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Internal Medicine Funnies

Here’s the first of many posts from Internal Medicine 2010 in lovely Toronto, Canada.

As you’d expect during a cardiology lecture, Steve Kopecky, FACP, reviewed lots of studies known by cool acronyms. He also explained why picking an inspiring name like “COURAGE” is important for your trial, based on his attempt to recruit a patient for the “BARI” trial:

“Oh no, doc, you ain’t gonna bury me,” the patient replied.

Because that joke was funny, I’ll forgive Dr. Kopecky the implied insult with which he began his lecture:

“The Wall Street Journal’s become one of the best medical journals you can read.” (Harumph.)

*This blog post was originally published at ACP Internist*

Should Doctors Disclose How Many Procedures They’ve Done?

Recently the WSJ Health Blog posted “Should Doctors Say How Often They’ve Performed a Procedure?” written by Jacob Goldstein.   It references another guest post by Adam Wolfberg, M.D — “Test Poses Challenge for OB-GYNs

Dr. Wolfberg writes:

None of the published studies of CVS pitted seasoned physicians against novices; what patient would agree to be randomly assigned to an inexperienced doctor holding a long needle? But several reports from individual hospitals demonstrate that the miscarriage rate declined over time as the hospital’s staff became more experienced.

These reports point to a dilemma: CVS mavens got that way by practicing, so their present-day patients benefit at the expense of previous patients.

When I first began my solo practice 19 years ago, patients often asked how long I had been in practice.  They ask less often these days.  I have never failed to answer.

Patients sometimes ask how many times I have done a procedure, but not often.  Early in my practice, and sometimes even now, if it is a procedure I feel a bit uneasy with or haven’t done in a while I will bring the subject up without being asked.  After all, some procedures you just don’t do every day or even every month.  Some diseases you don’t see every month or even every year.

In my mind, many of the procedures I do are built on basic surgical principles.  I withdrew my privileges for microvascular procedures more than 10 years ago.  I didn’t get enough patients referred to me to feel that my skills were kept sharp.  In private practice, unlike at a university, there are no labs to go do practice work in to maintain those rarely used skills.  I have no doubt that I could regain them given the chance, but at what cost (financially or complications).

Because I gave up my privileges for microvascular procedures, it means I have limited my repertoire of reconstructive procedures important in hand, breast, and other work.  I tell my patients about them.  If a breast reconstruction patient wants a free TRAM flap, then she is referred to someone who does it.  If she  wants to keep me as her surgeon, is there the possibility she is short changing herself on the outcome?  I suppose, but I try (TRY) to be upfront and fair to each patient.

The question asked “should doctors say how often they’ve performed a procedure?” may seem an easy one to answer.   If asked, yes.  If not asked, should it be part of the consent form?  I’m not sure it should for most procedures, but for extremely complex ones, maybe.

What if I did 100 of one type of procedure, but my last one was over a year ago?  What if I have done 50 of a second procedure that is closely related in skill-set?  What if that number is only 15? What if I have never done one and don’t wish to now, but the patient needs the procedure and is not willing to travel to another hospital?  Is it okay that I have “informed” them, but they want to take the risk?  How do I define that risk for them?

How many of which procedure is enough to become proficient?  How often does it need to be done to remain proficient?  Who gets to define proficient?  Who gets to define the “magic” number of how many is enough to be proficient?  Who get to define how often the procedure needs to be done to remain “proficient”?

As Dr Wolfberg noted

What patient would agree to be randomly assigned to an inexperienced doctor holding a long needle?

So how will these questions be answered?

*This blog post was originally published at Suture for a Living*

The True Life of a Pediatric Blogger

Not only am I welcoming in a new year, but also a new opportunity. This is my first blog on getbetterhealth.com, and I am very excited. I previously worked with Dr. Val at Revolution Health, where I was a pediatric consultant and blogger, and I now have the good fortune of working with her on her new health website.

I plan on blogging regularly and look forward to getting to know you better – your interests, questions, and goals. Actually, I would love to learn what you want from me and how I can best serve you. It might help if I first tell you about myself and my own interests. I am a pediatrician in private practice in Maryland. I am also a blogger, speaker and writer. I just finished my first book, “Anorexia,” for ABC-CLIO and recently wrote a story which will appear in a book about pediatricians, which is being edited by Dr. Perri Klass and published by Kaplan Publishing.

I love to teach. One of my favorite aspects of pediatrics is educating parents and kids, whether it’s about breastfeeding, asthma, puberty, or the latest clinical research. I love to travel and learn about new cultures. My late-husband and I spent three years working at the Kayenta Health Center on the Navajo Reservation, where we were constantly learning about health-related customs and decisions which were so different from our own.

And I love my children. I have two wonderful daughters (if I must say so myself), ages 13 and 10 years. I enjoy writing about them in my blogs occasionally. It hasn’t bothered them yet, but I assume I will soon have to be careful about what I divulge with regards to my teenager.

A very sad part of my life was the death of my incredible husband almost four years ago. He was diagnosed with a glioblastoma, a type of brain tumor, on his 40th birthday, and died exactly one year later. His illness and death were not only difficult for obvious reasons, but also because the location of the tumor caused significant personality changes and the loss of his ability to do every day things which we take for granted, such as motivating himself to stand up from a sitting position. I learned more than I ever wanted to know about the pitfalls of the health care system and how to look for clinical research trials. Since my husband became ill, I have been working on a book for children whose parents have cancer. I am determined to finish it.

I think that’s enough about me. Now I’d like to know about you. I want to know what your issues and concerns are, and what you would like me to discuss and blog about. Let’s make this year our best and most productive yet!

Stacy Beller Stryer, M.D., FAAP

 

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