ACP Internist

Thursday, March 4, 2010

QD: News Every Day--President resigned to reconciliation

ACP Internist continues its daily wrap-up of current events affecting internal medicine.

Health care reform
Citing the Children's Health Insurance Program and COBRA unemployment health coverage as examples, President Barack Obama called on Congress to pass health care reform using reconciliation. Those two health programs used the legislative tactic to secure passage. Senate Minority Leader Mitch McConnell said health care reform was bigger legislation, and "Big legislation always requires big majorities." (Washington Post, Wall Street Journal)

Haitian earthquake relief
The overwhelming wave of trauma victims has dwindled to a trickle aboard the USNS Comfort, the military hospital ship anchored in the harbor of Port-au-Prince, Haiti. Civilian doctors want the ship to stay to handle what they describe as a second wave of treatment--resetting poorly healed fractures and remaining public health issues. The Navy has not decided what the Comfort's future mission might be, if any. Read reports of the challenges internists faced while aboard the ship. (Baltimore Sun, U.S. Navy, Annals of Internal Medicine)

Lt. Yonnette Thomas, Officer in Charge of the Center for Information Dominance Learning Site in Norfolk, translates between Haitian patients and a delegation of visiting physicians from Colombia aboard the USNS Comfort.

Labels: disaster response, health care reform, QD

Snowmaggedon And Physician Responsibility

This post by Steve Simmons, MD, originally appeared at Better Health.

I practice medicine in the suburbs west of Washington, D.C., and everywhere I look I see 30 or more inches of snow. I keep reminding myself of where I am--not unlike a man pinching himself to ascertain wakefulness--because the view my window affords me is tailor made for the usual snow typical to Buffalo, N.Y. Two days after the snow stopped falling, schools are cancelled indefinitely, most side streets have yet to see a plow, and tens of thousands are without electricity, including my partner's family huddled together like in a dark basement enjoying the extra two or three degrees of warmth to be found there.

It is hard, but not impossible, to practice medicine when the pace of modern society grinds to a halt. Yet at least we, here, enjoy the benefits of living in a country with a well developed infrastructure prepared to rebound instead of recoiling from nature. To compare our "snowmageddon" (a term used on the news here) and the earthquake in Haiti would be both inappropriate and naive; yet, our daily lives have distinctly altered and in that an understanding of the fragility of society and the responsibility of a physician is possible. Still, there are many differences. We ask when our power will be returned, not if; snow will melt, but buildings don't un-crumble; and while my neighbors shiver together in their homes, many Haitians seek their loved ones with a shovel.

I know a few physicians who have been to Haiti and spoke with another today whose trip is planned for next week. I admire them all. Another doctor recently returned from Haiti was on the local news last night, shoveling the mountain of snow that had been waiting for him on his return home, a smile was on his face. The story they tell of Haiti isn't funny; it is one of an absent medical infrastructure and chaos, and still they go. One doctor described the coordination of Haitian medical relief as being akin to a group of five-year-olds playing soccer. Another story tells of doctors fleeing an angry crowd surrounding an unequipped hospital, their guards brandishing M16 rifles.

Nothing we see here could ever compare to these stories. However, people have died of carbon monoxide poisoning, accidents and the inevitable snow-shoveling heart attacks. My concern must be with my family and patients here and now. What do they need? What role should I play to best serve them today? We have been unable to open our office, let alone get to it but my practice does not rely on seeing patients face-to-face to treat. We don't have to generate insurance paper-work to keep the lights on or meet our overhead. Our laptops are open and pharmacies are filling our prescriptions. In our practice we continue to care for our patients using the telephone and e-mail to apply basic triage to patients we have already met and know. Most phone call visits are limited to upper and lower back pains plus a medley of other sore muscles, ligaments, and then attitudes, as the forecast for Wednesday morning's weather included up to 20 more inches of snow for our area.

American doctors, fortunate enough to practice medicine in the 21st century, should not become complacent or too dependent on the daily flow of patients through our offices. We must be able to adapt to circumstance and react to emergency. Society will depend on us and I, for one, am optimistic that our profession stands ready and will meet any challenges thrown our way as evidenced by recent events. The bravery of physicians volunteering in Haiti ennobles our entire profession and we can all feel pride in their actions. The responsibility towards all of our patients will not lessen after unforeseen events. Rather, it will increase and the chance to respond magnificently awaits us all as we support our patients in the seemingly mundane affairs of day-to-day living.

Until next week I remain yours in primary care,

Steve Simmons, MD

This post originally appeared on Better Health, a network of popular health bloggers brought together by Val Jones, MD. Better Health's mission is to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the provider point of view on health care reform, science, research and patient care.

Labels: disaster response

QD: News Every Day--Approaching a summit from opposite sides of the mountain

Health care reform
The White House summit between opposing sides of health care reform is planned for Feb. 25, with broadcast coverage on C-SPAN. The summit has drawn criticism from those opposing last year's effort, but that didn't stop opposition leadership from sending ahead some pointed questions and asking for a response. [Hint: They want the answer to be, "Start over."] (USA Today, Washington Post)

Haitian relief efforts
Telemedicine has arrived to Haiti. While waiting for hi-tech hookups, ham radio operators have aided in communications. (New York Times)

Patient-centered medical home
Five counties in north Texas have adopted a widespread medical home concept. It's led by an insurance company in conjunction with two large physician practices. (Dallas Morning News)

Labels: disaster response, health care reform, patient-centered medical home, QD, telemedicine

QD: News Every Day--Internists still seeing yet-untreated Haitians

ACP Internist's wrap-up of current events turns its attention back toward Hati, where 22 days after the earthquake, patients are still being seen for the first time for injuries. Peter Melchert, ACP Member, a hospitalist from Abbott Northwestern Hospital and Children's Hospital in Minneapolis, reports via internist and writer Craig Bowron, FACP. (MinnPost.com)

Health care reform
Amid a near-abandonment of broad sweeping reform, Congress members hope to salvage small victories. They are looking now at repealing the federal antitrust exemption for insurance companies to drive down prices in regions dominated by one company. Even this one small component faces Senate opposition, and the odds are even longer for the procedural maneuver of reconciliation, which is still being mulled in some pockets of Congress. Republicans want to start from scratch, while others have started drafting a compromise bill. And the clock is ticking as elected officials look to turn their attention toward other issues, such as employment, and as states assert their rights by drafting legislation that would bar individual insurance mandates. (Wall Street Journal, Politico, AP, AP/San Francisco Chronicle, AP/Boston Globe)

In case you missed it ...
Internists are discussing the pros and cons of e-mail diagnoses. Some see time savings, others see a time drag, or fear liability issues and the practice of "garbage" medicine (registration required). About 5% of patients used e-mail last year to talk to their doctors, but 51% looked up health information on the Internet. (Medscape, Reuters)

Labels: disaster response, health care reform, health policy, patient communication, QD

QD: News Every Day--Health politics becomes health policy

ACP Internist's wrap-up of current events turns its attention toward health care reform, and how health care policy translates into health care delivery.

Health care reform
Congressional legislation will move forward with the least controversial elements of health care reform: solving Medicare's pending insolvency and closing a gap in Medicare Part D coverage. But Democrats and Republicans differ on how to accomplish such goals. (Wall Street Journal)

Medicare's reimbursement system has long stuck in the craw of primary care physicians. As a result, they don't always accept such patients, so one in three Medicare enrollees had trouble finding a primary care doctor when entering the Medicare population, according to a June 2008 report by the Medicare Payment Advisory Commission. The impact is shortening an already pressed primary care system. In Arizona, only three of that state's 15 counties have the appropriate ratio of primary care doctors to the general population. (The Arizona Republic)

Physicians aren't waiting for health care reform that may never come. They continue to leave community practice and delve into concierge care, which they say allows them to practice the thorough, hands-on medicine they'd envisioned when they graduated medical school. ACP Fellow David Grulke, MD, of Norfolk, Va., converted his practice to a concierge model in 2002. He charges $660 to $1,080 annually (unlike some practices that charge thousands or more) and describes it as a service for ordinary people who want a relationship with their doctor. In the same article, Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, tells the Virginian-Pilot such arrangements are the symptom of a broken care system. (Virginian-Pilot)

Haitian relief efforts
ACP Member Myriame Casimir, MD, was raised in Haiti. Today, she returns there on a medical mission comprised of her and 20 other providers from Rush University Medical Center in Chicago. (Chicago Tribune)

Also, an aid worker used a first-aid app on his cell phone to survive 60 hours trapped in the rubble of a building. (CNN)

In case you missed it ...
ACP Fellow Turi McNamee, MD, blogs about the "weekend effect" and concludes that, on Satursdays and Sunday, it's better to be shot than have a heart attack. She covers her local hospital's shifts on weekends and wonders what the impact will be on her facility's relaxed atmosphere if more research leads to an increase in weekend staffing. (True/Slant)

Labels: concierge medicine, disaster response, health care reform, medicare, primary care shortage, QD, weekend effect

QD: News Every Day--Common ground in health care reform

ACP Internist's wrap-up of current events turns its attention toward those toiling in the wake of collapse--of health care reform. Congressional aides, the folks who do all the heavy lifting for new legislation, are seeking common ground for a pared back health care reform bill. Labor groups, patient advocates and some physicians, including Nancy Nielsen, MACP, a former AMA president, are calling for health reform. While it won't be easy to find common ground, there is a short list of items in the making. (New York Times, Los Angeles Times, AP/Washington Post)

Haitian relief efforts
In a country in dire need of emergency care, internists who'd regularly traveled to the country over the years return yet again to staff clinics and hospitals. They find themselves doing pre- and post-operative care and administering what medical supplies they can muster, such as in Cite Soleil, described as one of the poorest ghettos in the Western Hemisphere. Hospitals in Les Cayes, a hundred miles away from Port-au-Prince, survived the earthquake and are performing surgery around the clock to keep up. (Verona-Cedar Grove Times, Daily Hampshire Gazette)

ACP recommends supporting Haitian relief efforts through one or more of the organizations listed here.

In case you missed it ...
A physician recounts his own experience with a rare, life-threatening illness, and notes that the patient gets lost in discussions of treatments, health care delivery and health care reform. (Philadelphia Inquirer)

Labels: disaster response, health care delivery, health care reform, QD

QD: News Every Day--More internists arriving in Haiti

ACP Internist's wrap-up of current events follows MSNBC's chief health correspondent traveling through Haitian hospitals. He reports as they get up to speed on caring for patients in their facilities, they are also trying to coordinate care. Simple tasks, such as finding out who has space, are difficult. Relief efforts by many countries aren't fully coordinated with each other or with many of the nongovernmental efforts underway. Despite reports, logistical challenges are improving. (MSNBC, CNN)

Amid the logistics, independent medical teams are succeeding, such as a group from Christiana Care Hospital in Newark, Del. Reynold Agard, ACP Member, and Erin Meyer, ACP Associate Member, joined a team of 20 who travled to Jacmel, Haiti, a seaside town not far from the quake's epicenter, but that hadn't yet received help. Another team from Bridgeport, Conn., going to Jacmel was joined by Sangeetha Thiviyarajah, ACP Associate Member (pictured here). A team from Cooper University Hospital in Camden, NJ, has started surgical care, and physicians from Dayton, Ohio, set up a morgue, a decontamination area and showers for relief workers. And, the USNS Comfort received its first two patients by helicopter. It's now anchored off the Haitian Coast for an indefinite stay after upgrading to 1,000 hospital beds and more than 1,000 sailors. (Wilmington News-Journal, CTpost.com, Philadelphia Inquirer, Dayton Daily News, U.S. Navy)

The USNS Comfort anchored off the coast of Haiti and began receiving patients on Jan. 20.

Health care reform
Health care reform proponents look to salvage area of health care reform that were agreed upon throughout the legislative process, such as preventing insurers from canceling policies for people who fall ill. But many aspect of health care are related to one another, so a piecemeal approach has its own problems. Drug-makers, insurers and other health-related businesses are positioning themselves in the new landscape. So are medical societies, such as ACP. (free registration required) President Joseph Stubbs, FACP, explains. (Los Angeles Times, Wall Street Journal, MedScape Today)

In case you missed it ...
An internist in California was shocked when she saw the new Medicare schedule had cut reimbursement by 20%. Her overhead costs haven't fallen, so she's contemplating giving up that block of patients, even though she loves caring for them. (Los Altos Town Crier)

Also, LiveScience.com debunks seven common medical myths that even doctors believe.

Labels: disaster response, health care reform, medicare, QD, reimbursement

QD: News Every Day--Haiti, U.S. Senate feel strong motions

ACP Internist's wrap-up of current events continues with a look at Haitian relief. Haiti, which felt another earthquake this morning, is home to one of the world's best rural hospitals, a model copied globally. In the face of disaster, it has been overwhelmed. While that facility was built in Haiti's Central Plateau, another hospital was founded where none had been before in Thomassique, across a major river in Haiti. Founder and internist Gilbert Irwin, MD, expects a flood of patients seeking health care after being turned away from the Dominican Republic. Doctors in the capital, Port-au-Prince, reported peaceful conditions, but internist Jonathan Crocker, MD, of Beth Israel Deaconess Medical Center reported busy conditions as medical workers ramp up their efforts. (Boston Globe, Wall Street Journal, Star-Exponent, Harvard Gazette)

Health care reform
Massachusetts voters chose their Republican candidate for the U.S. Senate, fueled by discontent with health care reform efforts so far. The swing breaks the filibuster-proof majority Democrats held while pushing legislation through, and leaves future efforts vulnerable to procedural stonewalling. Amid unpalatable options, what's left is finding a bi-partisan way to move forward. (Boston Globe, Politico, Wall Street Journal, Washington Post)

In case you missed it ...
This may come up professionally, from a patient. This may come up personally. But finally, someone has developed a decision tree whether one should eat food that's been dropped on the floor. More than the five-second rule is involved.(San Francisco Weekly)

Labels: disaster response, health care reform, QD

QD: News Every Day--Haiti relief efforts struggle

ACP Internist's wrap-up of current events continues with a look at Haitian relief efforts and the internal medicine community's efforts. Domestically, a special election for Massachusetts's Senate seat could affect health care reform.

Conditions in Haiti could create a medical disaster that would complicate the earthquake's impact. Richard Wenzel, MACP, outlines the conditions in Haiti that might contribute to infectious disease outbreaks such as dengue and malaria. But diarrhea is the bigger concern. Trauma from crush injuries has its own set of sequelae that will require special management including kidney failure, worsening diabetes or asthma, post-traumatic stress disorders or permanent mental and physical impairments. Chronic conditions such as diabetes supplies still require management in the face of short supplies. (Reuters, Wall Street Journal, Newsweek, Diabetes 24/7)

Logistical challenges continue, as Doctors Without Borders planes have been diverted from Haitian airfields to the Dominican Republic. Although bottlenecks delayed many internists' privately planned medical missions or slowed ones made in the wake of the disaster, the waits will make the eventual trips more organized. Some teams are making it through, however, often bringing their own medical supplies from offices, and hospitals are not only sending teams but accepting patients. (The Daily Journal of Illinois, Crain's Detroit Business, NBC New York, CBS 3 of Philadelphia)

The Navy's top doctor predicts the USNS Comfort will be employed in the region for at least six months. For the time being, the Navy's home page is dedicated entirely to coverage of its efforts, including numerous pictures showing the vast scope of the effort.

Naval Air Crewman 2nd Class Jason Harold of Goldsboro, N.C., transfers a young Haitian earthquake victim from an SH-60B Seahawk helicopter during a medical evacuation in Port-au-Prince, Haiti. U.S. Navy photo by Mass Communication Specialist 2nd Class Candice Villarreal/Released by Lt. j.g. Erik Schneider)

Health care reform
Massachusetts, which has universal health care, now holds the key to the rest of the country getting it, too. Today's special election to elect a new Senator could swing the balance of power. Democrats tried to negotiate ahead of the election but couldn't reach a compromise. The Boston Globe is offering updates all day. If the Democrats do lose their Senate seat, there's still three ways to push the bill through in the face of likely opposition. (Wall Street Journal, Washington Post, Boston Globe, Christian Science Monitor)

H1N1 influenza
The Centers for Disease Control and Prevention estimates as many as 80 million Americans have been infected with H1N1 influenza, with 16,000 dead and 360,000 hospitalized. About one in five Americans overall have been vaccinated, but 90% of the most vulnerable people, those less than 65 with conditions that put them at risk for flu complications, aren't. Globally, the pandemic is still active. (Reuters, Los Angeles Times)

In the mean time, hospitals are lifting their visitor restrictions. (Des Moines Register)

Labels: disaster response, H1N1, health care reform, QD

QD: News Every Day--logistics stymie getting medical care into Haiti

ACP Internist's wrap-up of current events continues to follow the internal medicine community's response to the Haitian earthquake.

Overall, while needed supplies begin to reach Haiti, officials try to clear docks, roads and airports to get material into relief areas. In addition to a sizeable U.S. military presence, the U.S. Navy's hospital ship, USNS Comfort, is loading supplies and personnel and will leave this weekend. (CNN, Christian Science Monitor)

Shown is a map of the intensity of the shaking caused by the Haitian earthquake, adapted from the U.S. Geological Survey

Like other buildings, hospitals collapsed. Doctors Without Borders is struggling to manage medical care in the wake of losing its three facilities there. The group's deputy operations manager describes his group's disaster response operations. This morning, Stefano Zannini of the group updated reporters about the status of several hospitals that survived the quake and began surgeries. (New York Times, Doctors Without Borders, Wall Street Journal)

ACP members had planned medical missions for the spring, only to cancel them to make room for emergency teams. Marlo Hodnett, ACP Member from Madison, Ala., had planned a medical mission to Haiti, scheduled to depart Wednesday. The earthquake Tuesday pre-empted the group's plans. Retired internist Richard Perry, MACP, of Maryland, will put off his February medical education efforts at Hospital Sacre Coeur, 150 miles away, which survived with just a few cracks in the wall but will be repurposed as a medical and naval triage center. When contacted by phone, Dr. Perry told ACP Internist that trauma teams are more important right now--orthopedists, surgeons and their staff. Don Clark, ACP Member, of Charlottetown, Prince Edward Island, Canada, also will delay a planned medical mission, the fourth such he would have taken. Without infrastructure, there wouldn't be much he could do. Steven Williams, ACP Member, of Allegheny General Hospital in Pittsburgh, has visited Haiti for 20 years. He expects the country's already poor medical system to fare even worse under the strain. (Huntsville Times, CBC News, MedPage Today)

A physician with personal and familial connections in Haiti also spoke out about their response professionally, and the personal impact the earthquake's aftermath has had. (Boston University Today)

Editor's Note: QD: News Every Day will not be published on Jan. 18 due to the Martin Luther King Jr. holiday.

Labels: disaster response, QD

QD: News Every Day--Haiti's impact

ACP Internist's wrap-up of current events looks at the response to events in Haiti. The full scope of the disaster isn't known two days later. Physicians fear that the already fragile efforts in the country to control tropical diseases will be wiped out entirely. The facilities for Doctors Without Borders have been leveled, so they're inflating field units to help disaster relief efforts. Learn more about this method of disaster response from ACP Hospitalist. (CNN, Discovery Channel, ACP Hospitalist)

Health care reform
Marathon negotiations between the White House and members of Congress settled a few issues and raised a few others. Talks continue today. (Washington Post, Wall Street Journal, New York Times, AP)

Evidence-based medicine
Anne Nedrow, FACP, and Anastasia Rowland-Seymour, ACP Member, will travel to India to study the evidence base for introducing ayurveda, yoga and meditation into U.S. medical education and patient care. In India, such practices are mainstream medical care, not alternative medicine, and are the country has for ayurveda 150 colleges, 50 post-graduate programs and 3,000 hospitals.

Labels: alternative medicine, disaster response, health care reform, infectious disease, QD

Good Samaritans help (when it's needed)

Physicians can find themselves offering care in emergencies outside their medical practice, as happened this morning in front of the American College of Physicians' offices in Philadelphia. A bystander had a medical emergency outside our doors and an ACP physician responded.

Physicians don't always think about the duties and liabilities of offering help as a bystander during a moment of crisis. They offer what aid is needed. Most states extend liability protection to medically licensed caregivers who try to help; states that spell this out in plain English include Mississippi and Missouri although they are far from the only two.

As it turns out, most EMTs prefer not to have the help of a bystander, even one who is a doctor, said the ACP physician who rushed outside to offer help. EMTs can and should handle emergencies, and in this case, police and EMTs were already working on the patient's airway. Even in situations where the physician has started life support, once the EMTs arrive the doctor should relinquish control to the EMTs. And in this case, since ACP's offices are next door to Philadelphia's police headquarters, the situation was already in hand.

But the issue of offering emergency aid may be different after a mass crisis. Doctors have considered the impact of offering free-lance aid after the World Trade Center attack on Sept. 11 and Hurricane Katrina, or they are considering what the response should be to flu pandemics. The Georgetown Law Journal has a dense article on the pandemic question, and starting on page 34 it offers a state-by-state overview of Good Samaritan laws.

Labels: disaster response

ACP Internist hosted Grand Rounds on June 16, wrapping up the best of the medical blogosphere. Click here for the complete wrap-up.

Contact ACP Internist

Send comments to ACP Internist staff at acpinternist@acponline.org.

Blog log

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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Thursday, March 4, 2010

QD: News Every Day--President resigned to reconciliation

Wednesday, February 10, 2010

Snowmaggedon And Physician Responsibility

Tuesday, February 9, 2010

QD: News Every Day--Approaching a summit from opposite sides of the mountain

Wednesday, February 3, 2010

QD: News Every Day--Internists still seeing yet-untreated Haitians

Monday, January 25, 2010

QD: News Every Day--Health politics becomes health policy

Friday, January 22, 2010

QD: News Every Day--Common ground in health care reform

Thursday, January 21, 2010

QD: News Every Day--More internists arriving in Haiti

Wednesday, January 20, 2010

QD: News Every Day--Haiti, U.S. Senate feel strong motions

Tuesday, January 19, 2010

QD: News Every Day--Haiti relief efforts struggle

Friday, January 15, 2010

QD: News Every Day--logistics stymie getting medical care into Haiti

Thursday, January 14, 2010

QD: News Every Day--Haiti's impact

Thursday, October 23, 2008

Good Samaritans help (when it's needed)

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