MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Doc Advocate' source. Thu, 11 Sep 2008 15:45:26 +0100 http://docadvocate.com/?p=955 The American Academy of Hospice and Palliative Medicine announces two important medical education courses in hospice and palliative medicine and a significantly revised book series in keeping with the Academy’s ongoing commitment to prevent and relieve pain and suffering during serious illness. Hospice and palliative medicine physicians have demonstrated a unique skill set that is highly appealing to patients and those who care for them. Working together with a team of experienced healthcare professionals, these specialized physicians provide symptom management, pain relief, coordination of care and support to patients and their families during difficult times. The American Academy of Hospice and Palliative Medicine (AAHPM) is dedicated to meeting the increasing medical needs of the aging population by preparing more physicians to enter the specialty and educating doctors with an interest in hospice and palliative medicine to help improve patient care. “Hospice and palliative medicine is a newly recognized medical subspecialty,” says Porter Storey, MD, Executive Vice President of the American Academy of Hospice and Palliative Medicine. “This unique specialty reflects the need for specialized medical care for the growing number of older adults and persons with serious, complex, and chronic illnesses, which currently pose an enormous challenge to the healthcare industry.” Hospice and palliative medicine has been shown to provide excellent care at the end of life. Hospitals have determined that this type of care not only improves outcomes but also dramatically reduces costs. These services are becoming more widely available. “There is a much greater demand than supply of physicians skilled in hospice and palliative medicine,” explains Dr. Storey, who is a consultant in palliative care at Kaiser Permanente. “Well trained physicians in this field have unlimited opportunities. AAHPM is steadily expanding educational opportunities so that physicians who want to move into hospice and palliative medicine have more learning opportunities.” AAHPM is offering two medical education courses entitled “Current Concepts in Palliative Care: Update and Review Course” and “Hospice Medical Director Course,” which will be held August 28-30, 2008, at the Hyatt Regency Chicago. Media representatives who would like to learn more about the specialty are welcome to attend. Course Addresses Hot Issues in Field of Palliative Medicine The “Current Concepts in Palliative Care: Update and Review Course” offers a thorough update on current practice, clinical advancements, and research updates in palliative care from experts in the field while providing a comprehensive foundation for the board certification exam. The following hot topics will be addressed during the course: care of whole person and family, specialized care at the end of life, pain management and new hospice regulations, children and bereavement, and communication skills. Course Prepares Physicians for Medical Director Role The “Hospice Medical Director Course” is intended for hospice medical directors and for those interested in becoming medical directors. The course covers what a good hospice medical director does and needs to know. Physicians learn strategies to overcome the administrative, regulatory, and clinical challenges that medical directors face on a daily basis. UNIPAC Book Series Tackles Challenges Faced by Hospice and Palliative Care Physicians The 3rd edition of the Hospice/Palliative Care Training for Physicians: UNIPAC book series has been extensively updated and provides readers with a solid foundation in the field. Update topics include the hospice/palliative medicine approach to care; psychological and spiritual pain in the seriously ill; assessment and treatment of pain; management of selected nonpain symptoms; communication and the interdisciplinary team; ethical and legal decision making; care of patients with HIV/AIDS; and pediatric palliative care. “The UNIPAC book series helps to form a strong foundation for developing these skills,” says Dr. Storey, who is co-author and editor of UNIPAC book series. “Like good textbooks, the UNIPAC booklets have multiple contributors and have been peer reviewed by the leaders in the field.” (original) (Source: Doc Advocate) Doc Advocate blogs http://www.medworm.com/rss/comments.php?id=1733817 Tue, 26 Aug 2008 14:55:37 +0100 1733817 http://docadvocate.com/?p=954 A survey of 452 New York City men who had had sex with other men within the past year found that 39 percent had not disclosed their sexual orientation to their doctors, a problem particularly acute among black, Hispanic and Asian men, the city’s Department of Health and Mental Hygiene announced on Wednesday. Health officials said the survey results had troubling implications for H.I.V. prevention. The survey found, for example, that men who disclosed their sexual activity with other men were twice as likely as men who did not to have been tested for H.I.V. (63 percent versus 36 percent). The survey found a striking distinction: While 78 percent of the men who had sex with men and identified themselves as homosexual said they had discussed their sexuality with their doctors, none of the men who had sex with men but identified themselves as bisexual had told their doctors. The survey also found wide racial and ethnic variation in disclosure rates. Sixty percent of black men who had sex with other men said they had not discussed their sex lives with their doctors, compared with 48 percent of Hispanic men, 47 percent of Asian men and 19 percent of white men. Other differences in disclosure were also observed. Men who were 28 or older were more like than younger men (69 percent vs. 52 percent) to be out to their providers. Those born in the United States were more likely than immigrant men to disclose their practices, and those who were better educated disclosed at higher rates than the less educated. Dr. Monica Sweeney, the assistant health commissioner for H.I.V. prevention and control, said the findings reflected a strong stigma against homosexuality in minority communities. (About three-quarters of the men in the survey who described themselves as bisexual were black and Hispanic.) “There is a frequent phenomenon in the black community in which a man who is gay, by the conventional ways that we all know to identify somebody as gay, identifies himself as bisexual,” Dr. Sweeney said, referring to the phenomenon known as the “down low.” The survey results, published this month in The Archives of Internal Medicine, examined data from the National H.I.V. Behavioral Survey conducted in 2004-5 by the Centers for Disease Control and Prevention. The New York segment of the study involved data from 452 men who were interviewed anonymously at gay bars and clubs, tested for H.I.V., and offered medical and social services as needed. Officials not only urged patients to be forthcoming about their sexual behavior, but also urged doctors to ask about sexual history. “Health care providers should screen patients routinely for H.I.V.,” said Dr. Elizabeth Begier, director of H.I.V. epidemiology at the health department. “They should also ask their patients about behavior that may put them at risk. And New Yorkers shouldn’t hesitate to talk openly with their health care providers.” In a phone interview, Dr. Sweeney said that doctors are often squeamish about asking personal questions. “When the doctor initiates the subject, no matter how sensitive, most people talk about these things,” said Dr. Sweeney, who is trained in internal medicine and geriatrics. She added that she was not surprised by the survey findings; if anything, she said, she was surprised that the overall disclosure rate — 61 percent — was as high as it was. Marjorie J. Hill, chief executive of Gay Men’s Health Crisis, a nonprofit advocacy group, offered a similar assessment in a phone interview. “While distressed, I am not at all surprised,” she said of the findings. “Medical providers are not sufficiently trained in outreach and engagement with gay, lesbian, bisexual and transgendered people.” Outside of obstetrician-gynecologists, she said, “doctors are not encouraged to have conversations about sex.” (Source: Doc Advocate) Doc Advocate blogs http://www.medworm.com/rss/comments.php?id=1652279 Thu, 24 Jul 2008 16:11:11 +0100 1652279 http://docadvocate.com/?p=953 By Steven Reinberg HealthDay Reporter Monday, July 21, 2008; 12:00 AM MONDAY, July 21 (HealthDay News) — Starting next year, doctors can earn additional money from Medicare if they use electronic prescribing systems, U.S. health officials said Monday. The bonus program, which will continue for four years, is designed to streamline the prescription process and cut down on errors. In 2009 and 2010, Medicare will give doctors an additional 2 percent bonus on top of their fee for “e-prescribing.” In 2011 and 2012, the bonus will drop to 1 percent, and in 2013, the bonus will drop again to 0.5 percent, officials said. “There are terrific human and financial costs to illegible prescriptions,” Mike Leavitt, secretary of the U.S. Department of Health and Human Services, said during a Monday afternoon teleconference. According to the Institute of Medicine, 1.5 million Americans are injured every year by drug errors, Leavitt said. Another study found that each year pharmacists make more than 150 million phone calls to doctors to clarify what was written on the prescription, he added. ad_icon “That’s a lot of people needlessly hurt and a lot of time spent trying to sort out bad handwriting,” Leavitt said. “E-prescribing will help deliver safer or more efficient care to patients,” Leavitt said. He noted that the law that set up the Medicare prescription drug program in 2006 mandated that participating pharmacies be able to accept e-prescriptions. After five years, bonuses for e-prescribing will be phased out; doctors who haven’t adopted e-prescribing will be reimbursed at lower rates, Leavitt said. There will, however, be exceptions for doctors who have legitimate reasons for not complying. “We expect this will have a profound effect on the adoption and use of e-prescribing,” Leavitt said. Medicare started paying bonuses to doctors last year for using the Physician Quality Reporting Initiative, which collects data on the quality of care delivered by doctors. Medicare recently paid the first bonuses to more than 56,000 doctors, totaling more than $36 million. Payments ranged from $600 for individual doctors to $4,700 for group practices. The new bonuses for e-prescribing will be on top of those paid as part of the Physician Quality Reporting Initiative and other Medicare reimbursements. Medicare expects to save up to $156 million over the life of the e-prescribing program in fewer adverse drug events. Despite the advantages of e-prescribing, barriers to implementing such systems remain. One of the largest barriers is the cost. “It is fairly costly for a small practice to begin to change over to e-prescribing,” Dr. James King, a family physician in Tennessee and president of the American Academy of Family Physicians, said during the teleconference. “These incentives will help.” It’s estimated that it will cost about $3,000 per doctor to initiate an e-prescribing system. It also takes between $80 and $400 a month to maintain and operate a system, Kerry Weems, acting administrator of the U.S. Centers for Medicare & Medicaid Services, said during the teleconference. Other barriers include state laws that prohibit e-prescribing across state lines, King said. And, there are areas in the country where computer systems are slow and inefficient, he said. (see original) (Source: Doc Advocate) Doc Advocate blogs http://www.medworm.com/rss/comments.php?id=1645886 Tue, 22 Jul 2008 14:57:01 +0100 1645886 http://docadvocate.com/?p=952 Statement attributable to: J. James Rohack, M.D. President-elect, American Medical Association “Today the American Medical Association celebrates that the Senate heard the voices of patients and physicians and voted to stop Medicare physician payment cuts that would have hurt seniors’ access to care by a bipartisan, veto-proof majority of 69 to 30. We especially appreciate the heroic efforts of Sen. Edward Kennedy, who made this critical vote his first after his surgery. We also applaud those senators who put patients first and voted yes even though they had concerns about the process or some of the bill’s provisions. “Now we – along with seniors, the disabled, and military families – call on President Bush to sign this bill into law to protect access to health care for so many deserving Americans. “On July 1, a Medicare physician payment cut of 10.6 percent went into effect, putting access to health care for seniors, the disabled and military families at risk. In the first week of July, tens of thousands of patients and physicians contacted their senators and urged them to vote for HR 6331. Those voices were heard and heeded. “Just two weeks ago, the same bill – HR 6331 – passed the House of Representatives by an overwhelming, bipartisan, veto-proof majority of 355 to 59. “Now we urge President Bush to hear and heed the voices of seniors, the disabled and military families – and sign the bill into law for the health of America.” (Source: Doc Advocate) Doc Advocate blogs http://www.medworm.com/rss/comments.php?id=1605852 Thu, 10 Jul 2008 14:54:53 +0100 1605852 http://docadvocate.com/?p=951 Gov. David A. Paterson’s measures aimed at improving patient safety and putting more teeth into physician discipline drew a mixed reaction yesterday from experts in health care and the legal profession. During his news briefing yesterday, Paterson alluded to Dr. Harvey Finkelstein, the Long Island physician caught in controversy after more than 10,000 of his patients were notified they might have been exposed to hepatitis C, B and HIV. Under the governor’s plan, physicians would not be able to practice while an investigation is under way. But that denies doctors the right of due process, said Dr. Melissa Palmer, a liver specialist in Plainview who evaluated dozens of Finkelstein’s patients for liver disease. “What happened to innocent until proven guilty?” she said yesterday. “Don’t get me wrong, I think all doctors should be using universal precautions,” she said of guidelines to prevent the transmission of communicable infections in health care settings. “But until they’re actually proven 100 percent guilty, they should not be forced from practice.” Robert Tessler, a Manhattan lawyer, called the governor’s plans “a welcome move toward transparency and responsibility.” He was among lawyers who represented patients who contracted hepatitis C and possibly hepatitis B following exposure to contaminated colonoscopy equipment in Brooklyn. The cases were settled in the patients’ favor last year. Tessler said taking action against physicians has been tough in New York because the profession has protective firewalls. “It’s much easier to discipline a lawyer. The medical profession tends to be a little too protective.” One amendment authorizes an “administrative tribunal” to issue orders to the Office of Professional Medical Conduct to review personal medical records of physicians and other personnel deemed impaired by drugs, alcohol or physical or mental disability. “God is in the details on this one,” said David Rothman, founder of the Institute on Medicine as a Profession at Columbia University. “I hope this doesn’t mean that the doctors’ medical records would become public, but that the OPMC would have access to them.” (Source: Doc Advocate) Doc Advocate blogs http://www.medworm.com/rss/comments.php?id=1551294 Fri, 27 Jun 2008 14:26:13 +0100 1551294 http://docadvocate.com/?p=949 The findings aren’t new, but the sheer size of the study confirms what earlier research suggested. Docs know they provide better care, faster, when they switch from paper to electronic medical records. They just don’t want to spend the money to heal more patients and kill fewer. According to the New England Journal of Medicine, a poll of 2.758 doctors (with a 62 percent response rate) found that 17 percent were using some form of electronic record system. But those who do use electronic record systems rave about them. Among the small number of respondents who had fully functional electronic-records systems, most physicians reported the positive effects of the system on the quality of clinical decisions (82%), communication with other providers (92%) and patients (72%), prescription refills (95%), timely access to medical records (97%), and avoidance of medication errors (86%). Furthermore, 82 to 85% reported a positive effect on the delivery of long-term and preventive care that meets guidelines. But those results probably underestimate the importance of electronic records because they don’t consider the benefit that patients will get when it’s easy for them to import all their own medical records into the personal health systems I wrote about earlier this week. A New York Times story about the study asked some doctors to explain the situation and then explored ideas for fixing the situation: Dr. Paul Feldan, one of three physicians in a primary care practice in Mt. Laurel, N.J., has looked at investing in electronic health records, and decided against it. The initial cost of upgrading the office’s personal computers, purchasing new software and obtaining technical support to shift to computerized patient records would be $15,000 to $20,000 a doctor, he estimated. Then, during the time-consuming conversion from paper to computer records, the practice would be able to see far fewer patients, perhaps doubling the cost. “Certainly, the idea of electronic records is terrific,” Dr. Feldan said. “But if we don’t see patients, we don’t get paid. The economics of it just seem so daunting.” Several doctors interviewed for the story said the government should help them pay to upgrade their record keeping. And many government officials apparently agree. Medicare has launched a five year study that will pay individual doctors in 12 cities up to $58,000 to make the transition. Neither the NY Times article, nor any story I’ve seen on the issue, presses doctors to justify the decision to against spending such a small amount (relative to the annual revenue of any moderately successful practice) to improve care and reduce potentially fatal errors. Another question that always occurs to me — but always goes unanswered — is this: how does any insurer underwrite a medical malpractice policy without demanding a doctor take every reasonable step (including electronic records) to avoid errors and thus lawsuits? Another big question that never gets answered: why don’t regulators just mandate that doctors make the switch in, say, six months, rather than studying the situation for five years before deciding whether to spend billions of taxpayer dollars to buy equipment for wealthy people? None of these questions are trivial. The Institute of Medicine estimated in 2006 that prescription errors alone killed or sickened 1.5 MILLION AMERICANS PER YEAR. Systems that would have prevented nearly all of these errors — and improved care for 300 million Americans — have existed for about a decade. In that time, doctors have made more than 12 million drug errors, and still no one can figure out how to convince them to buy some software and a few computers. (see original) (Source: Doc Advocate) Doc Advocate blogs http://www.medworm.com/rss/comments.php?id=1531142 Thu, 19 Jun 2008 14:37:24 +0100 1531142 http://docadvocate.com/?p=948 Using “secret shoppers” to evaluate the way physicians manage relationships with patients could get in the way of providing needed care to actual patients, according to more than 12 doctors who testified before an American Medical Association panel, the Chicago Tribune reports. On Sunday, AMA held its annual House of Delegates meeting in Chicago. According to the Tribune, the use of secret shoppers “is becoming part of the consumer health information wave,” spurred by insurers, employers, consumers and others seeking to “ensure they are making informed choices about the kind of care and service they will receive.” The group’s Council on Ethical and Judicial Affairs has asked that the 565-member House endorse the practice, noting that secret shopper evaluations would focus on professional relationships with patients, not on clinical practices (Japsen, Chicago Tribune, 6/16). AMA information released on Friday stated that secret shoppers would be “individuals hired to act as patients to monitor service quality.” It added, “Secret shoppers have been used to evaluate most of the steps of the patient experience, from the ease of making an appointment over the phone, to the environment and flow of patients in the waiting room, to the encounter with the physician” (Snowbeck, “Medical Hotdish,” St. Paul Pioneer Press, 6/13). Rex Greene, a member of the ethics panel, said secret shopper evaluations can “highlight things that we are not aware of that can benefit our practices.” He said, “We would like certain parameters where ethically appropriate,” adding, “This is a practice-management tool.” However, physicians testifying before the panel disagreed. Howard Chodash, an associate professor of gastroenterology at Southern Illinois University School of Medicine and an AMA delegate, called the practice “grossly unethical.” George Anstadt, an AMA delegate representing the American College of Occupational and Environmental Medicine, said, “This goes against the grain of the doctor-patient relationship,” adding, “We should use real patients as sources of real information we need about quality of care.” The physicians also expressed concerns that information gathered by secret shoppers could be used to cut physician payments or used by trial lawyers in medical malpractice lawsuits. The proposal could be endorsed, rejected or referred for more study when the AMA House of Delegates votes this week (Chicago Tribune, 6/16). (see original) (Source: Doc Advocate) Doc Advocate blogs http://www.medworm.com/rss/comments.php?id=1526059 Tue, 17 Jun 2008 13:58:25 +0100 1526059 http://docadvocate.com/?p=946 ‘Several options’ may mean you’re stuck with no winning choice The Institute of Medicine did a study and found that 90 million Americans don’t understand what their doctors are telling them. So we asked Mehmet Oz, MD, professor and vice chairman of surgery at New York–Presbyterian/Columbia University and author of “You: Staying Young,” for some help deciphering the common phrases doctors use in the examination room. 1. If your doctor says: “You might want to consider taking a stress test.” What he means is: “You might be a ticking time bomb.” Your response should be: “Is this routine or is something in my profile worrying you?” A stress test is a risk stratification test. “It answers the question, ‘When you’re pushed as hard as you can be pushed, are you a ticking time bomb?’ ” says Dr. Oz. Your ability to exercise is the best predictor of how well you’re aging. 2. If your doctor says: “You could stand to lose a little weight.” What he means is: “If you don’t lose that gut, you’ll end up with diabetes.” Your response should be: “Do I have high blood pressure, prediabetes, or high cholesterol?” For all three conditions, the first line of defense is weight loss. “Don’t wait for your doctor to tell you to lose weight,” says Dr. Oz. Measure yourself around your waist at belly-button level. If the number is more than half your height, you’re overweight. 3. If your doctor says: “We have several options.” What he means is: “We have no good options.” Your response should be: “What are the problems with each option?” If your doctor had a perfect option, he wouldn’t offer the others, says Dr. Oz. 4. If your doctor says: “I would like to run some more tests.” What he means is: “I’m stalling for time because I have no idea what’s wrong with you.” Your response should be: “What diagnosis are you looking for with these tests?” Like everybody else, physicians go through illogical moments. Your job is to catch them. “Your doctor should be able to give you a flowchart explaining where each test result will lead him next,” says Dr. Oz. If the logic flow of the tests doesn’t make sense to you, tell him so. 5. If your doctor says: “If it doesn’t clear up in a week, come back in.” What he means is: “I’m giving you a placebo. It might work or it might not.” Your response should be: “What are the worst-case scenarios?” If a doctor is interested in seeing you in a week, he’s triaging problems. “Plus,” says Dr. Oz, “it gives him a chance to experiment, since no one therapy works on everyone.” 6. What your doctor will rarely say: “You need a second opinion.” What you should be thinking: “Second opinions change a diagnosis and treatment a third of the time. Why isn’t he recommending one?” Your response should be: “If I went to another high-quality doctor like you, what’s another legitimate approach he could offer me?” Any good physician should be able to offer you a plan B, says Dr. Oz. Copyright© 2008 Rodale Inc. All rights reserved. No reproduction, transmission or display is permitted without the written permissions of Rodale Inc. URL: http://www.msnbc.msn.com/id/24893978/ (Source: Doc Advocate) Doc Advocate blogs http://www.medworm.com/rss/comments.php?id=1512116 Thu, 12 Jun 2008 14:01:16 +0100 1512116 http://docadvocate.com/?p=945 The South Carolina Medical Association has formed a new company to offer malpractice insurance to physicians in the state. The South Carolina Physicians Assurance Company is designed as a safety net should commercial carriers leave the market during an earnings downturn, said Todd Atwater, CEO of SCMA and president of the new company. Currently, most physicians have their malpractice insurance through South Carolina Joint Underwriters Association, which was formed about 25 years ago to make sure doctors could get malpractice insurance, he said. The new company is also a hedge against JUA instability, he said. “Our number one goal is that physicians have coverage, whether it’s with us, the JUA or a commercial carrier,” Atwater said. “But we can’t take the chance there’s an underfunded situation (with JUA), or that a commercial carrier leaves the market, leaving our doctors without insurance.” The new company’s premiums are “competitively priced,” he said, and meant to offer an alternative to commercial insurers. Atwater said he expects the new company to insure only 500 to 600 of the 9,000 practicing physicians in the state. Physicians Assurance is a stock-owned company with SCMA holding all the shares, he said. Though it’s a for-profit venture, it’s not designed to make a profit, he said. The company has reserves of $2 million, provided by SCMA, he said. And physicians would pay 33 percent above premiums into a reserve account for claims to share the financial risk. At some point, he said, reserves might be returned to policyholders if the company took in more than it needed to pay claims and maintain reserves. SCMA also offers health insurance to its members and their employers and families. (see original) (Source: Doc Advocate) Doc Advocate blogs http://www.medworm.com/rss/comments.php?id=1508228 Tue, 10 Jun 2008 14:18:30 +0100 1508228 http://docadvocate.com/?p=944 Disgruntled patients can post reviews of treatments. Distraught over the results of cosmetic surgery on her nose, Katherine Chen did what many people do when they’re unhappy with a doctor. She consulted a malpractice lawyer and filed a complaint with the Medical Board of California. But the 22-year-old college student from West Covina , Calif., didn’t stop there. Chen logged onto her home computer and wrote a tearful review about her experience, posting it to a Web site that encourages consumers to rate their health-care providers. “I wasn’t nasty about it,” says Chen. “But I posted a comment about what I went through. These Web sites are useful. Doctors still have a lot of power.” Chen and other consumers are trying to rein in that power. They’re saying what they think about the current state of health care and, more specifically, the doctors who provide it. Dozens of Web sites that permit people to rate,review, spin or flame their doctors have sprung up in the last year, operating in much the same way as online services that help people find hotels or plumbers. Patients and site operators say the trend is good for consumers and good for healthcare. Thoughtful doctors, they say, will provide better customer service because of the feedback, and the bad ones will no longer be able to hide. And, they add, why should doctors be immune from the trend toward better customer service? Many physicians say the reviews on RateMDs.com, Vitals.com, DrScore.com and other sites are skewed by disgruntled patients and are unfair, pushing some doctors to near-ruin after a single post. “These sites don’t yield enough power yet to get bad doctors to change. And in the meantime, they may hurt good doctors,” says Dr. Phyllis Hollenbeck, a Washington, D.C., family physician and author of “Sacred Trust: The Ten Rules of Life, Death and Medicine,” a new book promoting patient empowerment. “It only takes one or two scathing comments and a doctor is put in a terrible position.” The sites, more than two dozen of them, vary in their scope of information and efforts to be fair. But the trend is toward free, anonymous, no-holds-barred forums. Some sites have grown out of existing ratings services. Five years after he started the hugely popular RateMyProfessors.com, John Swapceinski and his business partner launched RateMDs in 2004. “You can find ratings on cars and flat-screen TVs, but it’s hard to rate professional services,” he says. “I think that’s overlooked.” Angie’s List, a membership-based service that allows consumers to rate service providers, added health-care services in March. The operators of Vitals.com, which launched in January, say their goal is to provide people with free, fair and balanced information to help them select a doctor. “We think of it as something closer to Match.com, in which we want to match up patients with doctors who are right for them,” says Mitchel Rothschild, chief executive of the Lyndhurst, N.J., company. The restaurant survey company Zagat has even teamed with the health benefits company Wellpoint Inc., parent company of Anthem Blue Cross, to provide Blue Cross members with an online tool to evaluate doctors. The service allows members to issue scores based on trust, communication, availability and environment. Sharing information via the Web has given consumers a powerful tool. But viewing a doctor the same way as a product represents a dramatic shift. Once reverential of doctors, many U.S. consumers are more comfortable criticizing physicians, says Dr. Kevin Weiss, president of the American Board of Medical Specialties, an organization that sets performance standards and certifies doctors. “There is a lot of pent-up frustration,” Weiss says. “Costs are going up, and people are paying more out of pocket. Plus, there is a lot of data now on how the health-care system needs to do better in terms of quality and safety.” ACCOUNTABILITY? The tradition of doctors monitoring their own conduct through state medical boards and peer organizations is failing, Swapceinski says. “There is a lot of protection for doctors,” he says. “Even with the state medical boards there is recognition that doctors policing doctors is not the best way to handle things. Most complaints about doctors are never made public.” Chen says she did her homework - checking the doctor’s credentials and history of malpractice lawsuits and studying his Web site - before the surgery last year to shorten her long nose. “It was minor,” she says. “I actually shouldn’t have done anything, but I wanted to be perfect.” She found no red flags in the surgeon’s background. The results of the operation, however, horrified her. “I started crying. I didn’t recognize myself … I spent the next nine months at home. I was embarrassed to go out. I quit my job and dropped out of school.” Chen says her nose was crooked and much too short, and that she was left with breathing problems and nose bleeds. She filed a complaint with the Medical Board of California, a process she later abandoned, and consulted a lawyer who discouraged her from filing a lawsuit because of the cost. She was also facing surgery to correct her nose. Ultimately, Chen says, she felt exposing the doctor on the Internet was her only recourse. Later, pleased with her revision surgery, Chen also used a ratings Web site to write favorably about the doctor who performed it. “I wanted people to know about my experience with him because he didn’t really have any feedback on the site,” she says. ‘LONG VOICE’ OF THE INTERNET Dr. Richard Fischel, a thoracic surgeon in Orange, says his life was turned upside-down after a patient began posting vicious remarks online regarding a surgery Fischel performed. The surgery was an elective procedure, Fischel and the patient discussed the pros and cons, and the patient signed a consent form acknowledging that discussion. The operation went well, Fischel says. But after the surgery, the patient complained about a previously discussed side effect. “He decided his life was ruined and destroyed,” says Fischel, who graduated from the University of California medical school and is director of thoracic oncology at Hoag Hospital in Newport Beach. Online, Fischel says, the patient posted “slanderous rants and raves.” Fischel, who can’t reveal details because of a legal agreement he has since reached with the patient, soon discovered the pervasive power of the Internet. His business was affected and he suffered monetary and emotional costs because of the patient’s postings. Fischel hired a lawyer and became so depressed he considered leaving medicine. “Doctors, in general, are sitting ducks,” Fischel says. “It’s impossible to fight back. The courts make it so you have almost no options.” Federal laws protect patient privacy and prohibit doctors from discussing an individual’s health care in public. But the right of patients to criticize their doctors online has been established. Federal law asserts that the hosts of Web sites on which consumers post anonymous opinions are immune from charges of defamation. “There is a lot of power in the Internet and, in a way, certain doctors have used it to become famous,” says Dr. Jonathan Sykes, who is vice president of education for the American Academy of Facial Plastic and Reconstructive Surgery and the subject of a Web site created by a dissatisfied patient. “But it works in both directions. The Internet has a long voice. Something negative gets perpetuated because the Web site stays up. Good reputations can be tarnished by a sinister person.” (see original) (Source: Doc Advocate) Doc Advocate blogs http://www.medworm.com/rss/comments.php?id=1469593 Tue, 27 May 2008 14:56:11 +0100 1469593 http://docadvocate.com/?p=943 The death of the era of primary-physician health care in the United States may be the unintended consequence of the 10.1 percent cut in Medicare physician fee payment scheduled for July 1. The death of the era of primary-physician health care in the United States may be the unintended consequence of the 10.1 percent cut in Medicare physician fee payment scheduled for July 1. Gone will be the days of the “affable, available and affordable” primary care doctor who really knows you as a person and would see you in the office or hospital and personally take your telephone call day or night - as well as accept your health insurance as full payment. For several years, the number of new medical school graduates choosing primary care (family practice and general internal medicine) for their professional medical career has been decreasing rapidly. Almost no new primary care physicians will be available in the very near future. The low pay, the unacceptable lifestyle and the public’s dependency on “specialty” medical care are the reasons. Primary care physician pay has been decreasing for several years. Medicare’s control of all physician Medicare fees started with the birth of Medicare in 1965 when Medicare set maximal pay limits for physician services. In 1992 federal law established “relative value units” for all office, hospital, home and nursing facility physician services - most of the primary physician’s services. This was the first “fixed” Medicare fee schedule. Relative value units for all services are multiplied by a common “conversion factor.” This enabled control of total Medicare costs for physician services each year by moving the conversion factor up or down. Soon many private insurance companies adopted the policy of not paying more than Medicare “allowables.” The final blow was Congress’ 1998 passage of the “Sustainable Growth Rate” law to control rapidly rising health care costs - an ineffective and flawed law that must be changed. The idea is if the costs of physician medical care in the U.S. increases more or significantly less than the Medical Economic Index (2 percent to 3 percent a year), the next year the amount above or below the set targeted increase will be reduced or added to physician Medicare payments. For 2008, the SGR is a decrease of 10.1 percent. Each year since the SGR began, projected decreases in physician Medicare payments were 2 to 6 percent per year. Congress has intervened each year and mandated small increases in the Medicare fee schedule ranging from 1.7 percent in 2003 to none in 2007. Probably Congress will intervene again this year just before July 1 and increase physicians’ fee .5 percent for the next six months. Over the last 10 years, the average annual physician fee increase has been 1.1 percent compared to the average increase in the Physician Medicare Economic Index of 2.5 percent.The gap between physicians’ income and their overhead costs continues to widen each year. In order to maintain an adequate income, primary care doctors are trying to see more patients in less time. The patient is frustrated by too little time with the doctor. On the other hand, the physician is trying to stay on schedule and realizes his care isn’t comprehensive. Frustration on both sides is inevitable. In the future, more primary care doctors will not see as many Medicare patients due to low payment. More paramedical personnel and health care systems, such as hospital owned practices, will further separate you, the patient, from a personal and trusting relationship with “your” doctor. New forms of health care delivery are appearing - such as “concierge” services. You pay a monthly or yearly “retainer” dollar amount to the primary care doctor for care in his office, in the hospital or by telephone 24 hours a day, 365 days a year. Many more people will purchase consumer-driven high-deductible health care plans. With these plans, the buyer will fund her or his own medical savings account as well as purchase a high-deductible catastrophic insurance plan. The medical saving accounts contributions aren’t taxed. The high deductible may vary from $1,000 to $10,000. The higher the deductible, the less the cost of the insurance premium. With the present high and ever-increasing health care costs, you, the patient, will pay more “out of pocket” health care costs. If you have a personal trusted primary care physician who really knows you and understands all your concerns, is available whenever you need her or him, and accepts your insurance payment as full payment, thank that doctor. The era of good primary care medicine as we’ve known it over the past 40 years is about gone. Dr. Phil Sellers is a general internist practicing in Hendersonville. (see original) (Source: Doc Advocate) Doc Advocate blogs http://www.medworm.com/rss/comments.php?id=1469594 Tue, 27 May 2008 14:27:08 +0100 1469594 http://docadvocate.com/?p=942 Lawsuit reform has dramatically improved the fairness and efficiency of Texas’ civil justice system. Just a few years ago, the Lone Star State held a position near the bottom of state rankings and was frequently a source of derision in the national media. Objective studies now place the state’s civil justice system in the upper tier relative to many measures (though some challenges remain). This notable turnaround, from a legal system that was poorly regarded in several areas to one that is widely recognized as an effective model worthy of emulation, has brought substantial benefits. In the 1980s and early 1990s, Texas was known for the lack of fairness and balance in its civil justice system. The distortions caused by these problems significantly eroded the state’s competitive position. Fears of excessive litigation and outsized claims were a substantial disincentive for potential corporate locations and expansions. In February 1995, The Wall Street Journal called national attention to the civil litigation environment in Texas, and the state became infamous as the “Wild West of Lawsuits.” Even internationally, Texas was recognized as a paradise for plaintiffs. The London Observer reported that businesses in Texas should consider moving elsewhere to avoid the problems of the state’s civil justice system. The threat of litigation can significantly decrease product innovation. When businesses operate in a high-liability-risk environment, they respond by reducing investments in product innovation because new products have more uncertain safety characteristics and can leave them vulnerable to lawsuits. Another vulnerable sector is health care delivery. Prior to tort reform, medical malpractice premiums were extremely high, discouraging some doctors from continuing to practice or to perform certain procedures. An increase in “defensive medicine” (when doctors’ decisions to order tests, avoid procedures, or suggest treatments based in part on a fear of legal liability) was also a problem. In addition, the supply of doctors tends to be restricted by the higher risk and costs associated with an excessive system, thus further reducing access to health care. My firm, The Perryman Group, has studied the issue of tort reform in Texas and other states on numerous occasions and has consistently found that the misallocations of scarce societal assets lead to (1) a loss of economic efficiency; (2) increased risks of doing business; (3) cost increases unrelated to productivity; (4) escalating insurance rates, particularly in specific areas such as medical malpractice; and (5) other problems. In a recent study, we developed an extensive and comprehensive assessment process to measure the incremental gains from civil justice reforms. We looked at factors such as cost savings (administrative costs, court costs, non-productive expenditures to avoid or take advantage of excessive litigation reward opportunities, and the inefficiencies in the redistribution process); gains from safer products (in terms of people in the workforce who otherwise would have died from faulty products); and benefits of new products and manufacturing in Texas stemming from research, development, and innovation in a less litigious environment. The results clearly demonstrate the economic benefits of the more efficient and effective system. In fact, we found that the total impact of tort reforms implemented since 1995 includes gains of $112.5 billion in spending each year as well as almost 499,000 jobs in the state. The reforms related to asbestos/silica litigation, which were enacted in 2005, are already contributing $490.3 million in annual spending and 2,683 permanent jobs. Reforms limiting non-economic damages in medical malpractice litigation alone lead to increases of $55.3 billion in spending per year and more than 223,000 jobs. Tort reform and the resulting benefits to the legal environment enhance the prospects for investment in expansions and relocations to the state. In addition, companies already in Texas enjoy an advantageous competitive position relative to other areas. Gains in productivity stemming from a more effective and efficient tort system further add to the positive outcomes. Beyond these quantifiable measures, there are a number of other benefits such as growth in the number of doctors entering the state, the inclusion of almost 430,000 Texans in health plans who would otherwise be uninsured, a decrease in the volume of lawsuits with little real merit, and many more. Benefits accrue through multiple channels including the investment climate, business activity, insurance rates, consumer wellbeing, productivity, jobs, output, income, inflation, economic development, and fiscal soundness. In fact, State budget resources (enhanced revenue and reduced spending requirements) are almost $2.6 billion higher each year than they would be in the absence of these reforms. Benefits are spread across the state, positively affecting communities both large and small. Numerous studies of the impact of reforms on labor productivity and employment have demonstrated that states which changed their liability laws to decrease levels of liability experienced greater increases in aggregate productivity and employment than states that did not. At the same time, states adopting measures which increase liability often see productivity and employment fall. Our analysis clearly confirms this result. Despite the enormous progress to date, challenges remain, with some regions of the state being known as areas where justice is not fairly administered, and continued vigilance and improvement is warranted. Increasing the effectiveness and efficiency of the civil justice system has brought significant dividends to Texas, and ongoing efforts can help to assure long-term competitiveness, prosperity, and economic opportunity. Dr. M. Ray Perryman is President and Chief Executive Officer of The Perryman Group (www.perrymangroup.com). He also serves as Institute Distinguished Professor of Economic Theory and Method at the International Institute for Advanced Studies. (see original) (Source: Doc Advocate) Doc Advocate blogs http://www.medworm.com/rss/comments.php?id=1436805 Mon, 12 May 2008 14:33:17 +0100 1436805 http://docadvocate.com/?p=941 Neurosurgeons incur some of the highest annual malpractice premiums of any specialty, averaging more than $100,000 and as high as $300,000 per year in some states. Research analyzes a correlation between numbers of practicing and retiring neurosurgeons and the malpractice environment of each state. Newswise — While the medical malpractice system in the United States can provide remediation for negligent medical care, its overzealous application can have devastating effects on practicing surgeons, and inevitably hurt patient care by limiting the scope of care available to the general population. There are currently an estimated 3,229 active neurosurgeons in the United States certified by the American Board of Neurological Surgeons (ABNS). This corresponds to approximately one neurosurgeon for every 100,000 people in the United States. Neurosurgeons incur some of the highest annual malpractice premiums of any specialty, averaging more than $100,000 and as high as $300,000 per year in some states. In 2005 alone, neurosurgeons paid a total of $28 million in malpractice claims, with the highest average payment per specialist surgeon ($465,000), and the single highest payment of any claim in any specialty ($5.6 million). In 2002, the Council of State Neurosurgical Societies (CSNS) performed a survey of practicing neurosurgeons to assess the impact of malpractice on the workforce. The results were published along with a joint position statement from the two leading professional societies in neurosurgery – the American Association of Neurological Surgeons and Congress of Neurological Surgeons – as a report titled Neurosurgery in Crisis. As a direct result of malpractice claims and increasing malpractice insurance premiums, nearly half of all respondents were likely to restrict their practice – for example, limiting their practice to only spine, or not providing emergency or trauma coverage at a local emergency room. Nearly one third of respondents at that time stated that they were considering retirement, rather than continue to practice in the face of increasing insurance costs. One fifth stated that they were considering moving their practice to a state with “better” malpractice conditions. These changes in practice patterns would result in patients not being able to access lifesaving neurosurgical care, complex neurosurgical care or neurosurgical care close to home. Based on the findings of the 2002 survey, researchers at Oregon Health & Sciences University in Portland, Ore., decided to analyze ABNS data from 2005-2007, examining 4,584 active and retired neurosurgeons to look for a correlation between numbers of practicing and retiring neurosurgeons and the malpractice environment of each state. The results of this study, Impact of Malpractice Environments on the US Neurosurgical Workforce 2005-2007, will be presented by Zachary N. Litvack, MD, 11:30 to 11:44 a.m. on Monday, April 28, 2008, during the 76th Annual Meeting of the American Association of Neurological Surgeons in Chicago. Co-authors are Kim J. Burchiel, MD, FACS, and Matthew A. Hunt, MD. “If malpractice has such a negative impact on practicing neurosurgeons, we hypothesized that states with high malpractice claims and high malpractice insurance premiums (so called “crisis” states) would see a decrease in the number of practicing neurosurgeons over time, and an increase in the number of neurosurgeons moving or retiring from practice in that state. Conversely, states without major malpractice issues would see an increase in practicing neurosurgeons,” stated Dr. Litvack. The authors analyzed the effect of the malpractice environment as classified by the CSNS in 2002 and the American Medical Association (AMA) in 2007 on changes in active and retired diplomates of the ABNS between 2005 and 2007 using Pearson’s coefficient and two-tailed ANOVA. Findings were as follows: •Statistical analysis showed that states in “crisis” realized a 5 percent increase in the number of practicing neurosurgeons. •In the 10 states with the largest increases in the number of neurosurgeons, eight states were CSNS “severe” states and five were AMA “crisis” states. •Non-crisis states realized a 2 percent decrease in the number of practicing neurosurgeons. •The size of malpractice claims had no impact on the number of practicing neurosurgeons in that respective state. Interestingly, these results were exactly the opposite of the hypothesis. The authors believe this is caused by neurosurgeons restricting their practices to limit malpractice liability. This means that additional neurosurgeons are needed in the same geographic area to cover the spectrum of diseases and surgical needs of the population. In other words, two neurosurgeons are now needed to perform the job that used to be performed by one. “While malpractice claims do not on the surface appear to affect demographics alone, they inevitably erode the system of providing neurosurgical care to patients. As more neurosurgeons limit their scope of practice, patients will find it more difficult to obtain the expert care they need, and that is an issue that indeed needs to be addressed,” concluded Dr. Litvack. (Source: Doc Advocate) Doc Advocate blogs http://www.medworm.com/rss/comments.php?id=1409687 Wed, 30 Apr 2008 15:20:24 +0100 1409687 http://docadvocate.com/?p=940 Prostate cancer is the most common — and second-deadliest — cancer for men. Yet, doctors can’t agree on the best way to diagnose the disease, let alone treat it. Stop putting off prostate exam Prostate survivor urges other blacks: Get screened How the Sun-Times’ prostate test saved his life Where to find: Free prostate screenings In fact, the PSA test remains one of the most controversial screening tests in medicine, even though it has been around for more than 20 years. The test measures the level of prostate-specific antigen, or PSA, in the blood. High levels of PSA can be a sign of prostate cancer. But critics say that because of the test’s limitations, it can lead men to get unnecessary treatment that can have serious side-effects, including incontinence and impotence. “Which are the significant prostate cancers, the ones that are likely to progress and shorten someone’s life, and which are insignificant and probably don’t need treatment? It’s our dilemma,” said Dr. Lawrence Ross, a professor of urology at the University of Illinois at Chicago and a past president of the American Urological Association. One of the nation’s leading experts on prostate cancer, Dr. William Catalona, agrees that the PSA is “far from a perfect test.” But when its results are considered in context with other risk factors — such as family history and race — the test can accurately diagnose a disease that could take decades to produce symptoms, said Catalona, who runs the prostate-cancer program at Northwestern Memorial Hospital. “It’s getting very, very hard for people not to agree that the PSA can save lives,” said Catalona. The key is for doctors to track changes in their patients’ PSA scores over time, Catalona said, because “a rising PSA blood test is sometimes more important than knowing what the absolute value is.” The American Cancer Society recommends that all men get a yearly prostate screening after the age of 50. African Americans and men with a family history of prostate cancer should start earlier, the cancer society recommends. Once a man is diagnosed with prostate cancer, he’ll have to decide how to treat it, if at all. Surgical removal of the prostate gland is generally recommended for younger men whose cancer appears to be confined to the prostate. There are risks — including the possibility of sexual dysfunction and incontinence. And outcomes depend heavily on the experience level of the surgeon, said Catalona, who has done about 5,000 of these procedures. For older men — old enough it’s unlikely they’d live longer than another 10 to 15 years — it’s more of a “coin toss” between surgery and radiation therapy, said Dr. Greg Zagaja, a urologist at the University of Chicago Medical Center. For them, treatment might not mean a longer life. Some doctors recommend doing nothing to treat prostate cancer until it shows signs of growing. Catalona disagrees. He said this so-called “watchful waiting” approach can leave men without options by the time it’s clear their cancer is life-threatening. Once the tumor has spread, there is no cure. (see original) (Source: Doc Advocate) Doc Advocate blogs http://www.medworm.com/rss/comments.php?id=1388935 Mon, 21 Apr 2008 17:56:17 +0100 1388935 http://docadvocate.com/?p=939 Researchers are reporting that they have developed a new way to help doctors and parents make some of the most agonizing decisions in medicine, about how much treatment to give tiny, extremely premature infants. These are infants at the edge of viability, weighing less than 2.2 pounds and born after 22 to 25 weeks of pregnancy, far ahead of the normal 40 weeks. About 40,000 babies a year are born at this very early stage in the United States. The new method uses an online calculator developed for such cases factoring in traits like birth weight and sex and generating statistics on chances of the baby’s survival and the likelihood of disabilities (www.nichd.nih.gov/neonatalestimates). The statistics are not a personal prediction. They estimate risk based on data from similar infants in a large study being published on Thursday in The New England Journal of Medicine. Certain factors gave babies an advantage. At any given gestational age, they were more likely to survive and escape serious disability if they weighed more than others, if they were singletons rather than twins or multiples or if their mothers had been given steroids before birth to help the fetal lungs to mature. Girls also fared better than boys of the same age, a factor doctors have known a long time without being able to explain. Any of those factors was about as good as being a week older, which makes an enormous difference in development from 22 to 25 weeks’ pregnancy, the researchers said. The finding means that a girl at 23 weeks could be as strong as a boy at 24. “If you could take what the girls have and give it to the boys, we’d be one step ahead of the game,” said Dr. Rosemary D. Higgins, an author of the study and a program scientist at the Neonatal Research Network of the National Institute of Child Health and Human Development. Although some extremely premature infants do well, many die, sometimes after weeks or months of painful invasive procedures in the intensive care unit. Survivors often suffer brain damage, behavior problems, vision and hearing loss and other disabilities. Outcomes are nearly impossible to predict at birth. Doctors and parents struggle to decide when aggressive treatment seems reasonable — and when death or severe disability seems so likely, even with treatment, that it would be kinder to avoid painful procedures and provide just “comfort care,” letting nature take its course and letting the child die. These decisions, made every day in hospitals around the country, are “heart wrenching and passionate,” Dr. Higgins said. “No one ever thinks they’re going to be in this situation, and it’s difficult, for families and also for physicians.” Dr. Higgins said the study and the calculator were part of an effort to give doctors and parents more solid evidence to make decisions. She said people might be misled by occasional reports of tiny “miracle babies” who beat the odds and wrongly imagined high rates of survival and good health. Dr. Higgins said she had no idea what overall effect the study and calculator might have on medical practice or whether they would lead to more or less treatment of extremely premature infants. Two families in the exact same situation could easily make opposite decisions about whether to pursue treatment. Currently, decisions about using respirators, intravenous feeding and other forms of intensive care are mostly based on estimates of a baby’s gestational age — how far along the pregnancy was. Intensive care is often given to infants born in the 25th week, but not the 22nd. The hardest judgment calls are for babies in the 23rd and 24th weeks. Plugging numbers into the calculator shows that two infants with the same gestational age, the usual criterion to decide treatment, can have quite different odds of survival and disability. For instance, a 24-week-old two-pound male twin whose mother did not receive steroids has survival odds of 69 percent and a 50 percent chance of having a severe impairment. A female twin the same age and weight has survival odds of 86 percent and a 23 percent chance of severe impairment. In theory, at least, the calculator would seem to favor treating girls, because, all else being equal, their odds for survival are better. The study included 4,446 infants born at 22 to 25 weeks at 19 hospitals in the Neonatal Research Network; 744, generally the smallest and most premature, did not receive intensive care, and all died. The babies were assessed at birth, and the survivors were examined again shortly before turning 2. Over all, half the infants died, half the survivors had neurological impairments, and half the impairments were severe. Many survivors spent months in the hospital, at a typical cost of $3,400 a day. The researchers estimated that if all babies born at 22 to 23 weeks received intensive care, for every 100 infants treated there would be 1,749 extra hospital days and zero to nine additional survivors, with zero to three having no impairment. Dr. Eric C. Eichenwald, medical director of the newborn center at Texas Children’s Hospital in Houston, said that the study was important and that its most striking finding was how large the benefits of the various factors could be. Dr. Eichenwald said the calculator was “a way in which we can provide more accurate information to the process of counseling parents as to what the burdens of intensive care might be.” Dr. Nehal A. Parikh, another author of the study, from the University of Texas Medical School at Houston, said he thought the statistics would help doctors in advising families. “We lay out the facts, rather than our own opinions,” Dr. Parikh said, “because we’re not the ones taking these babies home.” (see original) (Source: Doc Advocate) Doc Advocate blogs http://www.medworm.com/rss/comments.php?id=1379365 Thu, 17 Apr 2008 14:53:10 +0100 1379365 http://docadvocate.com/?p=938 Walk into one of St. Joseph Health System’s Kentucky hospitals in the next few weeks and you’re likely to see something that resembles a tall, skinny version of R2D2 strolling, or rather rolling, down the hall, on its way to visit patients. Robots are stepping out of the pages of science fiction novels and into the middle of modern-day medicine. Doctors and nurses at St. Joseph East in Lexington are starting to train with one of the robots now, as are staffers at St. Joseph hospitals in Bardstown, Berea, London, Martin and Mount Sterling. St. Joseph Hospital in Lexington will get one next, though the robots won’t actually start “seeing” patients until sometime in May, officials said Monday. St. Joseph officials stress that the new robots, developed by California-based InTouch Health, won’t actually dispense any medicines or perform any medical procedures. But they will give doctors extra sets of eyes and ears to help keep track of patients and their medical needs. Each St. Joseph robot weighs about 200 pounds, stands 51/2 feet tall, and rolls silently along on three wheels. Each boasts a video screen instead of a face; real-time video cameras and microphones instead of eyes and ears; and hook-ups for various medical devices, such as stethoscopes or ultrasound sensors. Doctor, patient can talk St. Joseph officials say that, when the system is fully operational, a specialist in Lexington will be able to do a consultation on a patient many miles away at, say, St Joseph London, “seeing” the patient through real-time pictures transmitted from the robot’s video camera “eyes” to the specialist’s laptop via a wireless broadband connection. Patient and specialist will be able to talk with each other, and the specialist will be able to check the patient’s pulse, do a medical scan, or consult with the patient’s doctor in London. The specialist will even be able to use a computer joy stick to navigate the robot around the patient’s room, or direct it to another patient’s room — all from his or her own computer. A doctor at home after hours could even contact the robot at the hospital from his laptop and “send” it to check on patients in the hospital, officials say. Dr. Joshua Steiner, a general surgeon in Lexington, said he thought such scenarios sounded pretty ridiculous when he first heard about them from a colleague, Dr. Alex Gandsas of Maryland, who has used the robots extensively. But now Steiner is looking forward to using one of the robots at St. Joseph East. Doctor had his doubts “Initially, I made fun of him,” Steiner said Monday. “But the more I thought about it, the more appealing it became.” (According to St. Joseph officials, Gandsas was able to reduce post-operative recovery of his gastric bypass patients by 1.6 days, using an InTouch robot to help keep track of their progress.) Steiner said he particularly likes the idea of being able to “visit” his post-surgical patients at St. Joseph East after hours, directing the robot from his home computer. “I like to see every one of my patients at least once a day,” Steiner said. “Being able to use this system to actually see how the patient looks and see what is going on from home would be really helpful. It will let me sleep better.” St. Joseph spokesman Jeff Murphy stressed that the robots won’t replace doctors’ traditional hospital rounds to see patients. Rather, they will supplement those rounds. InTouch robots already are in use at the University of Louisville’s hospital and about 200 other locations nationwide. The number is expected to reach 300 by year’s end. (see original) (Source: Doc Advocate) Doc Advocate blogs http://www.medworm.com/rss/comments.php?id=1360540 Wed, 09 Apr 2008 14:33:03 +0100 1360540 http://docadvocate.com/?p=937 A new study reveals that Latinos and African-Americans are drastically underrepresented among the ranks of California doctors when compared with the state’s population. In the Bay Area, for instance, 20 percent of the population is Latino but only 3.6 percent of physicians are Latino. And African-Americans make up 7.3 percent of the area’s residents but only 2.9 percent of its physicians. Because minority physicians are more likely to practice in poor communities, they are vital to closing a health care gap that leaves Latinos and African-Americans less likely to receive the same quality health care as white and Asian patients, according to the report, released Wednesday by the Center for California Health Workforce Studies at the University of California-San Francisco. The report, conducted under the requirements of a new state law, is not the first to find such disparities. But it is unusually comprehensive because it is drawn from new California Medical Board data that details physicians’ ethnicity, languages spoken and other characteristics. In a state of more than 35 million people, the report finds there are only about 3,000 Latino and 2,000 African-American physicians engaged in patient care in California. “We have a massive problem,” said obstetrician-gynecologist Dr. Jose Bolanos, a native of El Salvador. The son of a carpenter, he earned a scholarship to University of Southern California and trained at Stanford University. He has delivered 7,500 babies during his two decades of practice in East San Jose and Los Gatos. “The Hispanic physicians who came through the ‘affirmative-action’ programs with me are out in the trenches, delivering the best possible care to the poor - the patients who don’t have the ability to drive to Valley Med,” he said. “But we need 10 times more doctors than we have.” Experts attribute the disparity to several factors. Court decisions have rolled back affirmative-action admissions policies at state universities. And the high cost of medical schools have discouraged many students. At Stanford, which has an aggressive outreach program, 10 percent of the incoming medical school class is Latino, but 46 percent is Asian. The ethnic disparities are even more pronounced outside the Bay Area. In the Inland Empire, Los Angeles and South Central Valley, where the Latino population is 40 percent or more, the Latino physician population is 6 percent to 8 percent. Some argue that physicians’ race or ethnicity is irrelevant as long as they provide quality care. But the new report says minority doctors are more willing to return to their communities, despite low payment from insurers like Medi-Cal. Moreover, these doctors provide better care because they are comfortable talking to patients with backgrounds similar to their own. For instance, Bolanos says his years of experience treating Latinos has shown him that the community’s young women suffer from unusually high rates of anemia, which puts their babies at risk, he said. So he has learned to monitor them with frequent tests, treat them with triple doses of iron supplements and teach them about improved nutrition. “This one factor alone has allowed us to ensure a dramatically different way that these babies are cared for,” he said. San Jose cardiologist Dr. Anthony C. Lopez agrees. “We offer a world of difference,” he said. “Patients feel comfortable. They are more expressive and less fearful. They are able to ask questions about their symptoms and the disease process.” When Armando Conrriquez of San Jose took his aging mother to Lopez for heart surgery, the doctor insisted that his cholesterol levels be tested as well. Tests showed they were dangerously high - so Lopez quickly put him on medicine, improved diet and exercise. Unlike his mother, Conrriquez won’t need surgery. “I am more healthy now. He helps a lot,” said Conrriquez, 42, a former construction worker. “What I don’t understand in English, he explains in Spanish, especially the medical words. He tries very hard.” The report “Physician Diversity in California: New Findings from the California Medical Board Survey,” can be found at www.calmedfoundation.org/publications/pubs.pressreleases.aspx. (see original) (Source: Doc Advocate) Doc Advocate blogs http://www.medworm.com/rss/comments.php?id=1352001 Fri, 04 Apr 2008 14:49:42 +0100 1352001 http://docadvocate.com/?p=936 The largest survey ever of American physicians’ opinions on health-care financing has found that 59 percent of doctors support government legislation to establish national health insurance while only 32 percent oppose it. A similar survey conducted by the IU researchers in 2002 found 49 percent of physicians supporting national health insurance and 40 percent opposing it. The 2007 survey results demonstrate a significant change in the level of support for national health insurance. Nearly every medical specialty showed an increase in levels of support for national health insurance. With the exception of radiologists, anesthesiologists and surgical subspecialists, a majority of every medical specialty now support national health insurance. The nationwide survey queried 2,200 physicians and was conducted by the Indiana University School of Medicine’s Center for Health Policy and Professionalism Research (CHPPR). The results appear in the April 1 issue of the Annals of Internal Medicine. The latest survey indicated that 83 percent of psychiatrists, 69 percent of emergency medicine physicians, 65 percent of pediatricians, 64 percent of internists, 60 percent of family physicians, and 55 percent of general surgeons favor government action to establish national health insurance. There are more than 800,000 doctors in the U.S., so this 10 percent increase in support for national health insurance represents at least 80,000 physicians who have changed their minds about national health insurance, study authors Aaron E. Carroll, M.D., M.S., assistant professor of pediatrics and director of CHPPR, and Ronald T. Ackermann, M.D., MPH, assistant professor of medicine and associate director of CHPPR, report in their Annals of Internal Medicine paper. “Many claim to speak for physicians and represent their views. We asked doctors directly and found that, contrary to conventional wisdom, most doctors support national health insurance,” said Dr. Carroll. “As doctors, we find that our patients suffer because of increasing deductibles, copayments, and restrictions on patient care,” said Dr. Ackermann. “More and more, physicians are turning to national health insurance as a solution to this problem.” Both Dr. Carroll and Dr. Ackermann are affiliated scientists of the Regenstrief Institute, Inc. CHPPR was established earlier this year as a think tank to conduct rapid turnaround research on the hottest topics of the day related to health including healthcare financing, health insurance, medical education and training, and ethical, professional and legal issues pertaining to physician practice. The Center is supported by Riley Hospital for Children and the IU School of Medicine. (Source: Doc Advocate) Doc Advocate blogs http://www.medworm.com/rss/comments.php?id=1346127 Wed, 02 Apr 2008 16:34:45 +0100 1346127 http://docadvocate.com/?p=935 Consumer and health advocacy groups in New York are criticizing a yet-to-be-made public plan to create a medical malpractice indemnity pool which would cover medical expenses for injured patients. Although no plan to create the pool has been announced, the coalition of groups – which includes the New York Public Interest Research Group, the Center for Medical Consumers and the Center for Justice and Democracy – has nevertheless sent letters to Gov. David Paterson decrying the rumored plan, which they say is a poor fix for the state’s health care troubles. “We don’t want the state subsidizing unsafe doctors,” said John Guyette, a spokesman for CURE-NY, an umbrella group for patient safety organizations in the state. The group, in the letter, chides the administration for what it says is a “lack of transparency and openness ” on the part of Insurance Superintendent Eric Dinallo and Health Commissioner Richard Daines. The two are heading efforts to find a solution to the Empire State’s skyrocketing malpractice premiums, and effort which began under the administration of former Gov. Eliot Spitzer The groups say they have been left out of the process, and their input in helping solve the state’s health care issues has been ignored. Andy Mais, spokesman for the New York’s Insurance Department said “the administration is continuing to work with all stakeholders in an effort to develop a workable proposal.” He declined further comment on the group’s letter. The budding controversy comes amidst a significant annual leap – roughly 14 percent – in malpractice premiums in New York State, a trend that many doctors groups charge has forced doctors to retire early, or pack up and head elsewhere. Earlier this month, The Medical Society of the State of New York staged a rally in the capitol in which they arranged empty chairs to symbolize many of the physicians who have already left New York to practice in other states, or sought early retirement. Many doctors left their white coats on the steps of the capitol to underscore the issue. (see original) (Source: Doc Advocate) Doc Advocate blogs http://www.medworm.com/rss/comments.php?id=1329043 Wed, 26 Mar 2008 13:53:43 +0100 1329043 http://docadvocate.com/?p=934 Patients given freebies spend nearly 40 percent more on meds, study says Leaving the doctor’s office with a bagful of free drug samples may seem like a good way to save money, not to mention an inconvenient trip to the pharmacy. But people banking on the freebies need to think again, according to a new study that shows patients who get samples end up with significantly higher out-of-pocket costs than those who don’t. On average, patients who got free prescription samples spent nearly 40 percent more for medication during the six months they received samples, and nearly 20 percent more in the six months afterward, than those who didn’t, according to University of Chicago researchers. “The notion that people have is that if you receive samples, it helps with out-of-pocket costs because you don’t have to go out and buy the drugs,” said Anirban Basu, one of the study authors and an assistant professor of medicine at the University of Chicago. “What we found, actually, was that their out-of-pocket expenditures increased. Most surprising was that those out-of-pocket expenditures continued even after the samples stopped.” The study, published this week in the journal Medical Care, renews debate about the role of more than $18 billion in free pharmaceutical samples distributed each year, which drug industry representatives have described as a cost-saving safety net for the poor. “This builds on a growing body of literature that shows that samples are not aimed to help the uninsured and the poor, but to increase the sales of the branded drugs,” said Dr. William Shrank, an instructor at Harvard Medical School, who has studied the issue. The study comes on the heels of a January report that showed free samples are more likely to go to insured and wealthy patients than to the needy. Drugmakers dispute critics But the Pharmaceutical Research and Manufacturers of America, a trade group representing most drugmakers, disputed those views. Free samples allow doctors to try new medicines and to implement them immediately in people of all income levels — including patients who lack prescription drug coverage, Ken Johnson, a PhRMA senior vice president, said in a statement. Looking at samples in isolation “misses the point,” Johnson said. “Contrary to statements made by critics, American’s physicians prescribe medicines based on a wide range of factors, not simply receipt of free prescription drug samples,” he wrote. Two out of every three drugs prescribed is generic, not branded, and drugmakers have offered struggling patients a range of options besides samples for receiving medication, Johnson added. In the Chicago study, patients who never received free samples spent an estimated $178 out-of-pocket on prescription drugs over six months. By comparison, patients given free samples spent about $166 of their own money during the six months before they got the samples — but then $244 during the six months they received the samples and $212 in the six months after that, researchers found. The study, billed as the first to examine the relationship between drug samples and patient expenses, followed more than 5,700 patients for two years using data from the 2002-2003 Medical Expenditure Panel Survey, a national poll conducted by the Agency for Healthcare Research and Quality. During that time, the patients received more than 2,300 free drug samples. The results were “counter-intuitive,” said lead author Dr. G. Caleb Alexander, an assistant professor of medicine at the University of Chicago Medical Center. “We expected that free sample receipt would be associated with lower, not higher, cost,” he said. Reason for higher costs isn’t clear Exactly why the costs rose wasn’t clear, said Alexander, who added that the study wasn’t designed to answer that question. Patients who received samples may have been sicker than those who didn’t, which would explain the higher costs, a point emphasized by PhRMA representatives. But analysis showed that illness played a small part, at most, in the higher expenses, Alexander said. Or, patients may have received higher-priced brand-name drugs — those ones most often given as samples — and then continued with the same pricey prescriptions, Alexander said. That would be in line with what other studies have shown, said Dr. Andrew F. Leuchter, a professor of psychiatry who heads a committee on drug industry relations at the David Geffen School of Medicine at the University of California, Los Angeles. “We have known for a while that sample use increases health care costs,” said Leuchter. But the new study provides first details of out-of-pocket costs, including the fact that the medication expenses remained high even after the samples were finished. That makes sense to patient J.W. Wright of Goodrich, Texas, who has lived with high blood pressure for 18 years. The 72-year-old retired aerospace engineer has received three different samples of medication in the past year alone. He didn’t continue with any of them because they didn’t work, but he said he understands how some patients could wind up paying more. “When you get a sample and a prescription, first you find it works, then you get that brand without thinking the cost, UNLESS the pharmacist tells you the insurance company will only pay for the generic,” Wright wrote in an e-mail. “There’s a trade-off. Do I buy the brand at $100 or do I take the generic at $5? I think I try the generic.” If the generic drug works, fine. But if it doesn’t, or if no alternative is suggested, the patient — — or the insurer — has to foot the higher bill. Doctors, patients need to consider larger costs The solution is for doctors and consumers to be vigilant about the use of drug samples, said Shrank, of Harvard. “Consumers just need to know that getting a free sample will not reduce their costs over time,” he said. Doctors and patients should discuss using more generic drugs, offering three-month instead of one-month supplies and discontinuing unnecessary medications, Alexander said. At UCLA, the medical school has adopted guidelines that prohibit shipping drug samples to individual doctors and allow their use only in cases where a patient is indigent or where there’s another significant barrier to care, Leuchter said. In cases where patients simply wants to avoid an insurance co-payment or a trip to the pharmacy, samples are discouraged. Sample drugs do have the potential to help needy patients, and to expose doctors to innovative new treatments, Leuchter said. But there’s no question indiscriminate use can drive up consumer health care costs, he said. “We’re trying to do everything we can to encourage people to do the right thing,” he said. URL: http://www.msnbc.msn.com/id/23783105/ (Source: Doc Advocate) Doc Advocate blogs http://www.medworm.com/rss/comments.php?id=1329044 Wed, 26 Mar 2008 13:51:43 +0100 1329044 http://docadvocate.com/?p=933 Does the medical system try to prevent you from “bothering” your doctor? That’s a question Sacramento physician Dr. Faith Fitzgerald mulled recently as she attempted to notify another physician about a health crisis involving one of his patients. She chronicles her futile effort to phone a fellow doctor in an essay that appeared in last months’ Annals of Internal Medicine. The patient was a secretary at the University of California, Davis, where Dr. Fitzgerald works. The woman staggered into her office with a headache and feeling faint. She ended up in the intensive care unit of a nearby hospital, and Dr. Fitzgerald called the woman’s regular physician to let him know what had happened. But instead of speaking to her colleague, she was blocked by a medical culture seemingly designed to prevent anybody from actually contacting a doctor while at work. Dr. Fitzgerald first ended up in an automated phone system. When she finally reached a live human, she was put on hold more than once, transferred to another operator for a futile attempt at paging the doctor, then sent back to the original operator before eventually being hung up on. Dr. Fitzgerald gave up, but the incident left her thinking about her own patients and co-workers who often apologized for “bothering” her. In her essay, she writes about how she once instructed the nursing staff to contact her about any change in a terminal patient’s condition, but nobody called her when the patient died. “It was late last night, I didn’t want to bother you,’’ the nurse said. Dr. Fitzgerald says that when a patient calls, the conversation always starts with, “I hate to bother you, but …” And she notes, with irony, that nobody ever apologizes when they notify her about an academic committee meeting she must attend. “Committees are important,’’ she writes. “I tell my patients, residents and students that they should call me if they need me. They are not an interruption to my work; they are my work. In this sense, I can’t be ‘bothered’ by them. But a system and a culture designed to protect doctors from their patients assume I am bothered, and so give that same impression to those trying to reach me. This really bothers me.’’ (Source: Doc Advocate) Doc Advocate blogs http://www.medworm.com/rss/comments.php?id=1310985 Tue, 18 Mar 2008 14:37:39 +0100 1310985 http://docadvocate.com/?p=932 Nevada Gov. Jim Gibbons is asking for the resignations of three doctors on the state’s Board of Medical Examiners because they’ve said they have conflicts of interest involving the now-closed endoscopy center at the vortex of a Hepatitis C outbreak in the state. nevada_state_seal.pngThe medical board is investigating physician involvement in the scare, set off by the Endoscopy Center of Southern Nevada, to which a half-dozen cases of acute hepatitis C were linked after it re-used syringes and then drew medicine for multiple patients from the same vials, according to local press. The Las-Vegas Review Journal, which is reporting the governor’s decision this morning, doesn’t specify the conflicts of the three doctors. But the paper says the governor’s announcement came the same day the newspaper reported that one of the doctors, the board’s president, had not initially disclosed that he is a longtime friend and business associate of the endoscopy center’s owner. All three of the doctors on Friday recused themselves from taking actions dealing with friends or business associates tied to the scare, the newspaper reports. “This in no way questions the integrity of the board’s members,” the governor told the Review-Journal. “I simply want to be certain that any member of this board can act on public health issues broad to them without conflict.” Meanwhile, the governor also asked for the resignation of the board’s executive director, and he instructed the director of the state’s department of health and human services to remove the head of the Nevada Bureau of Licensing and Certification, which oversees licensing and inspections of the state’s surgical centers. He also apologized for saying media “buffoonery” was creating hysteria around the issue. (see original) (Source: Doc Advocate) Doc Advocate blogs http://www.medworm.com/rss/comments.php?id=1310986 Tue, 18 Mar 2008 14:35:23 +0100 1310986 http://docadvocate.com/?p=931 Doctors are concerned that they will face massive medical malpractice actions brought by families of the more than 40,000 smokers who die each year because their doctors refuse to follow clear but simple federal guidelines for treating patients who smoke, reports the Philadelphia Bulletin. Indeed, the Patients and Physicians Alliance has protested vigorously, claiming that juries could easily rule against doctors when their testimony is contradicted by that of the patient or patient’s family over whether the physician adequately warned the patient about the risks of smoking and offered effective treatment to help him quit. The warning by the Bulletin that “Litigation By Smokers Would Worsen Tort Predicament” was triggered by a concern that state health commissioners would join the New York City Health Department in reminding doctors of their professional responsibilities to effectively treat smokers, saying that “because physician intervention can be so effective, failure to provide optimal counseling and treatment is failure to meet the standard of care - and could be considered malpractice.” In a letter to state health commissioners, Action on Smoking and Health (ASH) reminded them of NYC’s warning, and of a major article in a medical journal suggesting that bringing smoker law suits against physicians — similar to the earlier smoker law suits against tobacco companies — could be an effective way to save lives. This is based in turn upon a recent study that at least 42,000 lives could be saved annually if physicians would only follow the clear and simple federal guidelines for treating smokers. ASH’s letter argued: “Since physician malpractice kills over 40,000 smokers annually - more than motor vehicle or product liability accidents - it should not be surprising if antismoking lawyers, as well as those in private practice working on contingency fees, find physicians who deliberately flout federal guidelines to be a major target of litigation.” ASH’s Executive Director John Banzhaf, the public interest lawyer who has been called the “Ralph Nader of the tobacco industry,” “a driving force behind the lawsuits that have cost tobacco companies billions of dollars,” and “the law professor who masterminded litigation against the tobacco industry,” suggested the following scenario. “If a physician fails to advise a smoking patient of the many risks of smoking — just as he is required to advise patients of the many risks of high blood pressure or C-reactive protein — and to offer effective treatment (as with high blood pressure), and the patient subsequently dies or suffers a heart attack, stroke, or other problem as to which the failure to warn and/or treat is a substantial factor, the physician may be held liable in a medical malpractice action for his fair share of the costs.” Banzhaf notes that many medical malpractice actions occur when a physician has to make a quick decision (e.g., during an operation or baby delivery) and there are no clear guidelines that he can rely upon to protect himself from liability. In contrast, when the majority of physicians ignore long-standing and very clear federal and other guidelines regarding situations which occur every day (i.e., visits by smokers), their failures are deliberate, as well as often fatal. A recent study found that, although these guidelines have been in effective for many years, and several educational efforts aimed at boosting compliance have been undertake, most physicians still fail to follow them, and most patients are denied the assistance they are entitled to. That, says Banzhaf, has lead many in the antismoking community to wonder whether, since all other measures have failed, the only effective recourse to save these lives is a few medical malpractice law suits. (Source: Doc Advocate) Doc Advocate blogs http://www.medworm.com/rss/comments.php?id=1300289 Thu, 13 Mar 2008 14:43:32 +0100 1300289 http://docadvocate.com/?p=930 Rising rate of procedures is costly and can take heavy toll on patient health, physicians say A growing number of people are getting CT and PET scans, multi-dimensional images that can help physicians diagnose and treat numerous conditions. The scans are painless and often life-saving. But concerns are growing about their use. Are too many being given and are there long-term effects from radiation overexposure? How can insurance companies hold down the costs? And who will decide — the doctor or the insurance company — when a patient should have a scan? In the latest move, Indianapolis-based health insurer WellPoint last month unveiled its newest business unit — a company with a new computer program that WellPoint says is designed to educate physicians and patients about overexposure to radiation from CT (computed tomography), PET (positron emission tomography) and nuclear medicine scans. Purchased by WellPoint last year for $300 million, American Imaging Management makes software that is designed to help manage the use and costs of medical imaging. Doctors and patients access AIM’s Web site for information that helps them decide which X-ray should be used, based on the patient’s symptoms, potential for radiation exposure and costs. The Web site, americanimaging.net, also gives common uses for specific scans and suggests alternatives. For instance, AIM said CT scans should be used for patients with known or clinically suspected diseases, not for screening purposes. Health-care providers have to submit information about the patient, the symptoms and the scan they would like to perform. AIM, through its Web program, may accept the scanning order or suggest an alternative such as an X-ray in place of a CT scan. If the imaging order does not meet AIM’s guidelines, it can be denied — which means the insurer may not pay for the scan. After declining requests for an interview, WellPoint responded by e-mail: “AIM’s goal is to provide information that can be used as part of the dialogue that all physicians should have with their patients regarding treatment options,” said Paul Danao, AIM vice president of business development, in the written statement. The use of medical imaging services in Indiana has been rising at a rate of about 20 percent a year, according to WellPoint’s Anthem Blue Cross and Blue Shield. That far outpaces the roughly 5 percent to 10 percent annual growth for all medical services in the state. Imaging can cost from several hundred to several thousand dollars. According to AIM, the amount of radiation exposure can be high: An abdominal CT scan, for example, is equal to 500 chest X-rays or 2.74 years of natural sunlight. A new study in the journal Annals of Emergency Medicine found that the median radiation from scans that trauma patients received in an emergency department was equal to 1,005 chest X-rays. “There are times where clearly there are certain imaging tests for certain situations,” said Dr. Valerie Jackson, the John A. Campbell Professor of radiology at Indiana University School of Medicine. “Or there are times where tests are inappropriate (and) . . . don’t give you any information and chew up resources.” High-tech scans have helped revolutionize the way medicine is practiced by providing better ways to diagnose and treat medical problems, she said. “But you have to wonder when somebody’s getting multiple tests when it could be evaluated with one test.” Physicians also are facing more questions about what is best for the patient’s long-term health. “There’s no question about it, there is a dilemma that we’re exposing people to a lot of radiation,” said Dr. Bernie Emkes, medical director of managed care services for Indianapolis-based hospital system St. Vincent Health. Emkes said he fears that AIM and other efforts from health insurers threaten to intrude on the doctor-patient relationship. “When a doctor and a patient are sitting in an exam room trying to make sure what’s best for the patient, and then to have a third party come in and say, ‘Well, yeah, but what you decided is wrong,’ it’s creating mistrust with the patient,” he said. Instead of just accepting or denying claims, health insurers such as WellPoint and UnitedHealth Group increasingly want to be seen as collaborators with physicians and hospitals, said Ann Tynan, a researcher with the Center for Studying Health System Change, a nonprofit research group in Washington. It could be safety initiatives such as AIM’s radiation Web tool. Or it could be programs such as WellPoint’s Anthem Blue Cross and Blue Shield OptiNet initiative, which collects information from medical imaging providers and assigns them a letter grade. “It’s going to be an issue for a while,” Tynan said. “Health plans are really building up their toolset to deal with the continued escalation of the utilization of these tests.” (see original) (Source: Doc Advocate) Doc Advocate blogs http://www.medworm.com/rss/comments.php?id=1290987 Mon, 10 Mar 2008 14:52:45 +0100 1290987 http://docadvocate.com/?p=929 The American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) have issued a new guideline on current pharmacologic treatment of dementia. The guideline appears ssue of Annals of Internal Medicine, ACP’s flagship journal, and is available online at http://www.annals.org. A committee representing ACP and AAFP reviewed dementia literature for outcomes such as cognition, global function, behavior/mood, and quality of life/activities of daily living — areas of importance to physicians treating patients. The committee found that high-quality scientific evidence was limited and so developed cautious recommendations: 1. Clinicians should base the decision to try therapy with the FDA approved drugs for dementia on an individualized assessment of the patient. 2. Clinicians should base the choice of drugs on tolerability, adverse effect profile, ease of use and cost of medication. 3. Further research is urgently needed to address gaps in knowledge about the clinical effectiveness of pharmacologic management of dementia. Currently five drugs are approved by the FDA for dementia: four acetylcholinesterase inhibitors [donepezil (Aricept®), galantamine (Razadyne™, Reminyl™, Nivalin), rivastigmine (Exelon), and tacrine], and one neuropeptide-modifying agent [memantine (Mamenda®)]. These drugs do not cure dementia (there is no cure at this time) or repair brain damage. They may improve symptoms or slow down the disease. “Doctors, patients, and family care-givers desperately want information on how to treat this disease,” said Amir Qaseem, MD, PhD, MHA, Senior Medical Associate in the Clinical Programs and Quality of Care Department at ACP. “It is disheartening to find out that all we have to work with is these five drugs, and the evidence on these is scant. Consider that in 50 years, one in 45 Americans will suffer from Alzheimer’s disease. This is huge problem.” The guideline outlines research that needs to be done: - Evaluate the appropriate duration of therapy. - Test drugs head-to-head. - Test drugs in combination therapy. One reason for the urgent call for research is the deficiencies found in the existing medical literature. The ACP-AAFP committee found that most of the existing studies focused on statistical significance of changes, but patients with dementia, caregivers, and physicians are more interested in clinically important improvement. “More research is warranted because the available evidence concerning these pharmaceuticals’ effects on quality of life is mixed and the clinical significance of many of the findings is questionable,” said Kenneth G. Schellhase, MD, MPH, an AAFP representative on the guideline committee. “In addition, the duration of existing trials was usually less than one year, providing insufficient information to determine the optimal length of treatment, and few trials compare one drug directly with another.” In summary, no convincing evidence demonstrated that one therapeutic treatment is more effective than another, the committee concluded. The National Institutes of Health describes dementia as a group of symptoms caused by disorders that affect the brain. Dementia is not a specific disease. NIH says “people with dementia may not be able to think well enough to do normal activities, such as getting dressed or eating. They may lose their ability to solve problems or control their emotions. Their personalities may change. They may become agitated or see things that are not there.” Two of the most common types of dementia, Alzheimer’s disease and vascular dementia, are covered by the ACP-AAFP guideline. ACP, through its Clinical Efficacy Assessment Subcommittee, has been developing guidelines since 1981. ACP guidelines have relied on evidence or clinical documentation rather than consensus or expert opinion. The guidelines grade the evidence recommendations using the American College of Physicians’ clinical practice guidelines grading system. ACP cautions that its clinical practice guidelines are guides only and may not apply to all patients and all clinical situations and are not intended to override clinicians’ judgment. The AAFP’s clinical practice guidelines are designed to assist the clinician and patients in making decisions about appropriate health care for specific clinical circumstances. These evidence-based guidelines are often developed collaboratively between the AAFP’s Commission on Science and those of other specialty societies and the federal Agency for Healthcare Research and Quality. The dementia guideline was passed by the ACP Board of Regents on April 16, 2007, and by the American Academy of Family Physicians Board of Directors on June 13, 2007. Annals of Internal Medicine is one of the most widely cited peer-reviewed medical journals in the world. The journal has been published for 80 years and accepts only seven percent of the original research studies submitted for publication. Annals of Internal Medicine is published by the American College of Physicians , the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 124,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection, and treatment of illness in adults. Founded in 1947, the AAFP represents nearly 94,000 physicians and medical students nationwide. It is the only medical society devoted solely to primary care. Nearly one in four of all office visits are made to general and family physicians. That is 207 million office visits each year - 62 million more than to any other medical specialty. Today, family physicians provide the majority of care for America’s underserved and rural populations. In the increasingly fragmented world of health care where many medical specialties limit their practice to a particular organ, disease, age or sex, family physicians are dedicated to treating the whole person across the full spectrum of ages. Family medicine’s cornerstone is an ongoing, personal patient-physician relationship focused on integrated care. To learn more about the American Academy of Family physicians and about the specialty of family medicine, please visit http://www.aafp.org. American Academy of Family Physicians Article URL: http://www.medicalnewstoday.com/articles/99582.php (Source: Doc Advocate) Doc Advocate blogs http://www.medworm.com/rss/comments.php?id=1286182 Fri, 07 Mar 2008 16:22:31 +0100 1286182 http://docadvocate.com/?p=928 A notification went out this week to about 40,000 patients of a Las Vegas health clinic, alerting them that the clinic had been reusing syringes and medication vials in an effort to cut costs. Patients who visited the Endoscopy Center of Southern Nevada from March 2004 through Januray 2008 are urged to get tested for HIV and Hepatitis B and C. The notification was sent as a result of an investigation of the clinic that began in Januray after health officials noticed an increase in Hepatitis C cases at the clinic. According to the Associated Press article, the Centers for Disease Control (CDC) count 14 hepatitis outbreaks in the U.S. linked to bad injection practices since 1999. (see original) (Source: Doc Advocate) Doc Advocate blogs http://www.medworm.com/rss/comments.php?id=1286183 Fri, 07 Mar 2008 16:15:53 +0100 1286183 http://docadvocate.com/?p=927 Las Vegas class action attorney Will Kemp said he got a phone call Wednesday from a man who feared he had contracted a harmful virus at a medical clinic. “At first I thought he was kidding,” Kemp said. He wasn’t. As Kemp learned in the 7 p.m. call, the Endoscopy Center of Southern Nevada is believed by the Southern Nevada Health District to have exposed as many as 40,000 patients to the hepatitis C virus. The office of the Endoscopy Center of Southern Nevada, 700 Shadow Lane, is shown Wednesday, February 27, 2008. The Southern Nevada Health District is notifying approximately 40,000 former patients of the center that they may have been exposed to hepatitis C. The office of the Endoscopy Center of Southern Nevada, 700 Shadow Lane, is shown Wednesday, February 27, 2008. The Southern Nevada Health District is notifying approximately 40,000 former patients of the center that they may have been exposed to hepatitis C. Less than 24 hours after the call, Kemp filed a class action lawsuit in District Court in Clark County against the Endoscopy Center. Kemp is seeking payment to cover tests for hepatitis B and C on his two Nevada clients, former Endoscopy Center patients Michael Cordero and Richard Taylor. Kemp also wants them tested for the HIV antibody, and they’re seeking damages for pain and suffering. If the court grants the lawsuit class action status, other former patients could become part of it. “I would think at least hundreds of people have been infected just on the basis of the percentage of people who have hepatitis or AIDS in the general population,” Kemp said. “There’s so many things wrong here. Using dirty syringes is a Third World practice. My clients are scared to death that they could have an infectious disease.” Fellow Las Vegas attorney Gerald Gillock, a medical malpractice specialist who represents one of the six people the Health District believes were infected with hepatitis at the clinic, said he wouldn’t be surprised if this turns out to be the state’s largest-ever class action medical malpractice case. “If these allegations are true, there will be a number of medical malpractice cases,” Gillock said. “Once these people get tested, it could be a real tragedy.” Under a 2004 state law, damages for pain and suffering from medical malpractice cannot exceed $350,000 per incident. But Gillock said it is a certainty that the constitutionality of the cap will be challenged before the Nevada Supreme Court and that the $350,000 ceiling could be struck down before any Endoscopy Center cases make their way through the courts. The clients represented by Kemp and Gillock make up what UNLV Boyd School of Law professor Jean Sternlight said could be two types of plaintiffs — those who have been infected with a virus and are therefore in line for potential big-money damages, and a larger number of individuals who aren’t infected but claim to be traumatized by the threat of infection and seek compensation for testing. “There’s no reason to believe that only six people were infected,” Sternlight said. “The clinic should have known that what it was doing was wrong.” The Associated Press reported Thursday night that another class action suit has been filed, naming Charles Anthony Rader Jr. as a plaintiff who claims he could have been exposed to the diseases at the Endoscopy Center. Las Vegas attorney Peter Wetherall is handling the case. (see original) (Source: Doc Advocate) Doc Advocate blogs http://www.medworm.com/rss/comments.php?id=1277827 Tue, 04 Mar 2008 15:45:20 +0100 1277827 http://docadvocate.com/?p=926 A survey of 276 Colorado physicians was published in the May 2002 issue of Archives of Internal Medicine. Physicians were asked about their attitudes toward alternative medicine and their pattern of recommendation and personal use. Here are the interesting findings: At the doctor’s office, patients are sometimes asked about their use of alternative therapies. * 8% always ask about alternative therapy use * 23% asked their patients about alternative therapy use more than half of the time * 52% asked about alternative therapy use less than half of the time * 17% never ask Many doctors do not feel comfortable discussing alternative therapies with their patients. * 9% had a very positive attitude toward discussing alternative therapies with patients * 35% had a somewhat positive attitude * 40% were neutral * 14% had a somewhat negative attitude * 2% had a very negative attitude Patients want information from their doctors about the safety and effectiveness of alternative therapies. In this study, 59% of the doctors had been asked about alternative therapies. Patients requested information about: * Acupuncture (59%) * Herbal (botanical) medicine (55%) * Chiropractic (52%) * Alternative medicine in general (49%) * Massage therapy (41%) * Special diet (35%) * Megavitamins (32%) * Biofeedback (29%) * Relaxation (28%) * Homeopathy (21%) * Folk Medicine (17%) * Yoga (16%) * Hypnosis (14%) Nearly half (48%) of the doctors surveyed had recommended alternative medicine to a patient. Interestingly, 24% of the doctors had personally used alternative medicine, and this was strongly associated with the likelihood of recommending alternative medicine to patients. Some of the therapies doctors personally used were: massage therapy (24%), relaxation techniques (17%), alternative medicine in general (16%), herbal therapy (14%), yoga (11%), and acupuncture (10%). Doctors are interested in learning more about alternative medicine to address patient concerns. In this survey, 60% of doctors wanted to learn more, 24% said they were unsure or maybe wanted to learn more, and 16% said they did not want to learn more. The doctors recommended these therapies to their patients: * Massage therapy (48%) * Relaxation techniques (41%) * Acupuncture (35%) * Biofeedback (35%) * Chiropractic (30%) * Alternative medicine in general (28%) * Herbal medicine (21%) * Yoga (16%) * Hypnosis (15%) Note: Surveys were delivered to 705 physicians. Of these, 302 (43%) were returned. This must be considered when interpreting the survey results because they may not accurately reflect the physician population. Reference Corbin Winslow L, Shapiro H. Physicians want education about complementary and alternative medicine to enhance communication with their patients. Archives of Internal Medicine. 2002:162:1176-81. (see original) (Source: Doc Advocate) Doc Advocate blogs http://www.medworm.com/rss/comments.php?id=1261603 Wed, 27 Feb 2008 17:20:31 +0100 1261603 http://docadvocate.com/?p=925 In the modest building that houses Shore Memorial Hospital in this town of about 600 people between the Chesapeake and Hog Island bays, a health care crisis is brewing. It’s a problem rooted in the 1980s and 1990s, when U.S. medical schools put a cap on enrollments, believing that managed health care, among other factors, would create a glut of doctors. They were wrong. And now the impact of a national shortage of surgeons and family practice doctors is echoing across the country. The shortage of surgeons is a particular threat to the health care of 54 million rural Americans, medical specialists say, including the “watermen” who catch crabs, scoop clams and grow oysters here. Shore Memorial, which on average has 61 patient admissions a day, was built 70 years ago to save lives being lost to simple ills such as appendicitis. Having a surgeon is vital to keeping open the doors of Shore Memorial and thousands of other small hospitals like it. But as local doctors have moved away from this community or retired during the past 10 years, the ranks have fallen from seven full-time surgeons to two. There also are only two anesthesiologists; one is nearing retirement. Medical schools were “woefully wrong” in their calculations, says Josef Fischer, who as chairman of surgery at Beth Israel Deaconess Medical Center in Boston trains new surgeons every year. “It’s going to be tough in this situation to make it better.” From the late 1970s to the mid-1990s, several national advisory groups, including the Institute of Medicine and the Council on Graduate Medical Education, issued reports forecasting a surplus of physicians. As a result, medical schools voluntarily held enrollment relatively constant at about 16,000 new students a year. From 1980 to 2005, enrollment was flat while the U.S. population grew by more than 70 million, according to the Association of American Medical Colleges (AAMC). After educators realized the forecasting mistake, medical schools began accepting more applicants. Last year nearly 17,800 students entered U.S. medical schools, the largest entering class ever. However, Fischer says there’s “a perfect storm” forming for a shortage of doctors and surgeons because of the time it takes to train doctors — typically three to seven years — and the fact that the number of senior citizens in the USA is growing rapidly. As the 79 million baby boomers begin entering retirement age, so are their doctors. From 1985 to 2006, the percentage of doctors 55 and older rose from 27% to 34%, and the AAMC predicted in a 2006 report that members of this group — roughly 250,000 active physicians — will retire by 2020. The impact often is most severe in rural America, where only 9,334 of 211,908 physicians are general surgeons, according to AMA data. The Census Bureau defines “rural” as open country or small towns with fewer than 2,500 residents. David Lingle, 43, chief of surgery at Shore Memorial, says he is happy doing the work of several doctors. He answers calls for help when he’s in his yard playing with his children or chopping wood. He can venture farther to fish for flounder or speckled trout only when he is not on call. Because Lingle is a general surgeon in a small town, the alarm from his hospital pager could mean that a stranger needs help following a crash on the highway that connects North Carolina’s Outer Banks to the New Jersey shore, or a friend from church might be having an aneurysm. “I like the variety,” says Lingle, who grew up in Arnold, Mo., a suburb of St. Louis. “We’ve figured out a way to make this work, but access to surgery in the periphery is in jeopardy.” He says that he is worried that “nobody will want to sign up for this job anymore.” Thomas Russell, executive director of the American College of Surgeons, says there are not enough new doctors going into general surgery. Surgeons such as Lingle “have no one to sign off to, they are on call all the time,” Russell says. “They can burn out after doing this year after year after year.” ‘They want balance in their life’ The shortage of surgeons is part of a larger shortage of medical professionals that has been recognized as a threat for more than five years. Medical schools have been enrolling more and more students annually to achieve a 30% increase in enrollment over 2002 levels by 2015. But even a growing corps of young doctors may not help those who need general medical care, particularly if they live in rural areas, because of the career paths physicians are choosing. Many of today’s young doctors start their careers $150,000 to $250,000 in debt in education costs, so they often go where they can make the most money, Fischer says. And critical areas such as general surgery and family practice medicine are less lucrative than some specialties, such as bariatric or orthopedic surgery. A typical new surgeon makes about $165,000 in his or her first year, Fischer says. After five years, he or she will earn $220,000 to $300,000 or more a year, depending on whether the practice is private or in an academic setting. In rural areas, however, surgeons generally make less, Fischer says, especially if their hospitals don’t supplement their salaries. The number of physicians in specialties such as thoracic surgery and emergency medicine has more than doubled since 1990, according to the AMA. However, “fewer and fewer are going into family medicine and primary care,” says James King, president of the American Academy of Family Physicians. And “many are not willing to go” to rural areas. After an industry-wide review of allegations that surgeons were charging too much, Medicare lowered the amounts that the U.S. government pays d