July 25th, 2011 by Edwin Leap, M.D. in Opinion
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For years now, we’ve all heard the drum-beat. Bill-boards in cities have proclaimed it. Various medical associations have touted it’s importance. Stroke symptoms have to be treated immediately! Give clot-busting drugs, also known as ‘thrombolytics!’
Until, of course, those in favor of giving the drugs (namely neurologists) realized that a) Not everyone with a stroke, aka ‘brain attack’ has insurance and b) people have a very inconsiderate habit of having said strokes at the most inconvenient of hours. For instance, after 5PM, on the weekend, on holidays. The nerve!
So across the country, physicians in emergency departments like mine are finding themselves expected by the court of public opinion to give a potentially dangerous drug (albeit a sometimes useful drug) without any neurologist being available to evaluate the patient. Our emergency department thought we had a tele-medicine link; even that has failed, as nearby physicians in our regional referral center don’t feel keen to take responsibility for our patients. Our own neurologists, of course, have Read more »
*This blog post was originally published at edwinleap.com*
July 22nd, 2011 by StevenWilkinsMPH in Opinion
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“I don’t have the time…I don’t get reimbursed for that.” This is an all too common refrain from primary care physicians and practice managers when ever the subject of improving physician-patient communications comes up.
I get it. Primary care physicians in particular are under tremendous pressure to produce. Just imagine…physicians in small primary care practices spend about 3.5 hours/week just on dealing with insurance-related paperwork. Then there’s keeping up with recommended treatment guidelines, journals, and IT issues and routine staffing issues…not to mention routine patient care, much of which they in fact do not get paid for. Physicians do have it rough right now.
But Doctors Can Sometimes Be Their Own Worst Enemies
Currently, in just about every State, Read more »
*This blog post was originally published at Mind The Gap*
July 19th, 2011 by DrRich in Health Policy, Opinion
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In his last post, DrRich pointed out to his PCP friends that their chosen profession of primary care medicine is dead and buried – with an official obituary and everything – and that it is pointless for PCPs to waste their time worrying about “secret shoppers” and other petty annoyances.
It is time for you PCPs to abandon “primary care” altogether. It is time to move on.
Walking away from primary care should not be a loss, because actually, primary care has long since abandoned you. Whatever “primary care” may have once been, it has now been reduced to strict adherence to “guidelines,” 7.5 minutes per patient “encounter,” placing chits on various “Pay for Performance” checklists, striving to induce high-and-mighty healthcare bureaucrats (who wouldn’t know a sphygmomanometer from a sphincter) to smile benignly at your humble compliance with their dictates, and most recently, competing for business with nurses.
This is not really primary care medicine. It’s not medicine at all. It’s something else. But whatever it is, it’s what has now been designated by law as “primary care,” and anyone the government unleashes to do it (whether doctors, nurses, or high-school graduates with a checklist of questions) now are all officially Primary Care Practitioners.
What generalist physicians (heretofore known as primary care physicians) need to realize is that “primary care” has been dumbed-down to the point where abandoning it is no loss; indeed, it ought to be liberating to walk away from it.
The beauty is that Read more »
*This blog post was originally published at The Covert Rationing Blog*
July 16th, 2011 by Michael Sevilla, M.D. in Health Policy, Opinion
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Every day in the news, you hear about the United States federal budget and the potential political complications if something is done or if nothing is done. And every day in the news you hear about possible cuts in Medicare. What you don’t know is that some cuts in Medicare can significantly impact the training of future Family Physicians. What do I mean by this? Well, did you know that residency programs are paid Medicare funds (called Graduate Medical Education funds) going to hospitals? Check out this great article about how residency programs are funded.
So, let’s play this out with its potential complications for Family Medicine. If GME funds are cut as they are proposed, then many hospitals with only one residency program (usually a Family Medicine program), may be forced to close the program – thereby decreasing the number of Family Physicians being trained. In those hospitals with multispecialty programs (like large university hospitals), cuts in GME funding would force hospitals to cut their Family Medicine residency slots in favor of more specialty residency slots, which are more lucrative for hospitals. Again, this would decrease the number of Family Physicians being trained.
With GME funding being cut, there are two other disturbing possibilities that may happen. First, Read more »
*This blog post was originally published at Family Medicine Rocks Blog - Mike Sevilla, MD*
July 13th, 2011 by admin in Opinion
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Both Germany and France have now suspended the marketing of Actos (pioglitazone) due to concerns of a link between Actos and bladder cancer. Though we have known about bladder cancer concerns for some time, these recent concerns about the bladder cancer link stem from a recent report analyzing the FDA’s Adverse Event Reporting System (AERS), which found that 93 cases of cancer were recorded between 2004 and 2009 in patients treated with antidiabetic drugs, of which 31 patients were treated with pioglitazone, representing a statistically significant increased risk of bladder cancer (ROR 4.30, 95% confidence interval, 2.82-6.52; P less than 0.0001).
Interestingly, the FDA announced that it was going to look into the link between Actos and bladder cancer only a few days before it made its final decision on what to do with Avandia (as if they didn’t know about the Actos cancer risk before the July 2010 advisory board).
Despite the many things you have heard about Avandia, back in July 2010, the FDA decided to severely restrict the use of Avandia for three reasons: Read more »
*This blog post was originally published at ACP Internist*
