May 1st, 2011 by admin in Opinion
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The rise of prophylactic double mastectomy in women with increased risk of breast cancer has been a topic of recent discussion. In particular, this trend has been observed amongst women with the diagnosis of unilateral carcinoma in situ, or pre-invasive breast cancer. While it has been known that in women with genetic cancer syndromes, including BRCA1 and BRCA2, double mastectomy reduces risk, the efficacy of the approach is uncertain in women with other risk profiles, yet more women and surgeons seem to be doing it.
Knowing when to test, treat and act is part of art of medical practice. The ability to convey this information effectively is also an art. Both patients and doctors may have a hard time embracing watchful waiting with respect to many forms of cancer and pre-cancer. In the case of cancer of the cervix, it is known that infection with human papillomavirus (HPV) is causative in cancer development. However, only a small percentage of those infected actually go on to get cancer. Low grade dysplasia, a condition that is early in the cervical cancer development continuum, frequently spontaneously resolves without treatment. Fortunately, in the case of cervical cancer, there is now a vaccine to prevent high risk HPV infection.
“Watchful waiting” has been most discussed as a treatment strategy for prostate cancer. Read more »
*This blog post was originally published at ACP Internist*
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).
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*This blog post was originally published at Mind The Gap*
April 27th, 2011 by AnneHansonMD in Health Tips, Opinion
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Sideways Shrink posed a great question recently in a comment on my post “When A Thick Skin Helps.” The question was whether or not physicians are allowed to hit a patient who tries to assault them.
Certainly, physical assaults on patients are not the standard of practice in psychiatry or any other medical specialty. Psychiatrists do undergo some training about physical management of violent patients: I remember in residency we had to get trained in “take down” and restraint procedures. As a group we practiced applying pressure point joint locks on each other in order to make a patient break a grip on us, and to do two person restraints to hold someone immobile until security could arrive. None of this involved any “Crouching Tiger, Hidden Dragon”-type kung fu moves, there was no kicking or hitting or loud kiai karate yells. There was a lot of talk about the importance of being as least forceful as possible. Frankly, I’m not sure how much of that I would have remembered if I had ever been in a position to have to use it. The few times when I was actually assaulted by patients the incidents happened so fast there really wasn’t anything I could have done. (OK, so the little manic lady who hit me with a stuffed dog really couldn’t count as an assault, and she was already restrained in a geri-chair to begin with.)
But the real question is: will a doctor get into trouble for defending him or herself? Read more »
*This blog post was originally published at Shrink Rap*
April 23rd, 2011 by Steven Roy Daviss, M.D. in Research
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This month’s Psychiatric Times continues the discussion [registration required 🙁 ] about the NY Times article on psychotherapy that Dinah and readers discussed on April 9. This time, our colleague, Ron Pies MD, authored this article which deconstructs the myths perpetrated in the NYT article, which interviewed a med check doctor who found it “sad” that his patients found him to be important to them in their lives (read the article for the full flavor).
I’m glad that Ron pointed out (as we have) that the 2008 Mojtabai and Olfson article — which implied that only 11% of US outpatient psychiatrists provide psychotherapy — was a misleading statistic. Why? Because they did not consider brief psychotherapy sessions (30 minutes or less) to be classified as “psychotherapy” for their session. Thus, a 90807 (45-50 min) is considered psychotherapy, but a 90805 (20-30 min) would not be considered so, even though the AMA’s CPT manual defines it as psychotherapy. Also, brief and supportive forms of psychotherapy are often given even when only a “med check” is billed. Nonetheless, the sound bite from that article has been: “Only 11% of psychiatrists do psychotherapy”. It just ain’t true. As Mark Twain said, “There are three kinds of lies: lies, damned lies and statistics.“—–
*This blog post was originally published at Shrink Rap*
April 19th, 2011 by Jessie Gruman, Ph.D. in Opinion
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“Life gives you lemons and you make lemonade…your response to all those cancer diagnoses is so positive, such a contribution!” “Your work demonstrates that illness is a great teacher.” ”Your illness has been a blessing in disguise.”
Well-meaning, thoughtful people have said things like this to me since I started writing about the experience of being seriously ill and describing what I had to do to make my health care work for me. I generally hear in such comments polite appreciation of my efforts, which is nice because I know that people often struggle to know just what to say when confronted by others’ hardships.
But beneath that appreciation I detect a common belief about the nature of suffering from illness in particular, that in its inaccuracy can inadvertently hurt sick people and those who love them.
The belief is that sickness ennobles us; that there is good to be found in the experience of illness; while diseases are bad, they teach life lessons that are good. Read more »
*This blog post was originally published at CFAH PPF Blog*
