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It’s no secret that, in an attempt to increase the pay of primary care doctors, Medicare is going to run in serious resistance from the specialists. In this article from Bloomberg, for example, we’re seeing backlash from cardiologists.
What caught my attention was how cardiologists in residency programs may now harbor resentment against primary care doctors in training. Consider what Ted Epperly, president of the American Academy of Family Physicians says:
Specialist colleagues have implied his support for the Medicare changes may cost his students, he said.
While family-care students typically spend parts of their three-year residencies training with specialists, “What I’ve heard is ‘maybe we just won’t have time any longer to teach your residents,’” Epperly said.
From my experience, I would have a hard time believing that cardiologists would allow these reimbursement battles prejudice their desire to teach primary care residents.
But with specialists facing increasing reimbursement pressures, to the benefit of primary care doctors, the situation bears watching.
(via Dr. Wes)
Posted at KevinMD.com. Stay updated and subscribe, follow me on Twitter, or become a fan on Facebook.
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The following is part of a series of original guest columns by the American Medical Association.
by Nancy H. Nielsen, MD
This year’s flu season promises to be different than in years past. With the potential of both seasonal and H1N1 influenza circulating this year, it is more critical than ever that health care professionals proactively talk to their patients about influenza.
Many patients will be confused about who needs the H1N1 vaccine, who needs the seasonal vaccine, and who needs both.
Health care professionals should drive the conversation to help patients understand that this year numerous strains of influenza may be circulating, in addition to H1N1, and that two separate vaccines are available and necessary to provide optimal protection for the recommended populations. Given this year’s recommendations – that many people receive both vaccines – the earlier we get people protected against seasonal influenza, the better.
Office-based physicians and health care providers will get many questions on the need, efficiency and safety of both the seasonal influenza and H1N1 vaccines, and we want to help them be as prepared as possible.
So how can physicians and health care providers better prepare for this unique flu season? We can start with being prepared for the unexpected. There is no way to know what the burden of the H1N1 virus will be.
Today, I am participating in the National Foundation for Infectious Diseases press conference in Washington, D.C. Because the burden of the H1N1 virus is unclear, this event is aimed at getting the word out to the public on the need to get immunized for seasonal influenza early, so physician offices will be more capable of vaccinating the recommended groups with the H1N1 vaccine when it becomes available in mid-October.
There are a lot of free resources on seasonal influenza and H1N1 available for both health care professionals and patients. For example, the AMA will be hosting a free webinar to identify action steps and guidelines for the 2009 influenza season on September 22. There is also a wealth of free information on both seasonal influenza and H1N1 on the AMA web site, including toolkits and patient handouts. The CDC recently prepared a special document for health care providers titled “10 Steps You Can Take: Actions for Novel H1N1 Influenza Planning and Response for Medical Offices and Outpatient Facilities” to help prepare physician practices for this flu season.
More resources for patients, health care providers and the media can be downloaded directly from the official AMA/CDC National Influenza Vaccine Summit web site. The summit represents more than 130 public and private organizations and convenes each year to address influenza and influenza vaccine issues and collaborate on prevention and education activities.
Many city, county and state health departments will be hosting free influenza clinics for residents this year. Physicians should be aware of these and other community resources that may assist them in vaccinating and educating their patients.
Physicians and other health care providers are recommended to receive both the H1N1 influenza vaccine and the seasonal vaccine. Despite a continued recommendation that health care providers be immunized against seasonal influenza, the vaccination rates for this group remain below the targeted rates. It’s important that we exemplify the messaging we promote to our patients and get immunized for the safety of ourselves, our patients and our families.
This flu season will be challenging, but by educating our patients on the importance of getting vaccinated against seasonal influenza, and preparing our practices for the influx of patients and new H1N1 vaccine, we can successfully brave this storm.
Nancy H. Nielsen is Immediate Past President of the American Medical Association.
Posted at KevinMD.com. Stay updated and subscribe, follow me on Twitter, or become a fan on Facebook.
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by Nancy Walsh, Contributing Writer, MedPage Today
Almost 3% of healthy, asymptomatic people who underwent MRI brain scans showed incidental abnormalities in a recent study, leading researchers to express concern about about psychological and medical fallout from these increasingly popular screenings.
In meta-analysis of MRI brain scans, the prevalence of neoplastic incidental findings was 0.70% (95% CI 0.47 to 0.98), while the prevalence of non-neoplastic findings was 2% (95% CI 1.1 to 3.1), according to Zoe Morris, MD, of Western General Hospital in Edinburgh, and colleagues.
The combined prevalence of neoplastic and non-neoplastic abnormalities, excluding markers of cerebrovascular disease, was 2.7%, with a number needed to scan of 37, the researchers reported online in the British Medical Journal.
They said the increasing use of brain MRI in research and among the “worried well” who are trying to allay fears of a possible silent disease, is “fast becoming problematic.” That’s because there is little evidence for treatment of most of these lesions, and treatment itself can be risky.
“A major dilemma is whether to treat incidental brain findings and, if so, how,” Morris and colleagues wrote.
Knowing that the prevalence and types of incidental brain findings has varied in previous studies, Morris’ group performed a systematic literature review and meta-analysis that included 16 studies involving 19,559 people.
The number of participants in the individual studies ranged from 60 to 4,000, and mean ages were 11 to 63 years.
The most common finding was an arachnoid cyst, found in 0.5% (95% CI 0.21 to 0.87), followed by aneurysms in 0.35% (95% CI 0.13 to 0.67).
Incidental abnormalities were found more commonly using high resolution MRI (4.3%, 95% CI 3 to 5.8), than using standard resolution sequences (1.7%, 95% CI 1.1 to 2.4, P<0.001).
Prevalence was higher among research cases (3.4%, 95% CI 0.9 to 7.5) than among subjects seeking commercial screening (2%, 95% CI 0.9 to 3.3) and research controls (1.6%, 95% CI 1 to 2.2, P<0.001).
Grouped summary data on age-specific prevalence found that white matter hyperintensities were more common with increasing age (x2 for linear trend=71, P<0.001), as were silent infarcts (x2 for linear trend=104, P<0.001) and neoplastic findings (x2 for linear trend=8.8, P=0.003).
In contrast, non-neoplastic findings appeared to decline with age (x2 for linear trend=6.9, P=0.008), although this finding was reversed in a sensitivity analysis restricted to high-resolution MRI (x2 for linear trend=66, P<0.001).
The increase in neoplastic abnormalities seen with increasing age most likely represented the prevalence of meningiomas, according to the researchers.
Discussing the pros and cons of treating these conditions, the the investigators wrote, “The risk of hemorrhage from most unruptured aneurysms seems to be low, yet the risk of death and stroke from interventional treatment is sizeable.”
Nonetheless, they pointed out, awareness of such a lesion could encourage better management of risk factors.
And treatment for asymptomatic meningiomas, the most common age-related neoplastic finding in the analysis, generally is conservative because more than 90% never become symptomatic and more than 60% do not increase in size.
Aside from uncertainty as to the risks of intervention, detection of a brain abnormality also can lead to patient anxiety, a “costly cascade of further investigations, with risks of complications,” and possible loss of insurance, driver’s license, and employment.
Clinicians therefore should proceed with caution in ordering brain scans, counseling patients about the possibility of incidental findings. Research volunteers should also understand the risks, they said.
“Although true negative results from brain MRI may be reassuring, many of the requirements of a screening test are not fulfilled; most of all, the overall benefit of such screening on quality adjusted life years is unproved,” they wrote.
Nor has anyone proven cost-effectiveness, with one Japanese study having found that the cost for one person with an incidental finding requiring further evaluation was $24,733.
“Furthermore, there is little evidence that ‘peace of mind’ lasts for the people with normal brain scans,” co-author Rustam Al-Shahi Salma, MD, also of the University of Edinburgh, said in a statement.
Future research should focus on individual patient data, including age-specific data to confirm the trends found in this meta-analysis, as well as on more detail on the imaging sequences used.
Visit MedPageToday.com for more preventive care news.
Posted at KevinMD.com. Stay updated and subscribe, follow me on Twitter, or become a fan on Facebook.
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Kirstie Alley was on the Oprah show today and they were discussing the causes of her falling off the wagon. If you didn’t know,
Kirstie Alley used to be the Jenny Craig spokesperson and lost a lot of weight. She has since put on all of the weight she lost and what happened to her is nothing uncommon.
Many people have lost weight only to put it back on. Since she is in the public eye, and was recently promoting Jenny Craig, every pound she gains is scrutinized. Here are some of the things that caused her to fall off the wagon:
She Stopped Exercising
While she was still on the Jenny Craig program, she kept all of her exercise equipment in her house (dining room area) and worked out regularly. Eventually, she stored all of her equipment in her garage and stopped exercising all together.
No Longer Accountable
Kirstie mentioned that it was easier to keep the weight off when she was a spokesperson because of the pressure placed on her from the legal standpoint. She had to lose weight because of the business agreement between her and Jenny Craig. She was weighed in all the time and being under that kind of pressure forced her to meet her goals. Once the pressure was taken off, it was all too easy to indulge in the wrong foods and slack off.
How She Could Have Stayed On Track
I do think her big mistake was stopping the exercise. When you slack off on exercising, it’s all too easy to regain the weight and even harder to get motivated to exercise again. Even if she wanted all of her exercise equipment out of her dining room, she should have continued to exercise.
It seemed like she did better at exercising and eating the right foods when she was under some type of pressure. Maybe it would have helped to answer to someone like a personal trainer.
One thing I noticed was that she kept apologizing for letting people down. I don’t feel she needed to apologize for that at all. If anything, people who have dealt with weight issues should know where she is coming from.
Another point that Oprah made was that we usually give ourselves 5 pounds to play with. The problem is that gaining 5 pounds can easily turn into 25 pounds if you’re not careful.
Did you watch the show? What do you think?
This post is sponsored by:
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photo credit: Ed Yourdon
We can all come up with numerous
excuses for not working out but for some people, it comes down to false beliefs that they may hold about themselves. When it comes to getting into shape there are tons of myths out there that many people hold on to and it keeps them from becoming healthier.
I Don’t Have Good Genes - While genetics does play a part in the type of physique you can develop, it is a poor excuse for not attempting to get into shape. You may not make the cover of a fitness magazine, but you will still feel and look good.
I Have to Join a Gym - This is a common excuse for putting off fitness which is absolutely false. Gyms have never been necessary for getting into shape. You know that you can start anytime, even in the smallest of spaces.
I’m Too Old - Fitness knows
no age limits so don’t put one on yourself by using your age as an excuse. Check out the
81 Year Old Marathoner.
I’m Not Athletic - You do not need to be an athlete to get into shape. I was never good at sports growing up and I’m not today for that matter, but I don’t need an athletic background to run or lift weights.
I’m Too Overweight - Nobody’s excess weight is a lost cause even in cases of extreme obesity. With the right guidance, exercise can be performed even if it is something simple.
I’m Already Thin - Being at your ideal weight is great but it doesn’t mean you are in shape. Can you run a block without being winded? Do you lack energy? Thin and in shape are two different things. Exercise will benefit anyone regardless of current body size.
Don’t let false fitness beliefs hold you back.
This post is sponsored by:
Turbulence Training fat loss workouts have been featured multiple times in Men’s Fitness and Maximum Fitness magazines, and have helped thousands of men and women around the world lose fat, gain muscle, and get lean in less than 45 minutes three times per week.
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