Monday, October 14, 2013

The Unnecessary Annual Physical

Danielle Ofri, ('Doctors' Bad Habits', Sunday Review October 6) after evaluating data that pointed to the lack of benefit in performing annual physical exams on young, healthy, asymptomatic patients, concluded that they were still worthwhile - at least for her.  Without citing any data of her own, the doctor concluded that an annual visit "establishes a solid doctor-patient relationship." We are not told, however, what her patients think about this medically unnecessary visit.  After all, they are asked to come to see her for no medically established reason, and in the process may be losing a day's work, or having to find someone to provide child care, etc.  I feel quite certain that a fee is involved as well.

Medicine should be practiced using well established guidelines.  Physicians often practice methods taught years ago, or practice by some "grandfathered" idea, if you will, that actually has no basis whatsoever in fact.  Evidence-based medicine is the path that all physicians should follow.  If they feel otherwise they should offer their patients a good explanation before he is asked to give up his time and spend his (or, more of then than not - our) money.

Dr. Ofri has decided that annual physicals are worthwhile despite data showing otherwise.  Why not semi-annual physicals, or quarterly physicals?  Why has "annual" become the standard for Dr. Ofri?  Maybe weekly phone calls would be even more beneficial for the doctor-patient relationship, Dr. Ofri.

Thursday, October 10, 2013

Non-MD Medical Providers Performing Abortions in California

We are getting there!  As you, my readers know, The Blog has been a champion of non-physician medical care, knowing full well that properly trained, skilled nurse practitioners and physician assistants are highly qualified to provide such service.

Gov. Jerry Brown of California has signed into law a bill that will permit nurse practitioners, midwives and physician assistants to perform all forms of abortion, including surgical abortions.  Those opposed to abortions are maintaining that the new law will "reduce the medical standards for abortion," thereby "reducing safety."(1)

Ridiculous.  This bill will put the procedure within reach of women who often live in settings where physician-provided abortions are difficult to access, and provide them with skilled practitioners.

You do not have to be a physician to perform an abortion.  You do not have to be a physician to perform many forms of surgery.  You do not have to be a physician to perform many emergency medical procedures. You do not have to be a physician to provided excellent general (or even specialized medical care).

An interesting article in the recent edition of The New England Journal of Medicine (2) concluded that he best surgery is carried out by the physicians with the greatest "skills," not necessarily those with the best training.  "Our study showed wide variation in technical skill among fully trained, practicing surgeons." (2)

Academic training is one thing.  Developing the necessary skills is something else.  And, you know, there are many skilled non-MD practitioners who may be far more skilled than those with MD degrees.  Trust your experienced, skilled non-MD medical provider - your physician often does, the city government does (EMTs, etc.), the armed services do (front-line medics) - and so should you.

1. New York Times, Oct. 10.
2. The New England Journal of Medicine, Oct. 10.

Tuesday, October 1, 2013

What a Hospital Ad Does Not Tell You

"The thousands of minimally invasive procedures performed by our cardiac surgeons have shown shorter hospital stays and reduced recovery time, among other benefits.  This proven record of strong outcomes is why we are nationally ranked in cardology and heart surgery by U.S. News and World Report."

This full page advertisement by NYC Langone Medical Center,  on the back page of the Business Section of The New York Times (Oct 1) must have cost quite a bit.

You need to notice what it does not say.  It says nothing about actual long-term outcomes.  It says nothing about the success of the procedures.  It says nothing about re-admission rates, it says nothing about infection rates.  It says nothing about morbidity and mortality rates.  It says nothing about actual diagnoses and statistics regarding each form of abnormality treated.

Please readers, pay no attention to such ads.  The only useful information contained therein is that minimally invasive heart surgery techniques are available at Langone (as they are, by the way, at most all major cardiovascular surgical centers in the United States).

Below is a summary of the state of minimally invasive surgery from a recent NIH review:

1. Minimally invasive cardiac surgery (MICS) represents a safe and effective approach for a variety of cardiac surgical diseases.
2. MICS does not appear to result in differences in short- or long-term survival compared with the sternotomy approach.
3. MICS may be associated with lower rates of perioperative complications in certain instances.
4. MICS appears to result in decreased length of hospitalization, improved pain control and faster recovery to normal activities.
5. Continued research is necessary to assess long-term outcomes of minimally invasive approaches.
6. With regard to outcome measures such as quality of life, minimally invasive approaches may be the standard on which to compare evolving percutaneous technologies.

Pay particular attention to statements No. 2 and No. 5.

When choosing your medical center and your surgeon, ask the right questions - be fully informed.  Do not pay attention to these expensive marketing techniques that many medical centers are now using to increase their market-share!