Tuesday, October 20, 2009
QD: News Every Day--Senate considers SGR overhaul
ACP Internist's daily digest of news and events continues with the tantalizing prospect of permanently ending the annual SGR cuts, changing public support over health care reform, and Maine's effort to recruit medical students to its rural areas.
SGR cuts
The Senate considers today closing debate and proceeding to vote on a way to permanently end annual SGR cuts. This year, a 21% reduction is on the line, which would prompt primary care doctors to stop seeing Medicare patients. Democrats and Republicans had put off the procedural step, called a cloture vote, to allow time for consensus on the issue instead. ACP reports what doctors can do ahead of this key vote. The separation of SGR cuts from health care reform was done in exchange for physician support for both items.
Health care reform
The Robert Wood Johnson Foundation found that about one-third of Americans worry about losing health care coverage, a slight increase from last month. The number of Americans who worry about losing coverage in the next year has increased by 11% points since the spring. Young adults are the most often concerned (40%), followed by middle-aged (38%) and then seniors (29%) even though they have Medicare.
The Washington Post reports 57% of all Americans now favor some form of a public insurance option while 40% oppose it. More specifically, 45% of Americans favor current outlines in Congress, and 48% are opposed.
H1N1 influenza
H1N1 influenza--"swine flu"--has finally been confirmed in pigs. The agriculture department confirmed that a pig exhibited at the Minnesota State Fair was infected, and that the infection was unrelated to teenagers there who later became sick. But, three other piglets may have become ill after being handled by humans.
In case you missed it ...
Tufts University School of Medicine in Boston and the State of Maine will offer all Maine-based students half-tuition scholarships for those who agree to clinical practice in rural Maine. The students will spend most of the first two years in Boston studying at Tufts’ main campus, then get immediate hands-on experience traveling around rural locations in the state. Maine used Recovery Act stimulus package funds and private sources for the scholarships and hopes in return to retain 75% of students as doctors after graduation.
Also, Illinois' largest insurer is launching a patient-centered medical home pilot. The Chicago Tribune spells out how it might work.
Labels: H1N1, health care reform, medical education, QD, reimbursement
posted by Ryan DuBosar at
11:46 AM
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Thursday, October 15, 2009
QD: News Every Day--legislative tricks, treat the underserved and banning sick kids ... from hospitals
ACP Internist's daily digest of internal medicine in the news continues with a look at legislative tricks for health legislation, a medical school that sends students into poor neighborhoods as part of their training, and hospitals that are enacting bans on minor visitors to avoid spreading H1N1.
Health care reform
Senates are seeking a bill that increases Medicare fees by $247 billion in the next decade. Because it will raise the deficit, Senators are trying a two-bill approach, a bit of legislative sleight-of-hand, to let them claim that health care reform won't cost more. At stake is a 21% reduction in Medicare reimbursement that was is scheduled to take effect in January.
In another bit of having one's cake while eating it, too, seniors will pay more for Medicare Advantage when costs increase from an average of $32 to $39 per month next year. Insurers are cutting plans that have no premiums--a federal requirement. Also being scrutinized are the free perks meant to entice traditional Medicare patients into private Medicare Advantage policies. But free to patients means paid for by the government--or sometimes hidden as higher co-pays and additional fees.
Investor's Business Daily points out a looming fight between primary care and specialty medicine. Legislation in the Senate gives primary care doctors a 10% bonus if they work in a Health Professional Shortage Area and 60% of their services are primary care. Half of the funding for the bonus comes from across-the-board cuts for specialists, who are refusing support.
Primary care shortage
Federally qualified clinics could treat more than 20 million patients this year, 2 million more than last year, the AP reports. The increase comes at a time that states are cutting their health care budgets.
To serve this need, Florida International University curriculum will send medical students to poor neighborhoods as part of their training. TIME profiles the program (and quotes ACP president Joseph W. Stubbs, FACP in the process.)
Finally, an emergency room doctor wrote an open letter to President Obama, making the points that:
--people without health care head to ER for treatment,
--medical training is expensive and causes primary care shortages, and
--legislators would discuss the space program without involving astrophysicists, so it's time to get doctors involved in health care reform.
These are all familiar points, but the letter is worth a read.
In case you missed it ...
To avoid spreading H1N1 influenza, hospitals have begun banning visitors less than 18 years old. These are children's' hospitals, too. M.D. Anderson followed suit, as well.
Labels: flu, health care reform, medical education, medicare, primary care shortage, QD
posted by Ryan DuBosar at
12:04 PM
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Friday, October 9, 2009
QD: News Every Day on insurance coverage, primary care shortage and H1N1
ACP Internist's daily digest of internal medicine in the news continues with who's covering the uninsured, students weighing in on why they eschew primary care careers, and H1N1's widespread but less lethal path.
Covering the uninsured
While the number of uninsured people rose slightly from 2007 to 2008, more people were covered by government programs as employer-sponsored coverage continued to decline, according to the U.S. Census. The ACP Advocate reports census figures showing that 15% of the population was uninsured in 2008, increasing from 45.7 million to 46.3 million. However, coverage by private plans fell from 67.5% to 66.7% and coverage by employers fell from 59.3% to 58.5%. Government coverage rose from 27.8% to 29%.
Primary care shortage
Medical students weigh in on health reform, and have their doubts. Also, they won't go into primary care. "When it's a difference of $200,000 in your paycheck, it's tough," one student said.
Flu update
The H1N1 pandemic has been more widespread than lethal, notes the Harvard Health Letter. The virus seems to cause fewer cases of serious disease than expected. Harvard experts discussed the latest at a forum, with video posted online. In short, estimates for the death rate for H1N1 range between one death for every 2,000 symptomatic cases and one death for every 14,000 (0.007%). In comparison, the death rate for seasonal flu is roughly one death for every 1,000 to 2,000 cases. Seasonal flu infects roughly 5% to 20% of the population annually, whereas pandemics infect 25% to 40%. This H1N1 epidemic may not rise to pandemic levels.
In case you missed it ...
Doctors drive medical consumption, not patients. Illness and patient preference play a much smaller role. NPR reports on one epidemiologist's lifelong work. Meanwhile, a Newsweek columnist weighs evidence-based medical treatments against clinical judgment. It's the age-old question: How does a study impact treatment of the patient sitting before a doctor, seeking a cure?
Labels: epidemiology, evidence-based medicine, flu, H1N1, health insurance, medical education, primary care shortage, QD
posted by Ryan DuBosar at
12:34 PM
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Wednesday, August 26, 2009
Pinpointing the transition from human to doctor
"When they embark on the journey to become physicians, most students are enthusiastic, filled with idealism and a genuine intention to serve those in need of help," says a new study in Academic Medicine. What happens to them, you wonder? The study authors did too, so they set out to analyze the loss of empathy in a group of medical students.
Turns out empathy takes a big hit during the third year of medical school, when the students start really interacting with patients. And no, it's not just because real patients are more obnoxious and difficult than hypotheticals. Researchers attribute the problem to a number of factors, including a lack of role models, too much to learn, lack of sleep, technology and a focus on the science of medicine. The article suggests several methods for teaching empathy to med students (including keeping them away from the really obnoxious patients) and calls on medical educators to take action.
"Most of us in medical education advocate empathy, but the effect of simply advocating empathy without embracing it and living with it, and without implementing targeted programs to enhance it, is analogous to singing a lovely song only in one's own mind without others ever enjoying it!"
Labels: medical education
posted by Stacey Butterfield at
6:00 PM
1 Comments
Wednesday, June 24, 2009
One more thing to learn
As part of ACP Internist's standard profile feature, we ask physicians "What's one thing you wish you had learned in medical school?" Their answers are usually something about communicating with patients or accepting people's inability to change.
But an article on Slate.com makes the argument that what's missing from medical education is health policy. The authors report on how some schools are trying change the system, so that students actually know what a "third-party payer" is by the time they graduate.
The article may exaggerate students' ignorance a little. I've certainly seen a lot of med students/policy activists at ACP's Leadership Day. But spreading the knowledge more widely sounds like a good thing. Only one problem: what classes will these health policy lessons replace? Maybe, to be more useful, we should rephrase our profile question. What do you wish you hadn't learned in med school?
Labels: health policy, medical education
posted by Stacey Butterfield at
3:20 PM
0 Comments
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
posted by Stacey Butterfield at
3:18 PM
0 Comments
Friday, December 5, 2008
Internship years often trigger depression
Recent research involving medical students in Brazil suggests that professors should be alert to signs of suicidal thoughts during the internship years, when students appear mostly likely to suffer from depression.
In the study of 481 students, depression scores were highest in the "affective" (sadness, dissatisfaction, episodes of crying, irritability and social withdrawal) and "cognitive" (pessimism, sense of failure or guilt, expectation of punishment, dislike of self, suicidal ideation, indecisiveness and change in body image) clusters during the internship years. The latter symptoms, researchers noted, were likely linked to fear about entering the hospital environment. One thing that seemed to alleviate symptoms: having a physician parent who had already been through the internship process.
According to one of the researchers, “Frequently pre-internship students fear they ‘know nothing’, and are insecure about the physical examination of other people.”
Labels: depression, medical education
posted by Janet Colwell at
9:00 AM
0 Comments
Friday, November 21, 2008
Drinking and doctoring
In conjunction with a conference on doctors' health, the new issue of BMJ assesses phyisicians' (sometimes problematic) relationships with alcohol.
Two studies assessed the results of physician-specific substance abuse treatment programs in the U.S. and Canada and concluded that they were fairly successful, since 75% and 85% of the participating docs, respectively, were practicing and staying clean at 5 years. Less happily, the U.S. study found that physicians who didn't complete their treatment programs were much more likely to die (with 6 of the 22 in-treatment deaths caused by suicide) or lose their licenses.
Another study in the issue looked at the potential roots of these substance abuse problems, by analyzing the drinking habits of med students. Although they drink less than their nonmedical peers, U.S. students do find time to knock them back--24% of female and 43% of male students reported excessive drinking in the past month (random fact: non-primary-care-track students drank more than future PCPs).
Why does it matter? The students' habits could have effects on public health as well, the study found. Not surprisingly, the drinkers weren't eager to throw stones in their glass houses and were less likely than non-imbibers to counsel patients about alcohol use. Despite the findings, study authors were pretty moderate in their recommended actions: "Medical schools should consider...discouraging excessive drinking," they concluded. Better get that keg out of the lab.
Labels: alcoholism, medical education
posted by Stacey Butterfield at
9:47 AM
0 Comments
Thursday, October 16, 2008
Texts teach anatomy of white males
It's a man's world...at least on the shelves of medical libraries, according to researchers who reported that, "Images of white men predominate in western anatomy textbooks, which present them as a 'universal model' of the human being."
Researchers looked at 16,329 images from 12 manuals currently recommended by universities in Europe, the U.S. and Canada, so it was no small sample. Nine of the 12 manuals used Caucausian images exclusively to illustrate anatomical concepts. So much for diversity.
Labels: medical education
posted by Janet Colwell at
12:42 PM
0 Comments
ACP Internist hosted Grand Rounds on June 16, wrapping up the best of the medical blogosphere. Click here for the complete wrap-up.
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Previous Posts
- QD: News Every Day--waiting for the weekend
- QD: News Every Day--health care reform's eerie rep...
- Which patients sue for malpractice?
- Ties that bind, and make you gag
- QD: News Every Day--health care reform's 'sunshine...
- QD: News Every Day--health care reform splits urba...
- QD: News Every Day--the public option as a Straw M...
- The story of two little pigs
- Medical news of the obvious
- The vaccine that went away.
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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.
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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.
