May 28th, 2011 by GarySchwitzer in Health Tips
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On the NPR Shots blog, Scott Hensley writes, “Quality Prescription For Primary Care Doctors: Do Less,” about an article in the Archives of Internal Medicine. Excerpt:
“A group of docs who want to improve the quality and cost-effectiveness of primary care tinkered with some Top 5 lists for of dos and don’ts for pediatricians, family doctors and internists.
After testing them a bit, they published online by the Archives of Internal Medicine. Most of the advice falls in the category of less is more.
So what should family doctors not be doing? The Top 5 list for them goes like this:
1. No MRI or other imaging tests for low back pain, unless it has persisted longer than six weeks or there are red flags, such as neurological problems.
2. No antibiotics for mild to moderate sinusitis, unless it has lasted a week or longer. Or the condition worsens after first getting better.
3. No annual electrocardiograms for low-risk patients without cardiac symptoms.
4. No Pap tests in patients under 21, or women who’ve had hysterectomies for non-malignant disease.
5. No bone scans for women under 65 or men under 70, unless they have specific risk factors.”
*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*
May 25th, 2011 by BobDoherty in Health Policy, Opinion
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You’d think that ensuring that there will be enough primary care doctors would not become a partisan issue. If you are a Republican congressman from Texas, or a Democratic Senator from California, you’d want your constituents to have access to a primary care doctor, right?
Apparently not: in the hyper-polarized and ideological world in which we now live, even modest steps to support primary care have been caught up in the worst kind of partisanship. The Washington Post reported recently that funding for a new expert commission authorized by the Affordable Care Act (ACA), which was to examine barriers to careers in primary care, has been blocked by Republicans:
“When the government set out to help 32 million more Americans gain health insurance, Congress and the Obama administration acknowledged that steering more people into coverage had a dark underside: If it works, it will aggravate a shortage of family doctors, internists and other kinds of primary care. So Page 519 of the sprawling 2010 law to overhaul the health-care system creates an influential commission to guide the country in matching the supply of health-care workers with the need. But in the eight months since its members were named, the commission has been unable to start any work. Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
May 24th, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
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There is a widespread discrepancy between the opinions of organized medical group leaders in the American Medical Association (AMA), the American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), and practicing physicians. AMA, AAFP, and ACP are part of organized medicine.
These organizations supported the healthcare reform law in 2010 and continue to support the legislation. I believe they have taken this position because they want a seat at the table as implementation of the legislation moves forward. President Obama has not paid attention to them so far and there is little evidence that he will in the future.
In March of 2010, Speaker of the House Nancy Pelosi famously said, “We have to pass the [health care] bill so that you can find out what is in it.”
Most physicians are starting to realize the implications of President Obama’s Healthcare Reform Act (ACA) (Obamacare). They are terrified about the implications for the practice of medicine.
Organized medicine is still not disenchanted with President Obama’s Healthcare Reform Act. Charles Cutler, MD, chair of the ACP Board of Governors said recently, “The medical community recognizes that so much of the ACA is good.” Read more »
*This blog post was originally published at Repairing the Healthcare System*
May 4th, 2011 by Davis Liu, M.D. in Primary Care Wednesdays
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The New York Times recently published an article titled the Family Can’t Give Away Solo Practice wistfully noting that doctors like Dr. Ronald Sroka and “doctors like him are increasingly being replaced by teams of rotating doctors and nurses who do not know their patients nearly as well. A centuries-old intimacy between doctor and patient is being lost, and patients who visit the doctor are often kept guessing about who will appear in the white coat…larger practices tend to be less intimate”
As a practicing family doctor of Gen X, I applaud Dr. Sroka for his many years of dedication and service. How he can keep 4000 patients completely clear and straight in a paper-based medical system is frankly amazing. Of course, there was a price. His life was focused solely around medicine which was the norm of his generation. Just because the current cohort of doctors wish to define themselves as more than their medical degree does not mean the care they provide is necessarily less personal or intimate or that the larger practices they join need to be as well. Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
April 30th, 2011 by StevenWilkinsMPH in Health Policy, Opinion
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Ok…here’s a brain teaser. What medical condition is the most costly to employers? I’ll give you a hint. It is also a medical condition that is likely to go unrecognized and undiagnosed by primary care physicians.
If you guessed depression you are correct. If you mentioned obesity you get a gold star since that comes in right behind depression for both criteria…at least in terms of cost and the undiagnosed part.
Four out of every ten people at work or sitting in the doctor’s waiting room suffer from moderate to severe depression. Prevalence rates for depression are highest among women and older patients with chronic conditions. Yet despite its high prevalence and costly nature, depression is significantly under-diagnosed (<50%) and under-treated by physicians.
For employers, the cost of depression cost far exceeds the direct costs associated with its diagnosis and treatment As the graphic above indicates, the cost of lost productivity for on the job depressed workers (Presenteeism) and lost time for depressed workers that are absent from the job (Absenteeism) far exceed the cost of cost of treatment (medical and medication cost).
Read more »
*This blog post was originally published at Mind The Gap*
