Interesting stuff. Turns out that patients treated by International Medical Graduates (They have apparently cleaned up the terminology from “FMG’s,” Foreign Medical Graduates, that we used to condescendingly call these practitioners when I was working in a hospital system) have outcomes as good as those treated by physicians trained in U.S. medical schools.
Demonstrating what? Remember that there is a selection process at work here. Likely (hopefully!) we get only the cream of the IMG crop, while we are “stuck” with all of the doctors that we graduate on our own shores. Regardless, if you are hospitalized in the U.S., you shouldn’t spend a lot of time worrying about where your physician was trained.
Bottom Line. Like you, I have been reading a gazillion articles about the impact that Trump’s travel ban will have on U.S. healthcare. This BMJ article suggests that the travel ban is likely to deny us the services of some very good doctors!
And so it goes!!!
Check out blog post. In it you will find the case being emphatically made that healthcare workers have at least as much of a responsibility to be appropriately dressed as does any other profession. Maybe more.
Why? In order to provide comfort to patients, for one thing. The example of those in pediatric practice was specifically called out in this regard. Uniforms for such professionals might most appropriately be designed in light and airy fashion so as to show the young patients that these team members are non-threatening.
More generally, showing that a professional is actually a bona fide member of the medical team is worthwhile in and of itself in terms not only of providing patient comfort, but also helping to assist in security measures in these dangerous times.
Bottom Line. Scary that someone actually feels that they have to post a blog on this topic. But there are probably enough offenders that it is worthwhile. Welcome to 2016!
We have talked before about various forms of quackery. Chiropractic, Naturopathy, etc. But here is a fascinating spin. It’s an article by a renowned (?) chiropractor that explores how to make his profession more like medicine and less like quackery. Radical ideas like not performing services that aren’t needed, pulling back on bogus ideas like “lifetime chiropractic care” and actually basing treatment on research.
Bottom Line. Having thought about all of this for a while, I have concluded that if chiropractic were to do all of these things, it would no longer be chiropractic. Rather, it would close in on already existing fields like orthopedics and physical therapy.
Do I think that chiropractors will actually make the changes recommended to move away from quackery and toward legitimate medical practice?
In the wake of Orlando, we have heard many things. We have heard the predictable call for gun control. We have heard the event used for political leverage by both of the “presumptive” candidates for the presidency. Etc.
What I haven’t heard much of, however, are insights concerning the up close and personal, emotional ramifications of this event for the ER physicians who had to deal with its aftermath. Sure, ER doctors have to be tough. Wimps don’t pick that specialty. BUT. When presented with the carnage described in this post, even the most seasoned trauma surgeon is likely to be physically and emotionally overwhelmed.
Bottom Line. Just think about it for a moment. We often forget that physicians are people too. I’m thinking that the impact of this event on those who treated the injured of Pulse is likely to remain long after the event’s newsworthy elements have faded into the distant past.
Yup! Underserved populations. That is the way many professions, e.g., Physician Assistants and Nurse Practitioners, got their initial traction. And the way in which many scope-of-practice turf wars developed as a result.
Check out this article. It seems that “American Indians” are having a difficult time getting dentists to serve their communities. So, they are turning to a reliance on “Dental Therapists” to perform “simple procedures” such as fillings and extractions.
BUT. Not so fast, says the American Dental Association. Fillings and extractions are surgical procedures, and there is a real danger to patients in having someone without appropriate training, i.e. Dental School, doing this work.
Problem is, most state laws (e.g., Washington, where the tribe discussed here lives) don’t recognize dental therapists, thus blocking payments for their services. By way of response, the Native Americans are declaring “tribal sovereignty,” and forging ahead with their dental therapist program anyway.
Bottom Line. This is just another chapter in the scope-of-practice turf wars we have previously discussed. But, because of the tribal sovereignty spin, an interesting one nonetheless. Will Indian scouts (sorry!) be the ones to demonstrate that you don’t need four years of dental school to provide basic dental care safely, and thus provide legitimacy to a new dental therapist profession?
We shall see!
Nice photograph above, right. All kinds of natural stuff. Organic. Good for you.
BUT. These are NOT substances that should be trotted out as medications in an emergency. You probably knew that, right?
But check out this discussion of a question on the examination one takes to become a Naturopath. Yikes! A kid whose life might well be in danger is going to be “treated” by somebody who has never even seen such a kid in training? Give me a break!
Bottom Line. Just for giggles, I Googled Naturopath to see whether we have any on Hilton Head Island. In response, I got a list of Acupuncturists, Chiropractors and Lord knows what else. All apparently licensed in, and by, the State of South Carolina.
I remain in awe that in our theoretically civilized country in 2016, regulators still allow this kind of nonsense to be perpetrated on our citizens. WHY???
OK, I admit it. I look at this recent pronouncement by the AAP, i.e., that every school should have a school nurse, against the backdrop of the stories my wife has told me about her 17 years as a school RN. Three things have become quite clear to me as the result of listening to Casey’s stories.
First, school nurses do not sit in the health room all day waiting to treat boo-boo’s resulting from kids falling on asphalt playgrounds. Especially with the mainstreaming of kids with all kinds of disabilities, chronic medical conditions and allergies, there is plenty of serious (read life-or-death) medical care that they need to provide on a day-to-day basis.
Second, the RN in the school setting has nobody else to rely on to assist in making an important medical decision. She can’t run down the hall to ask another medical professional, since typically there isn’t one.
Finally, take a guess who handles such medical issues if there isn’t a school nurse on site. The Principal or other administrative staff.
Bottom Line. The AAP has finally endorsed the notion that there should be an RN in every school. Period. Read the linked article, and see if you don’t strongly agree.
As a matter of policy, my wife and I make it a habit to take any serious medical problems “up the road” to the Medical University of South Carolina in Charleston. The two-hour drive takes us to a campus that has “top docs” in every field, arrayed in huge buildings as far as the eye can see. It is THE teaching hospital in South Carolina, and the care we have received there has been nothing short of excellent.
BUT, teaching hospitals have students, and I must admit that when signing authorization forms prior to our surgeries, I have flinched a little at the statement in bold print that says I acknowledge that this IS a teaching hospital. I always understood that this meant that residents might well be involved in my care, and this caused me some pause. I didn’t know what to do or to say about my concerns in this regard, however, so I just kept my mouth shut.
This blog, penned by a surgical resident, shows that I was apparently not the first patient to have such concerns, nor was I the first person to think that residents should train by working on someone else. You know, the people with no money and no insurance.
Bottom Line. The blogging resident makes an entirely cogent argument, supported by data, that a patient is actually BETTER off when the surgical team includes a resident than when it doesn’t. The bad news is that I feel a little Archie Bunker-ish about my previous concerns and my reactions to them. The good news is that I won’t have these concerns anymore when I visit MUSC!
Don’t spend too much time thinking about this. It will only give you a headache. BUT. There is an important and surprising issue unveiled in this blog post from a Hospitalist. More specifically, it seems that his specialty now includes NP’s, PA’s and others who practice in the hospital in their definition of “Hospitalist.” That’s right, not just docs!
Read down quickly to the end of the article, where the blogger asks if other specialties will follow suit. Will an NP who has practiced on a cardiology unit for 3 years, he asks (tongue in cheek???) become known as a “Cardiologist?”
Bottom Line. While much has been written, here and elsewhere, about giving non-physician practitioners appropriate respect, I am somehow thinking that initiatives like this one are likely to cause significant amounts of confusion in the minds of patients and others.
See, I told you this would give you a headache!
What happens when a subject in a clinical trial dies, regardless of cause? Obviously, nothing good!
Not so obvious is the impact that such an isolated, and possibly causally unrelated, event can have on the value of the stock of the sponsoring company, especially if it is a start up with all of its eggs in one product basket. While scientists working on drug development must have a long time line, investors in speculative stocks typically make quick decisions and act on them immediately. Check out this podcast to get a better understanding of this disparity in time lines.
Bottom Line. It’s unfortunate that snap decisions on Wall Street can derail promising drug development programs. BUT. Disparities in time lines and other expectations are essential to understand for everyone involved. Such differences in perspective are, after all, sort of inherent, and not likely to be eliminated in the near future.