ACP Internist

QD: News Every Day--more time, more patients, more quality

noreply@blogger.com (Ryan DuBosar) — Tue, 10 Nov 2009 16:25:00 +0000

ACP Internist's daily digest of news and events continues with a snapshot of health care reform, as well as a look at an ACP member's findings that doctors are spending more time with more patients, and still providing better care across nine quality measures.

Health care reform
The focus has now shifted to the Democrats for health care reform.
--Some Democrats don't think it slows health spending enough.
--Some Democrats think it pits young constituents against elderly ones.
--It's either pragmatic and flexible or just as good as it gets.

As the debate moves back to the Senate next week, there's five "flash points" to consider. (New York Times, Wall Street Journal, Politico, The Hill, Cristian Science Monitor)

Patient encounter
Doctors are spending more time with their patients--21 minutes in 2005 compared to 18 minutes in 1997, reports Lena Chen, ACP Member. And, primary care visits increased 10%, from about 273 million visits in 1997 to 338 million in 2005. Yet, quality is improving across nine performance measures. The population is aging, which requires more time, but also health care in general is more complex now. And, patients are better informed and more engaged. (U.S. News & World Report)

In case you missed it ...
Medical education is changing to focus on health care reform, the patient-centered medical home and patient communication, and leaving anatomy for later. Genetics, demography and the environment are being included. Students are helping design the curriculum, too. What's going on? (Washington Post)

Kaiser Health News looks back to 1977 for a familiar scenario--politicizing living wills that might lower unneeded or unwanted health care use at the end of life.

H1N1, or how I learned to stop worrying and love the flu

noreply@blogger.com (Ryan DuBosar) — Tue, 10 Nov 2009 13:00:00 +0000

How did I get vaccinated for H1N1? I showed up at a free community health clinic. There were plenty of doses available. I didn't stand in a line. It took me longer to figure out parking than to get inoculated.

With a newborn at home, my wife and I decided to make H1N1 vaccination a priority. We'd already gotten seasonal flu shots and whooping cough updates. But the H1N1 vaccine shortage is well-documented. You need me to Google it for you? Click and pick for yourself from among 739,000 results.

But our family doctor posted a sign that he won't get the H1N1 vaccine at all. Our pediatrician's phone system collapsed under the weight of all the calls for H1N1; we couldn't get through for any reason.

We're not alone. A Harvard poll said that two-third of parents who'd tried couldn't get their children vaccinated.

So when the county announced it would have vaccines available one afternoon, my wife took our older son to stand in line. She arrived just as it started and waited 45 minutes. But by the time she left there was no line, so she called me to come over.

For comparison, here's what happened at a clinic that same day in an adjoining county. Friends of ours got stuck in that mess. Certainly, the death of a teen there spurred a lot of response. And I can imagine that some clinics are better advertised than others.

But by the time I stopped work and slogged through rush hour, the clinic in my county was busy, but there was no waiting. One piece of paperwork later I was getting injected--painless, not counting rush hour traffic. It was a pocket of availability amidst a lot of shortage. My wife wonders if we got a discount version of the vaccine--H1N2. But you can't beat free swag; I even got a nifty, palm-sized can of wipes.

(If you're interested in duplicating my success, WebMD chimed in with ways to get vaccinated.)

QD: News Every Day--health reform ready to reconcile

noreply@blogger.com (Ryan DuBosar) — Mon, 09 Nov 2009 17:34:00 +0000

ACP Internist's daily digest of news and events continues with updates from the weekend's passage of health reform in the U.S. House, a global look at H1N1 influenza, and a look at a local hospitals attempt to make a profit by hiring an internist.

Health care reform
Health care passed in the U.S. House over the weekend, and now pressure is on to reconcile it all in the Senate and with the White House. (Kaiser Health News, New York Times, Los Angeles Times)

H1N1 influenza
It hasn't been just H1N1 influenza vaccines in short supply. Hand sanitizers are also evaporating in the face of increased demand. One manufacturer is running its plants around the clock with increased workers, and has asked customers not to stockpile. (CNN)

Globally, an Amazon tribe faces hundreds of infected members and possibly seven deaths from H1N1. Meanwhile, Saudi Arabia's health minister received the H1N1 vaccination on television to calm fears and encourage vaccination among those participating in the Hajj, the once-a-lifetime pilgrimage required of Muslims. (BBC, CNN International)

New Scientist examines H1N1's impact throughout history.

Smoking cessation
America's new "anti-smoking czar" lays out his goals as head of the FDA's new agency, the Center for Tobacco Products: reduce youth smoking rates, reduce tobacco-related disease, and inform the public about tobacco products' ingredients. (Courier-Journal, Louisville, Ky.)

In case you missed it ...
Unicoi County Memorial Hospital in Tennessee was losing money. The hospital's auditor helpfully suggested, "We'd always like to see the hospital have an income." So board members hired an internist and a surgeon to join the staff. Read about their gamble to break even. (The Erwin Record)

Medical news of the obvious

noreply@blogger.com (Ryan DuBosar) — Mon, 09 Nov 2009 14:00:00 +0000

Men who get their sleep apnea treated golf better. Twelve golfers with moderate to severe obstructive sleep apnea who started nasal positive airway pressure (NPAP) treatment saw a drop in their mean handicap from 12.4 to 11.0 (P=0.01), compared to 12 controls. The rested duffers said they felt more alert, and NPAP compliance was 85%, said researcher, who added he wants to conduct a larger, multicenter study to explore what drives high treatment compliance. (It must be those really powerful tee shots.)

QD: News Every Day--waiting for the weekend

noreply@blogger.com (Ryan DuBosar) — Fri, 06 Nov 2009 15:47:00 +0000

ACP Internist's daily digest of news and events continues with this weekend's expected vote on health care reform, H1N1 influenza's ascendance as the dominant strain, and Texas' look at doctor-owned hospitals.

Health care reform
Everyone is gearing up for the expected weekend vote in the U.S. House on health care reform. ACP President Joseph W. Stubbs, FACP, said while the legislation doesn't have every proposal the organiation wants, it "... would represent an historic step forward to achieving ACP's desired future of a U.S. health care delivery system that provides access, best quality care and health insurance coverage for 100% of its people." The American Medical Association is supporting it, with its president saying in a press release that while the legislation is not perfect, "It goes a long way toward expanding access to high-quality affordable health coverage for all Americans, and it would make the system better for patients and physicians."

While the Congressional Budget Office estimates the legislation will cost $894 billion over 10 years and reduce the national deficit by $30 billion, the actuary for the Centers for Medicare and Medicaid Services said he may not have an estimate ready by the weekend vote. While Congress is bound to budget office estimates, CMS figures may sway some votes. (The Hill)

H1N1 influenza
H1N1 influenza is now the dominant strain globally. Obesity may be a factor for complications. More on this will be reported in ACP InternistWeekly on Tuesday. (CNN, CBS News)

In case you missed it ...
This weekend's New York Times Magazine features the debate about evidence-based medicine--clinical judgment squares off against the scientific method, and what happens when doctors at Intermountain Healthcare create their own evidence base.

In Texas, legislators are debating how to treat doctor-owned hospitals. Texas has 67 physician-owned hospitals with about 50 more expected to open, state Rep. Sam Johnson told the Dallas Morning News. While pending legislation would severely curtail existing facilities and prohibit new ones, amendments may grandfather the existing ones. At is issue is whether these facilities cherry-pick the wealthiest patients.

QD: News Every Day--health care reform's eerie repeat history

noreply@blogger.com (Ryan DuBosar) — Thu, 05 Nov 2009 16:47:00 +0000

ACP Internist's daily digest of news and events continues with updates on health care reform, "swine" flu in a cat, and two views on fixing the shortage of primary care doctors.

Health care reform
Health care reform is streaking toward a vote in the U.S. House Saturday, but is it just a case of history repeating itself--specifically, the Clintons' 1994 effort? A New England Journal of Medicine paper analyzed 30 public opinion surveys and compared the shift in public opinion, both then and now. (AP, Boston Globe, NEJM)

Waiting in the wings, the Senate's legislation is facing opposition from surgeons and other specialists. (The Hill)

One aspect of health care that needs reform is the practice of defensive medicine. One doctor was profiled about why he encourages patients not to get unneeded tests, and then capitulates if the patients insist. (AP)

Primary care shortage
Op-eds in two major dailies agree that fixing the shortage of primary care doctors is an important component of health care reform. You wouldn't normally expect the Los Angeles Times and Wall Street Journal to agree on anything but the rising cost of newsprint.

H1N1 influenza
Swine flu has jumped from a cat owner to the pet, ABC News reports.

In case you missed it ...
In case the mainstream media misses something, there's always a blogger who digs a little deeper and finds it. Hats off to the person who found this outlier right in the middle of the U.S. House legislation on health care reform--a tax credit for second generation biofuels. (FireDogLake.com)

And, an economist offers "vaguely heretical" musings on the proposed legislations floating around Congress. His social conscience doesn't override his desire to balance the books. (The New Yorker)

Which patients sue for malpractice?

almom2@comcast.net (Toni Brayer MD) — Thu, 05 Nov 2009 12:00:00 +0000

There are a lot of myths out there about which patients are most likely to sue a doctor for malpractice. Many doctors think it is "poor patients on welfare." They would be wrong. Evidence shows that low income patients on Medicaid are actually less likely to sue than others. But there are some patients and situations that should raise a red flag for physicians that they could bring a lawsuit.

--Angry patients: A patient who is upset about the doctor-patient relationship, either because something didn't work out or they perceived a lack of caring, is more likely to sue the doctor. Plaintiff attorneys say that the majority of their calls come from patients who had poor rapport with their physicians. What works in a medical error? An explanation of what went wrong and, if appropriate, an apology!
--Money Issues: Now that more patients are paying out of pocket costs, if they feel overcharged they become less tolerant of errors. If patients know the approximate costs up front, they aren't surprised and outraged when that big bill arrives. We all know, however, how hard it is to find out anything about costs in advance. Big problem!
--Doctors Dissing Others: So many lawsuits have been filed because of one doctor or nurse making disparaging remarks about another; "How did such a thing happen to you?" It's easy to be a Monday morning quarterback.
--Lousy Service: Bad service goes along with poor doctor-patient rapport. It is hard for someone to feel respected and cared for, if they get bad service or the rooms are dirty or the phone call isn't returned. If a mistake happens, the doctor must be available to discuss it. An absent doctor or poor service turns patients and family members into "angry patients" (see number 1).

Medical mistakes happen because the human body is complex, treatments are complex and there are no guarantees in life. Most patients don't sue their doctors when a bad outcome occurs. The experts in risk warn us that the relationship is the most important prevention for lawsuits, followed by meticulous documentation in the medical record.

Toni Brayer, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.

Ties that bind, and make you gag

noreply@blogger.com (Ryan DuBosar) — Wed, 04 Nov 2009 17:37:00 +0000

Here's a complex solution to a simple problem. Doctors wear ties, which may carry germs that may add to the problem of health care acquired infections. British hospitals banned ties. In America, we made them germ resistant.

SafetyTies claims to make ties and scarves with a built-in barrier for dirt, liquids and bacteria. The company describes its "nanotechnology" and cites "independent studies" that show 99.95% resistance to H1N1 influenza.

Whether the ties are attractive enough to wear is a matter of opinion, however. Patterns include those of MRSA microbes and other common germs. Do write us or send pictures if you actually buy one of these and wear it to your health care facility.

"In our effort to stop the spread of H1N1, we need every tool at our disposal," said SafeSmart co-founder April Strider in a press release. "While vaccinations and handwashing are obviously the first line of defense, SafetyTies and SafetyScarves are an easy, sensible and fashionable way for individuals to help reduce the spread of H1N1."

Or, doctors can stop wearing them. We've covered this issue before. ACP Hospitalist has a bit more practical advice from our magazine and our weekly e-news about serious efforts to reduce health care acquired infections. And, others have suggested using dedicated stethoscopes in rooms dedicated to treating resistant infections.

QD: News Every Day--health care reform's 'sunshine provision'

noreply@blogger.com (Ryan DuBosar) — Wed, 04 Nov 2009 17:20:00 +0000

ACP Internist's daily digest of news and events continues with findings that N95 respirators weren't all they were cracked up to be, and a look at disclosing more about doctors' financial ties with industry.

H1N1 influenza
Authors retracted findings that N95 respirators were better than surgical masks at preventing flu, causing a stir at the Infectious Diseases Society of America meeting, where the retraction was announced. Reviewers questioned the study, and re-analysis resulted in the findings being no longer significant. The original study spurred guidance from the Centers for Disease Control and Prevention and the Institute of Medicine on using the masks.

Blogger Gerald O'Malley, DO, says that he's not getting vaccinated. Hospital administrators are pressuring him, he sees flu patients in emergency wards and his two kids have it. But he's not budging. Neither are college students. (Physicians Practice, The Washington Post)

"Presenteeism" could exacerbate flu's spread, public health leaders said, since 39% of all private-sector workers do not receive paid sick days, (Bureau of Labor Statistics figure). They also send their sick kids to school because they have to work. (New York Times)

Health care reform
Legislation in the U.S. House could get a vote as early as Friday night, But in the senate, Majority Leader Harry Reid isn't making any promises to pass legislation this year, which could frustrate the White House if it delays health care reform until 2010. (The Hill, CBS News, AP)

One aspect of health care reform legislation includes "sunshine provisions" intended to disclose the financial relationships between the medical industry and doctors and hospitals. It's been tried before, though, and bioethicist Bernard Lo, FACP, argues that sunshine provisions don't go far enough. It needs to include other health professionals, and academic research. A survey in Health Affairs found that 53% of academic research faculty in the life sciences at top schools reported financial ties to industry. (New York Times, Wall Street Journal)

QD: News Every Day--health care reform splits urban, rural hospitals

noreply@blogger.com (Ryan DuBosar) — Tue, 03 Nov 2009 18:28:00 +0000

ACP Internist's daily digest of news and events continues with the focus of health care reform shifting toward the U.S. House of Representatives. Also, urban and rural hospitals eye each other for the lion's share of reimbursement.

Health care reform
Legislation released in the House faces opposition from abortion and immigration. The $1.2 trillion price tag over 10 years made many take a second look at what Americans would get for their money. Meanwhile, the deadline for potentially passing legislation is slipping into next year. (AP, Politico)

Rural and urban hospitals would fare differently under health care reform. For example, New York City facilities are worried about losing money to Iowa; Iowa, in turn, is already worried about subsidizing urban areas. (New York Times, WQAD.com)

H1N1 influenza
Pregnant women and children ages 10-17 need only one dose to inoculate against H1N1 influenza. But children ages 6 months to nine years still need two doses for best efficacy. Anne Schuchat, FACP, reports that half of all vaccinations have gone to minors. While the World Health Organization is recommending one dose for all kids and the use of adjuvanted vaccines to stretch supplies, U.S. officials are still recommending two doses. Adjuvanted doses have not been cleared for use in the U.S. Research on them was reported in the Sept. 15 ACP InternistWeekly. (Washington Post, Washington Times, New York Times)

Scientists have used a supercomputer to predict a third wave of H1N1 coming this spring. But others want to use handheld devices to predict which individuals might get sick before they actually do. (Wall Street Journal)

QD: News Every Day--the public option as a Straw Man

noreply@blogger.com (Ryan DuBosar) — Mon, 02 Nov 2009 17:12:00 +0000

ACP Internist's daily digest of news and events catches up with newly appointed Surgeon General Regina Benjamin, MD, fears about adverse reactions to H1N1 vaccinations, and why one ACP member says hope for recovery isn't always the best for a patient.

Surgeon General confirmed
Newly confirmed Surgeon General Regina Benjamin said preventive medicine will be her priority, following her confirmation by a unanimous Senate vote late last week. Month before, during a press conference announcing her nomination, she had spoken about losing relatives to lung cancer, diabetes and other lifestyle-related illnesses. (al.com)

Health care reform
For all the fuss over the public option, the Congressional Budget office estimates that 2% of the nation, 6 million in all, would enroll in it. (AP/The Washington Post)

Barry Izenstein, FACP, Governor of ACP's Massachusetts Chapter, writes that health care reform should cover all Americans, create more primary care doctors and reform medical liability. (The Springfield Republican)

Meanwhile, Peter Boling, ACP Member, is undertaking his own effort at health care reform by falling back on the old-fashioned house call. The House and Senate are considering such measures as part of the "Independence at Home" provision of current legislation. (AP)

H1N1 influenza
Independent experts started today tracking adverse events from the H1N1 vaccine to spot any real problems quickly, explain false alarms and separate normal disease rates from potential yet real risks. (AP/Boston Globe) There's a basis to the fear of H1N1 vaccination, and it's generational, says one psychologist. (Psychology Today)

In case you missed it ...
Sometimes, it's better to lose hope for recovery, University of Michigan researchers said.

Peter Ubel, ACP Member, teamed up on a study that noted while it's important not to lose hope, it's also important to realize that hope might make some people unhappier because they fall into a holding pattern of sorts, waiting for their condition or chronic pain to wane before moving on with their lives. They compared outlook among patients who'd just had colostomies. Some were told the procedure would be reversible, and some were told the procedures were permanent. He explains more about hope's "dark side."

The story of two little pigs

noreply@blogger.com (Stacey Butterfield) — Mon, 02 Nov 2009 15:37:00 +0000

Not surprisingly, flu was a major topic of the IDSA meeting. I'll be writing a full article about the information presented, but in the meantime, a funny story from the CDC about pigs and H1N1. The first two cases of the novel flu were identified in kids in Southern California last April. Both children had been in contact with pigs, so the CDC wanted to determine whether the swine had been the source of the flu.

The 9-year-old girl had visited pigs at the state fair, but when the authorities went there, they found that the pigs had been butchered. The 10-year-old boy had met his pig on a leash at the San Diego Zoo, and when the CDC went to test that pig, they ran into a legal tussle with the zoo. So, concluded CDC expert Dan Jernigan, MD, "This is the story of two pigs--one had been slaughtered, and one had a lawyer."

Medical news of the obvious

noreply@blogger.com (Stacey Butterfield) — Mon, 02 Nov 2009 14:27:00 +0000

Why are athletes young? Why are couch potatoes out of shape? If questions like these have been plaguing you, not to worry, researchers have the answer.

A new study from the Archives of Internal Medicine finds that "men and women become gradually less fit with age" and that "maintaining a healthy body mass index (BMI), not smoking and being physically active are associated with higher fitness levels throughout adult life."

The study authors also make a pretty dramatic leap from these findings to proposed interventions. "These data indicate the need for physicians to recommend to their patients the necessity to maintain their weight, engage in regular aerobic exercise and abstain from smoking," they concluded. Call me overly cautious, but I think we should see some data from controlled trials first. Bet there'd be no problem finding volunteers for the eating, sitting around and smoking arm.

The vaccine that went away.

noreply@blogger.com (Stacey Butterfield) — Sat, 31 Oct 2009 13:11:00 +0000

You could almost think of it as part of the positive publication bias that almost all conference session are about things we do have, whether they're diseases, drugs, or dilemmas.

The IDSA session "Why is there no vaccine for Lyme disease?" bucked that trend. Experts reviewed why the Lymerix vaccine (on the market from 98-02) didn't work out. Problems included that the vaccine wasn't approved for kids, who are one of the highest risk groups, and it required multiple shots to acheive good (80%) effectiveness. Because of these factors (and others), the CDC gave it an underwhelming recommendation and uptake was limited. Protest, on the other hand, was serious and involved class action lawsuits claiming an association with arthritis that was never proven by the evidence.

Therefore, it's not surprising that no manufacturer has come up with a new vaccine, the experts said, but it is a "public health disaster" according to Stanley Plotkin, MD. Parts of the U.S. (like the Northeast) have a high prevalence of Lyme disease and residents who could benefit from a vaccine. Some are so eager for a vaccine that they've asked vets to give them the USDA-approved dog vaccine, Greg Poland reported.

Yet the only work on a Lyme disease vaccine (which hasn't gotten as far as human testing yet) is being done in Europe by Baxter. Europeans are less hostile to the concept and public attitude is really the factor that will determine whether the U.S. ever gets a vaccine, the experts concluded. "At least with Lyme disease, the advocacy groups are a lot more influential than we are," said CDC's C. Ben Beard. "Without their support, it's doubtful that vaccination would be successful."

Infectious tidbits

noreply@blogger.com (Stacey Butterfield) — Fri, 30 Oct 2009 17:00:00 +0000

More hot stuff in infectious disease, this time from Bennett Lorber, MD. Dr. Lorber reviewed an array of recent research yesterday at IDSA. Here's the super-condensed version of his conclusions:

It's pretty clear that acid-suppressive medications are increasing the risk of pneumonia, and thereby causing excess hospital deaths, so they should not be prescribed so broadly. "We need to tell our medicine and hospital colleagues that acid-suppression should be a carefully considered decision," Dr. Lorber told the infectious disease docs.

Prescribing prophylactic antibiotics before catheter removal, on the other hand, is supported by new evidence. A recent trial found a NNT of 6 to prevent symptomatic infection. "We don't like this idea, but it's a pretty good study," Dr. Lorber said.

However, if you're trying to prevent infections after cardiac surgery, there's not enough evidence to justify putting patients on a statin before the procedure. A recent cohort study found that statins weren't associated with reduced post-op infections.

And finally, if you suspect a prosthetic joint infection, tell the lab to hold on to the specimen for at least 2 weeks, because a recent study showed that about a quarter of bacteria grown in cultures didn't show up until after a week had passed.

It's a party! Bring your own alcohol (gel).

noreply@blogger.com (Stacey Butterfield) — Fri, 30 Oct 2009 16:49:00 +0000

I learned about a new holiday today at IDSA. The WHO has declared May 5 to be hand-hygiene day. I'd suggest that we all celebrate by washing our hands, but apparently the point is that health care workers should be cleaning their hands all the time--specifically at 5 moments in the patient encounter. (See, 5 moments for the cinco de Mayo.)

This international effort is trying to make hand hygiene "easy, convenient and even sexy," according to Didier Pittet, MD. The project is very country-specific--in some developing countries, they're teaching how to make your own hand gel, while in others the focus is on humorous education to improve compliance. The importance of localizing humor was made clear by a French cartoon of a germ on a couch that Dr. Pittet presented. "Dr. Freud, in this hospital, it's become impossible to cause infections anymore," the germ said. It sure wouldn't win the ACP Internist/Hospitalist cartoon caption contest.

QD: News Every Day--the Halloween edition

noreply@blogger.com (Ryan DuBosar) — Fri, 30 Oct 2009 11:00:00 +0000

Doctors who are ghostwriting has recently come to the fore recently, so now we're writing about ghosts for our doctors. Enjoy ACP Internist's Halloween edition of QD: News Every Day.

First, physicians are looking at near-death experiences and trying to come up with answers about them--the bright light at the end of the tunnel, for example. It may have a neurological cause, but why do so many people all report a common experience? If a near-death experience has left you terrified, then it's not entirely a myth that your hair could turn white overnight.

For those of you trying to stave off death one more day through exercise, here's one fitness trainer's fun idea: use pumpkins for your workout instead of for pies. This one is worth the click-through just for the photos (putrid pushups, devilish diagonal chops and more).

Next on this haunted tour, Dr. Justina Ford, the first black woman to practice west of the Mississippi, is said to still haunt her office and home. Further west and further back in time comes this folklore about a physician who gets help from beyond the grave in making the correct diagnosis.

Coming back into a more modern concern, A Happy Hospitalist writes about spooky contact lenses being commonly available, even though they require a prescription. Finally, hospitalist Jamie Newman, FACP, tells his tale of working the graveyard shift at locum tenens facility that's off the beaten path.

The fact that it is almost Halloween is purely coincidental.

noreply@blogger.com (Stacey Butterfield) — Thu, 29 Oct 2009 22:38:00 +0000

At an IDSA session on "What's hot in infectious disease," John Bartlett, MD, updated us on the risks of bat bites. Apparently (surprising as this sounds), it's easy to be bitten by a bat without noticing, and a fair number of bats are rabid.

Therefore, standard protocol (at least in Canada, I'm not sure if this also applies to the U.S.) was "If you wake up and see a bat in the bedroom, you should be considered for rabies prophylaxis." Some Canadian researchers were suspicious of the cost-effectiveness of this recommendation, so they did a study of 36,000 people. They asked how many of them had either had contact with a bat or seen one in a bedroom, and then calculated the cost of providing rabies prophylaxis.

Turns out that just the therapy--not even counting clinician time--would cost $2 billion per rabies case prevented if you treated all the bedroom encounters, and $48 million each if you treated just the people who had contact. Canadian policy was revised based on these calculations, and the results appear to confirm the projections, Dr. Bartlett said. "The epidemic of rabies has not been found."

Get your darn flu shot!

noreply@blogger.com (Stacey Butterfield) — Thu, 29 Oct 2009 21:04:00 +0000

The press conference I attended today at the Infectious Disease Society of America's annual meeting had a clear message and it was pretty much a more polite version of this post's title.

Researchers presented data showing that flu vaccination of pregnant women (seasonal, not pandemic, by the way) makes their babies less likely to be premature, small or admitted to the hospital for flu early in their lives. So, such vaccinations would solve the problem of not having a vaccination for newborns and achieve the cost-effectiveness of protecting two people with one shot. The scientists expressed hope that their findings would increase the currently "dismal" rates of expectant-mother vaccination. "If they're not doing it for themselves, maybe they'll do it for their babies," said Marietta Vasquez, MD.

I wouldn't count on it, based on the results presented about vaccination attitudes among hospital workers. The one-hospital survey found that plenty of health care workers, and even some physicians, believe that flu vaccines aren't safe and could give you the flu. In addition, many of them were not aware that one can transmit the flu without having symptoms. Depressing.

On the bright side, even though vaccine expert Paul Offit, MD, termed his part of the press conference a "mini-rant," he actually had some positive news to offer. "The pendulum is starting to swing the other way," he said. Concerns from parents of immunocompromised kids and the refusal by some docs to see unvaccinated children, among other factors, are putting the anti-vaccine troops on the defense, he thinks.

QD: News Every Day--public option in da House!

noreply@blogger.com (Ryan DuBosar) — Thu, 29 Oct 2009 15:46:00 +0000

ACP Internist's daily digest of news and events covers how health care reform is being reconciled in Congress, how the primary care shortage impacts local emergency rooms, and how community doctors in Bermuda are reacting to the introduction of hospitalists.

Health care reform
While the Senate stares down a threatened filibuster of legislation that includes a public option, the House introduced its version, which includes it. As the House and Senate reconcile their respective bills into one per each chamber,
Cecil B. Wilson, MACP, who is also the American Medical Association's president-elect, told Floridians at a union-sponsored rally that the majority of Americans, including physicians and AMA members, want reform. (Washington Post, Miami Herald)

Primary care shortage
A column in The Olympian (Olympia, Wash.) points out that the community already has universal health care. Unfortunately, it's the local emergency room. In Palm Beach, Fla., county commissioners are considering whether to build a public hospital for just that purpose. Jose Arrascue, ACP Member, representing the Palm Beach County Medical Society, told commissioners, "We believe the health care delivery system in Palm Beach County is in critical condition. We have escalating numbers of uninsured, diminished access to care, an aging physician population and a lack of specialty care." (Palm Beach Post)

University of Pennsylvania bioethicist Arthur Caplan told an audience in Bakersfield, Calif., that one way to alleviate the primary care shortage is to forgive medical school loans. (Bakersfield.com)

H1N1 influenza
Now, there's an app for that. Harvard Medical School has launched an iPhone application that includes information on the pandemic's spread, practical steps people can take to mitigate their risk of infection, key symptoms to watch for, and what to do in case of infection. The application includes text, video and links to government databases. It also provides information to businesses for managing through the pandemic. People need all the help they can get. Richard Wenzel, MACP, reports that half of all outpatient H1N1 influenza cases don't develop a fever, so the patients don't take precautions. Even among hospitalized patients, 15% don't get a fever. (Minnesota Public Radio)

In case you missed it ...
Family doctors claim that the switch to hospitalists has shut them out of their community hospital ... in Bermuda. The chief of staff at King Edward VII Memorial Hospital feared being hanged in effigy outside his office after general practitioners lost their hospital privileges and communication suffered between community and hospital doctors. But, the chief said outcomes have improved and the move is needed as his facility moves from being a rural provider to a modern metropolitan facility. (Bermuda Sun)

Trick or treat!

noreply@blogger.com (Stacey Butterfield) — Wed, 28 Oct 2009 18:08:00 +0000

Just in time for Halloween, we've got some spooky and disgusting medical news.

First, from the annals of how machines are out to get us (or the Journal of Craniofacial Surgery), a study of young healthy men who wear their cell phones on their hips found that pelvic bone density was slightly reduced on the side where they usually wear their phones. Apparently the phone holster was subjecting these men to not only ridicule by fashionistas, but electromagnetic fields. Based on the findings, researchers recommend keeping your phone "as far as possible" from your body, HealthDay reports.

And now, from the plastic surgeons' annual meeting, an image grosser than the bowl of brains at your neighborhood haunted house. A group of 50 women had fat liposuctioned from their thighs, bellies or "other areas" and injected into their breasts, according to HealthDay. The good news is that the procedure didn't impair cancer detection and took only slightly longer than a lunch hour. (Alternate fat reduction strategy: see some photos of this procedure and develop sudden motivation to skip lunch.)

QD: News Every Day--public option unsettles Senators

noreply@blogger.com (Ryan DuBosar) — Wed, 28 Oct 2009 15:32:00 +0000

ACP Internist's daily digest of news and events wraps up how the public option has shifted the balance of opinion in the Senate, how the public itself has shifted on H1N1 vaccination, and the economic impact of a rural physician.

Health care reform
The introduction of a public option has precariously shifted Senators' support. Democrats are divided. What bi-partisan support there was has evaporated. Liberals are happy, but that won't carry the day. (AP, Los Angeles Times, Boston Globe)

H1N1 influenza
Some hospitals are seeing their emergency department patient volumes double from H1N1 influenza as doctors are being recruited as the flu police, trying to prioritize who gets vaccinated. To ease the crunch, more than 22 million doses of H1N1 flu vaccine are now available now, and health officials are still saying better late than never. (USA Today, New York Times, AP/MSBNC.com)

Data produced by a supercomputer shows that there could be a third wave of the H1N1 virus in the spring. The University of Texas is using
the "Ranger" supercomputer to make its predictions. (KXAN-TV)

Handshaking was out, and now so is the simple fist bump. Here's some humorous ways to greet people. (NPR)

In case you missed it ...
Doctors' economic contributions are as important to rural communities as their medical ones. The National Center for Rural Health Works estimates that a rural hospital loses $236,565 from clinic visits and $451,169 net revenue for every half-a-physician they are short. When extrapolated to include services purchased by the physician, the clinic and employees, the shortage translates to 13.8 jobs and $533,493 in income. (Iowa Independent)

Irving Harper, ACP Member, discusses how he handles his patients with e-mail, cell phone and video chat. Ahhh, but it's good to practice in Hawaii. (U.S. News & World Report).

QD: News Every Day--the need for health reform

noreply@blogger.com (Ryan DuBosar) — Tue, 27 Oct 2009 16:29:00 +0000

ACP Internist's daily digest of news and events continues with more on how the need for health care reform plays out across the country, as well as the uneven distribution of H1N1 vaccines.

Health care reform
Sen. Reid's announcement of a public option in Senate legislation follows statements by legislators who said they'd oppose any bill without it. He still doesn't have 60 Senators on board to prevent filibuster. (AP/The Washington Post)

ACP Fellows continue to vent about the need for health care reform. In the latest op-ed, Rod Hochman, FACP, CEO of Swedish Medical Center in Seattle, talks about how the patient-centered medical home plays out in what he calls "the other Washington." (The Seattle Times)

The largest private group practice in Kansas City, Mo. has stopped accepting walk-in Medicare patients. At Kansas City Internal Medicine, 65% of its nearly 70,000 active patients are 65 or older. Keith Jantz, ACP Member, says that it's a harbinger of things to come if Medicare reimbursement is cut by 21%. (CNN) It's a situation that one patient experienced in Grand Junction, Colo. (KJCT8.com )

A Thomson Reuters piles on the blame, finding the health care system wastes between $505 billion and $850 billion every year, about a third of the overall bill. (Reuters)
--antibiotic overuse and lab tests to protect against malpractice are 37% of the wasteful spending, or $200 to $300 billion a year,
--fraud is 22% of waste,
--administrative inefficiency and redundant paperwork are 18%, and
--mistakes are 11%.

H1N1 influenza
Despite shortages and some tales of uneven or nonsensical distribution, the vaccine is worth getting late rather than never, said Health and Human Services Secretary Kathleen Sebelius. (ABC News; Los Angeles Times; GetBetterhealth.com; AP/The Washington Times) Also, USA Today breaks down H1N1 flu incidence by region.

In case you missed it ...
One medical student prefers primary care, despite the financial shortfalls he'll face. His profile is here. (Minneapolis Star Tribune)

QD: News Every Day--H1N1 'emergency' and vaccine shortage

noreply@blogger.com (Ryan DuBosar) — Mon, 26 Oct 2009 16:01:00 +0000

ACP Internist's daily digest of news and events continues with H1N1 updates, and physicians speaking out about health care reform.

H1N1 influenza
The weekend's health news had one theme: President Obama declared a national emergency, coupled together with pictures of long lines of people waiting for vaccines. Lines formed despite the large numbers of people refusing to get inoculated. (Half of all Canadians!)

Health insurance
Health care reform may have to start at the (medical) home. Eleven percent of health care workers are uninsured. Ambulatory care workers are three times as likely as hospital employees to not have insurance; residential care workers are four times as likely; and service workers are 50% more likely to be uninsured than those involved in treatment. Meanwhile, Blue Cross Blue Shield of Florida, that state's largest insurer, is moving its 5,000 employees to a high-deductible insurance plan linked to health savings accounts.

In case you missed it ...
Internist Randy Silverstine, MD, turned his solo office into a concierge practice but only charges $600 a year, a fraction of what others have charged. He joins the ranks of the 12% of internists who no longer accept health insurance. "This was the only way I knew how to keep practicing the kind of medicine I loved," he told the Sarasota, Fla. Herald-Tribune.

ACP Fellows are sounding off about health care reform. Charles M. Fischman, FACP, spells out how the possibility of a 21% cut in Medicare reimbursement would play out in Florida--with a mass exodus, he predicts. Paul Dolinsky, FACP, says there's plenty of blame to spread around for rising costs.

Medical News of the Obvious

noreply@blogger.com (Ryan DuBosar) — Mon, 26 Oct 2009 13:00:00 +0000

In our special migraine edition ...

Migraine sufferers may be more prone to hangovers. A rat study at Thomas Jefferson University found that rats with migraines experienced more pain four to six hours after drinking alcohol than the control rats. But researchers ruled out dehydration or impurities in the alcohol. (What's the rodent equivalent of "Beer then liquor, never sicker?")

Another cause of migraines is bad air quality. The Santiago Province of Chile is densely populated and surrounded mountains, so researchers found increased hospital admissions for migraines, as well as tension and cluster headaches, on days of heavy pollution. Hmmm, people who live in big cities get headaches ...