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Closest Thing to a Wonder Drug? Print E-mail
Written by Aaron Carroll, MD, MS   
Monday, 20 June 2016 00:00

After I wrote last year that diet, not exercise, was the key to weight loss, I was troubled by how some readers took this to mean that exercise therefore had no value.
Nothing could be further from the truth. Of all the things we as physicians can recommend for health, few provide as much benefit as physical activity.
In 2015, the Academy of Medical Royal Colleges put out a report calling exercise a "miracle cure." This isn't a conclusion based simply on some cohort or case-control studies. There are many, many randomized controlled trials. A huge meta-analysis examined the effect of exercise therapy on outcomes in people with chronic diseases.
Let's start with musculoskeletal diseases.

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Last Updated on Friday, 24 June 2016 13:07
Big Pharma's Sleight of Hand Print E-mail
Written by FHI's Week in Review   
Tuesday, 14 June 2016 17:20

MD Whistleblower writes on June 12, 2016:

The promotional material that pharmaceutical representatives present to doctors is riddled with soft deception. A favorite from their bag of tricks is to rely upon relative value rather than absolute value.

The author concludes: 

Like all skilled magicians, these guys are expert at distraction and sleight of hand. Hint: Whenever you hear the word 'percent', as in "35% of patients responded...", you should pay particular attention...I've taken you behind the curtain here. Let's make it a fair fight between us and illusionists.

Read more in the current issue of Week in Review>>

Last Updated on Saturday, 09 July 2016 16:11
The Story of a Man Who Did Not Feel Well Print E-mail
Written by Mark E. Williams, MD | KevinMD   
Thursday, 09 June 2016 00:00

Once upon a time, not that long ago, there was man who lived an uncomplicated life. One morning he awoke and did not feel well. He could not really describe his malaise, but he definitely was not his usual self. Nothing particularly noteworthy had happened to him except that his dog had recently died of old age. William, a scruffy little terrier, was 17 years old, and the man knew for a long time that he was slowly sliding downhill. He was blind and limped, and his death was certainly not a surprise. Anyway, that was weeks ago.
The man continued to feel ill and after a while, he decided that he should seek some medical attention. He did not have a primary physician because he had never really been sick, took no prescription medications and no particular diseases ran in his family. He did not smoke and felt that his lifestyle was basically healthy. Sometimes he would enjoy a beer (or two) when he watched sports on television.
He called a clinic associated with a large regional medical center. A pre-recorded voice said that if he was having an emergency, he should hang up and dial "911." He did not think his condition was that urgent and he waited and was told to listen carefully since the options had changed. He was impressed that people memorized the options and figured out that option 3 was for him to schedule a new visit.

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Last Updated on Friday, 10 June 2016 17:13
When It Comes to Your Healthcare, Buyer Beware Print E-mail
Written by Michael P. Jones, MD | KevinMD   
Tuesday, 07 June 2016 17:12

...I received a call from a patient on whom I had performed an upper endoscopy to remove a small gastric polyp. Because removing stomach polyps can be complicated by bleeding, I did the procedure in the hospital rather than an outpatient center. The whole thing took 15 minutes. Anesthesia wasn't required, just routine conscious sedation. So, my patient wanted to know, what had I done that warranted an $18,000 bill from the hospital?

I had absolutely no explanation. For $18,000, you can just about buy your own endoscope. Amortized costs for an upper endoscopy at this hospital, including the use of the endoscopy unit, salaries for the whole staff, medication, and equipment expenses is probably not more than $200 for 15 minutes. By the way, the doctor doing the procedure - in that case, me - typically gets about $175 for an upper endoscopy.

And then there are the costly procedures you could probably do without.

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Last Updated on Wednesday, 06 July 2016 10:47
Thinking of starting a cash-based practice? Here are the pros and cons. Print E-mail
Written by Ashley Maltz, MD, MPH | KevinMD   
Thursday, 02 June 2016 00:00

As an integrative medicine physician, I am often questioned about what I do and how I decided to diverge from the normalcy of allopathic medicine. I usually go into a short spiel about my love for thinking outside the box and creating solutions for patients that seek a kinder, gentler style of medicine; one that blends effective healing modalities from all over the globe with my traditional allopathic training.
Most people enjoy this explanation and inquire more into my practice. Others shy away. But the most frequent question I get after this explanation is if I take insurance in practice. The answer is a resounding "no."

Do I not take insurance because I'm a mean and vengeful physician? As it is, families pay an exorbitant amount of money for health insurance with the added load of high deductibles straining their budgets.
I get this as, I too, am a consumer of health insurance and know first hand that it is not cheap!

However, what the masses may not understand about being a physician is the hefty price doctors who take insurance pay.

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Intricacies of Antidepressant Interactions Print E-mail
Written by FHI's Week in Review   
Monday, 30 May 2016 00:00

Once upon a time there were jokes circulating about putting Prozac (fluoxetine) in the drinking water.
The idea was that the modern antidepressants were indicated for most people living in today's society, and that these drugs were completely safe to use.
Now, these same drugs have so many warnings that they have become increasingly difficult to use in treating the common maladies of depression and anxiety.

Read more in  the current issue of Week in Review>>

Last Updated on Friday, 17 June 2016 12:03
EMRs, PCMH and OCD are Limiting Access to Care Print E-mail
Written by A Country Doctor Writes   
Thursday, 19 May 2016 00:00

We have a problem in our clinic.

Between our EMR implementation a few years ago and our PCMH recognition shortly after that, our office visit documentation has become bloated and our cycle time has almost doubled.

There are no brief visits anymore, since every visit entails screening for multiple psychosocial conditions and consideration of various immunization and health maintenance reminders.

Nobody sees over thirty patients a day anymore; we're lucky to exceed twenty.

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