FPMD

Want Viagra? Ohio lawmaker wants men to get second opinion

Thu, 08 Mar 2012 21:30:44 -0500

Want Viagra? Ohio lawmaker wants men to get second opinion

September is Prostate Cancer Awareness month. About 1 out of...

Thu, 01 Sep 2011 00:00:06 -0400

September is Prostate Cancer Awareness month. About 1 out of every 6 men will be diagnosed with prostate cancer in his lifetime, and it’s the second leading cause of cancer deaths in men (behind lung cancer). Get checked! [Image from Mike Rodriguez Designs]

This isn't a question, but the only way I could figure out how to contact you. I just published and article from my queue that is a good follow on about your statins/ diabetes post as it discussed the problems with people's perceptions and the way statistics are presented:

http://allisondroberts.tumblr.com/post/4224487258/poorly-presented-risk-statistics-could-misinform-health

I thought you might be interested.

Sat, 02 Apr 2011 20:24:53 -0400

Very nice!

Small increase in risk of diabetes with statins, but .....

Wed, 30 Mar 2011 07:26:00 -0400

Small increase in risk of diabetes with statins, but .....:

Mark Twain used to speak of the three types of lies: lies, damned lies, and statistics. Mr. Twain, I’ve got another example for you.

In an article in yesterday’s Journal of the American College of Cardiology, there was a reported association between the cholesterol medication Lipitor and diabetes. But if you look at the data, it would take 255 patients on Lipitor for four years to produce one extra case of diabetes. It shows what we commonly see: a statistically significant but clinically irrelevant link.

There is an epidemic of diabetes in this country, and one extra case per 1000 patient years use of Lipitor may not be that important. Considering that heart disease is the number one killer of all Americans, the benefits of the statin (Lipitor) most likely outweighs the risk.

Damned statistics.

The 10 Types of Physican Bloggers

Sat, 26 Mar 2011 19:10:17 -0400

ziyadmd:

Physicians, and medical students for that matter tend to fall into 10 different categories — which type are you?

Broken Circles: Doctors Orders.

Sat, 26 Mar 2011 19:06:15 -0400

Broken Circles: Doctors Orders.:

He sounds like a real jerk; sorry you had that experience.

so-brokeh:

I woke up feeling like mad shit this morning.

It appears that my condition had worsened since last night. So, I end up going to walk-in clinic to see what the hell was up. I wait about 10 minutes before the doctor calls me into his office. I tell him what’s wrong:

I was coughing up phlegm, had a…

FDA approves Zostavax vaccine to prevent shingles in individuals 50 to 59 years of age

Fri, 25 Mar 2011 07:03:11 -0400

FDA approves Zostavax vaccine to prevent shingles in individuals 50 to 59 years of age

A Smarter Planet: Use of $4 generic drug programs could save society billions of dollars, study shows

Tue, 15 Mar 2011 22:29:24 -0400

A Smarter Planet: Use of $4 generic drug programs could save society billions of dollars, study shows :

smarterplanet:

“If all eligible patients filled their prescriptions through a $4 generic drug program, the societal savings could amount to nearly $6 billion, according to a University of Pittsburgh Graduate School of Public Health (GSPH) study. Published in the March 14 issue of Archives of Internal Medicine,…

American Red Cross: #Japan Earthquake and Pacific #Tsunami. Donate via Amazon.com

Sun, 13 Mar 2011 00:00:08 -0500

American Red Cross: #Japan Earthquake and Pacific #Tsunami. Donate via Amazon.com

"The continued successful evolution of family practice as a foundation of primary care in the United..."

Sat, 12 Mar 2011 17:22:36 -0500

““The continued successful evolution of family practice as a foundation of primary care in the United States is essential to extend the highest possible quality of care to the entire population at a cost that can be afforded in a society with limited resources for health care.””

- (Geyman. NEJM 298:593-601, 1978)

Seen in St. Augustine

Fri, 11 Mar 2011 21:37:02 -0500

Seen in St. Augustine

Dr. Oz and the hCG diet: Why do TV docs just go for ratings?

Fri, 11 Mar 2011 08:47:30 -0500

I try not to watch Dr. Oz. Or The Doctors. Or House Calls with Dr. Gupta. Or any of those doctor shows. Why, you ask?

It’s because they turn me into a maniacal lunatic, yelling at the TV.

“That’s not right!” I exclaim.

“You’re wrong!” I shout.

“You’re missing the point!” I anouce.

I heard Lawrence O’Donnell the other day say that a good way to keep your mind sharp is to read the opinions of those your disagree with. While I think he is correct, I just can’t do it with these guys. My mind is mush after a prolonged exposure.

My problem is that these guys go for the exciting, the glamorous, and the controversial. (I guess that’s what makes any form of media exciting: they don’t announce on the news the 10,000 planes that landed safely today. Too boring.) But as a nation facing a healthcare crisis, we need less glamor and more reason. I’d love to hear Dr. Oz do an hour not on some fad diet, but rather on how to keep your diabetes controlled.

To be fair, he has done a few shows like that. What I’m looking for is the bread and butter diabetes stuff, not silly topics like how many apples a day to eat. Let’s spend a great deal of time on talking about the ABC’s of diabetes. And maybe more to the point: let’s do A LOT of these shows.

Skip the shows on poop, plastic surgery, pajama parties. Please, before my head explodes!

Somewhere over Georgia.

Tue, 08 Mar 2011 00:00:07 -0500

Somewhere over Georgia.

Grits!

Sat, 05 Mar 2011 14:18:32 -0500

Grits!

Defensive medicine costs A LOT

Thu, 03 Mar 2011 08:16:00 -0500

Now here’s an interesting article that pretty much confirms what we all know: physicians order tests to protect themselves. In a survey done of Pennsylvania orthopedic surgeons, nearly 93% reported that they practice defensive medicine.

NINETY THREE PERCENT.

The authors define defensive medicine as “a deviation from sound medical practice that is induced primarily by a threat of liability.” Of those that practice defensive medicine, almost half (43%) ordered imaging in clinically unnecessary circumstance. Imaging includes x-rays and MRI’s. At roughly $2,000 per MRI and 41.8 ambulatory MRI’s per 1000 people (according to the Organisation for Economic Co-operation and Development — OECD), the cost of unnecessary exams quickly adds up.

So what’s the solution?

Well, I think it goes much beyond the knee-jerk response that most of us physicians give, which is “Tort Reform!” — don’t get me wrong, I think that’s needed. But we need to change culture. Patients have this expectation that testing will be done — I call it the ‘CSI effect’ — to accurately diagnose their condition. And physicians have a mindset that ordering tests is the pathway to diagnosis. Layer in the complex fee-for-service arrangements that benefit many physicians, and all of a sudden this problem of unnecessary testing become much more complex.

We need a top down response to this. We need to change attitudes toward medicine and testing, to refocus our expectation for care. Informed consent is the process of telling a patient the risk of a procedure (test), the benefits, the side effects, and risk of no procedure (or test). By helping to educate a patient about the need (or lack of need) for a test, it will go a long way toward reducing unneeded tests.

As physicians, we also need to keep the end game in mind. I have seen cardiologists order an echocardiogram after the patient has an abnormal stress test. Why? The patient is going to have a heart catheterization, so what value does the echo add? Nothing. Was it done for defensive medicine? Or for fee-for-service?

Defensive medicine is a problem. But the solution is much more complex.

Sun, 27 Feb 2011 08:47:37 -0500

Study Knocks Diagnostic Value of PSA Velocity

Thu, 24 Feb 2011 17:29:31 -0500

Study Knocks Diagnostic Value of PSA Velocity:

Might not be so good after all in helping to determine who needs a biopsy and who doesn’t — back to the drawing board.

Thanks for the follow! It means a lot. :)
I have a question for you:
Why did you choose primary care, as opposed to other paths?

Wed, 23 Feb 2011 10:49:38 -0500

My answer to that question has evolved over the years. Initially, my response was along the lines of “I like science and I like people, and family medicine gives me both”. As a medical student (and resident) I realized that I enjoyed everything I did, but nothing so much so that I could do just that for the rest of my life.

But as I’ve been in practice for a while and I love my job. I realize that it fits my personality:

I like working on a schedule.
I enjoy learning about a wide range of diseases.
I like being the patient’s first contact, their “go-to” guy.
I like managing many complex processes and diseases.
I like taking care of men, women, and children, and I love knowing their families.

After all this, I’ve realized that I didn’t choose family medicine: family medicine chose me.

I'm listed in Tumblweeds under healthcare, medicine

Wed, 23 Feb 2011 01:35:57 -0500

I’m listed in Tumblweeds, a user-generated community directory that rates Tumblr bloggers by their number of followers. Find me listed in #healthcare, #medicine

"Am I going to die, doc?"

Tue, 22 Feb 2011 10:00:07 -0500

That was the question my first patient asked me today. For confidentiality reasons I’ll leave some of the detail out of it, but essentially she’s suffering from a recurrence of her cancer, which is now metastatic (spread to other parts of her body). She was admitted to the hospital, and radiation therapy was recommended.

She said ‘No’.

So here she is today, frightened that she made the wrong decision. It’s not like she didn’t think about it. She did. And she has a great family to support her and discussed it at length with them. She weighed the pros and cons of treatment. But at the end of the day, she’s tired. She’s ready to just move on.

We sat there and talked about her decision: what happens if she changes her mind and gets treatment — what will her quality of life be? Will there be pain? How bad will the fatigue be? We balanced that out by looking at what her life will be like if she stays her current course of no treatment. And that’s where I gave her a different view on things. She’s not chosen a course of no treatment; she’s just chosen a course of no cancer treatment. We are still going to treat her pain. And nausea. And so on and so forth. There is no amount of pain medication that’s “too much” when we are treating cancer: the concept of addiction just doesn’t apply here. I offered to start the process myself, which she preferred over starting hospice.

All of a sudden she got it. It made sense. She wasn’t giving up. She was just going to go down a different road. I could see it on her face, something I hadn’t seen in her in a while: relief. She was relieved she had made the right choice. She was relieved her pain and suffering will be battled head on. She was relieved that she wasn’t going to be alone while she made the final journey of her life.

I never directly answered her question. And that’s OK. We answered much bigger, more important ones. With tears in her eyes as she squeezed me around the neck in a big hug, she mouthed the words “Thank You.”

FPMD

Want Viagra? Ohio lawmaker wants men to get second opinion

September is Prostate Cancer Awareness month. About 1 out of...

Small increase in risk of diabetes with statins, but .....

The 10 Types of Physican Bloggers

Broken Circles: Doctors Orders.

FDA approves Zostavax vaccine to prevent shingles in individuals 50 to 59 years of age

A Smarter Planet: Use of $4 generic drug programs could save society billions of dollars, study shows

American Red Cross: #Japan Earthquake and Pacific #Tsunami. Donate via Amazon.com

"The continued successful evolution of family practice as a foundation of primary care in the United..."

Seen in St. Augustine

Dr. Oz and the hCG diet: Why do TV docs just go for ratings?

Somewhere over Georgia.

Grits!

Defensive medicine costs A LOT

Study Knocks Diagnostic Value of PSA Velocity

Thanks for the follow! It means a lot. :) I have a question for you: Why did you choose primary care, as opposed to other paths?

I'm listed in Tumblweeds under healthcare, medicine

"Am I going to die, doc?"

Thanks for the follow! It means a lot. :)
I have a question for you:
Why did you choose primary care, as opposed to other paths?