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NEJM Publishes Proposal To Minimize Spending In Oncology

Recently the NEJM ran a Sounding Board piece on Bending the Cost Curve in Cancer Care. The author’s take on this problem:

Annual direct costs for cancer care are projected to rise — from $104 billion in 2006 to over $173 billion in 2020 and beyond.2…Medical oncologists directly or indirectly control or influence the majority of cancer care costs, including the use and choice of drugs, the types of supportive care, the frequency of imaging, and the number and extent of hospitalizations…

The article responds, in part, to Dr. Howard Brody’s 2010 proposal that each medical specialty society find five ways to reduce waste in health care. The authors, from the Divisions of Hematology-Oncology and Palliative Care at Virginia Commonwealth University in Richmond VA, offer two lists:

Suggested Changes in Oncologists’ Behavior (from the paper, verbatim — Table 1): Read more »

*This blog post was originally published at Medical Lessons*

When Doctors And Dentists Start Requiring “Mutual Privacy Agreements” With Patients

We (especially doctors themselves) like to think docs are smart. While all are very well educated in medicine, it doesn’t mean they’re actually smart at much else. Docs are well known to lose gobs of money in stupid ‘investements’ like Avacado farms and ostrich ranches (and yes, there are those with the chicken ranch problems, as well).

Here’s a dumb thing some docs are adopting I hope goes away quickly, as it’s actually not in the best interest of medicine:

When I walked into the offices of Dr. Ken Cirka, I was looking for cleaner teeth, not material for an Ars Technica story. I needed a new dentist, and Yelp says Dr. Cirka is one of the best in the Philadelphia area. The receptionist handed me a clipboard with forms to fill out. After the usual patient information form, there was a “mutual privacy agreement” that asked me to transfer ownership of any public commentary I might write in the future to Dr. Cirka. Surprised and a little outraged by this, Read more »

*This blog post was originally published at GruntDoc*

Beware Of Fake “Social Media Experts” Offering To Help You Create An Institutional Policy

They’re here: Creeping researchers who see the opportunity that’s social media.  Publications, position papers, professional guidelines and policies on social media are appearing faster than you can say ‘ARA grant opportunity.’  A simple search will show that some of these authors have little more than a token feel of what its like to be a doctor in the social space.  And they’ve got just enough of a footprint to fool the editors.  “They’ve actually got a Twitter account.  They must know what they’re talking about.”

The next time you see a policy or a guideline coming from a society or medical professional organization, deep search its authors.  Look to see if they have the experience and social scars to guide you as a professional.  If you’re a professional society or journal, be sure to do the same.  Thoroughly vetting the social media experience of authors should be part of peer review when it comes to medical research and policy generation in social media.  Otherwise expect those who have never experienced social media to position themselves as the new voice of authority. Read more »

*This blog post was originally published at 33 Charts*

Why We Need Both Primary Care Physicians And Sub-Specialists

An article in the March 24 NEJM called Specialization, Subspecialization, and Subsubspecialization in Internal Medicine might have some heads shaking: Isn’t there a shortage of primary care physicians? The sounding-board piece considers the recent decision of the American Board of Internal Medicine to issue certificates in two new fields: (1) hospice and palliative care and (2) advanced heart failure and plans in-the-works for official credentialing in other, relatively narrow fields like addiction and obesity.

The essay caught my attention because I do think it’s true that we need more well-trained specialists, as much as we need capable general physicians. Ultimately both are essential for delivery of high-quality care, and both are essential for reducing health care errors and costs.

Primary care physicians are invaluable. It’s these doctors who most-often establish rapport with patients over long periods of time, who earn their trust and, in case they should become very ill, hold their confidence on important decisions — like when and where to see a specialist and whether or not to seek more, or less, aggressive care. A well-educated, thoughtful family doctor or internist typically handles most common conditions: prophylactic care including vaccinations, weight management, high blood pressure, diabetes, straightforward infections – like bacterial pneumonia or UTIs, gout and other routine sorts of problems. Read more »

*This blog post was originally published at Medical Lessons*

Surgeons Advised To Give Up On Worst Injured In Case Of Nuclear Detonation

Researchers concluded that surgical triage following a nuclear detonation should treat moderately injured patients first, then severely and mildly injured people, because of the limited medical personnel and material resources that would be available.

The model of time and resource-based triage (MORTT) tests different hospital-based triage approaches in the first 48 hours after a nuclear detonation of an improvised nuclear device. It’s not a tool in and of itself, but it examines the effect of various prioritizations and focuses primarily on the surgical needs of trauma victims.

The report appears in Disaster Medicine and Public Health Preparedness. The entire issue, devoted to nuclear preparedness, is open access. Read more »

*This blog post was originally published at ACP Hospitalist*

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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