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Let's Face It: Medicine is Business

Category: Doctors

As the World Turns, So Are the Days of a Medical Transcriptionist

I found this candid piece by a medical transcriptionist hilarious, even though some of the mistakes made by either the doctor or the transcriptionist shouldn’t be funny at all. I always wondered why doctors carried around a microrecorder and mutter to themselves in the hallway or at their desks. “Wouldn’t it be easier to learn short hand and write those notes so you don’t need to write it up again?” I wondered. Now I know that they save themselves that time by outsourcing that task to medical transcriptionists.

Can Doctors Practice Preventive Medicine and Still Make a Living?

The mission of MDVIP is to change primary care practice in America by allowing their member doctors to practice medicine the way that MDVIP believes that medicine should be practiced: by focusing on prevention and empowering patients. According to a press release from the company in a landmark deal with Procter & Gamble, its business model is based on “exceptional doctors, exceptional care, and exceptional results.” (more…)

Antibiotic Stripped of 2 of 3 Approved Indications

This week, the U.S. Food and Drug Administration (FDA) removed 2 of 3 approved indications for the semi-synthetic macrolide antibiotic telithromycin (Ketek, manufactured by sanofi-aventis).

Ketek loses its indication for (1) acute bacterial sinusitis and (2) acute bacterial exacerbations of chronic bronchitis, often abbreviated as “ABECB”. Ketek remains approved for community acquired pneumonia of mild to moderate severity that is acquired outside of hospitals or long-term care facilities. (more…)

Making Businessmen of Doctors and Scientists

Some special interest groups are very critical of financial conflicts of interests between businesses (namely, pharmaceutical industry) and doctors and scientists. I’ve seen and worked on both sides. I think it’s very important to educate doctors and scientists on all aspects of medicine – the scientific, business, and sociopolitical aspects.

Don’t like the purported influence that drug companies have on doctors’ prescribing habits? Then teach doctors how drug companies market their products. Give doctors the tools and knowledge to ask meaningful questions to drug companies so that drug companies can do a better job at marketing in a fair balanced manner. (more…)

Truth in Medical Marketing and CMEs

Recently newsgroup user jkellymdmph asked a question that I had brought up when Google Co-op Health first launched:

How can this group health effort can resist infiltration by aggressive marketing?

jkellymdmph goes on to describe a continuing medical education (CME) event he attended that was supported with an unrestricted grant from a pharmaceutical company. There are two important notes in this story:

1) He thought the CME was very good, and “didn’t notice” that the supporter was a pharma company

2) … until the speaker began to tout the company’s drugs as “the best” (more…)

How Future Doctors Choose Their Specialties

Drs. Paul Ciechanowski and colleagues found that 129 fourth year medical students from Univeristy of Arkansas for Medical Sciences who choose to enter primary care specialties are attracted to a patient centered environment that affords a “secure” relating style. Those who choose to enter non-primary care specialties are attracted to career rewards that afford a “self-reliant” relating style. This study assessed how much the med students’ specialty choices were based on students’ own experiences with caregivers and learned ways of interacting with others (”relationship styles based on attachment theory”).

Choosing a medical specialty specialty is an important decision for medical students because students who change course after making a decision may not receive training funding. Additionally, career choice also predicates the type of work environment that the physician engages in. Fourth year medical students were an appropriate group to study because these students have had significant clinical experiences in medical school and the time to carefully consider their options. (more…)

Why We Like the Doctors We Like

I’ve visited with many doctors in the past – primary care docs and specialists, both as a patient and years ago as a professional. I’ve come to really appreciate the importance of bedside manners and compassion in medicine.

Because of some of the behaviors I have seen from doctors when I worked in the pharmaceutical industry, it’s made me highly distrustful of physicians. So in writing this, I already have had bad experiences that had made me biased against how some doctors “practice medicine.”

As a patient, I’ve met doctors who have been dismissive or judgmental, and who came across as barely caring about my wellbeing as a patient because I was just another body shuffling through the office in a highly managed care environment.

For example, a primary care doctor my husband and I went to had given us both annual physical exams and never bothered to call us about the blood test results. His office staff said that we would only get a call if something was “wrong.” I found this ridiculous especially when the doctor had made my husband take a 2 hour glucose tolerance test for his blood sugar levels. The doctor also made recommendations that ran counter to a world-class endocrinologist even when we told the doctor about family risk factors, etc.

This was a young doctor, and maybe that’s where his arrogance came from. (more…)

Normal Childhood Growth

By Robert Lamberts, M.D.

The majority of pediatric medicine is done hoping that nothing happens. We see children on a regular basis as they grow up and really are only there to pick up things that are out of the norm. If all goes well, we are superfluous – the child would have done just as well if we had not been there. I sometimes tell patients that they want to be “boring” patients – if they are “interesting” to me, then there is something to worry about. What I offer my patients is a trained eye that looks at various aspects of growth and development and looks for anything that falls outside of the norm. The earlier we can pick this up the better the chance of successful intervention. The purpose of the next few articles is to discuss the various aspects of growth and development we watch through the childhood years.

As a pediatrician my task is done when a child grows from infant size to adult size. That doesn’t seem hard! Well, we make it more complicated than it sounds. You may have noted that we seem to be obsessed with graphing things, spending part of every well child visit looking at growth curves. The important growth parameters we follow are:

  • Length
  • Weight
  • Head Circumference

When I see a child for the well-child visits, I put these measurements on a standard “growth curve.” A growth curve is a set of standard heights and weights at every age. The child is plotted in these three categories against “normal” children at the same age. I will then inform the parents that their child (“Little Bubba” in these parts) is in the “90th percentile” (or something like that). This is no better or worse than if the child were in the 50th or 5th percentile. We look far more at the rate of growth (or “growth velocity) than we do the size of the child at any given time. I worry less about a child that stays in the 5th percentile throughout the first year of life than I do a child that starts in the 90th percentile at 2 months and is down to the 25th percentile at 6 months. The latter child is growing at a much slower rate than the former. Likewise, if a child’s head size is going up rapidly, we may suspect hydrocephalus (a build up of fluid on the brain). If Hydrocephalus is discovered early it can be easily treated, but if it is missed, the consequence can be devastating. (more…)

Suicide and SSRI When Medical Legal Risk is High

By Robert Lamberts, M.D.

I had a tough situation in the office yesterday.

One of my patients is a 17-year old who went to the ER on Sunday for shortness of breath. They said she had a panic attack and should follow-up with me as soon as possible.

When I saw her, she was clearly distressed, but not to the point of needing to be hospitalized. I asked her what was up and she told me that she had been kicked out of school recently because she stabbed someone with a knife – apparently only after that person grabbed her forcibly. She lives with her mother and her father is a homeless alcoholic. Her mother tells her not to talk to him, but he calls regularly and tells her that she is all he has. He also says that he might kill himself. She knows that he shouldn’t say this kind of thing to her, but it puts her in a hard situation. On one hand, she knows that it tears her apart to talk with him. On the other hand, she fears that if she does not talk to him, he will kill himself.

I asked her if she ever thought of killing herself, and she said she had – especially after talking to her father – but was not at this time suicidal. She had a real good friend with her who was very supportive.

So I am stuck in a dilemma. On one hand, she is clearly depressed and needs both medication and psychological counseling. On the other hand, since there is a black-box warning for using SSRI’s in teens, putting her on one would put me at huge risk for a lawsuit should she follow-through and kill herself. I think she is at very high risk of doing that in the long-run, and don’t really have a longstanding relationship with her as her doctor. I did what I could to tell her to talk with either her friend or me if she should feel she is close to killing herself, but I don’t really know her that well. I am trying to reach one of the local child psychiatrists, but most of them are several months out for new patient visits. (more…)

Media Hyping and Premature Promises Do Not Help

Recently, journalists picked up on a poster session on the effect of ginger on ovarian cancer cells at the 97th American Association for Cancer Research Annual Meeting (AACR) in Washington, DC (April 1-5, 2006). Forbes called it, “Ginger an Ovarian Cancer Killer.” The poster authors’ school, University of Michigan also sent out a press release subtitled, “Cell studies show promise for ginger as potential ovarian cancer treatment.”

This illustrates my concern of how a piece of scientific “evidence” is so preliminary, yet generates a level of sensation that is far from warranted.

I also object to U. of Michigan’s use of the word “promise” in the press release. I’d have preferred the entire subtitle replaced with the disclaimer, “Study done in petri dish – not even animals or human – please do not gorge on ginger.”

A definition of “promise” speaks to expectation of something that is likely to happen. This study is too early to speak of any promises. (more…)

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