Tuesday, April 29, 2008

The Best Health Commercial

Nothing like a cute kid to make a great commercial. His interview with Ellen is priceless too.
(Hat Tip to Cynthia C. for the link)

New Doctors - New Culture


I attended a hospital retreat this weekend and the subject was how do we recruit new physicians into a medical community when they don't want to do private practice medicine? New young doctors want controlled lifestyle, guaranteed salary, benefits and predictability. The type of practice most primary care doctors have is just the opposite. We have no salary guarantee...you eat what you kill (pardon the awful metaphor). Patients don't get sick during predictable hours and there have been many years when I funded my employees IRA but there was no money left over to fund my own. That is just business "crazy" and the young doctors are smart enough to know that.

Today's article in the Wall Street Journal , "As Doctors Get a Life - Strain Shows" addresses this very issue. U.S. medicine is undergoing a cultural revolution that will change how patients receive care. It has already begun, with the emergence of "hospitalists", doctors who only work in the hospital and take care of patients who are admitted. The days of the family doctor meeting you at the Emergency Department and taking care of you in the hospital are long over. The hospitalist works by shift and when he goes off, another one assumes responsibility for the patient's care.

Young physicians do not want to take call. When they are off they want to be off. If they do cover on weekends, they expect to have weekdays off to be with family and friends. Young physicians do not want to deal with office employees or running a business. They expect a full schedule of patients to be there and an office administrator to deal with other business aspects like contracting with insurers, collecting payments and worrying about Medicare hassles.

The problem is that primary care practice and even some specialty practices have not been set up this way. There are thousands of practices across the U.S. that have aging physicians that want to retire or turn their loyal patients over to a new emerging doctor. The new doctors are choosing dermatology and plastic surgery as career choices (really, how much botox does America really need??). The number of doctors that choose primary care or general surgery as a specialty has plummeted and those few absolutely do not want to take over the old style practice.

Medicine is going to have to adjust really quickly to forgo a major shortage of caregivers over the next few years. Hospitals across the country are having difficulty finding doctors to take Emergency Department call. To counter this trend, hospitals are developing employment models for the new physicians so they can provide salary and benefits and office management.

In California, there is a law that prohibits hospitals and other corporations from employing doctors. Medical groups in Universities, Kaiser-Permanente and community clinics are able to offer real jobs and the new physicians are going for it. But that leaves the aging private practice physician with even more work, more call and no way to transition their patients when they retire.

In the meantime, I have about 15 people a month asking me to recommend a physician because their doctor dropped all insurance or retired. I have no names to offer.

Monday, April 28, 2008

I Love Health Blogging


I love being a health care blogger. Friends and family and acquaintances ask me why I blog. "Do you get paid to blog" The answer is No. "Is it hard to blog?" The answer is No. "How do people find you?" The answer is "I don't always know". Some people have told me they pass an interesting blog on to friends. I think that is "viral marketing". I have return visitors that bookmark the page or sign up for google alert. Most people find me when they google a certain topic. I am happy to say EverythingHealth is often at the top of the google page on a subject. I am not sure why, but I hope it is because my facts are researched and credible. I don't rant and rave on my blog and I keep it non-political (Although I am a VERY political person with strong opinions).

So why do I blog? I was blessed to receive a fantastic medical education and as a general Internist my medical knowledge is vast. I read constantly and try to think of subjects that would be of interest to everyone. I appreciate a free program called "statcounter" that tracks visits and even shows me a map of visits.

Yesterday I had visits from Latvia ("Do Drs. make too much money?") from Islamabad ("Top 10 drugs"), from Dubai ("Medical quiz"), from Korea ("Dash diet for hypertension") from Philippines ("Worst scams"), from Singapore ("Hair myths"), from Estonia, Paris, Poland and the UK. And of course, visits came from almost every state in the U.S.

The idea that someone in Dubai or Beijing is reading my blog is thrilling. I imagine someone who speaks a different language, has different customs and religion, sitting at their computer and we are sharing a human bond of knowledge and that brings us closer together. That is why I blog.


To receive an email link to EverythingHealth blog, just sign up at Google Alert.

Saturday, April 26, 2008

How to be a Health Advocate for a Loved One


I have been dealing with a personal family illness and it reminded me of a blog I did last year. I went back to review it and realized it is pretty damn good advise. I'm repeating it here for readers who may just now be reading EverythingHealth.

Five Things You Can Do for a Sick Loved One

When a loved one is sick, we often feel totally helpless and caught up in the medical world. If people only knew how important their role as caregiver really is. Credit goes to Elizabeth Cohen, CNN, for these wonderful tips on how to fight for and protect a sick loved one.
  • Don't be afraid to intervene: If you see something going on that strikes you as wrong, say so. A medication that you've never seen before, a dressing that remains after a doctor said it would be removed, IVs that should be given on a regular schedule. It's OK to push and not accept the first answer.

  • Ask Questions until you understand the answer: If the doctor says surgery is needed and you don't understand why or when or how...ask. If explanations are given in terms that make no sense..push until you understand.

  • You know things that the doctors don't: You know if your loved one is in pain, has been bleeding longer than the doctor thinks, is shy and won't talk or hundreds of other facts that the medical folks just can't know. Share information...it might be important to healing.

  • Temper your loved one's enthusiasm for quick fixes: Pain and anxiety can affect the way a patient hears the doctor. It is OK to ask for a 2nd opinion, look at alternative treatments or just stop and discuss. Be the advocate with the clear mind.
  • Scope out the nurses: The nurses are the ones that see it all. They know the details of tests, timing and the ins and outs of the complicated hospital environment. The nurse can often interpret things for you if you didn't follow rule #2. Nurses are the patient's second best advocate after you, so partner with them.
The patient without a significant loved one at their side is at a clear disadvantage. I am always happy to see family gathered around when I round on a hospital patient because I know we are all working together for a common goal.

Friday, April 25, 2008

Dr. Rating - Here to Stay


Once "google" became a noun as well as a verb, the cat was out of the bag in terms of getting information...all kinds of information...on doctors. There are a reported 31 online sites that use different rating systems and allow patients to post comments on service, promptness, kindness of staff and other parameters. There is a glut of venture capital money going into these sites and some are easy to navigate, some are a mess. See my prior post on rate your doctor.

Some doctors are none too happy about the new transparency. They say the rating systems are arbitrary and can be easily manipulated. They say patients don't have a clue about skill, or competence or the things that really make a good physician. One disgruntled patient can unfairly dis a doctor and influence others. Others feel the comments are random and meaningless.

The online rating systems cannot really tell a patient if the doctor is competent. Many brilliant physicians have lousy offices or gruff manner. Surgeons particularly may be great in the OR but really inept when it comes to patient interaction. If a patient just wants a technician for a one time surgery, getting referrals from other satisfied patients or nurses will be more valuable than online rating.

Right now there are too many rating sites and the ones that work the best for consumers will emerge as the winner. When that happens, the ratings will be more valuable and trustworthy as a place to get valid information.

I think you can't turn back. Rating systems and transparency with the internet are here to stay. Yes, there will be unfair comments, but if more patients do the ratings, they will be balanced by good comments. Unless the doctor is really a dud. Perhaps for him, the bad ratings could trigger a change in how the office is run or even some help with bedside manner.

To get the most out of online ratings, patients should look for themes. If all the comments say the doctor was dismissive, or the staff was rude, there is probably something to it. If there is one bad comment among a sea of satisfied patients, that rating can be thrown out. These ratings are not scientific and should be thought of as just another piece of information to help people make better choices with their health care dollar.

Healing is both an art and a science and the internet might give a little more nudge toward the compassion side of medicine and help with some needed changes.

Tuesday, April 22, 2008

Answers to Genetics Quiz

See the post below. Here are the answers
1. D - 25,000
2. Deoxyribonucleic acid (DNA)
3. chromosomes
4. mutation
5. genetic code
6. environment

How did you do?

Monday, April 21, 2008

Basic Genetics Quiz


Genetics and genomes are in the news every day. Genetics is the study of how human characteristics are inherited from one's parents. Since my son is studying genetics now in Science, here is a quiz to test your basic knowledge. The answers will be posted tomorrow. Have fun, and no "googling."

1. Genes are contained in a person's cells. About how many genes are in each human cell?
a. 100
b. 500
c. 5000
d. 25,000

2. What is the chemical that genes are made of that carries the genetic instructions for making living things?

3. Humans have 23 pairs (46 total) of packets of genes in a cell. What are these packets called?

4. When DNA is altered or changes, it is called a m________.

5. The order of nucleotides in DNA that produce specific sequences of amino acids is known as the____________ code.

6. The inherited pre-disposition to getting a medical disease (cancer, heart disease, certain mental illnesses, cystic fibrosis) is called a trait. These diseases can also be influenced by the ________________.

How did you do? Check back tomorrow for answers.

Sunday, April 20, 2008

Going Green


The most EverythingHealth thing we can do is live in a healthy environment. No one says it better than author Michael Pollan. Please take the time to read his amazing article in the New York Times...Why Bother?
I've often wondered if "going green" is just a meaningless fad to make us feel more rightous. Michael Pollan addresses this issue and more. Check it out!

Saturday, April 19, 2008

Health Care - No criminals allowed


I just finished reading a fascinating and disturbing book called "Blind Eye" by James B. Stewart. It is the true story of a mass murderer, Dr. Michael Swango, who went from State to State and Country to Country, killing his patients with poison injections. Surprisingly, he finished his medical school and residency training the same years that I did and his ability to evade his professors, teachers, hospital administrators and police was shocking. Even as a skilled sociopathic killer, I was amazed that he would be arrested and suspended from practice and then be able to pick up and go to another hospital and get privileges to work in the hospital as a doctor.

These egregious crimes occurred in the 1980's before implementation of the National Practitioners Data Bank. The NPDB was put into law in 1986 to encourage state licensing boards, hospitals, professional societies and other health care entities to identify and discipline those who engage in unprofessional behavior and to restrict them from moving from State to State. Coupled with the Healthcare Integrity and Protection Data Bank (HIPDB), these two agencies are designed to protect the public from incompetent physicians, dentists, nurses and other practitioners.

Hospitals and state licensing boards and malpractice carriers and professional societies supply the information on the conduct of practitioners to the data bank. Hospitals are the only health care entities with mandatory requirements for querying the NPDB before they grant privileges to physicians. Governmental agencies and health plans may also access this information. It is not available to the general public.

These data repositories are just one small step toward ensuring safety for the public. I didn't appreciate them until I read "Blind Eye".

Thursday, April 17, 2008

Medicare new "No Pay" Conditions


Medicare/Medicaid covers about 45% of American health care through payment for the disabled and old folks. (I know, I know, "65 is the new 35", but you get Medicare anyway). The rules and payment strategies of Medicare are adopted by the entire industry, and what Medicare pays for and doesn't pay for, eventually is picked up by private insurers too.

Starting in 2008, Medicare has identified 7 conditions that they will not pay for if the patient gets them after they are admitted to a hospital. Some of them make good sense as a push for quality improvement and patient safety. These include blood incompatibility, objects left in after surgery and wrong site surgery. These events are 100% preventable. Others are difficult for even the best caregivers to prevent, like patient falls. Unless you tie a patient into bed (which will definitely affect your "customer satisfaction" scores), a wobbly person, somewhere, sometime, will fall.

Now Medicare has completely lost it with a list of additional "no-pay" errors. The new list, with my comments is below:
  • Delirium (this is ridiculous. There are so many causes for delirium that have nothing to do with the caregiver. Delirium is an altered state of consciousness that may require treatment, not sanction)
  • Surgical site infections following certain elective procedures (I'm OK with this one if they eliminate trauma, dirty wounds, or immune suppressed individuals, where infection may be unpreventable)
  • Legionnaires' disease (this can happen in an isolated case, with the origin of the bacterium being a mystery. If a hospital has an outbreak that affects many, the health department should investigate. One incidence may have nothing to do with hospital acquired infection)
  • Extreme blood sugar derangement (talk about vague. Too high? Too low?)
  • Ventilator-associated pneumonia (yes, preventable)
  • Deep vein thrombosis/pulmonary embolism (mostly preventable)
  • Staph infection in the bloodstream (I presume they are talking about MRSA. I do not think this is 100% preventable anywhere.)
  • Clostridium difficile infection (ridiculous. Anyone who is on antibiotics could get c.diff infection. Should we give up antibiotics in the hospital?)
  • Collapse of the lung from medical procedure (a small collapse of the lung is a known risk of placing central lines. These lines are placed in emergencies all the time to save lives in hospitals and the only way to prevent them is to transport the patient to a fluro Xray and do the procedure there. I would rather take the risk of a small lung collapse than die during delay and transport)
Medicare has a cost and financing problem. Refusing to pay caregivers for taking care of patients is a ridiculous and dangerous policy. These "no-pay" conditions need to be reevaluated pronto, using sound science and input from doctors and nurses that are on the ground day in an day out, caring for sick people.

Wednesday, April 16, 2008

Tuesday, April 15, 2008

Testosterone and Women's Sexuality


The Annals of Internal Medicine has published results of a randomized trial that studied the effects of testosterone on women's sexual satisfaction. Testosterone is the sex hormone that is present in both women and men. Men have much higher levels (of course) and there has always been speculation that testosterone and sexual desire/satisfaction are linked.

This study administered testosterone spray in three different doses vs. placebo. They surveyed the women on their sexual "well-being" on a weekly basis by self rating.

Guess what they found? Yes, testosterone did increase these women's libido and "sexually satisfying events". But placebo was just as effective.

Score another one for the placebo effect and the fact that the most important sexual organ may just be the mind.

Saturday, April 12, 2008

Myths dispelled - Hair


There are so many "old wives tales" and myths in health care, that each week EverythingHealth will pick a subject and give you a quick dose of truth. Today's topic is Hair. Everyone is interested in hair and that makes for lots of hair myths.

1. Split ends can be repaired: When the tips of hairs are damaged and fray, it is called a split end. Once split there is no product that can bond the ends together. Some products smooth the surface but the only way to end a split end is to cut it off.

2. Shampooing makes hair fall out: The hairs that clog the drain are part of the natural cycle of shedding. Some times more hairs fall out but scrubbing with shampoo does not cause it. The lifespan of a hair is 2-4 years and hairs are falling out and regenerating all the time.

3. Brushing is good for your hair. Do 100 strokes/day: The opposite is true. Vigorous brushing can tear and damage hairs and even pull hair out. In the old days when people didn't bathe regularly, brushing may have distributed scalp oils and dandruff and helped with lice control. For us, use the brush for styling only.

4. If you pluck grey hair, two will grow back in its place: As we get older the melanocyte cells that create colored pigment stop working. This is determined by our genes and some environmental factors like smoking and diet deficiencies. Pulling out grey hair doesn't affect the other hair follicles, but the passage of time does, so it may seem that more grey is occurring. Some people start greying in their 30's, others (Ronald Reagan ?) make it to old age without much grey. Go figure!

5. If you shave hair, it grows back darker and thicker: Cutting or shaving doesn't affect hair growth or texture. If it did, we could cure baldness with a razor. Hairs have a natural tapered end and when that is cut or shaved, the remaining shaft feels thicker and darker.

5. Shock can make hair turn white overnight: There are a number of reports of this happening (Marie Antoinette, Barbara Bush, Survivors of Titanic ) but there is no medical evidence that it can happen. Extreme stress can cause alopecia, where hairs at the end of their cycle fall out all at once. Hairs that are left may be the white hairs, giving the appearance of it happening suddenly (but certainly not overnight).

There you have it.

Friday, April 11, 2008

Medical Privacy - "just me being nosy"


UCLA is facing a bit of a crisis as it reveals that more than 60 patient's health records had been improperly accessed by an employee that had no right to view those confidential records. Most of these records were celebs (Brittney Spears, Tom Cruise, George Clooney, Farah Fawcett, Maria Shriver) or other high-profile people. The fired employee who snooped says "it was just me being nosy".

All hospitals and doctors follow HIPPA (Health Insurance Portability and Accountability Act) guidelines that should protect patients. They are allowed to share confidential health information only with other care givers that have a "need to know" for the benefit of patient care. But all the regulations and guidelines in the world cannot fully protect privacy. Access to records, whether paper or electronic, cannot be fully secured.

I don't know that more laws are the answer. The electronic health record does have the ability to block from view anyone who is not authorized to see a certain record. There is also a footprint left for every viewer. I think that will be our best way to protect patients privacy in the future.

Wednesday, April 9, 2008

Obesity and Baby Boomers - business opportunity


The obesity epidemic in America will create new business opportunities for the innovative businessman or woman if they can just project themselves into the future. The baby boomers are getting older and America is getting fatter. This is a recipe for someone to create new products and services.

The New York Times reports on new ambulance equipment that has been developed to accommodate large patients as they are transported. There are already supersize beds and operating equipment for bariatric surgery.

For some other opportunities one just needs to just look around. Airports are ripe for services. By 2020 millions of traveling aged boomers or obese travelers will need electronic carts to transport them over the blocks of walkways at the airport. Carry on luggage will need to be electric so it can be easily pushed and have features so one can stop, sit and rest on the luggage. Airplane seats will definitely need to be larger and there will need to be special storage for walkers and canes.

Hip prosthesis, cardiac implants and pacemakers will need to have special sensors so they don't trigger the security wands. Small traveler healthy snacks and juices should be packaged and sold for easy plane travel and to prevent hypoglycemia.

We can't do anything about the aging baby boomers...that is inevitable, but it isn't too late to address obesity. In any case, watch out for new products that make it easier for older, fatter people to get around in society. They will be coming on the market for sure.

Tuesday, April 8, 2008

Paroxetine vs. Placebo for depression


Depression is a serious condition and Paroxetine (Paxil®) has been in my toolbox as one of many treatment choices for over a decade. I've seen patients who are put on SSRI medications like Paroxetine have dramatic improvement in just a few weeks.

Now new evidence has emerged that shows placebo is as good as Paroxetine for treating depression and (of course), placebo has fewer side effects.

We all know that trials favorable to a product are more likely to be published. Investigators in Italy report a large study of 29 published and 11 unpublished randomized trials that included patients with moderate to severe depression. When they compared the patients who received placebo to Paroxetine, they found that it was not better in therapeutic effectiveness. The Paroxetine patients improved on some features but the placebo patients were less suicidal. More patients dropped out of the Paroxetine study because of side effects.

Damn, we physicians hate it when data proves us wrong, but if we are willing to change our practices when new information is presented, it benefits everyone. We do need, however, to be vigilant and review all the data before we make decisions. That includes this new study. I would certainly not take a patient off Paxil if they are doing well.

I think this shows us that placebo and mind-body connection are powerful instruments for healing.

Monday, April 7, 2008

Participate in Torture - Lose your License


The California Senate will be voting on a bill this week that says California regulators would notify physicians in the military that if they participate in torture, they will loose their license to practice medicine and could be prosecuted by the State.

During a Senate committee hearing, there was testimony that cited the International Red Cross, military records and first-person accounts about torture. These reports said physicians, psychologists and nurses licensed by the State of California have participated in torture or its coverup against detainees in U. S. custody.

Dr. Vito Imbascini, state surgeon of the California National Guard testified that "a few Californians were among practitioners in the healing arts involved in torture" at Abu Ghraib prison in Iraq and Guantanamo Bay, Cuba.

President Bush- with an emphatic "We do not torture" - has defended these interrogation practices as lawful.

I have written before on physicians and torture and there is no doubt that physicians are obliged by oath to refrain from participating in torture or maltreatment of prisoners. The State has jurisdiction over licensees serving in the military or practicing in federal facilities, and revocation of their license to practice medicine is warranted for doctors who participate.

Kudos to the California legislature for tackling a controversial issue that should really not even need to be addressed in an enlightened society.

Sunday, April 6, 2008

Medical Journal Update


Watch out for elevated triglycerides: Most patients (and physicians) are concerned about their cholesterol but triglycerides get over looked. An excellent study has shown that elevated levels of nonfasting triglycerides were associated with increased risk for death, heart attack and ischemic heart disease in both women and men. The other risks for heart disease and strokes are age, blood pressure, diabetes, smoking , family history in close relatives (mother, father, siblings) and LDL and HDL cholesterol levels. Triglycerides are lipoproteins from fats in the diet. Lower fat, lower triglyceride!
(Journal of the American Medical Association)

Self monitoring of blood glucose in patients with diabetes didn't improve control: This study was a surprise to most clinicians. In patients with type 2 diabetes, treated with pills rather than insulin, there was no benefit to self testing their blood glucose levels. Type 2 diabetes is one of the fastest growing conditions due to worldwide obesity. Traditionally patients are taught to do finger sticks and test their glucose levels with a glucometer. It is time consuming, painful and expensive. This study, which ran for 12 months, showed no benefit in glucose control for the patients who did self testing.
(British Medical Journal)

Oral medication to treat nail fungus is safe: Onchomycosis (nail fungus infections) is a very common condition and topical creams and potions are not effective treatments. Because these patients are not ill, doctors (including me) are reluctant to use oral medications that need to be taken for several months because of the risk of drug-drug interactions and liver injury. This study is reassuring and shows the risk of adverse events is low and patients with onchomycosis can be safely treated with oral medication to clear up the condition.
(
Am Journal of Medicine)

Sorry for the weird sized font on this blog...something wrong with the blogger program, I think. TB




Saturday, April 5, 2008

Universal Healthcare? Not without Primary Care


I've written about the primary care shortage before so I am happy to see the New York Times feature it today.

In Massachusetts they have mandated insurance coverage for everyone (Universal coverage) but the unintended consequence is that these newly insured people cannot find a doctor. There are not enough primary care doctors available and the ones that practice in clinics and offices are full. Taking on more patients just leaves less time for everyone and makes for harried, rushed medicine.

The article is a must read but here are some highlights for you ADD readers.
  • With the aging population, we will need 40% more primary care doctors by 2020
  • Presidential candidates on both sides have stressed the importance of primary care but...
  • There are no plans to overhaul an unfair payment system that undervalues primary care
  • The majority of general practitioners are aging and planning retirement over the next decade
  • President Bush has proposed eliminating $48 million in federal support for primary care training programs
  • New doctors training in primary care have dropped by more than half over the past decade
  • Of those small numbers in training, even fewer (1/16 at Tufts, 4/28 at U Mass) actually plan to practice primary care
Why is this happening? I leave you with an article quote from a busy, successful Family Practice doctor in the medical mecca of Boston. I can assure you, this quote could be duplicated thousands of times across the United States:

"Dr. Atkinson, 45, said she paid herself a salary of $110,000 last year. Her insurance reimbursements often do not cover her costs, she said.

“I calculated that every time I have a Medicare patient it’s like handing them a $20 bill when they leave,” she said. “I never went into medicine to get rich, but I never expected to feel as disrespected as I feel. Where is the incentive for a practice like ours?”"

Step it Up


I just read about an intriguing small study done in Sweden that worked "backwards" and showed that reduced exercise promoted chronic disorders and premature mortality.

They took healthy non smoker men who took no medication and without any family history of diabetes. These people walked over 3500 steps a day (measured with a pedometer) or did more than 2 hours of exercise a week. In summary, active, healthy people (just like you?).

The study had the subjects reduce their daily steps. They had them ride in elevators instead of stairs and ride in cars instead of walk or bike. They reduced their daily steps to 1500 but they kept their diets the same. That's all they did!

Within three weeks the subjects developed impaired glucose tolerance, increased triglyceride levels and 7% increase in intra abdominal (waist) fat.

Think about it folks...by working backward they created serious health risk problems in healthy guys by making them sedentary. It reminds me of the great documentary film "Supersize Me" where he developed severe health problems and obesity by eating nothing but burgers, frys and soft drinks for a month. Our bodies are perfect machines that need exercise and activity. Lay around and the machine fails.

Take home message - Start walking and prolong your life.

Friday, April 4, 2008

Mickey the Wonder Border Collie


Mickey was a rescue dog that we brought into our lives over 14 years ago. Herding was in his DNA and herd he did. Because we never had a flock of sheep, he had to find his own jobs to do. Making sure his flock (us) was safe and rounded up became his passion.

They say Border Collies are the smartest breed of dogs. I believe that. Mickey could open doors, climb trees and understand moods and gestures better than most humans. When young, he was the fastest dog at "dog park" and watching him glide at top speed, herding the other dogs was a joy to behold.

Mickey had more friends than I do. A walk downtown would have strangers saying "Hi, Mickey" and I would wonder about his life and how he knew so many people.

Mickey passed on this week and we are sad, but his spirit and good will remains. All we can do is be good guardians to our pets while they bless us with their love.

Thursday, April 3, 2008

Food Tees


I'm too busy to surf the web...in case you are too, here is a neat idea that is fun and promotes healthy eating. They have a lot of cute items at this site. I guess this is my contribution to free advertising (my blog) , capitalism and the American Way. When the going gets tough, we Americans go shopping. Check it out: Food Tees

Wednesday, April 2, 2008

Nurses as Doctors


The Wall Street Journal wrote today that more than 200 nursing schools will launch a doctorate of nursing program so "Nurse-doctors" will graduate with the "skills equivalent to primary-care physicians."

Whoa there, Kimosabe. By whose standards is a two year program that includes a one-year residency, equivalent to the rigors of four years of medical school followed by three -plus years of internship and residency? How is a voluntary (yes, voluntary) certification exam the same as the multiple and ongoing certification exams that physicians are subject to?

We already have advanced nurse practitioners who work under the supervision of physicians and are able to write prescriptions and practice within specific guidelines. They are valued members of treatment teams and serve a vital role in health care. So what is the purpose of allowing a nurse to use "Doctor" before his/her name? We already have PhD in Nursing along with EdD and DNSc degrees that cover nurse educators and researchers. Believe me, just putting "Doctor" before your name does not qualify you to diagnose or treat anything.

It is clear the goal is to allow nurses to bill independently for Medicare and insurance services without needing to go to the trouble, time and expense of medical school. According the to article, these Nurse-doctors will handle complex diagnosis, treatment and management of patients in hospitals, emergency departments and medical offices. All this from nursing school. Hmmmmmm!

There is no doubt we are facing a primary care shortage in this country that will reach crisis proportions. We have devalued primary care to the extent that we will now put it in the hands of nursing...call them doctors (without medical school training), pay them lousy primary care rates and get what we pay for. There is no doubt that referrals to specialists will increase and care will become increasingly more fragmented and expensive overall.

As a last aside, I truly value and work well with both Advanced Nurse Practitioners and Physician Assistants. Some of them have amazing skills but they don't have my training and they don't do what I do.

(Hat tip to J.S. for alerting me to the article in WSJ)

Carnival HR

Check out Fortify your Oasis for great reading links in the Human Resources field. They mentioned EverythingHealth this week and it will give you another glimpse into the blogosphere.

Tuesday, April 1, 2008

Obesity - the last discrimination


The journal Cancer has published a review that found obese, white women are less likely than other women to undergo regular screenings for breast and cervical cancer. Obese women were 10-40% less likely to undergo these screening tests when compared to other women.

We can only speculate why this is so. One theory is that heavier women have emotional barriers such as embarrassment and fear of being weighed. There might also be fat bias from physicians. It is difficult to perform good pap tests on larger women and some Doctors, like others in society, may see obesity as a sign of someone who just doesn't care for their own health.

Obesity and lower economic status also go hand in hand. Perhaps these women are uninsured and have minimal access to screening programs.

Lets be honest, there is definite "fat" discrimination in our society. Despite the fact that obesity is an ever growing problem, it is still seen as a moral or laziness issue. Fat people can be discriminated against by restaurants (less desirable seating) , jobs (you'll never prove it), merchants (that disdainful look from the clerk) and even health workers (gowns that don't fit, scales that don't weigh enough, chairs that are too tiny, tables that are too narrow, screening tests that don't get done).

Obesity may be the last permissible discrimination in our society.