In the article, “Herpes Zoster Vaccine in Older Adults and the Risk of Subsequent Herpes Zoster Disease,” Hung Fu Tseng and his colleagues reported their findings in the Journal of the American Medical Association (JAMA 2011;305[2]:160-161). They evaluated the risk of herpes zoster after persons received the vaccine in a general practice setting.
In a retrospective (looking back at a cohort of patients from medical records) study, the researchers compared Read more »
This post, Article Recommends Herpes Zoster Vaccine For Adults Over 60, was originally published on
Healthine.com by Paul Auerbach, M.D..
August 27th, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
2 Comments »
The Role of Physicians in Controlling Medical Care Costs and Reducing Waste by the RAND Corporation and David Geffen, University of California Los Angeles School of Medicine, Santa Monica was just published in the Journal of the American Medical Association (JAMA). I do not think the JAMA should have published this article.
1.Why would the JAMA publish such an article?
2. Why are physicians blamed for all the waste in the system?
3. Why is it the physicians’ responsibility to eliminate waste when they are not the cause of the greatest percentage of the waste?
“The amount of money spent on medical care is increasing faster than the gross domestic product (GDP), and the federal deficit is increasing.”
The initial statement assumes that the government deficit is increasing because physicians control government spending for healthcare.
This is only partly correct. Read more »
*This blog post was originally published at Repairing the Healthcare System*
March 7th, 2011 by DrRich in Health Policy, Opinion
1 Comment »
In his last post, DrRich analyzed whether the young Wisconsin doctors who stood out on street corners proudly offering fake “sick excuses” to protesting teachers were engaging in an act of civil disobedience. DrRich respectfully kept an open mind on this question, but after careful deliberation concluded that it is very unlikely that their actions constituted classic civil disobedience as espoused by Thoreau or Gandhi.
Instead, these doctors were, in a professional capacity, lying. They did not lie in any truly malicious way, however. They lied because they have been trained to believe in a higher cause than mere professional ethics, namely, the cause of social justice. They lied in full confidence that telling lies to advance such a noble cause is a natural duty of the medical profession. They never expected to be criticized for it (except perhaps by Rush Limbaugh and sundry teabaggers and the like), and they almost certainly will be stunned into indignant incoherence if they end up actually receiving the full punishments their actions allow.
But what really interests DrRich is the near-perfect silence we have seen from the mainstream news media regarding this sad episode. While it’s easy to find stories about the phony sick excuses all over Fox News and conservative websites, major outlets like the New York Times, Washington Post, CNN, CBS and NBC — sources one might expect to express at least some sympathy for these doctors and their work to advance a just cause – have reported next to nothing about it. When a left-leaning mainstream outlet does report on the episode (for instance, this article appearing in the Atlantic), rather than expressing any support for the Wisconsin doctors, they express at least mild dismay. It seems plain to DrRich that the mainstream media wish the whole thing hadn’t happened, and that perhaps their silence might help it go away as soon as possible.
So here we’ve got a small cadre of youthful and idealistic physicians, behaving in a manner entirely consistent with what they’ve just learned during their medical training, and not only are they facing formal investigations and potential punishment, but also the very people and organizations whom they were surely counting on for support have retreated into an embarrassed silence, or worse, criticism. What gives? Read more »
*This blog post was originally published at The Covert Rationing Blog*
