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Showing posts from April, 2010

Comparative Effectiveness Research: Follow the Herd or Lead It?

I never took a psychology course in my life. Perhaps, I should have. How was I to know, or even suspect, that years beyond college, I would be the father of 5 kids? In retrospect, I should have been a psych major, so that I could have developed essential parenting skills in negotiating techniques, behavior modification, unflappable self control, brinkmanship, verbal dueling and mind reading. Without a solid psychological foundation, I have been fenced in and cornered by teenagers who know very well that I am shooting blanks. This has not been a fair fight. Two weeks ago, my daughter and I traveled to the east coast to visit 3 institutions of higher learning. This is the 3rd child that I have done college visits with. By now, I could give these ‘info sessions’ myself. They are verbal versions of Mad Libs, where the speaker simply plugs in terms specific to his institution. For example: “What really makes __________ University so unique, is our ( insert superlative adjective ) profes

Does Board Certification Really Matter?

My patients have the confidence of knowing that I am a board certified gastroenterologist (GI). I haven’t disclosed this to them personally, but somehow resourceful and curious patients can now find out facts about me that heretofore would have required a government warrant. (In fact, for my entire medical career, I have never displayed a diploma or any professional certificate in my office, which annoys my mom.) Now, with a few keystrokes, patients can read about my suspension from the fifth grade after making an unwelcome comment about another student. Being from the northeast, my initial reaction to this transgression was, “Will this be on my college record?” Assuming that I successfully recertify in gastroenterology in the coming year, I will enjoy this prestigious designation for another decade. I hope I that I am still practicing then, since the health care reformists have promised us a medical nirvana in in the coming years. It would be a shame if I retired just before the nirva

Cost-Effective Medicine: Cracking the Code

My friend, the Buckeye Surgeon , has resisted reforms in medical residency training programs, that have eased some of the inhumane exhaustion on young interns and residents. I have a different view on the subject. This issue generates spirited debate in the blogosphere and in teaching hospitals across the country. Not all medical education reforms, however, provoke controversy. I learned recently from an Ohio medical student that they are now being taught about the financial costs of medical tests and treatments. This makes so much sense that I am astonished it has taken so many decades to be incorporated into medical training. Indeed, even practicing physicians like me are often clueless about the costs of the tests we recommend. Perhaps, if we saw the price tags of the prescriptions and imaging tests we ordered, we might hesitate and reflect for a few nanoseconds A commentary in the current issue of The New England Journal of Medicine chastised medical educators and training p

Obama Passes on Colonoscopy: Oh, What Might Have Been!

Does anyone out there know why President Obama underwent a virtual  ‘colonscopy’ (VC) instead of a conventional colonoscopy earlier this year? In my gastroenterology practice, we do not offer colon cancer screening to 48-year-old individuals, unless special risk factors are present. Of course, maintaining the president’s health is in the national interest, so I understand why professional screening guidelines might not apply to him. For similar reasons, airline pilots are subjected to routine cardiac testing, not to protect the pilots' health, but to protect the passengers.  Stricter scrutiny of the president's health is proper. So, if the national interest required that the First Colon be studied prematurely, then why didn’t the president choose the screening test that nearly every physician opts for when we turn 50?  I’m baffled. It is inarguable that a colonoscopy is more accurate than VC and can remove polyps and obtain biopies at the time of the examination. In every i