http://pcehive.com/forum/ This is a discussion forum powered by vBulletin. To find out about vBulletin, go to http://www.vbulletin.com/ . en Sat, 19 May 2012 11:28:16 GMT vBulletin 60 http://pcehive.com/forum/images/futurevision/misc/rss.jpg http://pcehive.com/forum/ http://pcehive.com/forum/showthread.php?t=8523&goto=newpost Thu, 26 Apr 2012 21:21:14 GMT A recent article in the Washington Post brought attention to the issue of drug shortages. They reported it to be a national problem with pharmacists... A recent article in the Washington Post brought attention to the issue of drug shortages. They reported it to be a national problem with pharmacists spending triple the time they spent in 2004 on problems related to drug shortages. How is this affecting you and your patients? Have you created any work arounds? ]]> Main Forum DJackson http://pcehive.com/forum/showthread.php?t=8523 http://pcehive.com/forum/showthread.php?t=8522&goto=newpost Thu, 26 Apr 2012 12:43:18 GMT There is an ongoing debate in Washington, as well as, amongst medical professionals about the paternalistic use of “best practice” standards. While... There is an ongoing debate in Washington, as well as, amongst medical professionals about the paternalistic use of “best practice” standards. While best practices may serve as guidelines for decision-making in medical practice, they are not the be all and end all. As one colleague said to me, “the creators of innovation and tomorrow’s best practices are not following them today.” The policy of strictly following “best practices” does not allow for improvement, or respect for a patient’s right to decide what is best for them. ]]> Main Forum DJackson http://pcehive.com/forum/showthread.php?t=8522 http://pcehive.com/forum/showthread.php?t=8521&goto=newpost Wed, 25 Apr 2012 12:30:44 GMT How much responsibility do we, as practitioners, have in the issue of childhood obesity? Medicine is a business. We do try to provide the best care... How much responsibility do we, as practitioners, have in the issue of childhood obesity? Medicine is a business. We do try to provide the best care to our patients as possible, but is there a limit? Are we afraid of alienating our patients’ parents by telling them the unpleasant truth that their child is overweight? Recently I spoke with several parents of clearly overweight children and asked them, “What does your child’s provider say about their weight?” The overwhelming response was nothing.

Is the business of medicine preventing good health? ]]> Main Forum DJackson http://pcehive.com/forum/showthread.php?t=8521 http://pcehive.com/forum/showthread.php?t=8520&goto=newpost Tue, 24 Apr 2012 12:04:29 GMT How much will the Supreme Court decision really matter? The ball is rolling downhill fast and many of the States and insurance companies are... How much will the Supreme Court decision really matter?

The ball is rolling downhill fast and many of the States and insurance companies are already adopting changes to either get ready for the 2014 implementation date or reform the way healthcare is financed and provided in their jurisdiction. On April 12, 2012 New York Gov. Andrew Cuomo used his executive power, issuing an executive order "to establish a health insurance exchange”. The New York Health Benefit Exchange, will allow individuals and small businesses purchasing coverage through the exchange to tap up to $2.6 billion in federal tax credits and subsidies (Associated Press, 2012).

Associated Press. (2012). Cuomo order sets up health-care exchange for New York state. Retrieved from http://www.recordonline.com/apps/pbc...NEWS/120419905 ]]> Main Forum DJackson http://pcehive.com/forum/showthread.php?t=8520 http://pcehive.com/forum/showthread.php?t=8519&goto=newpost Mon, 23 Apr 2012 12:56:27 GMT Here is an interesting article that refutes prior studies indicating a risk of early menopause in women who are egg donors. A study by Dominic Stoop... Here is an interesting article that refutes prior studies indicating a risk of early menopause in women who are egg donors. A study by Dominic Stoop and his team questioned, “whether there is an increased risk of infertility in women that have previously undergone ovarian stimulation and oocyte retrieval for oocyte donation” (Stoop, et al., 2012). Their study included 194 past donors and was conducted by telephone interview.

The outcomes were favorable indicating the process of donation does not appear to affect short-term reproductive health (Stoop, et al., 2012). The results of the study were, “Of the women that indicated having pursued conception after oocyte donation, 95% (57/60) became pregnant unassisted. Before oocyte donation, 41 women in this cohort had already been trying to conceive, of which 38 had delivered a child and 3 (7.3%) had needed infertility treatment” (Stoop, et al., 2012).

While this study does not address long-term prospects for reproduction it does not show any reason for concern in the short term.

Stoop, D., Vercammen, L., Polyzos, N. P., de Vos, M., Nekkebroeck, J., & Devroey, P. (2012). Effect of ovarian stimulation and oocyte retrieval on reproductive outcome in oocyte donors. Fertility and sterility. ]]> Main Forum DJackson http://pcehive.com/forum/showthread.php?t=8519 http://pcehive.com/forum/showthread.php?t=8518&goto=newpost Mon, 23 Apr 2012 12:49:00 GMT Fortunately – and maybe I’m jinxing myself by even saying this – I’ve never been sued. But in spite of this, my malpractice premiums have gone up more than ten-fold over the last decade. But there may be some hope just over the horizon because of a growing trend beginning in malpractice awards and subsequent appeals. Specifically, there have been a series of cases in states with capped judgments, notably Louisiana and Missouri. In these cases, juries made large awards – in Louisiana more than $6 million against a nurse practitioner – but the lower courts significantly reduced the jury award because of the state’s cap and compensation mechanism. The family appealed and the appeal upheld the constitutionality of the cap. A similar appeal has been heard in Missouri (and other states). Significantly, these caps do not apply to cost of continued medical care for patients but usually do apply to punitive damages and/or pain and suffering. Should these higher court ruling begin to consistently uphold the constitutionality of these caps, it is forecast to have a dramatic impact on malpractice rates. ]]> Main Forum L.Herman http://pcehive.com/forum/showthread.php?t=8518 http://pcehive.com/forum/showthread.php?t=8517&goto=newpost Thu, 19 Apr 2012 13:59:54 GMT About 10 days ago it was widely reported that 9 major physician groups each detailed 5 commonly performed tests or treatments that physicians within... About 10 days ago it was widely reported that 9 major physician groups each detailed 5 commonly performed tests or treatments that physicians within each specialty perform that generally don’t need to be performed. These 45 tests or treatments include things like routine EKGs for low-risk patients, and antibiotics for sinusitis. And The New York Times points out that “patients must take responsibility as well. They must discipline themselves not to request care of little or no value.” They also point out that in an effort to help patients make informed decisions, Consumer Reports is developing more-accessible versions of the lists and will join other organizations in disseminating them.

I applaud this reinforced, evidence-based approach to practice. And I also applaud the implied cost-containment without digression from the standard of care. But I have repeatedly heard comments from colleagues that focus around two questions: first, what do I do when a patient demands a test or a treatment, like an antibiotic for their sinus infection because they’ve always gotten a prescription in the past? And, perhaps more importantly, what do I do when somebody serves me with a suit because I didn’t do a test in a low-risk patient and there was a very bad outcome as a result of my indifference (or ignorance) based upon some expert’s testimony? Will these recommendations actually change the practice of medicine in the short term, or even the long term? Perhaps by linking these tests and treatments to reimbursements we would find greater success, in that the patient and the clinician would be aligned and feel the impact immediately: their wallets. ]]> Main Forum L.Herman http://pcehive.com/forum/showthread.php?t=8517 http://pcehive.com/forum/showthread.php?t=8515&goto=newpost Thu, 19 Apr 2012 13:34:51 GMT Last week, the Institute of Medicine endorsed a tax on health care to fund improvements in public health. Among the programs proposed to be funded by... Last week, the Institute of Medicine endorsed a tax on health care to fund improvements in public health. Among the programs proposed to be funded by such a tax would be anti-smoking programs, vaccinations, screening, and substance-abuse programs. Not surprising, the reaction to the proposal is said to be largely negative. Sen. Orrin Hatch (R-UT) called the idea, "an absurd and misguided proposal," adding that "half-baked ideas like this do nothing to address the challenge of rising costs in our health care." Even supporters of public health funding said that it was unlikely to get any support. While these programs are clearly important, is this the best way to accomplish funding? ]]> Main Forum L.Herman http://pcehive.com/forum/showthread.php?t=8515