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Entries in Doctors (40)

Thursday
Jan032013

Too Many Doctors Can Hurt a Patient in 'Bystander Effect'

Comstock/Thinkstock(NEW YORK) -- An acutely ill man with mysterious symptoms -- a nasty rash, kidney and lung failure -- was admitted to Yale-New Haven Hospital where he was treated by 40 of its finest doctors.

But because so many cared for him, two of the attending residents say, the 32-year-old patient actually got sicker.  That's because of the so-called "bystander effect," they say in an article published Thursday in the New England Journal of Medicine.

Authors Dr. Robert R. Stavert and Dr. Jason P. Lott argue that because of changes in health care, more specialists get involved, leading to "decay in coordination of care."

The psychological phenomenon, also known as "Genovese syndrome," was first coined in 1964 after Catherine "Kitty" Genovese, 28, was stabbed to death in New York City as others appeared to have been aware of the attack and did nothing, although the number of bystanders has become a matter of dispute.

One witness told police at the time, "I didn't want to be involved."

A large body of research now shows that humans are less likely to offer help in an emergency when others are present.  The key factor is "diffusion of responsibility" -- the larger the group, the less likely an individual will act.

"We have talked a lot about the broader issues of healthcare -- and not just within our field -- and it really struck a chord," Stavert, a resident in dermatology at Yale, told ABC News.  "We came to realize that the people involved were really excellent doctors and all worked with really good intentions but it became apparent the pitfalls people could fall into."

The patient the Yale team treated spent 11 days in intensive care, but nine sub-specialty units were tending to his case, causing "more of a handoff" of responsibility, the authors wrote.

"Our inability to easily name his disease process quickly created ambiguity about 'ownership' of the patient," they say.  "While our team sat in a remote rounding room pondering potential causes of the patient's rash, another team of intensivists gathered in the ICU hallways to debate his ventilator settings, while yet another consultation team sat at a distant ICU desk, struggling to understand his multi-organ failure."

The patient had more than 25 diagnostic lab tests and two imaging procedures daily, many of them "duplicative and unnecessary."

"This cloud of medical purgatory lifted only when acute decompensation occurred, forcing the doctor-of-the-moment to act decisively," they wrote.

"This happens all the time in medicine," said Lott, who, in addition to being a resident in dermatology at Yale, is a clinical fellow at the Robert Wood Johnson Foundation.  "You make your best guess and keep your fingers crossed and it turns out for the best."

Copyright 2013 ABC News Radio

Wednesday
Dec052012

US Headed Toward Dramatic Shortage of Primary Care Physicians

Burke/Triolo Productions/Thinkstock(NEW YORK) -- Where are the medical students going?  Not into primary care, a study in the latest issue of the Journal of the American Medical Association reveals.

In what study author Dr. Colin West calls a "worrisome" development, more fledgling physicians are eschewing a career in general medicine, choosing instead more lucrative specialties.

Just over one in five of the 17,000 third-year residents surveyed said they were headed for internal medicine, with more women than men apt to choose this endeavor and more Americans than graduates from international medical schools moving in that direction.

West says if the trend continues -- and there's no reason to expect it won't -- the U.S. will be shortchanged in primary-care doctors by 50,000 physicians.

Making the situation worse is that millions of people will be going to the doctor more often over the next several years because of the Affordable Care Act.

Compounding the predicament is that many veteran primary care doctors are heading for retirement with no one to replace them.

Copyright 2012 ABC News Radio

Saturday
Sep292012

Doctor's Grow New Ear on Cancer Victim's Arm


Courtesy Johns Hopkins(NEW YORK) -- When Sherrie Walter lost her ear to cancer two years ago, she told herself she'd never be one of those survivors attaching a prosthetic ear every day.

"The concept of having to tape something to my skin every day didn't feel like that was who I was," the 42-year-old mother of two told ABC News.

But doctors at Johns Hopkins Hospital in Baltimore offered Walter a chance at a new ear -- a permanent one built from her own tissue.

The groundbreaking procedure, described as one of the most complicated ear constructions in the U.S., involves removing cartilage from the rib cage to form a new ear, which is then placed under the skin of the forearm to grow.

"It was under my arm for about four months," Walter said. "I just thought I was something from science fiction."

This week, Walter received some of the finishing touches on her ear, with doctors sculpting and carving tissue to reposition it.

"Family and friends say it looks great," Walter said. "I'm not looking until the big reveal."

Walter's journey began in 2010, when a sore in her left ear was diagnosed as basal-cell carcinoma, a type of skin cancer.

In October 2012, Walter was told the cancer had spread to her ear canal. She went through a 16-hour procedure to have the entire ear, neck glands, lymph nodes tissue and part of her skull removed.

That's when a team of doctors stepped in and told Walter she had options.

"I described to her how prosthetic ears have to be fixated somehow and sometimes fall off," said Dr. Patrick Byrne, an associate professor in otolaryngology-head and neck surgery at the Johns Hopkins University School of Medicine. "Sherrie's skull bone had been removed, so the only way of attaching a prosthetic would be through tape and glue. We both agreed that wasn't an option."

Byrne, who pioneered the procedure, said most ear reconstruction uses facial and neck skin, but most of Walter's skin had been removed from those areas.

Doctors opted to place the ear under the forearm.

"We've talked for years about finding the right patient, in terms of age and health and a good support system. Sherrie had all that," Walter said.

In November 2011, Walter's new ear was inserted under the surface of her forearm skin.

"We implanted the ear near the wrist and just let it live there so all the skin could grow," Byrne said.

After four months, the ear was removed from her arm and re-attached to her head.

The entire process took 20 months.

Since the re-attachment in March, Byrne and his team have been working on the cosmetic aspect of the ear, fully matching it to her right ear.

"Her reveal will be in about a week, and that's going to really be an amazing," Byrne said.

For Walter, the reveal of her new ear is the opportunity to give other cancer survivors hope.

"I just want people to learn from the story and understand that they have options out there," Walter said. "Talking to your doctor and realizing you have options. Because honestly, anything is possible."

Copyright 2012 ABC News Radio

Tuesday
Aug212012

Half of Nation's Doctors Feel Burnt Out

Pixland/Getty Images(NEW YORK) -- About half of U.S. physicians are displaying signs that they've about reached the end of their rope, a new study in the Archives of Internal Medicine finds.  This is especially due to long days that can exceed 60 hours a week.

Tait Shanafelt, a professor of medicine at the Mayo Clinic who led the study, says the problem will only get worse because of the enactment of the Affordable Care Act by 2014 that will mean 33 million more people with health insurance, thus straining doctors even more.

Shanafelt say feelings of being burnt out or exhaustion can result in medical errors by doctors, or at the very least, lack of compassion for the patients they treat.

Those most likely to show signs of strain are emergency room doctors, family physicians and internists, according to the study.

Much of the problem has to do with physicians having to see more patients to compensate for cuts from insurers and the government, while private practice doctors say they're under pressure to implement electronic medical records because of new federal rules.

Copyright 2012 ABC News Radio

Friday
Jul132012

Physician-Assisted Dying: Experts Debate Doctor's Role

Pixland/Thinkstock(NEW YORK) -- Peggy Sutherland was ready to die.  The morphine oozing from a pump in her spine was no match for the pain of lung cancer, which had evaded treatment and invaded her ribs.

"She needed so much morphine it would have rendered her basically unconscious," said Sutherland's daughter, Julie McMurchie, who lives in Portland, Ore.  "She was just kind of done."

Sutherland, 68, decided to use Oregon's "Death With Dignity Act," which allows terminally-ill residents to end their lives after a 15-day requisite waiting period by self-administering a lethal prescription drug.

"Her doctor wrote the prescription and met my husband and me at the pharmacy on the 15th day," said McMurchie, recalling how her mother "didn't want to wait."  "Then he came back to the house, and he stayed with us until her heart stopped beating."

But not all doctors are on board with the law.  In the 15 years since Oregon legalized physician-assisted dying, only Washington and Montana have followed suit, a resistance some experts blame on the medical community.

"I think it has to do with the role of physicians in the process," said Dr. Lisa Lehmann, director of the Center for Bioethics at Brigham and Women's Hospital in Boston and assistant professor of medicine at Harvard Medical School.  "Prescribing a lethal medication with the explicit intent of ending life is really at odds with the role of a physician as a healer."

More than two-thirds of American doctors object to physician-assisted suicide, according to a 2008 study published in the American Journal of Hospice and Palliative Care.  And in an editorial published Wednesday in the New England Journal of Medicine, Lehmann argues that removing doctors from assisted dying could make it more available to patients.

"I believe patients should have control over the timing of death if they desire.  And I suggest rethinking the role of physicians in the process so we can respect patient choices without doing something at odds with the integrity of physicians," she said.

Instead of prescribing the life-ending medication, physicians should only be responsible for diagnosing patients as terminally ill, Lehmann said.  Terminally ill patients should then be able to pick up the medication from a state-approved center, similar to medical marijuana dispensaries.

But assisted dying advocates say doctors should be involved in the dying.

"Patients deserve to have their physician accompany them there and not walk away," said Barbara Coombs Lee, president of the Denver nonprofit Compassion and Choices.

Coombs Lee, a nurse-turned-lawyer and chief petitioner for the Oregon Death with Dignity Act, said decisions about death should be no different than other treatment decisions.

"Physicians don't walk away from patients who make other intentional decisions to advance death, such as refusing a ventilator or a pacemaker," she said.  "Why walk away from a terminally ill patient requesting life-ending medication?"

Copyright 2012 ABC News Radio

Tuesday
Jun122012

Who Makes More Money? Male v. Female Doctors

iStockphoto/Thinkstock(NEW YORK) -- If you were asked to imagine a prominent, wealthy doctor, who would come to mind? Chances are no matter whom you envision, they would have one thing in common: a Y chromosome, the defining genetic material of a man.

A new study found male physicians make $12,000 more per year than female doctors when adjusting for differences in specialties, work hours and academic rank. If you do the math, this amounts to more than $350,000 in the course of a career.

"With increased participation of women in medicine, I suspect that conscious discrimination is probably less likely to be a robust explanation for much of the differences in salary," said Dr. Reshma Jagsi, a radiation oncologist at the University of Michigan Health System and lead author of study published today in the Journal of the American Medical Association. "Instead, I think that an important reason for the difference may be unconscious gender bias."

These discrepancies in pay are no small deal. Medical school graduates can accumulate up to a quarter of a million dollars of debt from their training, and many doctors are stuck paying back their loans in the course of their careers. And with women now representing the majority of students entering medical school, the conversation around salary disparities is more relevant than ever.

"Over the last decade, even the last quarter century, there has been a huge increase in the number of women physicians," said Dr. Gayatri Devi, president of the American Medical Women's Association. "When I refer a patient to another doctor, I say, 'He or she,' because I can no longer make the assumption the doctor is going to be male."

In the past, differences in salaries between male and female physicians were attributed to life factors such as parental status and the subsequent need for flexible work schedules. But this study did not see those factors as explanatory; in fact, even women without children had lower pay than men.  

Copyright 2012 ABC News Radio

Thursday
Apr052012

Doctors: Extra Tests Not Key to Best Patient Care

Comstock/Thinkstock(NEW YORK) -- In an effort to end medical over-testing, nine major medical professional organizations have banded together to try to change the way doctors use tests and procedures once considered fairly routine.

The campaign, Choosing Wisely, a joint effort led by the American Board of Internal Medicine Foundation and Consumer Reports, released a list of 45 common tests and procedures it hopes will be more carefully prescribed and performed.

The campaign is a frank attempt by a wide consortium of medical groups to address what many characterize as rampant, wasteful procedures and spending in the U.S. health care system.

"The distinction to be drawn is between 'care' and 'tests,'" said Dr. Thoralf Sundt, chief of cardiac surgery at Massachusetts General Hospital.  "Doing tests is not the same as providing care in all instances."

Several of the over-used tests called out by the specialty organizations are procedures that have long been considered routine or harmless by many.  Staples such as cardiac stress tests or chest x-rays before minor surgery got the thumbs down from several of the groups.

Some of the recommendations are not radically different from what other groups have been saying for years.  Several guidelines, such as those recommending against Pap tests for women under age 21 or bone density scans for women before age 65, have recently been publicized by the U.S. Preventive Services Task Force, the government body charged with reviewing and recommending health care processes.

But many doctors say that the endorsement of less testing by the heavyweight medical specialty groups may just resonate with more physicians and could alter what has been routine practice.

"It is important because it signals from physician leadership that there is waste in the system that should and could be reduced," said Dr. Harlan Krumholz, professor of investigative medicine and public health at Yale University School of Medicine.  "And it should be just the beginning of a movement."

Many doctors do such screenings and procedures for a variety of reasons other than patient care, doctors say.  Often the reason is simple: a given test or procedure is what the doctor has always done.

Others feel that ordering a barrage of tests will yield the source of a patient's problem, or will reveal an unknown danger.  Other doctors use tests defensively, out of fear that not ordering a test could look like negligence and prompt a lawsuit.

"After a while, getting a CT for a headache or fainting spell even without any neurologic deficits or a stress test for asymptomatic patients becomes the de facto 'standard of care' and physicians are afraid to miss something lest they be sued," said Dr. John Messmer, associate professor of family and community medicine at Penn State College of Medicine.

But experts say it's time to drop this just-in-case mindset.

Reframing conventional medical thinking about testing would likely be a money-saver for the U.S. healthcare system. Some research groups estimate that excessive, unnecessary testing and procedures account for as much as one-third of U.S. medical spending, which totaled more than $2 trillion in 2009 alone.

Copyright 2012 ABC News Radio

Monday
Feb202012

13 Things Your Pediatrician Won't Tell You

Getty(NEW YORK) – An inside look at what your child's doctor really wants you to know:

1. Want to avoid the wait? Schedule your appointment for the middle of the week, and ask for the first time slot of the morning or right after lunch.

2. Even though studies show that antibiotics for ear infections are rarely better than watching and waiting for kids over age 2, many of us prescribe them anyway. We want to feel like we're doing something. If I prescribe an antibiotic and a few days later your child feels better, I look like a genius.

3. Want to make vaccines less painful for your child? Ask if you can breast-feed while we give your infant his shots. Or if you have an older child, see if we can use cold spray or a numbing cream to decrease the pain.

4. Don't ask if I'll take a "quick look" at the sibling who doesn't have an appointment. If your mom went with you to the gynecologist, would you ever say, "Doc, would you mind putting her on the table and giving her a quick look?" Every patient deserves a full evaluation.

5. Sometimes we have less than ten minutes per patient, so make the most of your time and ask about the most pressing problems first. If you have a lot of questions, request an extra-long appointment.

6. Even though I tell you to let your baby cry himself back to sleep once he's older, don't ask me if I always followed that advice with my own kids. I didn't.

7. If you have an urgent concern and the front desk tells you there are no appointments available, ask for a nurse and explain your situation. Often she can work you in even if the schedule indicates there's no time.

8. Don't delay treating your child because you want me to see the symptoms. People do this a lot: "I didn't give him Tylenol, because I wanted you to feel the fever." "I didn't use the nebulizer, because I wanted you to hear the wheezing." Trust me, I will believe you that the child had a fever or was wheezing. Delaying the treatment only makes your child suffer.

9. As soon as you say "He doesn't like it when you look in his ears," you remind your child of the last time and set us up for another failure. Be matter-of-fact: "It's time for the doctor to look in your ears."

10. Sure, we have a "sick" waiting room and a "well" waiting room, but no studies show it really makes a difference. Germs are everywhere and we can't disinfect after each patient. My advice? Bring your own toys, and if your child touches anything, give him a hit of hand sanitizer.

11. Don't tell your kid the doctor will give him a shot if he doesn't behave. I won't.

12. Insurance companies won't pay us to check complex problems at a well visit. So if your child has been complaining of headaches for months, I may tell you to make another appointment. I literally won't get paid if I investigate the headaches while you're here.

13. Pediatricians are among the lowest-paid doctors, making half as much as many specialists. We get pooped, peed, and thrown up on — and worse. But we love helping kids, and that's why we do it.

"GMA" teamed up with Reader's Digest on a special series of "13 Things Your ____ Won't Tell You."


Copyright 2012 ABC News Radio

Tuesday
Feb142012

Women's Chronic Pain Misdiagnosed, Undertreated, Dismissed

Keith Brofsky/Photodisc/Thinkstock(WASHINGTON) -- Women make up the vast majority of the nation's 116 million chronic pain sufferers, yet doctors frequently dismiss their complaints as all in their heads, sending them on years-long searches for relief, a patient told senators Tuesday.

Although studies have observed women's chronic pain is more frequent, more severe and longer lasting than men's, many women still are told "their problem isn't real. Your pain doesn't exist, you must be imagining this," Christin Veasley testified.

In her case, she said, back and neck pain from an old car accident became "an unwanted companion for 21 years." Since 2008, migraine headaches, facial pain and jaw pain piled on more misery, she said.

"From the moment I open my eyes each morning, the first thing I feel is pain," said Veasley, executive director of the non-profit National Vulvodynia Association, which aims to help the one in four American women and "countless adolescents" suffering invisible but excruciating genital pain at some point during their lives.

Veasley, who has recovered from vulvodynia she had in her 20s, testified on behalf of the Chronic Pain Research Alliance. She said she hopes Congress will lead the way in enacting "long overdue change to help us regain our quality of life and ability to contribute to society."

She was among five witnesses appearing at a Capitol Hill hearing on "Pain in America: Exploring Challenges to Relief," called by Sen. Tom Harkin, D-Iowa, chairman of the Senate Committee on Health, Education, Labor and Pensions.

The hearing followed publication last year of an Institute of Medicine report that included recommendations for improving diagnosis, treatment and research into chronic pain, as well as boosting health professionals' recognition of both the problem and its toll.

The cost of chronic pain exceeds $600 billion each year -- more than cancer, heart disease and diabetes combined, the IOM report found. Chronic pain is defined as pain that lasts several months or more, according to testimony from Dr. Lawrence A. Tabak, principal deputy director of the National Institutes of Health. It may crop up as persistent pain after an injury heals, or arise as a debilitating symptom of long-term diseases like arthritis, diabetes or cancer.

Often, Tabak said, people suffer from chronic pain associated with more invisible conditions like fibromyalgia, irritable bowel syndrome, chronic headaches or jaw pain -- all more common in women than men.

"The majority of my patients are women," said Dr. Timothy A. Collins, a neurologist with the Duke Pain and Palliative Care Clinic in Durham, N.C., who was not involved in the hearing.

He said migraine headache is "three times as common in women compared to men." Fibromyalgia "appears more common in women than men," and "a number of pain conditions are directly caused by abuse (sexual and physical) and unfortunately, women are more commonly on the abused side of the equation."

Collins said U.S. culture encourages women "to voice feelings, emotions and physical complaints" while generally discouraging such complaints in men.

"This tends to affect the perception of the care provider -- if there are significant emotional issues, the other complaints may become attributed to the emotional complaints," he said.

In other words, if a woman with chronic pain also suffers from depression, a doctor may attribute all of her complaints "to being depressed, so no further evaluation or treatment is needed," Collins said.

Women with chronic pain also are subject to some of the same gender discrimination that contributes to their under-treatment for cardiac disease and or arthritis. For example, a 1999 study published in the New England Journal of Medicine found that white women (and black men) were 40 percent less likely to be referred for potentially life-saving cardiac surgery.

A 2008 study published by the Canadian Medical Association found doctors were more likely to recommend knee replacement surgery to male patients with knee arthritis than to female patients, suggesting that gender discrimination might contribute to women being three times less likely to undergo knee replacement than men.

In addition, when it comes to doctors' decisions about managing pain, a February 2003 study of doctors' pain management knowledge and attitudes, published in The Journal of Pain, found that women were less likely than men to receive "optimal treatment" for post-surgical or cancer-related pain. That study also found doctors set lesser goals for chronic pain relief than for acute pain and cancer pain.

Copyright 2012 ABC News Radio

Wednesday
Feb082012

Doctors Not Always Honest with Patients, Says Survey

Comstock/Thinkstock(BOSTON) -- About 10 percent of doctors recently surveyed said they haven’t always been honest with their patients, according to new research published in the journal Health Affairs.  They were most likely to lie about whether they committed any significant medical errors and whether they have a financial relationship with a drug or device company.

Researchers led by Dr. Lisa Iezzoni, director of the Massachusetts General Hospital’s Mongan Institute for Health Policy, gathered survey data from nearly 1,900 physicians from different specialties.  They asked the doctors what information they thought they needed to disclose to patients.

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Approximately 33 percent of doctors said they didn’t completely agree with telling patients about serious medical errors, and nearly 40 percent said they didn’t believe they always had to inform patients of any financial ties to drug or device companies.  About 20 percent of the doctors surveyed said they didn’t think they always had to be entirely truthful with patients.  More than half of the doctors also said they did not tell their patients about all the risks or benefits of specific medical procedures.

The doctors were also asked about patient privacy, and about one-third said they shared confidential medical information with people who were not authorized to have it.

“Our findings raise concerns that some patients might not be receiving complete and accurate information from their physicians,” the authors wrote.  “The effects of these communication lapses are unclear, but they could include patients’ lack of information needed to make fully informed decisions about their health care.”

The Charter on Medical Professionalism, a document that requires that doctors be open and honest when communicating with patients, is supported by more than 100 professional medical groups worldwide, but the study authors said “substantial percentages of U.S. physicians did not completely endorse these precepts.”

Women, minorities and surgeons were more likely to follow the charter’s principles of honesty and openness.

It isn’t entirely clear why doctors lie under these circumstances or why there are gender, specialty and ethnic differences, the authors said.

“Some physicians might not tell patients the full truth, to avoid upsetting them or causing them to lose hope,” they wrote.

And doctors may not want to disclose medical errors if their mistakes didn’t cause any significant harm to patients, but, according to the authors, “informing patients fully about medical errors can reduce anger and lessen patients’ interest in bringing malpractice lawsuits.”

The researchers were also troubled by the finding that doctors didn’t always believe it’s important to divulge their dealings with drug and device manufacturers.  Under the 2009 Physician Payment Sunshine Act, companies will be required to report payments to doctors of $10 or more beginning in 2013.

“Physicians who do not support public disclosure might resist communicating this information to inquiring patients or might make these conversations difficult,” the researchers said.

Study co-author Eric Campbell, director of research at the Mongan Institute for Health Policy, told ABC News he and his colleagues plan to further explore the reasons doctors support nondisclosure as well as why there are differences among doctors of different sexes, ethnicities and specialties.

“Until we know what the problem is, we can’t come up with ways to fix it,” Campbell said.

Copyright 2012 ABC News Radio







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