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Bill Gates Takes On Donald Trump

March 30, 2017

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Bill Gates

Check this out. What you will see is a Time Magazine article in which Bill Gates challenges the reasoning behind Trump’s cutting of foreign aid related to health care. More specifically, Bill argues that by nipping epidemics like Ebola in the bud, investing in health care outside the U.S. makes Americans safer.

As an aside, Gates’ thesis here could be expanded well beyond healthcare. It might well be rational, even in an increasingly nationalistic political environment, to selectively invest dollars offshore. Makes sense!

Bottom Line. Gates and Trump are supposed to meet sometime in the near future to discuss this issue. Wouldn’t you like to be a fly on the wall for that one???

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States With The Highest And Lowest Paid Doctors???

March 17, 2017

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Go here to see a ranking of the 50 States in terms of average physician salary.

Bottom Line. Why would you care? I am guessing that you are not a physician looking for a State in which to practice. BUT. There are broader questions underlying these dollar amounts. Things like why the discrepancy? And no, it’s not cost of living. And what do these different compensation levels mean for the kinds (?) of physicians that wind up being attracted to practice in these states, etc.

Interesting stuff!

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Why Do We All Want To Die???

March 13, 2017

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That is the question posed, and elucidated, in this blog post from the Psychiatrist pictured above. Read the post at two levels. First, ponder the causes of suicidal ideation and think of the extent to which these causes are increasingly ubiquitous. Feelings of global unrest, absence of belonging, etc. Quite unfortunate, actually!!!

Second, ponder the notion that this Psychiatrist is dealing with suicidal ideation with tele-psychiatry. As I read his musings on the topic, I thought about the fact that the good news here is that I would guess that the vast majority of the patients who come to him digitally would never have gotten to the bricks and mortar office of a shrink in the old days.

All good.

Well, not quite all good. You might note that the doctor is one busy dude, often having a backlog of patients waiting for a consult. Sad if a patient does the deed while waiting to be seen!

Bottom Line. One of my favorite truisms has always been la plus ca change, plus c’est la meme chose. The more things change, the more they remain the same. But not this time, folks. In this one blog post we see a rather accurate and devastating description of changes in the world that are making us all, yes all, more prone to suicide. AND. You see the blossoming of tele-psychiatry to help us to deal with these and other mental health issues. Yup! In 2017, things really are different!

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If Legalizing Same Sex Marriages Reduces Suicide Rates Among Homosexual Adolescents, Then …

March 10, 2017

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What? A recent study found that legalization of same sex marriages has significantly reduced the rate of adolescent suicide attempts among kids who are members of  sexual minorities. As discussed in the linked video, the working assumption here is that this drop is due to the reduction in stigma experienced by kids in these groups.

While this specific outcome is no doubt a positive one, one ponders its greater meaning. At the extreme, does it mean that the legalization of other stigmatized behaviors would result in the avoidance of even more adolescent suicides? And if so, what are the legalization steps that would be instrumental in this outcome? And the unintended consequences of these steps?

We can ponder, for example, the oft discussed (and now jeopardized!) legalization of transgendered individuals using the rest room of the sex with which they “identify.” Did thus reduce stigmatization in public schools? Suicide among adolescents? I frankly don’t know!

Bottom Line. Today, spend a couple of minutes and ponder the connection between “legal” and “popularly accepted.” I’m thinking this link is going to become increasingly important in years to come.

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Prescriber Expectations

February 27, 2017

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Interesting stuff. Check out this NYT article. What you will find is that physicians who prescribe a lot of opioid medications also wind up with a greater percentage of their patients on chronic opioid use. This somewhat less than surprising statement, of course, is open to multiple interpretations. Seems like the simplest one is that physicians who are more open to opioid use are not only more likely to prescribe these drugs initially but are also more liable to allow patients to remain on the products chronically. An alternative interpretation, i.e., that the high prescribing/chronic prescribing doctors see more severe pain patients, deserves some consideration but is likely not what is happening here.

Bottom Line. Much has been written about the “opioid epidemic” in this country. The study reported in this article seems to indicate that some doctors do need to toughen up their prescribing philosophies and practices in this area. 

More generally, the article serves as a reminder that treatments and treatment outcomes are highly dependent upon the specific physicians involved in the prescribing.

Lots of reasons for us to keep that in mind!

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Where Do The BEST Doctors Come From?

February 17, 2017

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globe

 

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

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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

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Walgreens

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

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obesity

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.

HUH?

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

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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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