American College of Physicians: Internal Medicine — Doctors for Adults ®

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Wednesday, December 23, 2009

ACP Internist will return in January

ACP Internist will be back with more Medical News of the Obvious, QD: News Every Day and the rest of our regular coverage in January. Enjoy your holiday season.
Snowman Neighbor by MGShelton via Flickr

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QD: News Every Day--reform on the cusp of Senate passage

ACP Internist's final news round-up before the holiday break finds the Senate on the cusp of voting for a health care reform measure that's getting a mixed reaction from the public. Something has to be done to alleviate the primary care shortage.

QD: News Every Day will resume coverage Jan. 4.

Health care reform
The Senate is on the cusp of passing its version of health care reform, but more people oppose the measure overall, a national poll found. But, there's been more support for the public option, which was dropped, and for allowing younger Americans to buy into Medicare. And, both chambers of Congress will have to reconcile their differences when the Senate completes its version. As a sign of how difficult that could be, Alabama Rep. Parker Griffith, a radiation oncologist, switched his party allegiance to Republican as a result of health care reform. (Detroit Free Press, Politico)

White House photos by Pete SouzaH1N1 influenza
The First Family is now vaccinated. The first dog has come down with H1N1 flu. (Not Bo, the First Dog, but a canine in suburban New York. (USE Today, AP)

Primary care shortage
Olympia, Wash. has a physician shortage, but it just got a little better. Two family medical practices opened on the town's underserved west side. (The Olympian)

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Tuesday, December 22, 2009

QD: News Every Day--Senate vote set

ACP Internist's daily digest of news and events continues with an update on health care reform legislation and H1N1 vaccination.

Health care reform
The Senate moved another step closer to a vote on the health care reform bill, voting today on several procedural issues. A final vote on the bill has been set for 8 a.m. on Christmas Eve. (Washington Post, Politico)

H1N1
Two recent surveys indicate that 60 million Americans have been vaccinated against H1N1 influenza, the CDC said Tuesday. A substantial percentage of respondents, however, reported not wanting the vaccine for themselves or their children, most commonly because of safety concerns. (MSNBC.com)

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Monday, December 21, 2009

QD: News Every Day--let it snow, let it snow ... awww forget it

ACP Internist's daily digest of news and events continues with health care reform's progress.

Health care reform
The East Coast's blizzard shut down passage of everything but health reform, which kept moving forward by a filibuster-proof majority in the Senate. Four more procedural maneuvers could set up a Christmas Eve vote. But the coalition is fragile, and the abortion language will leave women writing two checks to their insurers--one for abortion coverage and another for everything else. (New York Times, Politico, Wall Street Journal)

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Medical news of the obvious

Political extremists are more willing to share their views, if they feel like more people share them. Keep that in mind when Uncle Bob blathers his politics at your holiday dinner.

Nadya's room ... by Nadya peek via FlickrWomen aren't put off of IT careers because they're hard, but rather, because IT folks are a bunch of Trekkie slobs. Researchers surveyed hundreds of non-IT students at Washington University but in different rooms: one decorated with a sci-fi poster, games kit and soda cans and the other with pleasing wall graphics, books and coffee cups. Women were much more likely to opt for careers in the more pleasant environs, the men were as well but less so.

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Friday, December 18, 2009

QD: News Every Day--health reform, H1N1 and patient safety

ACP Internist's daily digest of news and events continues.

Health care reform
Senate Majority Leader Harry Reid (D-Nev.) is still hoping to pass a health care reform bill before Christmas, but negotiations and roadblocks continue as the weekend approaches. Republicans are attempting to stall a vote with procedural tactics, while abortion funding remains a sticking point for at least one key Democrat. And the White House is facing criticism from liberals, including former Democratic National Committee chairman Howard Dean, that the current revised bill doesn't go far enough. The Senate must wrap up debate by Saturday, sources say, if Reid is to meet his self-imposed Christmas deadline. (The Hill, Washington Post, New York Times)

H1N1
The shortage of H1N1 vaccine in the U.S. has lessened, the Department of Health and Human Services announced yesterday. Officials are now urging vaccination for all groups, not just those at high risk. (Wall Street Journal)

In case you missed it...
The New York Times recently interviewed Robert Wachter, FACP, about the patient safety movement 10 years after the Institute of Medicine's report "To Err Is Human." Read the Q&A here.

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Santa's reindeer quarantined over Lyme disease fears

North Pole reindeer have been quarantined following the discovery of ticks carrying Lyme diseases, bringing into question their availability on Dec. 24 and the possibility of causing a global Lyme disease pandemic should they cross international borders.

Photo illustration by Ryan DuBosar
















Elves first found reindeer ticks on Rudolph, which they reported to Santa. Responses to the question, "Who will guide my sleigh?" were greeted mostly by much tugging on beards and shuffling of pointy slippers.

"Normally, culling the herd is the best response," said one epidemiologist specializing in animal-human disease vectors, who declined to be named due to fears of being labeled a Grinch. "But I don't want to be the one to have to explain that my kids."

The issue has created considerable response, though, for fears of widespread Lyme disease infection. The North American Aerospace Defense Command (NORAD) is now tracking Santa's sleigh and mulling possible responses.

"We'll track Santa," NORAD's commander emphasized. "But I have no authorization from the President to engage him under any circumstances. Besides, how would he explain that to Congress?"

Global pandemic experts remain concerned, however. "What if reindeer ticks can fly, too," asked one epidemiologist at the Centers for Disease Control and Prevention, who declined to be named for fear of nothing in his stocking this year. "Frankly, I don't want to be the one to have to explain that. I can't explain that."

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Thursday, December 17, 2009

QD: News Every Day--mistletoe and miscellanea

ACP Internist's daily digest of news and events continues with delays in the Senate, progress for hospital medicine and mistletoe's evidence-based medical uses.

Health care reform
Senators may find lumps of coal in their stockings if they miss their self-imposed Christmas deadline to pass a reform measure. With the 60-vote coalition so fragile, any diva can hold up the works to wring the most out of the process. Following grandstanding by Senators Joseph Lieberman and Bernard Saunders, it's now Sen. Ben Nelson's turn to wring some provisions out of the Senate. He wants tougher abortion language. Sen. Max Baucus has said his party would work on Christmas day to reach the deadline.(Washington Post, Los Angeles Times, The Hill)

Health reform is needed. A Centers for Disease Control and Prevention survey showed that 45.4 million (15.1%) were uninsured at the time of survey, 58.4 million (19.4%) had been uninsured for at least part of the year prior to interview, and 31.9 million (10.6%) had been uninsured for more than a year.

Physician reimbursement
A Senate amendment By Sen. Arlen Specter would postpone for one year an increase in payments for primary care physicians. The American Academy of Family Physicians is moving to raise opposition.

Świąteczna jemioła by Dorocia via FlickrIn case you missed it ...
Mistletoe has an evidence-based background. It's not as poisonous as feared, and it's being examined for uses in cancer treatment. The good folks at ChiroACCESS digested the peer review literature on this decorative holiday staple.

Hospital medicine
In Wilmar, Minn., hospitalist Fred Hund, ACP Member, is featured at part of Rice Memorial Hospital's plan increase the number of primary and specialty care doctors. They'll work with local practices to increase primary care, specialty and hospital positions in the community. (West Central Tribune)

ACP members in Amarillo, Texas, are rolling out a hospitalist model to their community to ease the physician shortage there. Hospitalist Sheryl Williams, FACP, and Alan Keister, ACP Member, of Amarillo Medical Specialists, say doctors spend too much shuttling between facilities, and not having hospitalists has hindered recruitment that would ease the shortage. They've e-mailed patients to explain the changes. (NewsWest9.com)

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Wednesday, December 16, 2009

QD: News Every Day--an end in sight?

ACP Internist's daily digest of news and events continues.

Health care reform
The Washington Post reports that "final negotiations" are under way to secure the necessary support for the Senate's health care reform bill, although Senate Republicans are said to be hoping to delay a pre-Christmas vote.

The House voted today to delay a scheduled 21% cut in Medicare payments to physicians until March 2010. The measure was part of a fiscal 2010 defense appropriations bill that passed with a vote of 395-34. A Senate vote on the bill is expected by Friday.

According to CDC data released today, almost 20% of the U.S. population has been uninsured at some point since January 2008. (Washington Post, Politico, Modern Healthcare.com, Reuters via ABC News)

In case you missed it...
A state commission has recommended a familiar fix to Alaska's primary care shortage: more money. (Anchorage Daily News)

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Another argument against the PSA

In addition to the possibility of futile treatment, men who are diagnosed with prostate cancer may risk dying from the stress of the diagnosis, according to a new analysis of suicides and cardiovascular events after a prostate cancer diagnosis.

The PLoS Medicine study included 168,000 men and found that they were 8x more likely to commit suicide in the week after diagnosis, and 2.8x more likely than usual to have a cardiovascular event in the week after diagnosis.

The study participants were all Swedes, but before you conclude that those Scandinavians are a dark, suicidal bunch, check out these stats. Swedish women are twice as likely to kill themselves as American women, but rates are pretty similar between men in the two countries.

We can only hope that maybe American docs are better at breaking the bad news gently. That's one of the big lessons of the study, PLoS editors said: in addition to affecting whether PSAs are done, the study should motivate better clinical and psychological monitoring of these patients after diagnosis.

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Tuesday, December 15, 2009

Should I call you doctor, doctor?

I used to live in a small town in Colorado where everyone called the local physician Dr. PJ. He was a hippie who marched in parades throwing out condoms, but even more formal doctors sometimes find themselves addressed by their first names, according to a column in today's New York Times.

The author seems a little distressed by this informality. "I wonder about these people. Are they trying to be chummy? Is it a power thing, making them feel less vulnerable while they sit half naked on the exam table?" It seems to me like a natural outgrowth of an increasingly informal society. Why should doctors be the only people addressed by titles?

Yet still, I conform to the practice. I always address my emails to Dr. So-and-so but sign them with my first name. Some docs write back with their first names but I rarely use them. Recently, though, I requested an interview from a doctor who I had spoken to many times before and decided to go for it and use his first name. He turned me down. Coincidence?

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QD: News Every Day--amid health care debate, fewer free screens

ACP Internist's daily digest of news and events continues with the Senate dropping an expansion of Medicare, and a few diagnostic mysteries to solve.

Health care reform
The Senate will scrap allowing those 55-64 to buy into Medicare in order to preserve a filibuster-proof majority. The decision followed what was called a tense, 90-minute meeting. If the Senate bill passes, it must be reconciled with the House legislation, which does contain a public option. Most of the finger-pointing is at Sen. Joe Lieberman, who spent the weekend explaining his opposition (free subscription required) and now stands accused of working on behalf of his key constituents--insurance companies. (Washington Post, New York Times, Wall Street Journal, Modern Healthcare, Christian Science Monitor)

While Congress debates reform, free screenings for breast cancer are facing shortfalls and programs are turning away women as unemployment and budget shortfalls accumulate. (AP/Atlanta Journal-Constitution)

In case you missed it ...
Internists love medical mysteries, and here's a case that would stump any doctor who's not also a presidential historian. And here's another medical mystery an internist recounts--whether to address patients by their first names and allow them to use hers. (Washington Post, New York Times)

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Monday, December 14, 2009

QD: News Every Day--disputes continue on health care reform

ACP Internist's daily digest of news and events continues with updates on health care reform.

Health care reform
The Washington Post reports that health care reform is at a critical juncture, with some senators indicating that they will not support the current bill if it includes a provision allowing uninsured individuals over 55 to buy into Medicare. The provision is part of a proposal released last week that was meant to serve as a compromise between those who champion and those who oppose a public-plan option. The Congressional Budget Office is set to issue an analysis of the proposal's potential financial impact soon, but the Post reports that timing is tight: Debate on the bill must wrap up this week or the vote risks being pushed into 2010. Senators are also debating today the merits of an amendment to allow importation of medications from other countries at lower costs. (Washington Post, Politico)

In case you missed it ...
Doctors at Georgetown University Hospital and Washington Hospital Center recently completed what's thought to be one of the largest kidney transplant chains ever in the U.S. Through a paired kidney donation program, 13 kidney transplants were performed, 10 of them in Hispanic, African-American or Asian-American recipients. (CNN.com, Associated Press)

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Medical News of the Obvious

We'd like to thank the Journal of the American College of Cardiology for sponsoring this edition of MNO by providing all of our content in a single issue.

First up, making chubby kids run turns out to serve a purpose besides the pleasure of unhappy gym teachers. The sadists (um, I mean, researchers) enrolled the fattest kids in the class (97th percentile for their 6 to 11 year old age range) in mandatory 60-minute exercise programs. Not surprisingly, they found that the exercise was good for the children's cardiovascular fitness. More surprisingly, they claim that the program was "deliberately made enjoyable for the children with activities including swimming and ball games." Right. Can't you just picture the coach yelling, "Get your butt on the field! This kickball game has been deliberately made enjoyable for you"?

Meanwhile, other researchers have been torturing older obese people by feeding them less to find out that weight loss is also good for your cardiovascular health. Oh, and smoking affects your recovery from a heart attack. That last one was observational. Apparently the researchers didn't have to make people smoke in order to prove that it's bad for you.

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Sunday, December 13, 2009

Concierge medicine as a practice model

A significant percent of people do not know what "concierge medicine" is. Also known as "retainer" practice, concierge is a growing type of medical practice where the patient pays the physician an up-front fee (retainer) for services. The fee can range from $100 a month to $20,000 a year, depending upon the practice and the services offered. The fee usually covers all visits to the doctor, phone calls, more prompt service and e-mail access. Labs, tests, X-rays, specialist visits, and hospitalization are not included.

The concierge of Artus hotel, Saint Germain des pres, Paris by infostreetcafe via FlickrMore and more primary care physicians are forgoing the hassle of dealing with insurance companies and Medicare and are becoming concierge doctors. Because of the retainer, physicians can have a smaller practice and be more accessible to patients. The doctors that charge $20,000 a year have only 100 patients and provide "spa" service. (You do the math!) One of my colleagues has a long waiting list!!!

Patients who go to concierge doctors still carry health insurance for other health care. But they have easier access to their primary care doctor and both physicians and patients are generally happy with their arrangements. If the patient doesn't feel like it is worth it, they can always just drop out. Many physicians say if they hadn't switched to concierge practice, they would have just quit medicine all together.

Some of the criticism of concierge medicine is that with the shortage of physicians, it only exacerbates the access problem. It is called elitist and leaves out the people who can't afford the retainer. Other critics say patients are paying for service that many physicians already provide without a retainer.

Proponents of concierge say it is the free market at its best and it restores the doctor-patient relationship and contract. Tell me what you think about it.

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.

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Friday, December 11, 2009

There are other things to say about breast cancer.

Hard to tell if this is a USPSTF-induced flurry, but there suddenly seems to be a lot of "news you can use" about breast cancer prevention.

To summarize: eating soy is good, according to JAMA. But drinking alcohol looks bad, says a conference presentation via the NY Times. Maybe you can replace that cocktail with a bisphosphonate, based on additional reports coming out of the same conference. It's important to note that all of these studies are observational, not that we want to get into any debates about the importance of evidence in making recommendations regarding breast cancer.

And while we have your attention, ladies, one more thing. The holiday issue of the Journal of the American College of Cardiology ("Statins: the perfect gift for all your friends and family") reports that cholesterol goes up at menopause. The study authors recommended more lipid testing and weight loss, according to HealthDay.

So to sum up, unless that eggnog is made out of tofu, you'd best step away from the punch bowl.

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QD: News Every Day--amendments piling up in the Senate

ACP Internist's daily digest of news and events continues with the piling amendments being considered for health care reform, and how they hinge on the pharma companies' blessings.

Health care reform
Amendments continue to crop up during the Senate's debate on health care reform:
--An amendment that would allow pharmacies and wholesalers to import drugs from other countries brought the Senate to a standstill. Loss of pharma support might jeopardize the bill's passage.
--Citing "harassing sales practices" and "undue influence," another amendment would restrict pharma companies from strip-mining sales records to find out which doctors are prescribing their drugs.
--Patient advocacy groups like the American Cancer Society are objecting to language that would let insurance companies cap medical care, as long as it's not "unreasonable." There is no definition of that, though.
--Finally, Virginia Sen. Mark Warner wants to do for health care what Travelocity did for flying--offer cost comparisons. An editorialist suggests expanding the discussion to include "evidence-based medicine." (Los Angeles Times, Washington Post, AP, The Virginian-Pilot)

The American Hospital Association and American Medical Association are opposing current health care reform legislation. But now some of the folks actually delivering health care speak out, including ACP President Joseph Stubbs, FACP. (AP, USA Today)

Primary care shortage
A resident explains why she's going into specialty medicine, while a doctor explains why he opened a clinic in Paint Lick, Ky., which hadn't had a medical office for 40 years. (CNN)

In case you missed it ...
Mathematician John Allen Paulos, who's authored commonsense explanations for complex topics, has taken up the controversy generated by the recently published mammography guidelines. He writes, "People quickly become anchored to such a number, whether it makes sense or not ("we use only 10 percent of our brains"), and they're reluctant to abandon it. If accustomed to an annual mammography, they're likely for that reason alone to resist biennial (or even semiannual) ones. " Meanwhile, John Peabody, FACP, PhD, Senior Vice President & Medical Director for health care consultants Sg2, discusses the mammography fallout with a colleague (free registration required). (New York Times, Sg2)

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Thursday, December 10, 2009

QD: News Every Day--states balancing doctor shortages, smoking funding and H1N1

ACP Internist's daily digest of news and events continues with a look at the shortage of primary care physicians and how it plays out in the state of New York, as well as how Congress might fund more incentives for medical students. But, the states aren't funding smoking cessation efforts like they should. (They're having enough problems trying to keep up with H1N1 vaccinations.)

Primary care shortage
Doctor's Office by PhotoDu.de via FlickrThe Health Care Association of New York State released its 2009 Physician Advocacy Survey, "The Doctor Can't See You Now," that says the state's doctor shortage is likely to worsen. The study shows that recruitment barely offsets retirements, and a severe lack of physicians in internal medicine and hospitalist care, as well as specialties such as obstetrics/gynecology, general surgery and psychiatry. Survey respondents reported a lack of 1,300 physicians, with 35% of that total comprised of a need for primary care/internal medicine and 7% a lack of hospitalists.

The survey found that:
--45% of hospitals lack ED coverage for certain specialists, forcing patients to travel to other hospitals, some time distant ones, to receive care;
--24% had to reduce or eliminate specialty services because of an inability to recruit physicians;
--66% indicated that they have to pay for on-call services; and
--75% employ locum tenens physicians.

The report not only calls for better funding of physician education from the state and the nation, but an expansion of telemedicine and an increased role for nurse practitioners and physician assistants.

One Congressional amendment introduced Wednesday would provide incentives and training programs for medical students who want to practice in rural communities. The 2,074-page Senate bill will grow longer as these types of amendments are considered. Learn how to read a 2,074-page bill. (MinnPost.com, CNN)

Health care reform
Although the Congressional Budget Office hasn't scored the Senate's health care reform bill (that is, put a price tag on it) the impact on individuals is becoming clear. Officially, details haven't been announced but they've been leaked widely. People ages 55 to 64 could enroll in Medicare and will likely pay less for health care than now. But those in their 20s and 30s will face higher premiums, though for better coverage. (AP)

Smoking cessation
While states collected record amounts of revenue from the 1998 settlement with tobacco companies ($25.1 billion this year) they are spending less of it on programs to prevent kids from smoking and help smokers quit. Sates have cut funding for tobacco prevention programs by more than 15% in the past year, and only North Dakota meets the funding recommended by the Centers for Disease Control and Prevention.

H1N1 influenza
State health departments have cut back or redirected resources from other efforts, such as screening for other diseases, restaurant inspections and anti-obesity campaigns, to staff H1N1 vaccination efforts. (Wall Street Journal)

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Wednesday, December 9, 2009

QD: News Every Day--Senate close to cloture

ACP Internist's daily digest of news and events continues with updates on health care reform and H1N1--both are less severe than predicted, but neither is over yet.

Health care reform
Democratic Senators have reached a deal and details are leaking out. The compromise may replace the public option with a private one like the health plan federal workers use, and also allow people 55 or older to buy into Medicare coverage. Some hospital and insurance groups oppose the idea, as do those who represent rural areas. Meanwhile, the Senate tabled more restrictive abortion language, although that needs to be reconciled with the House bill, which has more restrictions. (CNN, Kaiser Health News)

Family practitioner Jeffrey Brenner, MD, explained how Camden, NJ, one of the nation's most impoverished cities, avoided millions of dollars in ED visits by sending nurse practitioners to housing complexes and nursing homes. Bolstering the idea of using other types of medical providers is family practitioner and micropractice guru L. Gordon Moore, MD, who suggests that "'face to face with MD' need not be the only solution tested." (NJBIZ, Ideal Medical Practices blog)


H1N1 influenza
In the midst of the weakening predictions of the H1N1 influenza pandemic and ramped up vaccine production, availability is increasing and being offered in locations across the country without priority lists, for just one example, in Detroit. Germany is selling more than 2 million doses due to weak demand. (WebMD, CNN, Detroit News, Reuters)

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Tuesday, December 8, 2009

QD: News Every Day--options for the public option

ACP Internist's daily digest of news and events continues with options for the public option, as well as how drugmakers plan to curb opioid abuse. (They're asking doctors.)

Health care reform
Factions within the Senate are discussing a privately-offered public plan. It's not another government oxymoron, either. Also, those over 55 could buy subsidized coverage from Medicare if they couldn't find insurance elsewhere. Meanwhile, one physician imagines another "semi-public" option that would make medical care more like other consumer transactions. (Washington Post, Wall Street Journal, Physicians News Digest blog)

Prescription drug abuse
Drugmakers suggest patient medication guides, letters to doctors and additional physician training to combat inappropriate drug prescription and abuse. The idea stems from a meeting with FDA officials, who've targeted 16 companies that produce 24 opioid drugs. It's a tough balance between curbing abuse and misuse and having physicians opt out from overly onerous requirements. (San Diego Union-Tribune, Chicago Tribune, Reuters)

H1N1 influenza
With reports rolling in around the globe, the H1N1 pandemic may go down as the mildest on record. But even so, it's killed an unusually high number of younger adults and children, experts cautioned. (MSNBC)

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Doctors, ditch the tie and the coat

Illustration by Ryan DuBosarACP Internist has addressed doctors' dress before. Most recently, blogger Toni Brayer, FACP, dressed down doctors for wearing ties. Now, Ravi Reddy, MD, has taken casual dress to a new level--jeans and no white coat.

His sartorial choices are guided by his practice location--in Hawaii. It's a cultural thing, Dr. Reddy writes in the Hawai'i Medical Journal.

Studies done in the U.S. mainland show that most patients prefer their physician to wear a white coat, with a visible stethoscope and name tag. Attitudes are a little more laid back in Hawaii, explained Dr. Reddy. In public, many wear slippers (zoris) instead of covered shoes, and short pants and tee shirts are more common than long pants and collared shirts. Physicians favor an Aloha shirt or print dresses and slacks or skirts over ties and white coats.

So Dr. Reddy's front desk staff randomly surveyed 50 patients by questionnaire, asking if patients felt if their physicians wore slippers, scrubs, short pants, blue jeans, or a white medical coat. He then rated measures of trust and confidence.

Patients generally approved of scrubs (81%) and blue jeans (74%), but generally disapproved of slippers (57%) and shorts (69%). Patients preferred their physician not wear a white coat (52%). Regardless of their preferences, trust and confidence in the physician didn't vary much by physician attire, with the exception of the white coat. Those who expected to see one conferred a high degree of trust and confidence.

Aloha, casual everyday!

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Monday, December 7, 2009

QD: News every day--a new public plan?

ACP Internist's daily digest of news and events continues with more on health care reform and H1N1 influenza.

Health care reform
The health care reform debate continues on Capitol Hill. Democrats are said to be coming closer to approving an alternate public-plan option that would be administered by the government but controlled by nonprofit groups. A task force of five moderate and five liberal Democrat senators appointed by Senate Majority Leader Harry Reid (D.-Nev.) has been working on the issue. In addition, the Senate plans to vote soon on an amendment introduced today by Ben Nelson (D-Neb.) that would restrict federal funding for abortion. (New York Times, USA Today).

H1N1 influenza
The Obama Administration launched a new campaign today to encourage vaccination against H1N1 influenza, with TV and radio ads aimed at high-risk groups. Seventy-three million doses of the vaccine are available and 10 million more are expected to become available this week, the CDC said. In some areas, the shortage of vaccine has improved so much that state and local governments have approved its administration to all patients regardless of risk. (Washington Post)

In case you missed it...
British researchers have reported finding new DNA links to early-onset obesity. In particular, they said, a deletion on chromosome 16 could lead to overeating because it removes the brain’s ability to respond to leptin. The study looked at 300 British children and was published online Sunday by Nature. (AP via ABC News)

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Medical News of the Obvious

The selections this week are not so much obvious as they are fruitless. Call it "Medical News that is Likely to be Ignored."

A new study "provides evidence that the average cigarette is crawling with germs, including bacteria that cause respiratory disease," HealthDay reports. Because, of course, smokers typically have shown great concern about protecting themselves from respiratory disease. This research is in its early stage and the experts expressed a "need to figure out if they [the bacteria] are impacting human health." Would that mean that cigarettes are impacting human health, too?

There's bad news for ecstasy users, too. If you're not already bleary-eyed from raving all night, sleep apnea might be impairing your rest. A comparison of 71 ecstasy users with controls found an association between the drug and sleep apnea, reported WebMD. "The scientists...say doctors should warn young people that the drug 'damages their brains' and may cause sleep apnea." Hmm, which half of that warning do you find more attention-grabbing?

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Friday, December 4, 2009

QD: News Every Day--punishing med schools for graduates

ACP Internist's daily digest of news and events continues with punishment for medical schools that don't train enough primary care doctors.

Physician shortage
The CEO of the Texas Academy of Family Physicians wants to reward medical schools that train primary care doctors, and punish those that don't. Quotas would reserve a percentage of slots for family practice. Countering the idea are the heads of Texas' med schools, who say they can reward students who choose primary care, but that they can't force students into it.

One way to satisfy the need to train more doctors is to open another medical program, a measured approved by the University of North Texas in Fort Worth. But, the existing osteopathic program worries that start-up costs for a school for MDs will drain its funding. They'd rather see more support for their program, saying it produces more primary care doctors than any other program in the state. (The Texas Tribune, North Texas Daily)

Health care reform
The Senate is tackling the growing list of amendments for health care reform. Of four that came to a vote, two passed and two didn't. Passing were amendments that the Secretary of Health and Human Services could require health plans to cover preventive services for women, (such as mammograms, in the wake of the recent controversy) and the bill would not cut any access to basic Medicare services. Failing to pass were amendments that would strip out a half-a-trillion dollars in Medicare spending cuts to pay for some of the costs, and another that said abortion could not be considered a preventive care service. (Politico, Kaiser Health News)

Meanwhile, 19 groups representing nearly a quarter-million surgeons object to various facets of the law, including:
--an independent Medicare advisory board whose recommendations could become law without congressional action,
--mandatory participation in the Physician Quality Reporting Initiative,
--bonus payments to primary care physicians,
--relying solely on U.S. Preventive Services Task Force recommendations for minimum coverage standards,
--the provision that many types of providers could be reimbursed, and
--the lack of a permanent fix to Medicare reimbursement.

H1N1 influenza
H1N1 influenza rates are waning in Canada, says the country's chief public health officer. But, it may just be a lull. (ABC News)

Rhode Island is using its e-prescribing database to track H1N1 outbreaks. Prescribing data from the state's pharmacies gives epidemiologists at the Rhode Island Department of Health weekly updates that act as a proxy for detecting a potential outbreak, including its location and affected age group. It's then compared to the state's Sentinel system, made up of 25 physician practices that report flu outbreaks to the health department. David R. Gifford, ACP Member, director of the Rhode Island Department of Health, said, "This provides another important tool for the state's public health officials to look at trends related to the course, severity and treatment of the H1N1 pandemic." (Electronic Medical Record)

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Thursday, December 3, 2009

The WALL-E report

This week's New England Journal of Medicine includes a forecast of the effects of smoking and obesity on life expectancy in the U.S.

The good news is that if current trends continue, life expectancy will probably continue to rise and that "if all U.S. adults became nonsmokers of normal weight by 2020, we forecast that the life expectancy of an 18-year-old would increase by 3.76 life-years or 5.16 quality-adjusted years."

The bad news is that ain't going to happen. Instead, the researchers predict that "almost half the U.S. adult population will meet the WHO criteria for obesity by 2020." With robots becoming more capable of doing humans' work, how long will it be until we live in a WALL-E world?

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QD: News Every Day--let the voting begin

ACP Internist's daily digest of news and events continues with updates on health care reform and the USPSTF's breast cancer screening recommendations.

Health care reform
The Senate today approved an amendment that would require insurance companies to cover mammograms, and rejected an amendment that would have removed over $400 billion in Medicare cuts from the health care reform bill. Next up for a vote is an amendment to restrict funding for abortion, the AP reported. (AP via the Washington Post)

In case you missed it...
The Subcommittee on Health of the House Energy and Commerce Committee held a hearing yesterday on the recent U.S. Preventive Services Task Force breast cancer screening recommendations, published in the Nov. 17 Annals of Internal Medicine. Donna Sweet, MACP, presented testimony from ACP; her full remarks are available online. Bob Doherty, ACP's senior vice president for governmental affairs and public policy, offered his analysis of the hearing on his blog. (ACP, ACP Advocate)

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Wednesday, December 2, 2009

Should Doctors Ditch the Tie?

Stain by shareski via FlickrNeckties worn by physicians may be contaminated with dangerous bacteria and viruses that are transported from patient to patient. The British Medical Association made a decision in 2006 that doctors should forgo wearing neckties because they carry germs and bacteria. The American Medical Association is looking at the same issue.

Stethoscopes are draped across ties, patients sneeze on them and neckties are worn repeatedly without being washed. A study from 2004 at New York Hospital Medical Center at Queens showed half of the neckties worn by the study doctors harbored bacteria, including MRSA.

If an article of clothing has no function and may be contaminated, I say why wear it? I doubt that given the choice of a dressed up doctor vs. a clean doctor, patients would choose the necktie.

Personally, I think we should all be wearing scrubs in the hospital and in the office. They are comfortable, professional and clean. I would welcome saving $$ on clothes and dry cleaning. Or what about the old Dr. Kildare look?

What do you think? Is it time for men physicians to lose the tie?

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.

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QD: News Every Day--Senate considers a plan B

ACP Internist's daily digest of news and events continues with an update on the Senate's progress on health care reform.

Health care reform
Voting is expected to begin today on amendments to the Senate's health care reform legislation. Contentious issues include funding and abortion, but also under consideration is $2 billion more funding over 10 years to create 2,000 residency slots at large teaching hospitals in Florida, California, Pennsylvania, Illinois and New York. (Washington Post)

A pubic option plan B is scheduled to debut next week in the Senate. Meant to appease divergent sides in the debate, it could include a national insurance program managed by a non-governmental board that would operate alongside other options already proposed by the existing bill. (The Hill)

Having trouble following it all? The AP created a chart of the remaining steps for passage (if it ever comes to that).

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Tuesday, December 1, 2009

QD: News Every Day--health care costs go up and down

ACP Internist's daily digest of news and events continues with uncertainty about health care costs, and a definite fall in flu incidence in the past month.

Health care reform
The Congressional Budget Office scored the Senate's health care bill. The agency's conclusion: Health care costs will go up. They'll go down. Maybe a little.

Confused? The lead paragraph for the New York Times said, "The Senate health bill could significantly reduce costs for many people who buy health insurance on their own," while the Wall Street Journal said it "may raise them for some people who buy coverage on their own."

Who do you believe? Read the CBO director's summary and the original analysis. He chalks up the uncertainty to "estimating effects that depend heavily on how enrollees, insurers, employers, or other key actors would respond." Economics is the dismal science, indeed. (New York Times, Wall Street Journal, Christian Science Monitor)

H1N1 influenza
While H1N1 influenza incidence fell for the fourth straight week, the overall death toll is still rising, as are pneumonia rates, the Centers for Disease Control and Prevention reported.

The number of states reporting widespread flu activity decreased from 43 to 32. Nationally, doctor visits for influenza-like illness declined. Flu-related hospitalizations and deaths declined slightly over the previous week, but are still very high nationwide compared to what is expected for this time of year. The proportion of deaths attributed to pneumonia and influenza was above the epidemic threshold for the eighth consecutive week.

Anne Schuchat, FACP, who heads the CDC's National Center for Immunization and Respiratory Diseases, said this year's flu patterns are not typical, and that there may be more illnesses ahead. (Washington Post, New York Times, Boston Globe)
Figure provided by the CDC















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Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Auscultation
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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