|
|
By Elaine Schattner, MD, on October 3rd, 2011 
Today’s New Yorker has a story, Personal Best, by Atul Gawande. It’s about coaching, and the seemingly novel idea that doctors might engage coaches – individuals with relevant expertise and experience — to help them improve their usual work, i.e. how they practice medicine.
Dr. Gawande is a surgeon, now of eight years according to his article. His specialty is endocrine surgery – when he operates it’s most often on problematic glands like the thyroid, parathyroid or appendix. Results, and complications, are tracked. For a while after he completed his training he got better and better, in comparison to nation stats, by his accounting. And then things leveled off.
The surgeon-writer considered how coaches can help individuals get better at whatever they do, like playing a sport or singing. He writes:
The coaching model is different from the traditional conception of pedagogy, where there’s a presumption that, after a certain
See more Do Doctors Need Coaches? Atul Gawande Considers How Physicians Keep On Learning
By Elaine Schattner, MD, on September 19th, 2011 Today I visited my internist for a checkup and flu shot. We talked about how I’m doing, and she examined me, and we discussed what procedures I ought have done and not done. She’s been my doctor since the summer of 1987, when I was an intern at the hospital.
We reviewed so much that has happened in the interim.
How rare it is, now, to have a doctor who knows me. Continuity in care is so valuable.
One of my greatest fears is being in the hospital again, and having hospitalists – doctors who work full-time in the hospital – be the ones to see me each day, and make decisions about what I need. Yet I’m bracing for it because, well, that’s how it is, now.
From a health care administration perspective, I recognize the value of delegating inpatient care to physicians who are not my usual doctors.
See more The Immeasurable Value of Continuity of Care
By Elaine Schattner, MD, on July 25th, 2011 
Yours truly is busy this week, working on another writing project. This morning she got word from the Happy Hospitalist, via Google+, that a patient somewhere needs help.
…Here is a young male with a greater than 10 year history of progressive unilateral woody, nodular and odorous smelling skin changes of his calf. He has obstructive sleep apnea from significantly elevated body mass index…He has pain in his leg, which occasionally bleeds. There is no significant itching…
(For a full, disclaimed description and an instructive image, see Happy’s post.)
This story, if true, provides a good example of crowd-sourcing a diagnostic dilemma. This isn’t a “game,” played by doctors on-line who write in to say what they think is wrong in a case already solved. Rather, this is how physicians might use extant technology and free software for difficult cases, in real time, when assistance is needed.
I’ve never seen
See more Real-time Crowd-sourcing a Possible Case of Elephantiasis Nostras Verrucosa
By Elaine Schattner, MD, on July 14th, 2011 This week the Times ran a leading story on a new med school admission process, with multiple, mini-interviews, like speed dating. The idea is to assess applicants’ social, communication and ethical thinking (?) skills:
…It is called the multiple mini interview, or M.M.I., and its use is spreading. At least eight medical schools in the United States — including those at Stanford, the University of California, Los Angeles, and the University of Cincinnati — and 13 in Canada are using it.
At Virginia Tech Carilion, 26 candidates showed up on a Saturday in March and stood with their backs to the doors of 26 small rooms. When a bell sounded, the applicants spun around and read a sheet of paper taped to the door that described an ethical conundrum. Two minutes later, the bell sounded again and the applicants charged into the small rooms and found an interviewer waiting. A
See more On Admitting Nice, Ethically-Minded People to Med School
By Elaine Schattner, MD, on June 14th, 2011 Recently the NEJM ran a Sounding Board piece on Bending the Cost Curve in Cancer Care. The authors take on this problem:
Annual direct costs for cancer care are projected to rise — from $104 billion in 20061 to over $173 billion in 2020 and beyond.2…Medical oncologists directly or indirectly control or influence the majority of cancer care costs, including the use and choice of drugs, the types of supportive care, the frequency of imaging, and the number and extent of hospitalizations…
The article responds, in part, to Dr. Howard Brody’s 2010 proposal that each medical specialty society find five ways to reduce waste in health care. The authors, from the Divisions of Hematology-Oncology and Palliative Care at Virginia Commonwealth University in Richmond VA, offer two lists:
Suggested Changes in Oncologists’ Behavior (from the paper, verbatim — Table 1):
1. Target surveillance testing or imaging to situations in which a
See more Running 2 Lists That Might Lessen the Costs of Oncology Care
By Elaine Schattner, MD, on June 7th, 2011 Forbes kept a close eye on the annual ASCO meeting in Chicago. On THE MEDICINE SHOW, Forbes’ Matthew Herper provides a précis of a speech by outgoing ASCO President Dr. George Sledge.
Here are my two favorite parts:
“So what happens when, a few years from now, a patient walks into a doctor’s office and hands a physician a memory stick loaded with gigabytes of personal genomic data?” Sledge asks. His answer: the flood of data will help doctors and patients, but things will get “very, very complicated.”
and
…Doctors will need real-time access to clinical data from all practice settings. This in turn will require interoperable databases using common terminology. Health information technology should offer on-the-spot decision support to oncologists and patients facing the increasingly complex tapestry revealed by modern genomics. It should provide individualized, ready access to a clinical trials systems. It should support appropriate coverage and reimbursement
See more Quotes on Oncology, Via Forbes, and a Spiraling Helix
By Elaine Schattner, MD, on May 13th, 2011 Yesterday I wrote on some tough decisions facing a TV show’s protagonist. She’s got metastatic melanoma and might participate in a clinical trial when the show resumes.
Now imagine you’re an oncologist, or a real patient with this killing disease — you really need to be on top of new developments, to understand the pros and cons, because someone’s life depends on it.
If you’re the doctor in the relationship, you need keep abreast of current information for all the other tumors types of patients in your care: what are the new findings, if any, what are the limitations of the data. You need to know how the advances apply to an individual person who, most likely, has another condition or two, like high blood pressure or, say, osteoporosis.
Oncologists ought to be familiar with new drugs, and how those compare to old ones, and the side effects, and the
See more TV Meets Real Life Oncology, and Anticipating the MCATs
By Elaine Schattner, MD, on April 17th, 2011 The author learned a new word this weekend while attending the annual meeting of the Association of Health Care Journalists in Philadelphia.
In a richly-informative session on ethics of clinical trials, one of the speakers, Dr. Jason Karlawish — a bioethicist, geriatrician and Alzheimer’s researcher at the University of Pennsylvania, taught me a new term: theranostic (alt. spelling: theragnostic).
The neologism calculatingly brings together the concepts of medical therapy and diagnosis. This goes beyond biomarkers, he explained; theranostics are novel tests or diagnostic markers that would identify patients who, as defined, benefit from a particular therapy.
The first international conference on theranostics will be held in June, he told the audience.
—
Related Posts:News on Niaspan, Cholesterol Drugs and BiomarkersReview: Dr. Eric Topol’s Creative Destruction of MedicineNIH Sponsors New Website to Help Patients Understand Clinical TrialsNEJM Reports on 2 New Drugs for Hepatitis CWhat is the Disease Control Rate in Oncology?
By Elaine Schattner, MD, on April 12th, 2011 
Today Ed Silverman of Pharmalot considers the case of a ghost-written medical text’s mysterious disappearance. The 1999 book, “Recognition and Treatment of Psychiatric Disorders: A Psychopharmacology Handbook for Primary Care,” (reviewed in a psychiatry journal here) came under scrutiny last fall when it became evident that the physician “authors” didn’t just receive money from a relevant drug maker, SmithKline Beecham; they received an outline and text for the book from pharmaceutical company-hired writers.
poster for the X-Files
The book is no longer evident at the website for STI (Scientific Therapeutic Information), the company that provided authorship “help.” I tried to get a copy on Amazon.com, where it’s said to be temporarily out-of-stock. The work remains listed in the Library of Congress on-line catalog: #99015420.
I’m reminded of clinical handbooks I used all the time when I was practicing hematology and oncology. At the hospital, I’d get freebie,
See more Internet-Based Medical Information May Prove More Trustworthy Than Printed Texts
By Elaine Schattner, MD, on March 31st, 2011 An article in the March 24 NEJM called Specialization, Subspecialization, and Subsubspecialization in Internal Medicine might have some heads shaking: Isn’t there a shortage of primary care physicians? The sounding-board piece considers the recent decision of the American Board of Internal Medicine to issue certificates in two new fields: (1) hospice and palliative care and (2) advanced heart failure and plans in-the-works for official credentialing in other, relatively narrow fields like addiction and obesity.
The essay caught my attention because I do think it’s true that we need more well-trained specialists
See more In Defense of Primary Care, and of Sub-Sub-Sub-Specialists
By Elaine Schattner, MD, on March 24th, 2011 
The Times ran an intriguing experiment on its Well blog yesterday: a medical problem-solving contest. The challenge, based on the story of a real girl who lives near Philadelphia, drew 1379 posted comments and closed this morning with publication of the answer.
Dr. Lisa Sanders, who moderated the piece, says today that the first submitted correct response came from a California physician; the second came from a Minnesota woman who is not a physician. Evidently she recognized the condition’s manifestations from her experience working with people who have it.
The public contest – and even the concept of using the word “contest” – to solve a real person’s medical condition interests me a lot. This kind of puzzle is, as far as I know, unprecedented apart from the somewhat removed domains of doctors’ journals and on-line platforms intended for physicians, medical school problem-based learning cases, clinical pathological conferences (CPC’s) and
See more Crowd-Sourcing a Medical Puzzle
By Elaine Schattner, MD, on February 28th, 2011 
Since Watson won on Jeopardy, there’s been lots of talk of robots assuming doctors’ roles. Ten years into our future, machines with programmed empathy and nuanced diagnostic skills will solve diagnostic dilemmas, deduce optimal treatment and make us well.
Yesterday I found a new Xtranormal video, this one crafted by Dr. Charles of his excellent Examining Room blog, on Dr. Watson and the 7 Qualities of an Ideal Physician.
from the Examining Room of Dr. Charles
Dr. Charles cites a 2006 Mayo Clinic Proceedings review on what patients say are essential characteristics of a good physician: The ideal doctor is confident, empathetic, humane, personal, forthright, respectful, and thorough. In this clever, short movie crafted by Dr. Charles, the robot-doctor tries to demonstrate his capability in each of these dimensions in his interaction with a cartoon patient.
I hope the folks over at IBM, who are collaborating with real medical
See more A Video About a Robot and a Patient
By Elaine Schattner, MD, on January 25th, 2011 Today’s Times reports on our nation’s students’ poor science test results. The results are bleak: only 34% of fourth graders scored at a “proficient” level or higher; just 30% of eight graders scored at a proficient level or higher; 21% of twelfth graders scored at a proficient or higher level in science.
The mega-analysis, prepared by the National Center for Education Statistics, derives from 2009 testing of 156,500 fourth-graders and 151,100 eighth-graders, with state-by-state and nationwide metrics of those, and of 11,100 twelfth-graders. Student scores were ranked at one of three science knowledge levels for each peer group: advanced, proficient and basic, as defined by the Department of Education. Only a tiny fraction — as few as 1 or 2% of students — attained “advanced” scores on the science exams.
The complete report card analyzes the data by race, sex, urban vs. rural districts, private vs. public schools and other
See more Sad Stats for Science Knowledge in U.S. Schools
By Elaine Schattner, MD, on December 29th, 2010 
This morning I toured Google’s new Body Browser. The trip wasn’t as easy as I’d envisioned; I got sidetracked on my way, having to update my Web browser before entering. The site requires an advanced Web browser, like Chrome beta or Firefox 4.0, to accommodate 3-D graphics.
Update accomplished, I forged into Google-woman’s frame. (There is no man available, as yet.)
See more First Inspection of Google’s Anatomy
By Elaine Schattner, MD, on October 26th, 2010 
The cover of the November print edition of Wired features large, unnatural-appearing cleavage. Inside and toward the back of the issue, a curious article ties together stem cells and the future of breast reconstruction. It got my attention.
Wired, November 2010 issue
The detailed and admittedly interesting piece, by Sharon Begley, describes what’s science or science fiction: first humans, such as some plastic surgeons, remove adipose tissue, a.k.a. fat, by a well-established cosmetic surgery procedure called liposuction, from a body part where there’s a fat surplus — such as the belly or backside; next, laboratory workers purify and grow what are said to be stem cells from that that fat; finally, they use a nifty, calibrated and expensive device to inject those fatty stem cells where women want, such as in a hole or dimpled breast where a tumor’s been removed.
The story starts, unfortunately and distractingly, with a
See more Stem Cells, Breast Reconstruction and a Magazine Cover
By Elaine Schattner, MD, on October 11th, 2010 As Sue, a woman who’s had breast cancer told me last month: “You don’t want a radiologist who’s just looked at someone’s broken foot examining your mammogram.” She’s right. Expertise can make a huge difference in clinical outcomes.
See more Five Ways to Improve the Quality and Success of Breast Cancer Screening by Mammography
By Elaine Schattner M.D., on September 27th, 2010 What is comparative effectiveness research and why does it matter? The idea, basically, is to inform medical decisions with relevant data derived from well-designed clinical trials. This sort of research will provide the foundation for evidence-based medicine (EBM).
See more News, and Thoughts, on Comparative Effectiveness Research
By Elaine Schattner M.D., on September 21st, 2010 “This caught my interest because it doesn’t diminish physicians’ autonomy,” Blumenthal said. It just enables them to make decisions for their patients in the context of additional, current information. “The end goal is not to adopt technology, but to improve care.“
See more No More Clipboards
By Elaine Schattner M.D., on September 14th, 2010 So while this little debate might seem minor and technical, reflecting some pettiness and distinct personalities among the various physician-bloggers, it bears on a serious issue for medicine, which is not so easily resolved: what are the tasks that we really want doctors to do, and not to delegate. This discussion relates to a recent editorial in the New York Times on whether we really need physicians to administer anesthesia…It bears also on simpler matters — whether doctors should spend time calling patients themselves about routine test results, adjust coumadin and other drug doses …
See more Big Implications of Blog-Bickering About What Doctors Should Be Doing
By Elaine Schattner M.D., on August 9th, 2010 There’s been a recent barrage of med-blog posts on the unhappy relationship between doctors and electronic communications. The first, a mainly reasonable rant by Dr. Wes* dated August 7, When The Doctor’s Always In, considers email in the context of unbounded pressure on physicians to avail themselves to their patients 24⁄7. That piece triggered at least two prompt reactions: Distractible Dr. Rob’s** essay on Why I Don’t Accept eMail From Patients and 33 Charts’ Dr. V on The Boundaries of Physicians Availability.
Perhaps the most astonishing aspect of these three guys’ essays is that, in 2010, there’s still a question about whether doctors should use email to communicate with patients. It’s hard for me to imagine physicians – including bloggers — so disconnected. But many are.
Last year, I had the opportunity to speak with Professor Nathan Ensmenger, a historian of technology at the University of Pennsylvania who’s studied physicians’
See more Doctors Not Using Email Like It’s 2010
|
|
connections…