Sunday, December 25, 2016

Flaunting It

Somebody must have been very good this year. Or at least had a very good year. I saw this insane vehicle parked in the doctor's parking lot. It is a Lamborghini Aventador. It comes with a V12 engine with 700 HP and goes 0-60 mph in 2.9 seconds. And it has a base price of $400,000. Who drives this as a daily commuter car? I guess if you've got it, might as well flaunt it. Here's hoping I will get on Santa's nice list next year too.

Friday, December 23, 2016

Easy Way To Treat Gonorrhea

You know the uproar over those drug trials that involved $100,000 medications to treat an illness? Makes you wonder if medical scientists cared about the economic plight of the man on the street. Once in awhile, however, researchers will actually conduct a study that is truly useful for the average Joe and can significantly improve his daily life.

For instance, a study out of Australia has demonstrated the efficacy of using an over the counter mouthwash to treat oral gonorrhea. The researchers took oral swabs of gonorrhea positive men and had them rinse and gargle Listerine Cool Mint or saline for one minutes. Afterwards, 84% of the men in the placebo group remained positive for gonorrhea while only 52% of the group who used Listerine were positive.

This goes to show that academicians really do care about the little guy. Now we want to know if dipping any other body part into mouthwash will have the same effect. This could potentially be a cost effective way to treat millions of people without causing drug resistance. Or maybe people should wear condoms and stop hooking up with strangers so much.

Wednesday, December 21, 2016

Men Should Not Go Into Medicine

Men, you should not be doctors. If you're a male medical student, start thinking about changing course and go work for SnapChat instead. If you're already a practicing male physician, consider early retirement and start taking Bob Ross art classes. Your patients will thank you. Your hospital administrator will thank you. Your country will thank you. That is because a new paper published in JAMA Internal Medicine has shown that female physicians demonstrate statistically better outcomes than men.

The study out of the Harvard School of Public Health examined 1.5 million Medicare patients from 2011-2014. They found that the patients treated by female internists had lower mortality rates, 11.07% vs 11.49%. Their 30 day readmission rates were also lower, 15.02% vs 15.57%. If male internists had the same mortality rates for their patients as women, 32,000 lives would be saved in this country each year.

How to explain this discrepancy in outcomes? There are a few clues. The female doctors in the study, out of a total of 58,344 physicians examined, tended to be younger, 42.8 years old vs 47.8 years for men.They are more likely to have trained in osteopathic medicine and to have taken care of fewer patients.

But studies have also shown that male and female doctors conduct their practices differently. According to Dr. Ashish Jha, one of the coauthors of the study, "There is data out there that women practice evidence-based medicine, and they tend to stick more closely to clinical guidelines."

There you go. We men are like bulls in a china shop, running amok through the hospital corridors, cavalierly treating our patients based on nothing but a whim. Meanwhile our cerebral female colleagues follow the edicts from the ivory towers up high, following every new algorithm and wisdom they deign to pass down to us ignorant medical masses. The female doctors will even work for less money, earning on average $51,000 less per year than men. We male doctors should just do all our patients a favor and quit right now.

But of course we need to take these results with a large grain of salt. If male doctors truly produced worse outcomes for their patients, I would think that would have become readily apparent. Hospital administrators and state medical boards would long ago have disciplined doctors for not producing similar results, otherwise known as community standards, as their female colleagues.

The income disparity between male and female doctors is also a red herring. Like a widely quoted statistic where women make only 80¢ for every $1 that men make for similar work, there are multiple studies to disprove that. Otherwise industry would only hire women if they can truly do the exact same work with the same productivity for less money. Why bother hiring men?

Therefore this is just another shoddy medical study that is trying too hard to be politically correct to impress the liberal media and government organizations. What would be truly impressive would be a study that showed the productivity gains by hiring more male physicians over women. But that would probably never pass the scrutiny of the academic editors who control the medical journals.

Tuesday, December 20, 2016

Doctors For Trump

Let's get this straight. Not everybody who voted for Donald Trump for president is an uneducated disgruntled white male unemployed factory worker, as the liberal press would like to have you believe. Hundreds of thousands of doctors also voted for him. You can hardly call them uneducated.

For many physicians, their votes had nothing to do with Russian hacking of the Democratic National Committee or the FBI investigation of Hillary Clinton's careless handling of classified emails. No, the disastrous prospects of continuing Obamacare was probably one of their top priorities in sending Republicans into all federal branches of power.

We already know that President Obama lied when he promised that the PPACA would allow people to keep their insurance policies and doctors if they want it. His statements about Obamacare lowering healthcare costs have also proven to be false. The whole package was passed by hoodwinking Congress and the voting public. Now, insurance premiums have gone through the roof. My family's personal health insurance costs will increase almost 25% this year. If we switched to a cheaper plan we would lose our family doctor. Yet we consider ourselves lucky. Millions of people across the country will only have one insurance company to choose from thanks to the crippling costs mandated by the law.

Despite these drawbacks, I've been reading a lot of anger and frustration in medical forums like KevinMD about the potential demise of Obamacare as we know it. They predict doom and gloom for patients and medicine in general if Republicans dare repeal it.

Funny thing is, most of these prognostications were written by medical residents or faculty physicians in academic settings. These are hardly the unbiased views of what's really going on in the healthcare business. In fact, they are completely shielded from the real world of medicine.

They're not out there fighting for every penny from the insurance companies for proper reimbursements. These academics aren't dealing with losing long term patients because they are no longer part of the ever tighter insurance networks. As part of an academic institution, these big hospitals are usually included in almost all health plans. And if they did lose a few patients to insurance changes, how much did they really care?

How can medical residents be complaining about the demise of Obamacare when they haven't experienced how hard it is to make one honest nickel running a medical business? Have them come back in a few years when they've had the opportunity to implement all of Obama's expensive mandates like electronic medical records or alternative payment models.

So forgive me if I ignore all the whining and kvetching about an unfair Electoral College bypassing the will of the people. Millions of voters, thousands of doctors among them, voted for Donald Trump. Nobody said we had to vote against our own self interest in order to be good compassionate physicians. In fact, patients may find their doctors to be happier and more friendly once many of these Obama era rules are banished.

Monday, December 19, 2016

NAFTA For Doctors

Okay, this is one of the crazier ideas I've read in awhile. Dean Baker, co-director of the Center for Economic and Policy Research, laments in the LA Times that doctors make too much money. He bemoans that the North American Free Trade Agreement has decimated the ranks of blue collar and factory workers here in the U.S. because the treaty allowed corporations to use cheap labor outside the country to lower their costs. In a fit of inspiration, Mr. Baker asks why we can't do the same thing to doctors. Why can't we allow cheap foreign medical graduates to flood the American landscape to lower healthcare costs?

As the writer sees it, there are several good reasons to promote this plan. It's unfair to discriminate against perfectly well trained doctors from foreign countries to practice here. If it wasn't for the protectionist practices of our medical organizations, these fine young doctors would be here already taking care of the unmet needs of millions of patients. Why must the only way to practice medicine here is through an American residency program?

Then there is the awful amount of money physicians make in the U.S. We make twice as much money as other doctors in First World countries. The way to lower our incomes and promote income equality is to bring in competition. A two for one special. Anybody who argues otherwise is not a true believer of fair trade practices. These discriminatory policies cost the country $100 billion in higher labor costs. Imagine the savings if foreign doctors were allowed to see patients for a fraction of what American doctors charge.

He believes that the only downside to his plan is that this would cause a severe brain drain to other countries. All their smart doctors will clamor to our shores to set up shop, causing their native countries to lose healthcare access. His solution to this problem? Taxes of course. He would tax the incomes of these foreign doctors and return the money to their home countries so they can train even more doctors, who of course will want to come here to work too.

I don't even know where to begin to comment about this asinine idea. It hits all the liberal ideologies about taxes, income inequality, protectionism, and racial discrimination. All I can say to Mr. Baker is that there are plenty of doctors just south of the border that he can go see. Let him put his money where his mouth is and take his family's health needs to Tijuana or Ciudad Juarez. He will then be doing his part improving the healthcare system of this country by decreasing its burden by one family and improving the livelihoods of the Mexican doctors and nurses. Somehow, like most limousine liberals, I doubt he will follow his own prescription.

Sunday, December 18, 2016

Surgery Residents Are Abandoning Ship

A new study published in JAMA Surgery finds that almost 20% of general surgery residents quit their programs. The article reviewed 22 studies of general surgery residencies involving over 19,000 residents. They found that a quarter of female surgery residents leave versus about 15% of men. Of all the people who pull out, almost half of them leave after their intern year. Another 28% give up after their second year.

Where do these young doctors go after dropping out? Only a fifth of them choose a different general surgery program. The rest switched to a different specialty, the most popular being, surprise!, anesthesiology.

The most popular reason given for abandoning surgery residency is lifestyle issues. This was followed by the desire to go into a different specialty. Other excuses mentioned included financial hardship, poor performance or dismissal, and family needs.

The lead author of the study suggested that the solution is to expose medical students to an even longer surgery rotation. He thinks another six to eight weeks of surgery experience would help students realize if they are fit for general surgery. In a back handed slap at all the residents who leave for a more humane field, he stated that "Not everybody can be a commander or a Navy SEAL." Ouch.

Long time readers of this blog know that I too started my training in general surgery. Unlike most of the residents in this study though, I was too stubborn to quit after my first two years. I toiled on for four years before finally deciding that life is too short to live so unhappily. Now I think that was the best decision I ever made in my life. You don't appreciate how wonder anesthesiology is until you've been through the hell of general surgery and lived to tell about it.

Thursday, December 15, 2016

Anesthesia Is Bad For Developing Brains

One of the most common questions I get asked is about the effects of anesthesia on pregnancy and childhood development. Now the Food and Drug Administration has published some precautions they want the public to be aware of if they are getting anesthesia.

The FDA has issued a warning about repeated exposure to anesthetics in developing brains. Children under the age of 3 years and pregnant women in their third trimester should be more judicious in receiving anesthesia. According to animal models, a single anesthetic is unlikely to cause any problems but repeat surgeries, especially if they're over three hours long, can adversely affect brain growth. Warnings about these potential complications will now be required on the drug labels of general anesthetics and sedatives.

The AMA Is A Political Whore

Before the recent presidential election, most doctors suspected that the American Medical Association is nothing more than a political lobbyist group pretending to act on behalf of physicians. In reality, they care more about money and politics than the welfare of doctors who they claim they represent. That is why only about 15% of physicians in this country still belong to the AMA. Now after the election, our suspicions have been confirmed.

Back during President Obama's first term in office, the AMA gave a crucial endorsement of the PPACA, aka Obamacare. A letter written by AMA President, Dr. Jeremy Lazarus, to the Wall Street Journal stated, "While the law is not perfect, the AMA, the nation's largest physician organization, supported it because it makes necessary improvements to our health care system." This nod of support from an organization claiming to represent the doctors of the country gave the politicians an alibi to vote for legislation that they knew to be seriously flawed. Even up to last year, a study published in JAMA by authors affiliated with the federal government, praised the effectiveness of the health law.

Meanwhile, a survey of 20,000 physicians found a different reality. Almost half of the doctors described Obamacare as a failure. Only a quarter considered it a success. Fully two thirds of doctors in the survey did not accept health insurance that were offered on the Obamacare insurance exchange markets. This highlights the flaws of the system, namely people had more access to insurance, but less access to actual healthcare.

Since the election of Donald Trump, the AMA has displayed a sudden shameless change of heart about its endorsement of Obamacare. When Trump nominated Tom Price, a Congressman from Georgia and orthopedic surgeon by trade, for the position of the Secretary of Health and Human Services, the liberals were sent into fits of outrage. Why? Mr. Price has pretty much devoted his government career into devising ways to repeal Obamacare. The only reason he hasn't been more successful was because of Senate Democrats and President Obama. Now he and the Republicans are in a strong position to fulfill their vision.

So what does the AMA say when confronted by a person whose goal is to dismantle their major legislative accomplishment of the past decade? They heartily endorse Mr. Price for head of the HHS! What kind of logic is this? How can the AMA very publicly and loudly support a law that is despised by thousands of doctors yet quickly turn around and encourage the confirmation of the man who vows to destroy the same law?

The answer obviously is that the AMA has no moral or guiding principles other than political expediency and money grubbing. The AMA is like the prostitute who will sleep with the client with the most money. They don't care what acts they have to do to gain favor just as long as they are able to bring in more cash into the organization. If that means screwing their own membership, then so be it. Most doctors know that the AMA survives mainly as a legacy group with very little real support from the medical community. Nowadays doctors are more likely to be involved with their own state and national specialty societies than be in the AMA. But the AMA will continue to use its name recognition and historic relevance to push its own greedy survivalist agenda in Congress instead of acting on behalf of the doctors they falsely claim to represent. President-elect Trump just revealed that the American Medical Association is nothing but a government slut.

Wednesday, December 14, 2016

I Should Have Been A CRNA

Why didn't I go to nursing school and become a CRNA? After Medscape released its latest salary survey of advanced practice nurses, including CRNA's, that question should hang heavily over any student contemplating a medical career. The survey was completed by over 3,000 APRN's but only 290 were CRNA's so the sample size is very small. But the information that was revealed is still illuminating.

In 2015, CRNA's made an average salary of $176,000. That is up over three percent from last year. That is an income that would not be out of place for a primary care doctor. By contrast anesthesiologists' salaries, though at a much higher level, have remained static year over year, at around $360,000. But it's not just CRNA's that make good money. Other APRN's are also doing quite well. Nurse midwives and nurse practitioners both make over $100,000.

Besides the money, CRNA's also receive generous benefits. According to Medscape, 91% of APRN's receive paid time off. Three fourths get an education allowance and liability coverage. Many are reimbursed for society membership dues and paid family leave.

Going through nursing school and APRN training is much more affordable than medical school. The average medical school debt upon graduation is over $150,000. Some owe a lot more than that. In many parts of the country that is enough to buy a decent house. By contrast, nursing students are in debt for about $30,000 upon graduation. Consequently, only about a third of APRN's still have student loans outstanding.

Finally, what is the best reason to become a CRNA instead of an anesthesiologist? The total lack of accountability. Even though the AANA is fighting hard to allow their members to practice independently without the supervision of physicians, I suspect that many of them secretly prefer being directed by an MD. If any anesthesia complications arise, they can easily point their accusatory fingers at the anesthesiologist and say they are simply following orders from the physician. They are not held responsible far any adversities in care.

So to sum it all up, CRNA's make a very decent salary, with lower student loan debt, receive better benefits, and are not responsible for their actions. Sounds like a pretty decent living to me.

Tuesday, December 13, 2016

Safe Anesthesia At The VA Assured

Safety first. Safety always. The VA system has made its final ruling on the use of CRNA's in the operating room. They wisely sided with having physician anesthesiologists continue to lead the operating team in safely administering anesthetics to our nation's veterans. Thanks to over 200,000 comments submitted to the VA advocating for anesthesiologists in the OR, there will be no CRNA's practicing independently at the VA hospitals endangering our patriots with their inferior anesthesia training. By contrast only a little over 9,000 letters were sent recommending that nurses alone can take care of our veterans.

But the fight is not over yet. There is still a 30 day comment period after publication of this final ruling for people to express their satisfaction, or lack thereof, with this judgement. The AANA is desperately asking an all hands on deck offensive to use this last opportunity to voice their displeasure. They are hysterically calling this, "a slap in the face to veterans who will continue to endure dangerously long wait times for anesthesia." They are even singling out one individual for their lost cause, "the undersecretary of the VA--whose personal bias, politics, and favoritism may have undone years of work by the agency he oversees and subverted the best outcome for veterans." Bitter much? This guy should be promoted to the head of the Department of Veterans Administration by the Trump administration ASAP. He at least knows common sense and is not distracted by all the hype and falsehoods promoted by the AANA.

So thank you undersecretary of the VA and the VA department. This one act alone will help President-elect Trump fulfill his promise to our veterans that they will receive the best medical care that the country can offer. This is YUGE!

Friday, December 9, 2016

Medicine In A Time Of Hate

Pranay Sinha, a third year medicine resident at Yale, shared his experience with racial hatred post presidential election. He thought he would be lauded for going above and beyond the call of duty taking care of an older white patient. Instead he was shouted down and fired by the patient. This sets Dr. Sinha into all sorts of mental turmoil.

Was he being singled out because he is a foreign medical graduate? Was it racial intolerance, since he never saw the patient treat white doctors the same way? Is it acceptable for doctors to be angry at their patients? When patients are sick and vulnerable, are they responsible for their words and actions? Should he develop thicker skin or should doctors demand respect from their patients the way we show respect to them? Has the presidential election emboldened people to drop their facade of tolerance and revealed their true colors?

As physicians, it's hard to get angry at patients without coming off as uncaring and impatient. I've had patients swing at me with their fists, spat on, scratched at, verbally abused, or generally not following orders. Yet I attribute them to the patients' general circumstances. They're in an unfamiliar environment, practically naked, most likely hungry and cold, with needles stuck in them or getting stuck every single day. I try not to judge them based on their aggressions. But many days it requires the patience of Job to make it through the day. And frequently, when I see the patient again later on they have usually forgotten about any slights that have been thrown my way and we can resume a normal relationship. But it is a challenge every doctor has to master to have a successful career, no matter their color or ethnicity.