ACP Internist

Friday, May 15, 2009

Playing Operation

The SGIM session I attended this afternoon made it clear that patient simulators (whether they're mannequins, body parts or actors) are not just for fun. Medical students and residents should be required to use them and then tested on their skills, the speakers said. And they presented data to show how remarkably effective the simulators are.

But still...one of the simulations they mentioned cracked me up. The student/resident is presented with a woman (actually an actress) who needs a pelvic exam. The student makes all the proper conversation with the woman and then lifts her gown. And underneath they find...a fake pelvis (aka a part task trainer)! I know the students are probably told about the setup ahead of time, but I can't stop snickering at the image of a wide-eyed med student who's just unveiled plastic genitals on a live woman.

Labels: medical education, SGIM meeting

More about the benjamins.

Yesterday's discussion at SGIM centered on health care costs, and assumed that some kind of reform is coming, but both Bob Brook and Albert Siu avoided the issue of whether the new system should be single- or multi-payer. That contentious topic was the focus of this morning's plenary session. Richard Epstein, a law professor, and Steffie Woolhandler, MD, founder of Physicians for a National Health Program, each presented their views and then responded to questions from the audience. Their conclusions were pretty stark. Dr. Woolhandler, who comes from Massachusetts argued (and presented evidence) that the mandated coverage plan that her state has enacted and Obama is considering only makes health care worse and less accessible. She sees single-payer as the only possible solution. Meanwhile, Prof. Epstein said that single-payer would be a costly, bureaucratic disaster and that the only solution is an entirely free-market health care system. The poor and uninsured can get their lower quality health care from Wal-Mart, just as they do other goods and services, he said. As you might guess, that was not a popular suggestion with the audience.

Labels: health care reform, SGIM meeting

Fixing the house of medicine from the inside

As promised, the story of how Bob Brook wants doctors to spend less, in addition to eating less. At the SGIM opening session this morning, he called on physicians to improve the quality and lower the cost of their care, before making demands for insurance and payment reform. He suggested that the Journal of General Internal Medicine only publish research that works toward lowering costs (by, for example, testing out a new, less expensive alternative to an accepted treatment). He also recommend that physicians threaten their hospital CEOs with a job action unless they start working to increase the value of care provided at their facilities.

His ideas sounded pretty revolutionary until the keynote lecturer on geriatrics, Albert Siu, MD, made some similar arguments. He also called on general internal medicine to prove its value in caring for chronically ill patients. His point was that PCMH-like models would never be fully supported until primary care proved its value. Although he also said that payment system had to be reformed in order to show the value, so it seemed like a slightly circular argument.

Both lectures included the sort of digs on more procedural specialties that you would never hear at, um, other internal medicine meetings. These SGIM folks are not afraid to say how they think health care spending should be redistributed. But they also placed some of the blame on primary care, for not providing "excellent, affordable, humane care," as Bob Brook put it. Sounds like a challenge.

Labels: health care reform, SGIM meeting

A light breakfast

Regular readers of this blog know that our conference coverage usually serves as an opportunity not only to pick up clinical knowledge, but also to conduct some zoological observations of physicians in their natural habitat.

Along these lines, I'm pleased to report that attendees at the Society of General Internal Medicine's annual meeting practice the healthy eating that they preach. At this morning's buffet, piles of muffins and danishes sat untouched while people formed a LINE at the fruit table!

Those docs were probably glad of their restraint when keynote speaker Robert H. Brook, MD, took the stage. As a solution to the obesity epidemic, he advocated decreasing the availability of the food supply. For example, for his office at RAND, Dr. Brook has pushed for the elimination of all food outside the cafeteria and replacing buffets with calorie-limited servings.

He had similarly harsh prescriptions for practitioners of general internal medicine--think procedures and meds instead of snack food. More on that in my next post.

Labels: diet, SGIM meeting

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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, 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.

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

Everything Health
EverythingHealth is designed to address the rapid changes in science, medicine, health and healing in the 21st Century.

Getting Better with Dr. Val
Getting Better is the continuation of Dr. Val Jones' previous blog at Revolution Health. It is devoted to helping people understand health issues from a balanced, scientifically sound perspective.

HealthHombre
A roundup of health policy news drawn from a database of hundreds of Web sites.

Interact MD
Michael Benjamin, 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.

Kevin, MD
The alter ego of Kevin Pho, ACP Member, is the closest thing to royalty in the medical blog world.

LSUHSC-S Medical Library Evidence Alert
Major guidelines, systematic reviews, meta-analyses and/or major reviews by national and international organizations.

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 a doctor.

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