The joy has been sucked out of medicine. Here’s why.

November 27th, 2015 by admin

She came to the urgent care center with a sprained ankle. The primary care provider gave her excellent care, expertly applying evidence-based evaluation guidelines to her situation, and, thereby, avoiding unnecessary x-rays. By all measures, the provider’s care was excellent, but the interaction still ended up reducing his salary. You see, that patient’s only medical interaction that year was for this ankle sprain, and the provider was therefore held accountable for all of her primary care needs. Since she had not received a mammogram that year, or received a diabetes screening, he incurred an end-of-the-year penalty for failing to meet these quality standards.

Is it any wonder that many providers — primary care physicians, physician assistants, and even many beleaguered specialists — are increasingly dissatisfied with their jobs? What is happening to medical practice and what can we do to bring the joy back to being a health care provider?

am early into a one-year quest to connect with leading thinkers from inside and outside medical care, so I can better understand why many clinicians are miserable in their careers, and much more importantly, what can be done to help them thrive at work even though an increasing number of outside parties are looking over their shoulder, assessing the quality of the care they provide.

These increasingly burdensome rules and regulations are making it hard to enjoy medical practice these days. Several decades ago, physicians largely practiced as autonomous professionals, governed by standards developed by their professional peers. Physicians underwent intense and prolonged training to develop the knowledge and skills to know how best to help patients with their problems. And the world generally stood back and accepted, on faith, that most physicians would provide excellent care to most of their patients.

Click here to read all of this article originally posted on KevinMD.com

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Many People Who Think They Are ‪Allergic‬ To ‪Penicillin‬ May Safely Take It

November 7th, 2015 by admin

By Julienne Roman,

Researchers found that most people who are told that they are allergic to penicillin were mistakenly diagnosed as such based on initial reactions instead of a confirmatory test.

This mistaken perception led many to opt for more dangerous antibiotics and other treatments for their infections. Researchers pointed out that the patients who were thought to be penicillin-allergic had to take other antibiotics that put them at greater risk for acquiring complications such as colitis and the development of more antibiotic-resistant strains.

Study authors therefore stress the need to specifically test for penicillin allergy on suspected patients.

“Anyone who has been told they are penicillin allergic, but who hasn’t been tested by an allergist, should be tested,”said Dr. David Khan from the University of Texas Southwestern Medical Center.

He added that if patients are determined to be allergic, doctors will be able to determine which treatment options are most suited with the full confidence that it is the best course of action for the patient. But if the tests turned negative, then the patient will be able to take a drug that is just as effective as most antibiotics while being safer and more cost-effective.

Researchers studied data from patients who were reportedly allergic to penicillin but when tested were actually found to be negative. The team later found that the patients could be treated safely with the mentioned antibiotic even through intravenous injection.

“There is often thought to be a higher risk in patients who get intravenous penicillin, but we did not find this to be the case,” Khan added.

The misconception often stems from wrongly interpreting symptoms that manifest after taking the drug as signs of an allergic reaction. This mistake happens about 90 percent of the time among patients.

Penicillin side effects that include nausea and vomiting, mild diarrhea or headache commonly occur while taking the drug but do not herald an allergic reaction or are considered dangerous enough to halt continued taking of the drug.

Ever since its discovery, penicillin still remains a popular antibiotic because of its effectiveness and relatively low level of toxicity on healthy human cells. It comes in several different, non-interchangeable forms, and each one is often used to treat different infections.

However, there are people who are allergic to the drug, and people who report developing a rash, itching or difficulty of breathing while using the drug are advised to report these findings to a physician for a confirmatory test.

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Members of Congress Put Costly Drugs in Their Crosshairs

November 7th, 2015 by admin
  • by Shannon Firth

WASHINGTON — Prescription drug prices are getting more attention on Capitol Hill, with two senators from opposite sides of the aisle announcing plans to investigate while House Democrats declared they were forming a task force on the issue as well.

Sen. Claire McCaskill (D-Mo.) and Sen. Susan Collins (R-Maine) this week announced a bipartisan probe into drug costs, according to a press release from McCaskill’s office. The senators are requesting drug pricing information from four companies whose products’ prices have recently spiked: Valeant Pharmaceuticals, Turing Pharmaceuticals, Retrophin, and Rodelis Therapeutics.

“We need to get to the bottom of why we’re seeing huge spikes in drug prices that seemingly have no relationship to research and development costs,” McCaskill said, in the statement.

According to the release, the investigation will look into:

  • “Substantial price increases on recently acquired off-patent drugs”
  • “Mergers and acquisitions within the pharmaceutical industry that have led to dramatic increases in off-patent drug prices”
  • “The FDA’s role in the drug approval process for generic drugs, the agency’s distribution protocols, and, if necessary, its off-label regulatory regime”

The Senate Special Committee on Aging has scheduled an initial hearing on this issue for Dec. 9.

At a press briefing on Wednesday, Rep. Lloyd Doggett (D-Texas) announced the formation of the “Affordable Drug Pricing Task Force.”

House representatives said they hope to advance legislation that would enable Health and Human Services Secretary Sylvia Burwell to negotiate Medicare prices and to force drug companies to be transparent about the cost of making their products.

Doggett cited the now infamous example of Turing Pharmaceutical’s Daraprim (pyrimethamine), a drug for treating infections common in patients with cancer and AIDS. After the company acquired the drug 3 months ago, the price went from $13.50 to $750 per tablet. On Tuesday, the company said it would lower the price by the end of the year, but did not say by how much.

“But exorbitant drug prices are not about one wrongdoing, or one drug, or one class of drugs; they are a systemic problem that involve a wide range of manufacturers,” said Doggett while standing at a podium flanked by posters of Turing’s CEO Martin Shkrelivilified by the media for his tone-deaf comment that his actions would benefit society — and Michael Pearson, CEO of Valeant Pharmaceuticals.

Click here to read the rest of this article

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It’s important to have folic acid in your system during early stages of pregnancy when your baby’s brain and spinal cord are developing

February 16th, 2015 by admin

Folic acid is a pregnancy superhero!

Taking a prenatal vitamin with the recommended 400 micrograms (mcg) of folic acid before and during pregnancy can help prevent birth defects of your baby’s brain and spinal cord. Take it every day and go ahead and have a bowl of fortified cereal, too.

What Is Folic Acid?

Folic acid, which is also called folate, is a B vitamin. The best food sources of folic acid are fortified cereals. Folic acid plays an important role in the production of red blood cells and helps your baby’s neural tube develop into her brain and spinal cord.

When Should I Start Taking Folic Acid?

Birth defects occur within the first 3-4 weeks of pregnancy. So it’s important to have folic acid in your system during those early stages when your baby’s brain and spinal cord are developing.

If you talked to your doctor when you were trying to conceive, she probably told you to start taking a prenatal vitamin with folic acid. One study showed that women who took folic acid for at least a year before getting pregnant cut their chances of delivering early by 50% or more.

The CDC recommends that you start taking folic acid every day for at least a month before you become pregnant, and every day while you are pregnant. However, the CDC also recommends that all women of childbearing age take folic acid every day. So you’d be fine to start taking it even earlier.

If you picked out your own prenatal vitamin, take it to your OB once you’re pregnant to make sure it has the recommended amounts of everything you need, including folic acid. All prenatal vitamins are not the same and some may have less or more of the vitamins and minerals you need. For new parents go to babyidesign.com best baby carriers, to find the best carrier that will help support the babies body.

Click here to read the rest of this article and to see how much folic acid you should take

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Understanding the role of pharmacists

January 23rd, 2014 by admin

Pharmacist Amy Schiveley talks with a customer at Lakeview Pharmacy

If your recent flu vaccine was administered at a pharmacy, you have already sampled the expanded role that pharmacists play in our health care today.

A flu shot, though, is just one of many patient-care services pharmacies across the country offer beyond filling prescriptions. From blood pressure tracking to Medication Therapy Management counseling, today’s pharmacists can be a resource for a wide range of information and advice.

In a Medication Therapy Management session, pharmacists can sit down with a customer and go through all of their medications, find out what is working and what’s not, review the purpose of each medication, explain how they work and more, according to Amy Schiveley, managing pharmacist at Lakeview Pharmacy, 516 Monument Square.

Pharmacists already provide some consultation when a customer picks up a prescription, Schiveley said, but MTM sessions take a more in-depth look at the entire medicine profile — including over-the-counter products and supplements — and help the patient better understand what they are taking, why they are taking it and how to take it.

“We go through all of it with a fine-toothed comb,” Shiveley said.

Pharmacists can also help patients understand the risks versus benefits of each medication; explore ways to reduce costs; and work with physicians and insurance companies to figure out what medication options are best for each person, she said.

Click here to read the rest of this article

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Congressman and Medical Doctor Phil Roe Presents An Outstanding Obamacare Alternative

November 13th, 2013 by admin

Family Research Council discussion of the Republican Study Committee’s alternative to the Affordable Care Act, known as “Obamacare.”

Dr. Phil Roe, the Congressman representing Tennessee’s First Congressional District, will present an overview and answer questions about the RSC’s patient-centered and free market alternative, the American Health Care Reform Act. More information about RSC’s bill can be found here. Because of the federal government’s expansive role in structuring health care’s cost and coverage, this important discussion is relevant to all Americans. Dr. Roe has a valuable perspective as a medical doctor who understands the challenges facing America’s health system today.

Congressman Phil Roe represents the First Congressional District of Tennessee. A native of Tennessee, Phil was born on July 21, 1945 in Clarksville. He earned a degree in Biology with a minor in Chemistry from Austin Peay State University in 1967 and went on and to earn his Medical Degree from the University of Tennessee in 1970. Upon graduation, he served two years in the United States Army Medical Corps. Congressman Roe serves on two Committees, Education and the Workforce, and Veterans’ Affairs, that allow him to address and influence the many issues that are important to the First District students, teachers, veterans and workers.

Click here to watch this presentation on YouTube >>> Congressman Phil Roe: An Obamacare Alternative

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A photo essay: Is it Melanoma?

July 16th, 2013 by admin

A 47-year-old woman with a history of non-melanoma skin cancer presented for a total body skin check. During the examination, a 5 × 3-mm pigmented macule was noted on the anteromedial aspect of the right foreleg. Most important, the asymptomatic lesion had a small spot of eccentric darker pigmentation. The patient was unaware of the questionable growth. This type of eccentric pigmentation strongly suggests malignant melanoma. Since the lesion was so small, it was excised with 5-mm margins. Histology demonstrated malignant melanoma in situ.

Click on the picture above to see a ConsultantLive slide show with a total of 6 photos of potential melanomas.

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Psoriasis and Look-alikes—A Photo Essay

June 19th, 2013 by admin

Click on this picture for a slide show of photos and descriptions of psoriasis and look-alikes

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Understanding Melanoma In Situ (Stage 0)

June 7th, 2012 by admin

Learn about the symptoms, treatment, and prognosis for melanoma in situ, the earliest stage of melanoma.

.By Diana Rodriguez

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With regular and thorough examinations of your skin, you can increase your changes of catching any abnormalities very early — which is good news in terms of treatment and prognosis if that abnormality turns out to be a malignant melanoma. In fact, experts now recommend that men and women of all ages check their skin frequently to increase their odds of spotting potential malignant mole at the earliest possible point: stage 0, or melanoma in situ.

What Is Melanoma In Situ?
Melanoma in situ comes from the Latin phrase “in situ,” which means “in place.” Melanoma in situ is cancer in the very early stages, when it affects only the top layer of the skin. At this point, the cancer has not spread deeper into the body. Cancer diagnosed at this early stage also means that it is less likely to recur or spread to other parts of the body than melanomas that are diagnosed at a later stage.

The very first symptoms of melanoma are any abnormalities in one or more moles on the skin. Abnormalities include moles with anyAsymmetry, uneven Borders, different Colors, large Diameter, orEvolution (any change). That’s why learning the ABCDEs of melanoma and checking yourself regularly are so important. If you see anything different about any of your moles, it could be a sign of melanoma in situ. The best course is to report any changes that you see to your doctor and schedule an exam to rule out melanoma, or to catch and treat it early.

How Is Melanoma In Situ Treated?
The treatment for melanoma in situ is usually fairly simple. In a doctor’s office, an outpatient procedure can be performed in which the melanoma is cut out of the skin, a process that medical personnel call resecting or excising.

“The treatment option for early stage melanoma is a wide excision procedure,” says Bruce A. Brod, MD, a clinical associate professor of dermatology at the University of Pennsylvania School of Medicine. “The key prognostic feature in melanoma is the thickness [in millimeters] of the melanoma, which is based on the initial biopsy of the lesion.”

How much skin needs to be cut out depends, then, on the biopsy results. “The consensus for treatment of melanoma in situ is to remove a half-centimeter diameter around the lesion or the initial biopsy site,” Dr. Brod says. “The consensus for treating melanomas less than 2 millimeters in thickness is to remove a 1-centimeter diameter, if possible, around the lesion.”

If the melanoma is larger in size, more skin may need to be removed, and a biopsy performed. “In melanomas greater than 2 millimeters [in thickness], the consensus is to excise a 2-centimeter diameter area around the lesion,” he says. “Since melanoma can spread to the lymph nodes in close proximity to the initial melanoma, a biopsy of lymph nodes is sometimes performed for melanoma close to or greater than 1 millimeter in thickness at the time of the wide excision procedure.”

Following Up on Melanoma in Situ
The good news? People who are diagnosed with melanoma in situ and receive early treatment have a great survival rate — 100 percent at 5 and 10 years. And everyone with melanoma in situ, including those diagnosed at an early stage, should check in with their doctors frequently to be certain that the cancer has not returned. Patients should have a complete physical and skin exam every six months for a year or two after their initial diagnosis, and typically once each year for several years after that.

“When melanoma is found early, it is easily cured with simple outpatient surgery,” says Catherine Poole, president and co-founder of the Melanoma International Foundation. “When found in later stages, it may become life-threatening, and there are few effective therapies to treat metastasized melanoma.”

Some good advice for healthy, cancer-free skin: Protect your skin at all times. “The most effective sun protection is to wear protective clothing, a broad-rimmed hat, seek shade, avoid being in the sun during the prime-time solar hours of 10 to 4, and use sunscreen as an adjunct to these behaviors,” says Poole.

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Note *

A couple of weeks ago an ugly mole was removed from my stomach. After the biopsy results came back Doctor Rowe said that it was confirmed to be ‘Melanoma In Situ.’
Got it early enough that it shouldn’t be serious. I Praise God and thank the Veterans Administration!

Going back for one more minor surgery as a precautionary move. — Bob Diamond

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Odds of quitting smoking are affected by genetics

May 30th, 2012 by admin

NIH-funded research shows genetics can predict success of smoking cessation and need for medications

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Genetics can help determine whether a person is likely to quit smoking on his or her own or need medication to improve the chances of success, according to research published in today’s American Journal of Psychiatry. Researchers say the study moves health care providers a step closer to one day providing more individualized treatment plans to help patients quit smoking.

The study was supported by multiple components of the National Institutes of Health, including the National Institute on Drug Abuse (NIDA), the National Human Genome Research Institute, the National Cancer Institute, and the Clinical and Translational Science Awards program, administered by the National Center for Advancing Translational Sciences.

“This study builds on our knowledge of genetic vulnerability to nicotine dependence, and will help us tailor smoking cessation strategies accordingly,” said NIDA Director Nora D. Volkow, M.D. “It also highlights the potential value of genetic screening in helping to identify individuals early on and reduce their risk for tobacco addiction and its related negative health consequences.”

Researchers focused on specific variations in a cluster of nicotinic receptor genes, CHRNA5-CHRNA3-CHRNB4, which prior studies have shown contribute to nicotine dependence and heavy smoking. Using data obtained from a previous study supported by the National Heart Lung and Blood Institute, researchers showed that individuals carrying the high-risk form of this gene cluster reported a 2-year delay in the median quit age compared to those with the low-risk genes.  This delay was attributable to a pattern of heavier smoking among those with the high risk gene cluster. The researchers then conducted a clinical trial, which confirmed that persons with the high-risk genes were more likely to fail in their quit attempts compared to those with the low-risk genes when treated with placebo. However, medications approved for nicotine cessation (such as nicotine replacement therapies or bupropion) increased the likelihood of abstinence in the high risk groups. Those with the highest risk had a three-fold increase in their odds of being abstinent at the end of active treatment compared to placebo, indicating that these medications may be particularly beneficial for this population.

“We found that the effects of smoking cessation medications depend on a person’s genes,” said first author Li-Shiun Chen, M.D., of the Washington University School of Medicine, St. Louis. “If smokers have the risk genes, they don’t quit easily on their own and will benefit greatly from the medications. If smokers don’t have the risk genes, they are likely to quit successfully without the help of medications such as nicotine replacement or bupropion.”

According to the Centers for Disease Control and Prevention, tobacco use is the single most preventable cause of disease, disability, and death in the United States. Smoking or exposure to secondhand smoke results in more than 440,000 preventable deaths each year — about 1 in 5 U.S. deaths overall. Another 8.6 million live with a serious illness caused by smoking. Despite these well-documented health costs, over 46 million U.S. adults continue to smoke cigarettes.

The study can be found at: http://ajp.psychiatryonline.org/article.aspx?articleID=1169679. For information on tobacco addiction, go to: www.drugabuse.gov/drugs-abuse/tobacco-addiction-nicotine. For more information on tools and resources to help quit smoking, go to: www.smokefree.gov/.

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