July 17, 2018

Treat the Brain to Lessen the Pain

We have successfully helped many of our chronic pain patients reduce their need for opioid medications through our in-house cognitive pain management program. JAMA Neurology just published an article about a similar program with similar results:

http://app.jamanetwork.com/?doi=10.1001/jamaneurol.2018.0492&utm_source=email&utm_medium=app&utm_campaign=share

July 10, 2018

“Work For Us and Have No Say”

A promoted post keeps appearing in my LinkedIn feed. At first I just ignored it, but tonight I looked at it for a minute and thought to myself: What kind of doctor in today’s climate of time pressures and professional burnout wants to sign up for a job where you are told, “you see the patients and we’ll take care of everything else, including HOW you take care of your patients”?

I would think effective job ads for physicians today would say something like, “come work with us and we’ll value your input into everything our organization does”.

Anyway, I might have a spot for a well qualified family doc of the latter inclination.

July 7, 2018

Mini Quiz: Panic Disorder | Psychiatric Times

Benzodiazepines may have a long-term tolerability edge over the SSRIs, SNRIs, and TCAs, as they do not cause weight gain or sexual dysfunction. Generally, high-potency, shorter half-life benzodiazepines are preferable because of their more predictable pharmacokinetics and simpler metabolism. Regular dosing (vs PRN) is recommended to achieve optimal anxiolysis. >
> http://www.psychiatrictimes.com/quizzes/mini-quiz-panic-disorder?rememberme=1&elq_mid=2211&elq_cid=1758157 >

July 7, 2018

Primary Care and the Opioid-Overdose Crisis — Buprenorphine Myths and Realities | NEJM

“In part, the overdose crisis is an epidemic of poor access to care. One of the tragic ironies is that with well-established medical treatment, opioid use disorder can have an excellent prognosis. Decades of research have demonstrated the efficacy of medications such as methadone and buprenorphine in improving remission rates and reducing both medical complications and the likelihood of overdose death.1 Unfortunately, treatment capacity is lacking: nearly 80% of Americans with opioid use disorder don’t receive treatment.2 Although access to office-based addiction treatment has increased since federal approval of buprenorphine, data from the Drug Enforcement Administration (DEA) reveal that annual growth in buprenorphine distribution has been slowing, rather than accelerating to meet demand (see graph). To have any hope of stemming the overdose tide, we have to make it easier to obtain buprenorphine than to get heroin and fentanyl.”

https://www.nejm.org/doi/full/10.1056/NEJMp1802741?query=featured_home

July 7, 2018

Don’t Tell Me Doctor Salaries are Driving Healthcare Costs

The second major healthcare blog that reblogged some of my posts, after KevinMD, was The Healthcare Blog. I’m still appearing on both. And while I sometimes enjoy them very much, I don’t always agree with the posts I read on either one of those blogs.

Today I watched a video post by Matthew Holt, the founder of THCB. He is a master of brief, snappy commentary in video format, but this one bothered me a little. He implied, in a talk recorded in Finland, that the cause of high healthcare costs in the United States is that doctors want a Mercedes and a five bedroom house. I think that’s small potatoes compared to healthcare executives’ and healthcare investors’ eight figure payouts, which are enough to pay for jets and yachts:

http://thehealthcareblog.com/blog/2018/07/06/the-past-present-and-future-of-health-care/

https://www.beckershospitalreview.com/compensation-issues/20-highest-paid-healthcare-ceos-in-2015.html

July 4, 2018

The Loss of a Sense of Control as a Major Contributor to Physician Burnout

The current issue of JAMA Psychiatry points out that resilience training and mindfulness are strategies to decrease physician burnout only when it comes to dealing with unchangeable circumstances. The most important solution is to give physicians more control and influence about how we should work and how our practices and organizations should evolve.

http://app.jamanetwork.com?doi=10.1001/jamapsychiatry.2018.0566&utm_source=email&utm_medium=app&utm_campaign=share

July 1, 2018

BBC News: Seeing the same doctor over time ‘lowers death rates’

“The benefits applied to visits to GPs and specialists and were seen across different cultures and health systems.University of Exeter researchers said the human aspect of medical practice was “potentially life-saving” but had been neglected.
GPs’ leaders said they recognised the value of patients seeing “their own” doctor.
Because of intense workforce pressures, however, this could mean waiting even longer for an appointment, the Royal College of GPs said.”

Seeing the same doctor over time ‘lowers death rates’_102243589_gettyimages-689956326.jpgContinuity of care really is a matter of life and death, a review of studies suggests.

June 8, 2018

Hypochondriapp: British GP Humor

British GPs feel squeezed by online medical consultation app “Babylon” and Copperfield, one of the regular contributors on their website, Pulse, describes what GPs do and suggests another app, cleverly named “Hypochondriapp”.

“It also reinforces the completely wrong notion that symptoms inevitably and algorithmically lead to a diagnosis. When does that ever happen? The reality is that symptoms result in a spaghetti junction of confusion and contradiction which we GPs manage with clever time-passing manoeuvres such as umming and aahing, or arranging unnecessary blood tests, until they resolve spontaneously, as they usually do.”

“Because there’s definitely a market for an app which recognises this by inviting punters to enter their symptoms, type in their feared diagnosis and accept the advice: ‘Forget it.’ This is my idea, I already have a name for it (Hypochondriapp).”

> http://www.pulsetoday.co.uk/views/copperfield-/forget-babylon-im-pitching-the-hypochondriapp/20036841.article#.Wxlt5QhVd3I.email >

May 29, 2018

Intuition is Underappreciated

“Intuition or gut feelings are also the result of a lot of processing that happens in the brain. Research suggests that the brain is a large predictive machine, constantly comparing incoming sensory information and current experiences against stored knowledge and memories of previous experiences, and predicting what will come next. This is described in what scientists call the “predictive processing framework”.”

Should you trust your gut feelings?p06808sm.jpgWe live in an age of rational, analytical thinking. But your emotional responses are not as fallible as some would have you believe, says neuroscientist Valerie Van Mulukom.
Disclaimer: The BBC is not responsible for the content of this email, and anything written in this email does not necessarily reflect the BBC’s views or opinions. Please note that neither the email address nor name of the sender have been verified.

May 22, 2018

“Missing microbes ’cause’ childhood cancer” (BBC NEWS)

Acute lymphoblastic leukemia is more common where children are exposed to fewer bacteria

Missing microbes ’cause’ childhood cancer_101658923_f0173874-destruction_of_leukaemia_blood_cell_illustration-spl.jpgEarly exposure to microbes may help protect children against a type of leukaemia, says a UK scientist.
Disclaimer: The BBC is not responsible for the content of this email, and anything written in this email does not necessarily reflect the BBC’s views or opinions. Please note that neither the email address nor name of the sender have been verified.