A Country Doctor Writes: The Wall Street Journal Health Blog Morbidity & Mortality Well Blog / NY TimesI remember, many years ago, hearing about a software program that mirrored your comments like a psychotherapist in order to help you solve your problems or feel better. Tonight I read a blogpost about smartphone apps that do the same thing. The blog post also has a link to the older version of computer psychotherapy.
via Anxiety? Depression? Need Some Help? Therapy? There’s an App for That! « Mark D. Roberts.
Canadian Family Physician writes about older physicians this week. Some Canadians say there should be a mandatory retirement age, others disagree. One of the writers brings up Osler’s statement, made at age 55, that physicians should stop practicing at age 60. Obviously, Osler, (Canadian born and educated) did not follow his own advice in that regard. Another writer points out: “In Quebec, for example, some 30 family physicians older than 80 continue to practise and 1 physician is older than 95″. This is meant to be a shocking example of something inappropriate. I’m not sure it is.
In Sweden, private practice physicians, at least at one point in time, were prohibited from billing the government sponsored health insurance system after they had reached a certain age. My interpretation was that this kept older physicians from leaving their employed positions to enter private practice later in life; there was no mandatory retirement for employed doctors, so competency had nothing to do with it.
Some of the writers in Canadian Family Physician make the argument that there must be more to life than medicine.
Who are they to decide what is right for other physicians as long as they can do the work and derive satisfaction from it?
The new issue of The Lancet tells a story of a woman with a stubborn cough, unrelieved by standard treatments and no closer to a diagnosis even after extensive testing. When someone finally examined the whole patient, she turned out to have an obvious breast cancer. The cough, it turned out, was caused by pulmonary lymphangitic carcinomatosis.
The authors propose the term “McCoy’s Syndrome”, after the physician in Star Trek. He relied solely on technology to diagnose his patients. We should not, the authors say:
“Unfortunately, McCoy’s syndrome seems to be widespread in the health system at the moment, striking mainly doctors, but also other health-care professionals and even patients. The most characteristic feature of the syndrome is the excessive faith in medical technology, particularly imaging. Other components that might also be present are the absence of clinical reasoning and of establishing emotional links with sick people. Some cases also show incapacity to think about common diagnostic hypotheses, particularly in university hospital environments.”
Dabigatran, the first alternative to the age-old anticoagulant warfarin, is coming under increased scrutiny due to reports of increased risk of cardiac events according to The Lancet. A few months ago, trauma surgeons wrote in The New England Journal of Medicine about patients on dabigatran dying needlessly from internal bleeding after trauma, such as car accidents, because the only way to reverse its effect is by hemodialysis, which is not usually available on an emergency basis in community hospitals.
A lot of the doctor blogs I come across focus on the technical or lifestyle aspects on the practice of medicine. Not this one: A young doctor learns through his own heartbreaking experiences and through the mentoring of a rabbi that being human – a Mensch – is the first prerequisite in mastering the art of medicine.
The Mini Mental Status Exam has been a fairly quick and standardized way of screening for dementia. Clinics, hospitals and nursing homes have used it since the 1970′s – for free. Now its creators are asking for $1.23 per use, or they’ll take us all to court.
It’s like free samples from multinational pharmaceutical companies and neighborhood drug dealers: Give it away, and once they get dependent on it, make them pay…
The other day a pharmaceutical representative stopped me in the hall with a somber expression on his face. His drugs, Valturna and Tekturna had just been proven potentially unsafe because of increased stroke and kidney failure rates in diabetics, exactly the target group they were marketed for.
“That’s why I hadn’t prescribed them yet, not enough outcomes data…”
“I know”, he muttered.
And the law firms are already on it, before most doctors…
• Desired action: prescribe colchicine for acute gout
• Reason unable to perform desired action: insurer will not approve
• Alternative action: nothing; advised patient about possibility of increased flares
This quote is from this week’s “A Piece of my Mind” in JAMA. The article continues:
“It seems the effort to protest and fight the regulations has worn us down, and in one generation, physicians have gone from being advocates for their patients to gatekeepers for health care practices that may be cost saving for the system but may feel heartless and tragic to the individual patient. The sentinel events we face every day should be the raison d’être of a system. Each instance of this craziness is off the radar screen: a silent epidemic.”
“This has been the best and worst of times for our profession. New diseases and their pathophysiology have been elucidated, but the existence of some, such as chronic Lyme disease, are contested, and some physicians treat with therapies that have proven to be useless.“
“The world, at times, seems to have gone mad with senseless (at least from a clinical point of view) administrative rules. We have new powerful agents for gout and hyperuricemia, but colchicine, a highly efficacious drug used for gout since 1500 BC, is no longer readily available in Veterans Affairs hospitals (VAHs) because the cost has gone from 50 cents to more than 3 dollars a tablet.”
In another passage, the authors say:
“House staff are better rested, but their attending physicians are more anxious, as the fundamentals have taken a back seat.”
“It is clear that something has to change to facilitate patient care and address physicians’ helplessness to perform our jobs to the best of our ability.”
The authors’ proposal is to use classic research methods in order to collect the evidence to prove their theory that healthcare administration often stands in the way of delivering good care:
“The goal of accumulating the data is to aggregate these sentinel events so that the signal of administrative interference with the ability to provide good health care is both clear and compelling, providing the information necessary for a change in the system and possibly its conceptual framework. It would allow detection of an epidemic of damaging administrative decisions and, like all epidemiologic surveillance data, illuminate areas for detailed analysis.”
via The Quiet Epidemic, November 2, 2011, Chang and Liang 306 (17): 1843 — JAMA.
I came across this novel idea in the Wall Street Journal:
By Katherine Hobson
Call it a Happy Meal for your heart.
Researchers from the UK — where, it should be noted up front, you can buy a low-dose statin drug over the counter — suggest that fast-food restaurants could offset some of the cardiovascular effects of their meals by including a statin with that shake.
Authors of the new paper, from Imperial College London, draw from a meta-analysis of statins used for primary prevention of heart problems. They argue that the reduced cardiovascular risk associated with a once-daily dose of most statins is larger than the added risk from the extra fat in a 7-ounce burger with cheese and a small milkshake.
They suggest that a “MacStatin” packet (with the catchphrase “I’m neutralizin’ it”) could be handed out just like salt and ketchup packets, along with a leaflet advising people that the best way to cut heart risk is to eat well, exercise, stay trim and avoid smoking — and to see a doctor “for complete advice.”
via One Burger, Hold the Pickles, and Statins on the Side – Health Blog – WSJ.
Does simvastatin prevent heart disease in at-risk patients if you combine it with magic spells, blood letting or ezetimibe?
A recent study, published in The Lancet, shows that kidney disease patients have fewer cardiovascular events if they take Vytorin than placebo. We already learned from the 4S study many decades ago that simvastatin lowers heart attack risk. So what do we learn from a study that compares simvastatin plus something else with placebo?
Nothing. Or am I missing something here?
