Yes, I Sometimes Google Patients. Is That Weird?

There's no doubt about it. Typing your name (or your clinics name) into Google or Yahoo and seeing what pops up is something that the majority of your patients are now doing. So, we ask the question, is it fair to do the same?

Humans are curious creatures. Our curiosity has us doing utterly unproductive things like reading news about people we will never meet, learning topics we will never have use for, or exploring places we will never come back to. As social beings we're programmed to be interested in other people. It’s part of what makes us tick. (And let's face it, social media encourages us to become voyeuristic.)

Have any of you Googled a patient you found to be particuarly interesting? A patient you found to be behaving oddly? A famous patient? According to recently published articles, it appears that most M.D.’s answer that questions with a resounding “yes.”

In a New York Times column published online yesterday, Haider Javed Warraich, M.D. discusses whether or not that’s OK.

“Doctors do ‘Google’ their patients,’ he writes. “In fact, the vast majority of physicians I know have done so. “I remember when I first looked up a patient on Google. It was my last day on the bone marrow transplant unit, back when I was an intern. As I stood before the patient, taking her history, she told me she had been a painter and suggested I look up her work on the Internet. I did, and I found her paintings fascinating. Even though our paths crossed fleetingly, she is one of the few patients I vividly remember from that time. “But it surprises me that more physicians don’t pause and think about what it means for the patient-doctor relationship. What if one finds something that is not warm and fuzzy?” I recently read about a case in which a 26-year-old woman went to a surgeon wanting to have a prophylactic double mastectomy, citing an extensive history of cancer in her family. However, she was not willing to undergo any work-up, and her medical team noted several inconsistencies in her story. When they searched online, it turned out she had set up multiple Facebook accounts soliciting donations for malignancies she never had. One page showed her with her head shaved, as if she had already undergone chemotherapy. The surgeons immediately decided to halt her care.

I am tempted to prescribe that physicians should never look online for information about their patients, though I think the practice will become only more common, given doctors’ — and all of our — growing dependence on technology. The more important question health care providers need to ask themselves is why we would like to. Maintaining trust in the doctor–patient relationship is very important. Can a patient trust a doctor who presents information that has not been offered within the confines of the consultation?

Searching for information about patients online is ethical as long as the doctor is seeking information that helps treatment, Dr Warraich believes. “But if the only reason a doctor searches online is to gather personal information that patients don’t want to share with their physicians, then it is absolutely the wrong thing to do,” he concludes.

Thoughts? Is this a black and white, right/wrong issue? Please share. (We promise not to Google you.)

Is Technology Changing The Doctor-Patient Relationship (for the Worse)?

The first point of contact for a patient to ask post-surgical questions should be the surgeon who performed said surgery. The trend seems to be in exactly the opposite direction.

I've noticed a concerning trend. I participate in websites like RealSelf.com that connect plastic surgery patients and cosmetic surgeons. These sites are allowing patients to have near immediate access to expert plastic surgeons from across the nation and plastic surgeons to interact with potential patients.

In the past few months an increasing number of patients in the early post-operative period (some with dressings still in place!) have posed questions to “online surgeons” seemingly before seeking follow-up with the plastic surgeon who just performed the procedure. It is concerning that a patient would seek advice from a surgeon they do not have a doctor-patient relationship with and who is unfamiliar with the specifics of the surgery that they've recently undergone. Patients have even gone so far as to inquire about where to seek second opinions and whether revision surgery will be necessary all within the first post-operative week.

The early post-operative timing of this phenomenon is most concerning. This is the period in which we need to reassure our patients that bruising and swelling will resolve, dressings and sutures will be removed and that they truly will look great once they’ve healed. This period can cause patients significant distress and many require a lot of hand holding at this point.

We’re obviously failing some of our patients if they're reaching out online during this period instead of calling our offices and dropping in to be evaluated. I agree that second opinions are highly valuable and would not hesitate to arrange such for a concerned patient. However, a patient-initiated second opinion from an unfamiliar, online surgeon who has an incomplete picture of the patient's history is problematic at any time point let alone while the compression dressing is still in place!

What could possibly be responsible for this trend? As cosmetic surgeons are we so difficult to reach that our patients need to seek online advice from others? As we become more amenable to interacting with potential patients online are we failing to care for those who have already made a trip to our operating room? Is it simply easier for our patients to log onto a website rather than call the doctor's office? What can we do to direct those online inquires back to our own practices rather than into the digital ether?

As a Facial Plastic Surgery practice, my entire team is in the business of building relationships. If a patient has a professional, responsible and ethical plastic surgeon, the first point of contact to ask post-surgical questions should be the surgeon who performed said surgery. This trend seems about as far astray of that goal as one could imagine.

Has anybody else noticed this trend online? Have you experienced this with one of your own patients? What you have done to prevent this from happening in your practice? Please contribute your thoughts.

Hospital Administrators Are Not Always Honest

Hospital administrators have an agenda that's not always aligned with yours.

I used to do emergency work at a hospital in a large chain. It was hardy profitable and became less so over time. When I moved an hour away I sought to limit my emergency exposure for obvious reasons. The hospital administration cited sections of the Bylaws and Rules and Regulations that mandated that surgical specialists take call. This was specified for Plastic Surgery and Orthopedics.

Later and entirely by accident, I found out that the Orthopedists were being paid to take this emergency call by the same administration that was citing those hospital documents. Essentially they were being paid to take call from 15 minutes away whereas I was required to take call for free from four times the distance. Needless to say I dropped that hospital after briefly entertaining legal action. So soon after my divorce I hardly wanted to enrich another attorney. They are much smarter about getting paid than physicians are. I did inform a contact at the local newspaper who passed on the story stating that the public doesn't really care if a doctor gets screwed over. I found that a bit amusing.

As the story evolved I extended my practice up the street not so far away and something similar almost happened again. This time the administration in my new acute care hospital sought to get into an arrangement with me to take call. They were very quick to stipulate that this arrangement was to be secret. It was to involve some kind of payment from the hospital. The thought left a bad taste in my mouth. Emergency call is a loser. I just stopped taking it.

The moral of this story is that you should not expect hospital administrators to be honorable people. Entering into any kind of business arrangement with them especially a secret one is liable to be unfair, unjust or just plain illegal. You might want to avoid that.

Effects of Changes in the Medicare Physician Fee System

Relatively newly practicing physicians may not know that the Medicare physician payment system changed pretty substantially in the early nineties. This was by design.

The perception of those who designed this new system was that certain services were overpaid and others underpaid. It likely had much more to do with ratcheting down the costs of health care. As physician fees constitute only 10-20% of the entire equation, the wisdom of concentrating on physician’s fees to change the system is perhaps questionable. This is what was done nevertheless.

A cornerstone philosophy of the new system was that procedure-based specialties were overpaid. The physician fee system prior to this was based on usual and customary fees. This newer one based payments on a model that paid for a service at a uniform rate regardless of who performed it. While this seems fair on the surface, it had predictable effects.

Why would a surgeon with much higher overhead remove a lump in a patient if the new payment system put the procedure in a revenue negative position? The practice of surgeons removing certain lumps gave way to family practice and dermatology physicians removing many of them. These were the only specialties that under the newer system could turn a profit doing so.

The Medicare fee schedule economically regulates procedures in medicine. It also indirectly fed the growth of cosmetic medicine and surgery as this was the escape hatch many practitioners sought as the Medicare boom feel upon us. Surgeons interested in turning a profit quickly figured on what paid adequately and more importantly on what did not. As my grandfather told me as a young child, everyone needs to make a living. It is perhaps unfortunate that doctors do not discuss these matters with patients when telling them why they cannot offer a service. Is it really ever wrong to tell your patients the truth?

Dumbing It Down?

By Julie Silver MD

It's not uncommon that someone will make a comment to me about how we (physicians) need to "dumb it down" when it comes to publishing information for consumers. 

In fact, this is exactly the wrong approach when you are trying to reach people with important health information.  Instead, what we need to strive for is a smart translation of medical science. 

While it's true that people who are not in healthcare likely won't understand a highly technical medical research study (just as doctors probably wouldn't understand a complicated document in another industry), what isn't true is that our patients, readers and consumers need to have information "dumbed down."

A smart translation means that you are approaching your reader with respect for his or her intelligence and knowledge.  Dumbing anything down is just plain disrespectful.  Attitude comes across the written page and seeps into the "take home messge."  A respectful attitude means that readers are more likely to consider the information presented.  Perhaps to heed the advice and even to share it with others. 

Bottom line: everything that physicians write and publish should be done with the goal of offering a terrific translation for a given audience.  I think about this a lot.  When I don't get it right, it isn't because I dumbed my communication down.  I just didn't quite nail the translation.  Great translations aren't easy, but they are incredibly effective.  Offering important health information along with respect is what we should all aim for all of the time.

About: Julie K. Silver, MD is an assistant professor at Harvard Medical School in the Department of Physical Medicine and Rehabilitation and is the Chief Editor of Books at Harvard Health Publications, the consumer health branch of Harvard Medical School. She is the director of the annual Harvard CME course titled "Publishing Books, Memoirs and Other Creative Nonfiction". She blogs at Freelance MD.

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Are Medical Societies Irrelevant For Physicians?

By Greg Bledsoe MD

Ask yourself this question: "Why am I in my medical society?"

A few years ago I took the plunge and stopped hoping to become an entrepreneur and actually stepped out and gave it a whirl.  It was a crazy time. 

I learned very quickly that starting a business always takes a lot more time and money than you originally envision, and in short order I was scrounging for capital to fuel my dream.

It was during this time that I made a decision to let my medical society memberships lapse.  I had never considered it before, really, and as far as I was concerned, being a part of medical societies was simply part of being a physician-- I paid my dues and they supplied my, er, membership.

When I was in academics, my department paid my society dues as part of my contract.  I never thought about the cost since I didn't view the funds as coming from me (there seems to be a moral here somewhere...), but when I entered the world of community, or non-academic, medicine, suddenly the costs associated with these memberships became very real.

Five hundred dollars for this membership.  Three hundred a year for that one. It quickly added up, but I got a special tuition discount if I attended the annual meeting and I even got an occasional journal delivered to my mailbox with my name stamped on the front.  It all seemed very official and made me sort of feel like part of a special group, so I dutifully paid the dues and congratulated myself on my support of the furthering of the intellectual aims of XX society.  

However, as anyone who's ever been in business can tell you, at some point tough decisions have to be made, and for me, the relinquishing of my membership in these societies was one of those tough ones.  I believed in these organizations.  I liked being associated with them.  I enjoyed seeing my name stamped on the front of the journals and I even flipped through an article or two when I could.  Walking away from something that made me feel so "involved" made me feel isolated, vulnerable.  If being a member of these organizations made me feel included, leaving them made me feel...alone.

That was almost three years ago.

Since then, the various ventures with which I'm involved have finally started to right themselves and for the first time in quite a while I have begun to have the ability to get involved once again in medical societies.  In the past few months I've begun to ponder joining this society or that one, trying to figure out which one would be a better fit and from whose membership I would learn the most skills-- and meet the most talented leaders.

After marching down this path for a little bit, I finally stopped and asked myself a very simple question: why?

Why was I considering membership in a medical society?

It's true that when you begin a company your mind becomes much more keenly aware of the theoretical "return on investment" (ROI) than before.  I began asking myself the typical ROI questions I had asked myself at the beginning of any of my entrepreneurial ventures:  What would I gain from the investment of time and money in this organization?  Would my funds be better directed elsewhere?  Could I gain the same benefits without investing the relatively high annual dues?  How would I verify that my funds would be used appropriately and at what point would I be able to have an impact in the overall mission of this organization?

My honest assessment after a sit down talk with myself and a review of the available information before me was the following: For the most part, medical societies do not offer a significant enough ROI to warrant the investment required to participate.

I know this sounds like heresy for some, but let's review the facts...

From what I can tell, the reasons given for a physician to be a member of any medical society today basically revolve around three points.  

First, societies are said to offer camaraderie and networking opportunities for their members.  Second, societies supposedly help promote medical education and proper practice standards among their participants.  Third, medical societies, through the old "strength in numbers" adage, are in theory better able to represent their members politically and promote and pass legislation that furthers good medical practice.

Let's review these arguments in broad daylight and see if they hold water.

A generation ago, being a member of a medical society was really the only way a physician could connect with other physicians outside their basic social circle.  You joined the medical society of X in order to associate with its members, get invited to its galas, hear the latest research, and hopefully move up the ladder of influence of said organization as you progressed in notoriety and seniority.  This model was the same model used in the business world with the Elks Club, Rotary International, and the corporate culture at large.  Young, idealistic individuals, regardless of their skill set or motivation, waited in line patiently for their name to be called and an opportunity given to begin climbing the rungs of leadership within an organization, whether this organization was the Elks, IBM, or the X Medical Association.  One didn't even consider leaving if you had any career ambitions or longing for social connectedness.  The arrangement was what it was, and you just had to adjust.  

This model worked for quite a while since it was easy for senior members to control the benefits of membership, and parcel these benefits out only to those junior members who walked the line. 

In the corporate world, the personal computer revolution and especially the internet explosion, completely imploded this hierarchal regime.  No longer could senior corporate members exclusively hold the benefits of membership.  Enterprising upstarts could easily, from the comfort of home, begin a company on the web and not only leapfrog their old positions, in some cases they leapfrogged their entire industries.  The recent movie The Social Network , while criticized for not being 100% accurate, at least tells the gist of the story-- that a couple of Harvard undergrads turned the world on its ear from their dorm room.  

The internet has become the great world flattener, and while Richard Florida is correct that innovation still occurs in geographic regions, the ability to take your idea to the world in an instant is a tremendous power that prior generations did not have.  Furthermore, with the internet and more specifically, the social networking ability on the internet, junior members in every organization can instantly, and freely, associate themselves with whomever they choose all around the world.  Gone are the days when being on the outs with your local or even national medical society is a professional death sentence.  Individuals now have the ability to join any number of interesting networking groups, or even start their own.

Along this same line of thinking, the days when medical societies controlled medical education are long gone.  With the click of a keyboard, I can find medical education on almost any topic and I can access it at any time. I don't have to wait for my professional journal to arrive, and anything cutting edge will be posted on the web long before it hits my mailbox anyway. 

When I pay my fees to earn CME credits, I now have the opportunity to choose what topics I hear, and whom I hear teach them.  No more sitting in a conference lecture listening to the droning of Dr. Oldenkrinkle simply because he's the chair of the education committee. I can learn from the best teachers at any time in the comfort of my home and earn my CME credits on my own terms.

So with regards to the power of networking and the educational opportunities available, I would have to say that there are as many, or more, opportunities outside of medical societies today as there are within.  And when you consider that most of the membership societies available to the modern physician are free, why would you pay $300-$500 to be a member of a medical society for the networking or educational reasons?  It just doesn't make sense.

The last reason-- pooling our strength to become a stronger political lobbying force for X issues or specialty-- is the one most often cited in the recent past by modern physicians as a reason to be involved in a medical society.  Matter of fact, this one reason was a big one for me.  I mean, any objective person can see that physicians need a strong lobbying voice in Washington, if for no other reason than simply to attempt to counterbalance the influences of the trial lawyers and their ilk.  

However, I describe this as being cited in the "recent past" because I haven't heard it from any physician recently.

No, if there was one glorious revelation that came into full view during the healthcare debate in this country, it was the cowardice of the self-serving leadership at the helms of most medical societies in this country.

I don't think any physician will be fooled in the future with the "give us your money and we'll stand up for you" line that motivated us in the past.  What the healthcare debate clearly revealed was that when medical societies say they work for their constituents, they do truly mean this.  It's just that their constituents aren't the dues-paying members that constitute their ranks-- they're the entrenched bureaucrats in their leadership.

Physicians watched in horror as medical society after medical society lined up and endorsed Obamacare, and then spoke to America as if their members were in agreement.  The American Medical Association was the worst offender, selling its soul to keep intact its lucrative, exclusive right to the CPT billing codes that fund its bureaucracy.  It was appalling in its transparency, and no physician who saw it will ever forget it.

So what to do as a modern physician?

The point here isn't to argue that no medical society is worth joining.  Many societies do good work in certain areas and there are physicians who derive a great deal of pleasure from membership in a society or two of interest.

My point in this post is that being a member of a medical society is simply not the knee-jerk necessity it was a few years ago, and there's no credible reason to join any society unless you really feel that their mission meshes with yours and you want to be involved.

More importantly, I believe that medical societies need to begin asking themselves what real value they give their members.  Today's young physician will not be coerced in the traditional way into membership, and if value isn't apparent, many will simply walk away.

So will I eventually join a medical society?  

I don't know.

Maybe.  

I'll need to discuss it with my friends on Facebook and get back to you.

Greg Bledsoe MD MPH is a Board Certified Emergency Medicine physician and the founder and CEO of ExpedMed and the Medical Fusion Conference. He blogs at Freelance MD.

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Physicians Social Contract & Healthcare

At the Medical Fusion Conference this last weekend I was fortunate enough to get to hear Dr. Arlen Meyers speak. (You can listen to Dr. Arlen Meyers interview on the Medical Spa MD Podcast as soon as we release it.)

Dr. Meyers is very aware of the general malaise that physicians practicing medicine in the US feel and published this on LinkeIn which I thought was right on.

I've just returned from several meetings on healthcare IT and non-clinical careers. While there is considerable angst, confusion and outright anger over what's going on in healthcare, there are several things to consider:

1. During periods of change there are enormous opportunities. The challenge is to position yourself to identify them and arm yourself with the skills, networks and experience to capitalize on them.

2. Physicians have a social contract with society. We are afforded licenses, privileges, societal considerations and prestige by those we treat. Be careful advocating severing those contracts or unilaterally altering the terms.

3. Restructuring of the healthcare system , if done right, will allow those interested to leverage their abilities to treat more patients with the same amount of effort.

4. Doctors in the US make more money than the large majority of people in the world. Placing individual financial interest over societal and patient interest is understandable from a individual perspective, but, often won't pass the political smell test.

5. While you might feel dejected, unappreciated and stripped of your control, keep in mind that the initials after your name and the domain expertise you have, still commands respect in the business community and is highly sought. 

There is a tremendous amount of disruption that's happening in healthcare. Physicians who recognize how to take advantage of this are going to be far ahead when the music stops.

Race & Empathy In Medical Centers

Can race (or any difference) affect the quality of care that a patient receives at any medical center?

from CNN

In the study, which appears in the journal Current Biology, people of Italian and African descent watched short film clips that showed needles pricking black- and white-skinned hands. As they watched, researchers measured the participants' empathy (i.e., their nervous-system activity) by monitoring sensors attached to the same spot on their hands. They also tracked the participants' heart rates and sweat-gland activity, a common measure of emotional response.

"White observers reacted more to the pain of white than black models, and black observers reacted more to the pain of black than white models," says the lead researcher, Alessio Avenanti, Ph.D., an assistant professor of psychology at the University of Bologna.

The researchers also showed clips of a needle pricking a hand painted bright purple. Both the Italian and African participants were more likely to empathize with this intentionally strange-looking hand than with the hand of another race, which implies that the earlier lack of empathy was due to skin color, not just difference. "This is quite important, because it suggests that humans tend to empathize by default unless prejudice is at play," says Avenanti...

..."A doctor with high racial bias may understand the pain of other-race patients in a more detached or disembodied manner and, in principle, this may contribute to the causes of racial disparities in health care," Avenanti says.

Previous research has shown that doctors tend to empathize more with a patient's pain -- and provide higher-quality care -- if they have a history of pain themselves, or if someone close to them has experienced chronic, debilitating pain, Dr. Green says.

"Now we are understanding that if you see someone as being more like you, you can empathize with their pain better," she says. "Race, age, gender, and class probably play a role in how we assess and treat patients with pain."

So does that mean that, say, an African American with low back pain should seek out only doctors who are African American?

Not necessarily. Green says it's more important to find a doctor who actively listens to you and asks questions.

"If you feel you are not heard, or that your pain complaints are not being taken seriously, you can and should see another doctor," she says.

Interesting article and worth keeping in mind around your medical center when you have a varied patient population.

Zerona Lasers

Thoughts on Zerona Lasers

LH (Dr. Lornell E. Hansen II MD) has this comment on the latest Zerona Lasers review discussion around the effacacy of Zerona for 'fat melting' and a study that was just released.

Here's the Zerona Body Sculpting Study

Low-Level Laser Therapy Effectiveness for Reducing Pain After Breast Augmentation American Journal of Cosmetic Surgery Vol. 26, No. 3, 2009
Robert F. Jackson, MD; Gregory Roche, DO; Todd Mangione, DO

LH's comments:

...I do have to apologize as I did not know that the article had been published. The last I had read was that it was waiting for review. I also want people to understand that I am not saying that the physicians involved in the study did anything wrong with my evaluation of the article. I just think that the company is over marketing the product and charging way too much.

My critique:

1. The first thing they teach you in medical school on how to evaluate research is who paid for the research. In this case the sponsor of the research and article was Erchonia the company that makes Zerona.
2. Who wrote the article? In this case the article appears to have been written by Ryan Maloney. Who is Ryan Maloney? He not only is the medical director of Erchonia he actually has ownership in the patent of the Zerona. Other than that you do not know his background. We know he is not a PhD or physician otherwise it would be behind his name under the authorship of the article. He has a direct financial benefit to write the article in a positive light.
3. 8 Individuals did not have final measurements. The first question is why? 4 were from the treated group and 4 were from the placebo group. At first that seems OK, but when you look further into they kept all of these test subjects included in the study. What they did is they took the last measurements for those subjects and carried them forward. Again seems Ok at first but when you start to look at the trend of circumferential loss at the 2 weeks post treatment the measurements are trending back toward baseline. So if you include these patients last measurement (which by the way is the best overall average circumferential loss during the treatments for the treated group) and carry them forward they will artificially lower the true values two weeks post treatment. All 8 of these subjects should have been eliminated from the study.
4. There is no assessment of cosmetic benefit. To have this be worth something you would need before and after pictures that are reviewed by a group of individuals that are blinded to which treatment the individual participant received. So in other words is a 3 inch loss aesthetically significant.
5. They do not state if participants are male or female. So the question is left, does it work as well on males as it does on females? This could be very important as males tend to have thicker skin so does the laser penetrate as deep in men?
6. the study was limited to patients with a BMI of 25 to 30. Now I think it is fine to have this limitation as you have to start your research somewhere. But the limitation is that the article is implying that it will work for all BMI's. What about the thinner female patient with a BMI of 20 but has a small lower abdominal pooch? Or what about the patient that has a BMI of 35? This should be stated in the conclusion but Mr. Maloney seems to forget this.
7. They also do not state if the patients received their treatments for free or if they were compensated for their time. This is only important for the portion of the study that talked about the patient satisfaction. We need to understand that patients will put a value on the treatment because if something is free their expectations are much lower. their expectations are much higher if they paid $2500 for the treatment. So if this was free to the patient and you have 30% of the treated group that are dissatisfied or neutral what would that mean to a clinic if the patients are paying for it. I would guess you will have a much higher dissatisfied group that either wants their money back or free treatments. I do not want something in my clinic that has a 30% failure rate.
8. They do not discuss if either group was asked to change their diets. This should be stated up front in the methods portion of the article. They also do not mention if there were any dietary supplements required such as niacin. Most clinics using Zerona are having the patients take niacin even Erchonia recommends it.
9. They set the standard for success to be an inch loss of 3 inches or greater. Only 62.86% of the treated group achieved success. So this translates in to a 37.14% failure rate. Again, not something that I would want to stake my reputation on.
10. Now what do the numbers mean? If you look at the numbers the patients baseline combined measurement average was 120.31 inches. At week 2 of treatment (the best measurements achieved) the average was 116.79 inches or an inch loss of 3.52 inches on average. This sounds pretty good until you look at the true numbers. Using the numbers from the study this equates to a 2.9% inch loss as measured over 4 areas. Is this clinically (visually) significant? I do not think that most individuals will be able to see a 2.9% change or if they can it will be meaningful.
11. Lets take a look at the 2 weeks post treatment measurements. Remember, these are not true numbers as 4 patients had their best numbers included in these measurements pulled forward and included here. (I think all of their measurements should have been puled out). At 2 weeks post treatment, you see a 0.31 inch increase from the circumferential measurements at the 2 week treatments. What this equates to is an 8.8% increase in inches in only 2 weeks. So what happens at 4 weeks? 6 Weeks? So if it were a perfectly linear increase it would only take about 20 weeks or so to be 100% back at baseline. That is if it were linear and I highly doubt it is a linear response and if i had to guess most patients will be back at baseline measurements within 6 to 10 weeks and this is why there are no long term studies. The company has had ample time to produce longer term studies they apparently do not want to.

So as you can see, there are a few issues with this article and how it was analyzed and written. The first and foremost problem is that the article was authored by an individual with direct financial interest in the product. The ASLMS journal never should have published this article due to the authors conflict of interest or it should have a disclaimer prior to the abstract. I have no vested interest in any of these non-invasive technologies and would love to see something like this work and have long term benefits for the patients. I think this technology may have better long term benefits on cholesterol etc. I have heard that there are some interesting studies coming. I just hope they are not written by Mr. Maloney. And for others reading this I assume that Chad works for Erchonia or the marketing company that is selling this thing to anyone they can including chiropractors.

Sincerely,
Lornell E. Hansen II, M.D. (LH)
www.LazaDerm.com

p.s. Sorry for being so long winded but I could not help myself. I want these companies to be held to higher standards. I think the ASLMS should have higher standards as well.

If you read the thread there's some interesting thoughts that spring to mind. If Chad is not with Zerona it would be the first time in my experience that a patient has been searching for peer-reviewed medical studies before deciding to have a treatment... I'm just saying.

Of course this qualifies as a guest post and a well deserved back link.

Any other physicians using Zerona have any thoughts?

Are the best medical spas making the most money?

Is you're medical spa providing the best medical care or just making the most money? Are they mutually exclusive?

There's a New Yorker article detailing the commencement address Atul Gawande Atul Gawande delivered this commencement address, titled “Money,” to the graduates of the University of Chicago Pritzker School of Medicine. It expands on the themes he touched on in his recent article about health-care costs in McAllen, Texas, which figured in President Obama’s speech on health care.

The text of this speech is available in this article in the New Yorker:

No one talks to you about money in medical school, or how decisions are really made. That may be because we’ve not thought carefully about what we really believe about money and how decisions should be made. But as you look across the spectrum of health care in the United States—across the almost threefold difference in the costs of care—you come to realize that we are witnessing a battle for the soul of American medicine. And as you become doctors today, I want you to know that you are our hope for how this battle will play out.

Kevin MD has this on: Can doctors resist the lure of money?

That’s a tall order for many American physicians.

In his speech, which is an extension of his celebrated New Yorker piece, he looks at so-called “positive deviants,” or doctors who practice higher value, higher quality care, than everyone else.

What makes these doctors so special? In essence, they have to “resist the tendency built into every financial incentive in our system to see patients as a revenue stream.”

Indeed, “These are not the doctors who instruct their secretary to have patients calling with follow-up questions schedule an office visit because insurers don’t pay for phone calls. These are not the doctors who direct patients to their side-business doing Botox injections for cash or to the imaging center that they own. They do not focus, the way business people do, on maximizing their high-margin work and minimizing their low-margin work.”

Unfortunately, most American doctors fail to resist the allure of money. In some cases, it’s greed. But in many others, patients and business have to be intertwined simply to keep the doors open. Doctors cannot practice quality medicine while bankrupt.

Changing physician behavior needs to be accompanied by fundamentally modifying the incentives that influence doctors. Without radical physician payment reform, Dr. Gawande can implore future doctors to fight the financial incentives all he wants, but most will realize that resistance alone will be futile.

So where does that leave us? Are plastic surgeons and medical spas practicing medicine first, or business? How, if ever, does cosmetic medicine differ from 'real' medicine? Is there any ethical guideline that applies or is cosmetic medicine fundimentally different?

Medical Spa MD: Burned out & depressed plastic surgeons more likely to commit medical errors?

Surgeons who are burned out or depressed are more likely to say they had recently committed a major error on the job, according to the largest study to date on physician burnout.

The new findings suggest that the mental well-being of the plastic surgeon is associated with a higher rate of self-reported medical errors, something that may undermine patient safety more than the fatigue that is often blamed for many of the medical mistakes.

Although surgeons do not appear more likely to make mistakes than physicians in other disciplines, surgery errors may have more severe consequences for patients due to the interventional nature of the work. Some estimate that as many as 10 percent of hospitalized patients are impacted by medical errors.

"People have talked about fatigue and long working hours, but our results indicate that the dominant contributors to self-reported medical errors are burnout and depression," said Charles M. Balch, M.D., a professor of surgery at the Johns Hopkins University School of Medicine and one of the study's leaders. "All of us need to take this into account to a greater degree than in the past. Frankly, burnout and depression hadn't been on everybody's radar screen."

Nine percent of the 7,905 surgeons who responded to a June 2008 survey commissioned by the American College of Surgeons for a study led by researchers from Johns Hopkins University School of Medicine and the Mayo Clinic reported having made a major medical mistake in the previous three months. Overall, 40 percent of the surgeons who responded to the survey said they were burned out.

Researchers asked a variety of questions, including queries that rated three elements of burnout -- emotional exhaustion, depersonalization and personal accomplishment -- and others that screened for depression.

Each one-point increase on a scale that measured depersonalization -- a feeling of withdrawal or of treating patients as objects rather than as human beings -- was associated with an 11 percent increase in the likelihood of reporting an error. Each one-point increase on a scale measuring emotional exhaustion was associated with a 5 percent increase.

Mistakes also varied by specialty.  

Surgeons practicing obstetrics/gynecology and plastic surgery were much less likely to report errors than general surgeons.

Researchers acknowledged the limitations of self-reporting surveys, saying they couldn't tell from their research whether burnout and depression led to more medical errors or whether medical errors triggered burnout and depression among the surgeons who made the mistakes.

The results are being published online on November 23 in the Annals of Surgery and will be published in the printed journal in an upcoming issue.

Notably, the research shows that the number of nights on call per week and the number of hours worked were not associated with reported errors after controlling for other factors.

"The most important thing for those of us who work with other surgeons who do not appear well is to address it with them so that they can get the help they need," says Julie A. Freischlag, M.D., chair of the Department of Surgery at the Johns Hopkins University School of Medicine and another of the study's authors.

via sciencedaily.com

Perhaps the most relevant items here are the decreased reporting of problems by plastic surgeons and the fact that 'depersonalization' has entered the discussion.

I'm really curious about what plastic surgeons think of this study.