Entries in Physicians (9)


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


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


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


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


Benefactor Gives U. of Chicago $42 Million to Work on Bedside Manner

Hemera Technologies./Thinkstock(CHICAGO) -- A benefactor who believes doctors need to work on their bedside manner is giving $42 million to the University of Chicago Medical Center to train physicians to be good communicators.

The donation from Carolyn "Kay" Bucksbaum and her husband, Matthew, will create the Bucksbaum Institute for Clinical Excellence, the medical center announced Thursday.

Kay Bucksbaum, whose husband made his fortune developing shopping centers, said she was inspired by Dr. Mark Siegler, a leading medical ethicist at the University of Chicago who became the couple's internist when they moved to Chicago from Iowa about 10 years ago.

"He keeps front and center getting to know his patient," she said.

In contrast, she recalled a doctor years ago who didn't listen to her when she told him what she thought was wrong with her -- and didn't apologize when she turned out to be right.

When her husband needed surgery, she said, Siegler "took my husband by the hand to meet the surgeon, introduced him, and told the surgeon something about my husband."

He even scrubs up and watches his patients' surgeries when he can, she said. And he encourages patients to call him "Mark."

That kind of emphasis on bedside manner and developing a relationship with the patient is being eroded in modern medicine, said Dr. Matthew Sorrentino, a cardiologist who is co-director of the new center.

"The way I was taught, you sit down and look directly at the patient," he said.

That communication is crucial for good diagnosis, Sorrentino said. "If you listen carefully to the patient, 95 percent of the time people will tell you what's wrong."

Preliminary data show that good doctor-patient relationships can improve patients' health and well-being, he said.

Nowadays, he added, doctors are doing less looking at and listening to their patients.

"Medicine has become much more technology driven," he said. "Everything's become electronic these days. We start looking at computer screens and less at the patient."

Even the little things matter, Sorrentino said, such as avoiding using a patient's first name while they call you "doctor."

The new center has designated three second-year students as the first Bucksbaum fellows and anticipates supporting up to 15 such fellows by its third year of operation. It will recruit "master clinicians" to be role models for developing top-notch patient communication skills.

Kay Bucksbaum believes many students entering medical school today are altruistic and motivated by idealism.

"By the time they're into practice, that feeling seems to have gotten beaten out of them," she said. "It's not just the education beating it out of them, it's the red tape, the bookkeeping."

But in spite of those pressures, she said, some doctors manage to retain their humanity and rapport with patients. If the Bucksbaum Institute can teach young doctors how to achieve that balance, she added, then the $42 million will be "money well spent."

Copyright 2011 ABC News Radio


Patients as Likely to See Medical Error in Dr.'s Office as in Hospitals

Comstock/Thinkstock(EDUCATION CITY, Qatar) -- A study published in the June 15 issue of the Journal of the American Medical Association says the chances of experiencing injury due to medical error are the same in a doctor's office as in a hospital.

Researchers from the Weill Cornell Medical College compared medical malpractice claims both from doctor's offices and hospitals using the U.S. National Practicioner Data Bank.  They found that the 11,000 total malpractice payments paid by physicians in 2009 was nearly split between hospitals and private practices.

According to the report, doctor's offices tended to produce more errors related to incorrect diagnoses, whereas failed surgical procedures caused the most issues for hospitals.

Copyright 2011 ABC News Radio


Doctors Would Advise Themselves Differently than Their Patients, Study Says

Thomas Northcut/Digital Vision(DURHAM, N.C.) -- Primary care physicians often would choose a different option for their own care than what they would recommend to patients, a new study reports.

For the study, published in Monday's issue of the Archives of Internal Medicine, researchers told 242 doctors that either they or a patient could choose one of two surgeries after receiving a colon cancer diagnosis.  Although both procedures had an 80-percent cure rate, one carried a higher death rate with fewer side effects.  The other option with a lower death rate would leave patients potentially needing a colostomy or having chronic diarrhea or other side effects.

They found that 37.8 percent of doctors chose higher mortality with fewer side effects, compared to only 24.5 percent who thought patients would opt for the same option.

"It's a pretty clear message: There's a discrepancy between what doctors recommend to their patients and to themselves," said Dr. Timothy Quill, who authored an accompanying article in the journal.

Quill added that decisions ought to be guided by patient values, not doctors. 

The study's lead author, Dr. Peter A. Ubel agreed that doctors and patients should have in-depth discussions about what matters to the patient.

"Doctors and patients both need to just be aware that advice giving is not as neurtal as they think," Ubell said.  "This is not just about experts handing down expertise.  It fundamentally changes the way people weigh risks and benefits."

Copyright 2011 ABC News Radio´╗┐


Doctors' Conflicting Interests Can Cost Money and Lives and Hinder Medical Discoveries

Comstock/Thinkstock By Stefan P. Kruszewski, M.D.

(NEW YORK) -- In recent months, the print media have once again outed another group of physicians who benefit from undisclosed financial renumeration from pharmaceutical companies, accompanied by serious conflicts of interest. One headline from The New York Times News Service read "California Docs Paid to Promote Drugs," while other news outlets carried similar stories.

The fact that doctors take money from pharmaceutical companies happens to be old news. But this time around, the docs in question come from Stanford University. Previous news stories reported that doctors receiving pharmaceutical funding hailed from Harvard, the University of Miami, the Medical College of Georgia and the University of Cincinnati College of Medicine.

More than a few of these doctors are psychiatrists who have received tax-supported, public National Institutes of Health and National Institute of Mental Health funding for clinical research, have participated in U.S. Food and Drug Administation advisory panels or have appeared on, or on behalf of, various not-for-profit psychiatric advocacy boards -- some of which are heavily supported by the manufacturers of psychiatric medications.

For example, authors of a psychiatric study might recommend a specific antidepressant therapy but fail to reveal that they are being paid by multiple antidepressant manufacturers to speak, advocate and do research for the companies that sell the drugs. Academic journals, heavily supported by advertising money, are biased and complicit in the conflict of interest fiasco.

Drug promotion and clinical decision-making that are brokered on the backs of dollar bills have a greater chance of causing serious adverse outcomes, including illnesses and death. If a physician embellishes the effectiveness of a drug or minimizes its risk, that directly hurts patients.

Physicians who are heavily supported by pharmaceutical companies and medical device makers are not forming independent, unbiased decisions. Instead, their brains have been lined with gifts, perks and money, which influences their rose-colored opinions.

Conflicted clinical research -- often done especially by and for a particular psychiatric pharmaceutical manufacturer -- whose design and analysis are biased and whose summary and conclusions are misleadingly positive, fracture the backbone of scientific research.

The legacy of fraudulent research lingers for years before it is recognized and repudiated. That effort impedes real progress, wastes time, money and human resources that could be focused on finding real cures to help all of us. And that's not good for anybody.

Copyright 2011 ABC News Radio


Study: Surgeons More Prone than Most to Thoughts of Suicide

Photo Courtesy - Getty Images(CHICAGO) -- Six percent of U.S. surgeons have had suicidal thoughts during the past year -- a percentage 1.5 to three times higher than the general population -- according to a new report in the Archives of Surgery.

Pressures of the job often weigh heavily on doctors' minds, as well as guilt over mistakes they might have made.

To make matters worse, only about one in four have sought assistance from a mental health professional to help them deal with their issues.  Generally speaking, most of the surgeons who didn't go for therapy were concerned that they would put their medical licenses in jeopardy by opening up about their problems.

The majority of surgeons who think about killing themselves are male and over age 45.  Divorced doctors are also at a greater risk than their married counterparts.

Overall, it's estimated that between 300 and 400 physicians commit suicide annually, which is also more than the general population.´╗┐

Copyright 2011 ABC News Radio

ABC News Radio