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Where Do The BEST Doctors Come From?

February 17, 2017




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!!!

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Big Bellies Are Big Business

February 14, 2017


Big Bellies

Let’s note in passing a few simple facts. First, despite myriad public health efforts designed to get people to control their weight, obesity is a problem that is rapidly growing (pun intended) in the U.S.

Second, it has become painfully clear that traditional medical practices do a lousy job of treating obesity.

Third, it has also been demonstrated that bariatric surgery is the only method shown to provide long term success in many obese patients.

Put those facts together and ask why no one has opened a retail clinic specializing in bariatric surgery.

Now they have. As reported in this article, Novant Health has just opened such a clinic in North Carolina.

Bottom Line. Will such clinics start to pop up in other cities? As usual, folks, it will come down to insurance reimbursement. This business idea only makes sense if insurers will cover what will likely become a higher incidence of bariatric surgery if such clinics become common!

We shall see!

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Pharmacist Or Psychiatrist, or Both???

January 20, 2017



Somebody is going to different chain pharmacies than I am.  Check this out. I get part of what is being said in this article. Mental health is a good place to apply digital and telehealth technologies. That sounds right. What gets me confused is the role that Walgreens anticipates their pharmacists playing in the mental health screening, compliance, etc. activities. See, when I go into one of these pharmacies, the pharmacists are racing like crazy to fill prescriptions and have only minimal time to interact with patients. How they are going to find the time to play the other roles related to mental health still has me a little confused.

Bottom Line. The underlying premise here is correct. The incidence of mental health problems in the U.S. is high, and many of the needs of these patients are unmet by the current healthcare system. I believe that it is genuinely good news that Walgreens is exploring alternative delivery modalities that can encompass a larger percentage of the population. I hope this works!


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Doctors And Obesity

November 16, 2016



There is no doubt that obesity is a major health problem in the U.S. Let’s just stipulate that fact, not review the myriad data that speak to this issue, and move right along to the question as to what physicians should be doing about it.

Check this out. In this piece, a physician reveals that despite an obvious awareness of the risks of obesity for her patients, she has decided to stop trying to get them to lose weight.


Here’s her reasoning, based on experience. There is already a strong culture of weight loss miracle products, many of which contain speed. Coming down on patients about their weight, she has found, often actually sends patients out into this marketplace. Results? Little or no weight loss and the potential for side effects.

Counseling? Simply talking to patients about weight loss, this physician believes, is tantamount to telling them to keep doing what they have been doing for the past 10 years, only try harder. Likely to work? Nah!

And so forth. Genetics, demographics and myriad other factors make the waters even muddier here.

Bottom Line. While this doctor obviously believes that obesity is a significant health problem, she has decided that, according to the medical principle of “first, do no harm,” she should not inveigle herself into patients’ weight loss efforts unless and until she has something in her armamentarium to bring to the party. 

Unfortunate? Absolutely! Understandable and maybe even laudable? That too!

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Chemo Yes, Flu Shot No!?!?!

November 8, 2016

1 Comment

Sunrise Rounds

Fascinating post by our blogging Oncologist. Seems that it is often easier for him to talk a patient into receiving chemotherapy, even after a horrific explanation of likely and potential side effects, than it is to get a patient to take a relatively benign and safe flu shot. This despite the fact that influenza is often a killer of patients undergoing treatment for cancer.

How can this be? How indeed! The blogger certainly hasn’t figured out the answer.

Bottom Line. Think about this for a moment. What can this crazy example teach us about working with patients to get them to take rational approaches to their own healthcare?


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Does Safer Porn Yield Safer Sex???

November 3, 2016




Check out this article. There, you will discover that CA legislators are considering a law that will require all Porno actors to wear condoms.  This will not only provide safer sex for the actors, it is argued, but also serve as important modeling behavior for those who watch. Translated, those who see actors wear condoms while engaging in on-screen sex will be more likely to do so themselves in real life. Research findings, it should be noted, actually support this conclusion.

Bottom Line. As we have so frequently noted, psychology has taught us that there are many better ways to get people to engage in good health behavior than yelling at them to do so. While generally opposed to legislators getting involved in regulating sex, I must confess that this seems like legislation worth due consideration.

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Is Opioid Addiction Funny???

November 1, 2016


John Oliver

Sorry, but following up on my recommended assignment for you today is going to take almost 20 minutes of your time. BUT.  You will find watching this video both informative and, at times, amusing.  And also somewhat disturbing. In it, John Oliver recounts the story of how the epidemic of addiction to prescription opioids involved the interaction of aggressive marketing by pharmaceutical companies AND the apparent need of PCP’s to move chronic pain patients quickly through their offices.

Bottom Line. While watching the complex history of events set forth in this video, I got to thinking again about cause and effect. While we tend to want to view the world as a simple this-caused-that model, in many cases real life examples, like this one, are a lot more sequential, multifactorial and interactive.

Ponder this reality the next time you try to answer the “What made this happen?” question.

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The Day The Pediatricians Quit

October 26, 2016

1 Comment


About a year ago, my wife and I watched a preposterous show about a South Carolina town, Yemassee, where for one week all of the women were spirited away on a vacation leaving the men and children to fend for themselves. What happened under those circumstances is pretty much what you would expect, so I won’t belabor the dysfunction that befell this little town off of I-95.

I will, however, call your attention to this blog, which posits a hypothetical day when Pediatricians walk away from their practices en masse. Why? They got fed up with the pushback they are getting from parents armed with Internet Information, social trends causing them to have to spend additional time overcoming nonsensical patient objections, etc.

Bottom Line. This post actually got me to pondering how much foolishness doctors are in fact going to tolerate before they lay down their stethoscopes.  Much of the contents of my blog posts bemoans “stuff” that doctors must increasingly tolerate, and the notion of them going “on strike” for a while might well be a good thing for healthcare. 

Think about it!

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Is This The Most Bizarre Bad Doctor Ever?

October 25, 2016


Doc from skeptical scalpel


No, not the guy in the photo above! He is Skeptical Scalpel, one of our blogging physicians, who is perfectly OK.

Rather, read this story about a plastic surgeon, who by the way isn’t one, and some of his antics in and out of the operating room. Little things like killing a patient through over sedation in a 10-hour liposuction procedure, having an anesthetized patient sign an authorization form for more surgery at additional cost, etc.

Bottom Line. My major takeaway from this post is that while most doctors are working diligently to do good, one should never underestimate the evil potentially lurking in an individual with the title of “Doctor.”

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Breast Milk As A Medical Benefit

October 18, 2016


Breast milk

As everyone knows, breast milk provides significant health benefits to newborns. What I had never considered, however, is that the babies who need these benefits the most, e.g. preemies, are often unable to obtain them. Mothers who give birth prematurely are often unable to produce milk. Thus, there is a significant need for donated breast milk, and a commercial opportunity in managing the supply chain. But who pays?

Check out this article. Here you will learn that New York will apparently soon be covering breast milk under its Medicaid program. Makes sense!

Bottom Line. Interesting stuff. The article makes an excellent point that covering breast milk under Medicaid removes one of the important ways in which socioeconomic status determines health. One wonders what other good uses of funding, currently being spent/wasted on other things, could make similarly significant reductions in dollar-based health disparity. 


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