Saturday, September 20, 2008

MedlinePlus: News by Date

Read health-related news articles from Reuters Health Information (articles display for 30 days) and HealthDay (articles display for 90 days), plus the most recent press announcements from major medical organizations.

Friday, September 19, 2008

Post-traumatic stress disorder in ICU survivors. - Slate Magazine

What can cause post-traumatic stress disorder? 

Symptoms of stress following traumatic experiences have been reported since people began writing about war. But PTSD didn't come into formal use until 1980, when severe psychological symptoms were seen in Vietnam veterans. As the condition was studied, it became clear that it didn't apply only to Vietnam veterans. Almost anyone who had been exposed to severe stress or a traumatic event—surviving a tsunami, living through a terrorist attack—could experience PTSD. 

Typically, patients re-experience their trauma as flashbacks and nightmares and often have trouble sleeping. Many perform badly in their jobs or have difficulty with social relationships, perhaps because they are excessively prone to anger or irritability. 

A less obvious cause of PTSD, just recently written about in the journal General Hospital Psychiatry, involves the experience of being seriously ill or injured and treated by hospitalization in an intensive-care unit.

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Doctor and Patient - The Tyranny of Diagnosis -

For several years of my childhood, my mother suffered from an illness that could not be diagnosed. I have memories of her weakness, of days spent whispering so that she could sleep, and of living with the constant darkness of her bedroom and of her suffering.

Debilitated, my mother went from doctor to doctor, clinician to clinician. Despite their rapt attention to the details of her symptoms, she eventually heard from them what her surgeon-daughter would someday tell others: "We have no idea why you are so sick."

As I read up on cyptogenic cirrhosis, I was reminded of those words again. Over the last few years, medical researchers have made tremendous advances in our understanding of this illness; it is not quite so cryptogenic anymore, and those suffering from the disease may soon have specific drugs for treatment.

That's good news for patients, I thought as I scanned the Web sites. But also not-so-good news.

As comforting as it may be to have a real diagnosis, those diagnoses also carry powerful assumptions about our bodies and our place in the world, which can in turn influence our health care.

Charles Rosenberg, a Harvard historian, writes about the power of diagnoses in his book "Our Present Complaint: American Medicine, Then and Now" (Johns Hopkins University Press, 2007). He refers to it as the "tyranny of diagnosis."

The concept of disease, Professor Rosenberg writes, has historically focused on the individual — a single person's experience, story and sense of meaning.

Over the last century and a half, however, medicine has increasingly decoupled disease from the individual. This decoupling has given rise to the concept of precise, objective and quantifiable diagnoses, diagnoses so separate from patients that they seem in many ways to take on a life of their own.

Diagnoses cluster together by specific physiologic mechanisms, signs and symptoms, pathologic findings. They have insinuated themselves into health care economics as DRG's, or Diagnosis-Related Groups, which drive physician compensation. They have inspired whole subspecialty training programs and huge advances in how we understand and treat them. Think of heart failure, cancer and my own specialty, liver transplantation.

This greater understanding and improved treatment are important and good news for all, no doubt.

Yet along with these great clinical strides, diagnoses have also fomented their own cultural revolution. Diagnoses have changed the way we approach individuals.

Diagnosing a patient requires placing that single person's narrative against the larger predetermined trajectory of a diagnosis. When the individual's story fits into the diagnosis's trajectory, there is some relief for all of us. We know what is wrong.

But when we know what is wrong, we sometimes stop paying such close attention to those patient experiences that seem to have little relevance to the diagnosis at hand. We focus less on the individual and more on the diagnosis.

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Medicare Reaches Out to Caregivers - The New Old Age Blog -

What do you mean Medicare doesn't pay for it?

Nothing shocked me more in the early days of caring for my elderly mother than the discovery that Medicare, the U.S.'s universal health coverage for those ages 65 and older, does not pay for so many of the things the frail elderly require.

Not home health aides for those who can't get out of bed, bathe, dress or feed themselves. Not an assisted-living facility, with handicap-accessible apartments, congregate meals and transportation services. Not nursing homes where the most helpless of the elderly live out their days with round-the-clock supervision.

This remains true, and will remain so absent a complete overhaul of Medicare legislation, which was written in the 1960s when life expectancy was shorter and fewer people lived long enough to require long-term care. But starting today, on the federal government's new Web page for caregivers, it will be easier to figure out what Medicare does cover and what it doesn't; to find community-based resources to take up the slack; to access other government and non-profit agencies that assist the elderly and their caregivers (most often adult children); and to find the message boards, online forums and blogs that have proliferated along with the exploding needs of these two generations.

Kerry Weems, the acting administrator of the federal Centers for Medicare and Medicaid Services and the driving force behind its new one-stop-shopping Web page, acknowledges that all but the poorest Americans are on their own when it comes to paying for long-term care. "Unless Congress steps in, we have to be obedient to the legislation," he said, noting that the Medicare trust fund is already in such desperate straits that it could not begin to absorb the cost of long-term care.

Medicare caregivers site:

Health Blog : What's the Best Way to Pay Doctors?

Pay doctors for every procedure they do, and you give them a financial incentive to perform unnecessary treatments. Pay them a set price per patient, and you create an incentive to deny needed treatments. So everybody in health care is trying to find a third way that — ideally — ties payments to high-quality care that manages to reduce unnecessary costs.

In an essay in this week's New England Journal of Medicine, Harvard health economist Meredith Rosenthal lays out some of the experiments now underway. They include:

The medical home model pays primary care providers to coordinate care for patients with chronic illness, and typically includes pay-for-performance bonuses for delivery of recommended preventive care.

Episode-based payments such as the Prometheus System pay doctors a set fee for treatment of a given condition. The fee is adjusted based on a patient's individual characteristics, and there's a warranty for care if complications arise. There's also an incentive for docs who provide care that meets both quality and efficiency standards.

In the Medicare Physician Group Practice Demonstration program, a few large physician groups are trying to meet quality guidelines while saving money (as compared to risk-adjusted spending on other patients in the same market). Groups that manage to meet both goals get a big share of the savings.

Rosenthal closes with a rather gloomy thought that puts the whole endeavor in doubt. She writes: Given that the two major goals of reform are to constrain spending growth and to move money from more intensive to less intensive settings — from doctors who carry endoscopes and scalpels to primary care physicians, for example — there will be substantial resistance to even the best-designed plans.

Tons of drugs dumped into wastewater

U.S. hospitals and long-term care facilities annually flush millions of pounds of unused pharmaceuticals down the drain, pumping contaminants into America's drinking water, according to an ongoing Associated Press investigation.

These discarded medications are expired, spoiled, over-prescribed or unneeded. Some are simply unused because patients refuse to take them, can't tolerate them or die with nearly full 90-day supplies of multiple prescriptions on their nightstands.

Few of the country's 5,700 hospitals and 45,000 long-term care homes keep data on the pharmaceutical waste they generate. Based on a small sample, though, the AP was able to project an annual national estimate of at least 250 million pounds of pharmaceuticals and contaminated packaging, with no way to separate out the drug volume.

One thing is clear: The massive amount of pharmaceuticals being flushed by the health services industry is aggravating an emerging problem documented by a series of AP investigative stories - the commonplace presence of minute concentrations of pharmaceuticals in the nation's drinking water supplies, affecting at least 46 million Americans.

Researchers are finding evidence that even extremely diluted concentrations of pharmaceutical residues harm fish, frogs and other aquatic species in the wild. Also, researchers report that human cells fail to grow normally in the laboratory when exposed to trace concentrations of certain drugs.

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Speed Bump

Thursday, September 18, 2008

Speaking Doctorese - Why physicians can't communicate (National Post)

What is your doctor hiding from you? In his new book Hippocrates' Shadow: Secrets from the House of Medicine, emergency physician David H. Newman reveals uncomfortable truths about the profession. Today, learning how to obtain a good bedside manner.

Our class sat in the lecture hall, uncommonly attentive. Playing on the screen in front of us was a video of a woman undergoing a detailed breast and pelvic examination. Oddly, the woman looked into the camera and narrated as she was examined. She was a "professional patient," and in addition to being regularly poked and prodded by hapless medical students at our institution, she played the lead role in this educational videotape. It was indeed educational. And strange.

After the video had finished, we stood in the hallway outside the lecture hall. There was scattered nervous laughter and some awkward discussion, with many of the female students expressing amazement -- "How does she do that?" -- or just shaking their heads.

The male students fell into two distinct groups -- one silent, the other not so. Our class had a number of what we referred to as "six-year wonders," students who participated in a combined college/medical school program that included only two years of undergraduate study, followed immediately by enrolment in medical school. Many of them had begun their medical education at the age of 19 or 20, and it was one of these students (male) who blurted out, with a sour grimace, "That didn't turn me on at all!"

The hallway fell silent, and one of the oldest female students in the class fixed him with a powerful stare. After a few seconds of burning a hole through him, she walked over and said, her voice thick with disgust, "But you see, boy genius, it's not supposed to. Get it?"

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Essay - The Pitfalls of Linking Doctors’ Pay to Performance -

Not long ago, a colleague asked me for help in treating a patient with congestive heart failure who had just been transferred from another hospital.

When I looked over the medical chart, I noticed that the patient, in his early 60s, was receiving an intravenous antibiotic every day. No one seemed to know why. Apparently it had been started in the emergency room at the other hospital because doctors there thought he might have pneumonia.

But he did not appear to have pneumonia or any other infection. He had no fever. His white blood cell count was normal, and he wasn't coughing up sputum. His chest X-ray did show a vague marking, but that was probably just fluid in the lungs from heart failure.

I ordered the antibiotic stopped — but not in time to prevent the patient from developing a severe diarrheal infection called C. difficile colitis, often caused by antibiotics. He became dehydrated. His temperature spiked to alarming levels. His white blood cell count almost tripled. In the end, with different antibiotics, the infection was brought under control, but not before the patient had spent almost two weeks in the hospital.

The case illustrates a problem all too common in hospitals today: patients receiving antibiotics without solid evidence of an infection. And part of the blame lies with a program meant to improve patient care.

The program is called pay for performance, P4P for short. Employers and insurers, including Medicare, have started about 100 such initiatives across the country. The general intent is to reward doctors for providing better care.

For example, doctors receive bonuses if they prescribe ACE inhibitor drugs to patients with congestive heart failure. Hospitals get bonuses if they administer antibiotics to pneumonia patients in a timely manner.

On the surface, this seems like a good idea: reward doctors and hospitals for quality, not just quantity. But even as it gains momentum, the initiative may be having untoward consequences.

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Links and resources:

Canadian reading room:


Center for Medical Consumers

The Center for Medical Consumers, a non profit 501(c) 3 advocacy organization, was founded in 1976 with ambitious goals. One was to provide access to accurate, science-based information so that consumers could participate more meaningfully in medical decisions that often have profound effects upon their health. Another was to hold medicine more accountable by revealing that much of the treatment advice proffered by doctors and other health professionals is based on little or no evidence of safety and effectiveness.

US FDA/CDRH: Whole Body Scanning

Currently some medical imaging facilities are promoting a new use of computed tomography (CT), also called computerized axial tomography (CAT) scanning. This use is referred to as whole-body CT scanning or whole-body CT screening, and it is marketed as a preventive or proactive healthcare measure to healthy individuals who have no symptoms or suspicion of disease. At this time the FDA knows of no data demonstrating that whole-body CT screening is effective in detecting any particular disease early enough for the disease to be managed, treated, or cured and advantageously spare a person at least some of the detriment associated with serious illness or premature death. Any such presumed benefit of whole-body CT screening is currently uncertain, and such benefit may not be great enough to offset the potential harms such screening could cause.

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The mystery of patients who fail to follow prescriptions - Slate Magazine

Earlier this month, scientists at Georgia Tech announced their invention of a necklace that records the date and time at which a person swallows his prescription medicine. The device (which looks more like a dog collar than jewelry) responds to a tiny magnet in the pill as it travels down the esophagus. Other recently developed similar technologies include a drug-filled prosthetic tooth that slowly drips medicine into the mouth and a pill bottle that sends a wireless message to your pharmacist every time it's opened.

Are we so bad at taking medicine that we need false teeth to do it for us and pill bottles that tattle on us when we don't? It would seem so. About 50 percent of patients fail to correctly follow prescriptions: We forget to take pills, we alter doses, we take breaks. Nonadherence—the medical term for neglecting to abide by a doctor's orders—is rampant, resulting in up to one-quarter of all hospital and nursing home admissions. It's also expensive. The problem persists despite monumental efforts to prevent it. Why? For one thing, it's impossible to predict which patients are likely to deviate from their orders. And while the problem seems like it should have a simple solution, it doesn't. Nonadherence, it turns out, is one more reason to heed the call for better American health care.

Blowing off a doctor's instructions might seem like the act of a basically healthy person. Who hasn't neglected to take that last antibiotic or exercised less than the doctor said to? But treatment drop-off rates are high among the seriously ill, too. About half the people who undergo kidney transplants do not adequately adhere to the regimen necessary to thwart rejection of their new organ. A 1970s study found that 43 percent of glaucoma patients refused to take the doctor-ordered measures necessary to prevent blindness, even when that refusal had already led to blindness in one eye.

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Divided We Fail - AARP

In America today, it is a struggle for millions of people to afford the health care they need. The threat of rising health insurance premiums and the prospect of losing coverage altogether has become a constant concern for far too many American families.
We believe that:
  • All Americans should have access to affordable health care, including prescription drugs, and these costs should not burden future generations.
  • Wellness and prevention efforts, including changes in personal behavior such as diet and exercise, should be top national priorities.
  • Americans should have choices when it comes to long-term care - allowing them to maintain their independence at home or in their communities with expanded and affordable financing options.
We need to improve the health care system by making it more affordable, boosting quality and eliminating waste. But instead of bringing solutions to this problem, politicians in Washington have been content to stall, to argue, to criticize and to blame each other. While they play politics, we are left with huge health care bills, health care premiums and deductibles that are climbing through the roof, eroding benefits and little hope of reasonable, common-sense, balanced solutions.

The Organic Chemistry Backlash Grows (Wall Street Journal)

Turns out Harvard Medical School isn't alone in questioning the value of a year's worth of organic chemistry as a much-dreaded fixture in the pre-med curriculum.

In an article in this morning's WSJ, Health Blogger Jacob Goldstein elaborates on his post from mid-summer about a New England Journal of Medicine piece by a Harvard Brahmin questioning whether pre-med students "really need a full year of organic chemistry to prepare for the study of biochemistry."

Take, for instance, the Diels-Alder reaction, that orgo classic that has to do with the different ways two molecules combine to form a ring of six carbon atoms. It comes in handy if you're into chemical manufacturing. But here's what Robert Alpern, dean of the Yale School of Medicine, has to say about it: "In my many years of medicine, I have never heard the Diels-Alder reaction mentioned once."

Meantime, there are poor souls out there like Patti Van Leer, who found herself dreaming about carbon molecules and chemical reactions when she was taking orgo in college. And Kara Naber, who started sketching chemical reactions in the steam on her shower door during her second semester of orgo at the University of Minnesota Duluth.

There may be some respite in sight: The year-long introductory course in orgo may soon be pared back to make room for other subjects. The Association of American Medical Colleges and the Howard Hughes Medical Institute have a committee working on what basic science all entering medical students should know. They're likely to include biochemistry, genetics and statistics. It's unclear what exactly will happen to orgo, but one aim is to give colleges latitude to experiment with interdisciplinary classes.

Some comments:

Ridding American medicine of useful ways to distinguish the best and brightest from the not-so-bright seems to be the goal?
Medical school is a huge intellectual challenge and admitting the less capable, with much higher chances of failure is unfair to them and the more capable applicants passed over.
Comment by jgkmd - September 16, 2008 at 11:03 am

to eliminate o chem is another example of the dumbing of medicine in the USA. the thought processes that are required to achieve excellence in o chem are the same required to understand and diagnose complex biological interacting signs and symptoms in a sick person.
then again, health policy wonks believe that even with an ill-designed hit device (eg, computer ) paraprofessionals should be given the authority to make complex decisions that affect the lives of millions.
why not just issue licenses to practice medicine to anyone who wants to enroll…eg a lottery system?
Comment by dr. zhivago - September 16, 2008 at 11:21 am

Let's face it, organic is useless to 99% of physicians (including myself), and it's hard to explain its usefulness outside of being a weed-out class.
I think replacing this with classes that are both useful AND challenging, like statistics, is a good move. Docs need to know statistics to be able to interpret studies, but most lack a decent understanding. While orgo might be a test of one's ability to grind (and memorize), I'd rather judge students on their ability to comprehend and apply subjects that are actually germane to the practice of medicine.
Comment by How about...? - September 16, 2008 at 11:35 am

If pre-med students aren't given their organic chemistry, how else are we going to continue developing drugs like in the hyper-competitive world of synthetic organic chemistry of the '80s, when they turned 10-DAB into Taxol?
Comment by taxusin - September 16, 2008 at 11:41 am

I have to say this is ridiculous! Can we trust our medical education any more?
Comment by Dr. Kindt - September 16, 2008 at 11:53 am

NEJM article:

Relevance and Rigor in Premedical Education

Wednesday, September 17, 2008

How seniors became cyborgs. - Slate Magazine

Twenty-four years ago, Arnold Schwarzenegger starred in The Terminator, a movie about a cyborg—part man, part machine—sent back in time from the year 2029. He was young and buff, and the movie became his shtick. Campaigning for then-Vice President George Bush, he joked, "When it comes to the American future, Michael Dukakis will be the real Terminator."

Today, Schwarzenegger is 61, and the joke's on him. The cyborgs have arrived, and he's one of them. He's had a hip and two heart valves replaced, plus a femur repaired with screws, cables, and a metal plate. "This is what happens when you are the Terminator," he quipped. "They switch body parts."

In real life, cyborgs aren't studs from the future. They're old folks. As we age, our parts wear out. That used to mean immobility or death. Today, we can replace them. Bush had a hip switched out at 76, skydived on his 80th birthday, and got the other hip switched out at 82. Barbara Bush has an artificial hip; Cindy McCain has an artificial knee. The right arm of Sen. Daniel Inouye, lost when he was a soldier in World War II, is gone for good. But the left shoulder, which wore out five years ago at age 79, has been replaced.

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Why people overuse the E.R. - Slate Magazine

Perhaps you've heard about the guy who is wrecking the American health care system. He is uninsured, has no major medical problems, and loves the emergency room. He is said to stroll in about once a month to various E.R.s around town for reasons as diverse as a simple cold or an STD check. He usually asks a doctor to excuse him from work and complains if he doesn't get a prescription for narcotic pain medication. The cost of his medical care is unnecessarily high because for his complaints, the E.R. is more expensive than a doctor's office would be. But our legendary visitor doesn't have a primary-care doctor: Why should he, since everything he needs is at the local E.R.?

If you believe the conventional wisdom, the E.R. abusers of our nation are especially responsible for many problems in health care. They fill up E.R. waiting rooms and because they can't (or won't) pay their medical bills, the insured patients who prudently wait for weekday appointments to see their doctors end up bearing the costs of the abusers' in the form of higher insurance premiums. The oft-repeated claim is that if we can just find a way to get the abusers out of the E.R. waiting rooms, we'd eliminate many of the high costs associated with health care in the United States.

The problem is that this story of the healthy, cavalier, uninsured E.R. abuser is largely a myth. E.R. use by the uninsured is not wrecking health care. In fact, the uninsured don't even use the E.R. any more often than those with insurance do. And now, a new study shows that the increased use of the E.R. over the past decade (119 million U.S. visits in 2006, to be precise, compared with 67 million in 1996) is actually driven by more visits from insured, middle-class patients who usually get their care from a doctor's office. So, the real question is: Why is everybody, insured and uninsured, coming to the E.R. in droves? The answer is about economics. The ways in which health information is shared and incentives aligned, for both patients and doctors, are driving the uninsured and insured alike to line up in the E.R. for medical care.

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Tom Forrestall, Capsule (egg tempera, 1978)

"It is common enough for many of us taking medication of some sort. But reveals my broad interests in what I paint, indeed I'll paint anything without concern for subject. Here also I explore oversizing to bring it up so close to the viewer."

Overdoses and Other Medical Mistakes Put Young Patients at Risk -

WHEN 6-year-old Chance Pendleton came out of surgery for a wandering eye, it was obvious that something was not right. "He was crying hysterically, vomiting and kept saying, 'I wish I was dead,' " his mother, Grace Alexander, of Paris, Tex., recalled.

The boy had been through surgery before and had never reacted this way. "The nurse was quite peeved and wanted me to calm him before he disturbed anyone," said Ms. Alexander, who said Chance was denied more pain and anti-nausea medication. "She thought he was just throwing a tantrum."

After about 20 minutes, another nurse walked by, and Ms. Alexander beckoned her for help. The nurse checked the intravenous line in Chance's ankle and saw that it wasn't inserted correctly. He wasn't receiving any medication. She immediately fixed it, bringing relief to Chance in a matter of seconds.

Medical mistakes, though also common in adults, can have more serious consequences in children, doctors say. The actor Dennis Quaid's newborn twins nearly died last year after receiving 1,000 times the prescribed dose of a blood thinner. Other infants have died from the same error. A study in the journal Pediatrics in April found that problems due to medications occurred in 11 percent of children who were in the hospital, and that 22 percent of them were preventable.

An Institute of Medicine report nearly a decade ago highlighted the prevalence of medical errors, and they are still a major problem. "There's been slow progress in the decline of these errors," said Dr. Peter B. Angood, chief patient safety officer of the Joint Commission, the independent hospital accreditation agency. The agency recently called on hospitals to further reduce medication errors in children.

Children are also the victims of diagnostic errors, incorrect procedures or tests, infections and injuries.

Medical errors pose a greater threat to children than to adults for a number of reasons. They are physically small, and their kidneys, liver and immune system are still developing. Even a tiny increase in the dose of medication can have serious effects — especially in babies born prematurely. And if children take a turn for the worse, they can deteriorate more rapidly than adults. Children also are less able to communicate what they are feeling, making it difficult to diagnose their problem or know when a symptom or complication develops.

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What doctors don't tell you -

Physician David Newman has written a book about the secrets your doctor keeps from you. But he's not talking about "secret cures" that sell books on alternative medicine. Instead, his new book, Hippocrates' Shadow: Secrets From the House of Medicine (Scribner), is all about the secrets that hide in plain sight in medical journals and hospital hallways:

 •Doctors don't know as much as you think they do. For example, they don't know what causes most cases of back pain or what makes it better.

•Doctors do know that many of the tests, drugs and procedures they order and prescribe either do not work or have not been proved to work. Case in point: They keep prescribing antibiotics for colds and bronchitis.

•Doctors disagree, often, about everything, including whether that chest X-ray you just had really shows pneumonia.

•Doctors like ordering tests better than they like listening to you.

"These doctors are not bad human beings," says Newman, a New York City emergency department physician who also has studied philosophy, worked as a paramedic and served at an Army hospital in Iraq. He now trains medical students and residents at Columbia University and St. Luke's/Roosevelt Hospital Center.

Time limits, lawsuit fears and the demands of insurers deserve some blame for the truth gap, he says, but medical training and traditions play big roles.

Take the antibiotic problem. Studies show half of patients who go to a doctor with a cold are prescribed an antibiotic. Colds are caused by viruses; antibiotics kill only bacteria.

"Doctors think patients want a prescription," Newman says. They also know, he says, that patients feel better once they get that "magic pill."

But doctors should know, he says, that patients are just as satisfied when physicians take a few minutes to listen, explain why antibiotics won't help and suggest some symptom relief — relief that won't come with side effects such as diarrhea, yeast infections and allergic reactions.

Likewise, he says, doctors don't like to admit that many test results are not as black and white as they appear. Communicating shades of gray is harder, he says, and not taught in medical school. And while patients assume doctors rely on science, "it's not uncommon for the decisions we make to be entirely based on opinion," Newman says.

Letting patients in on secrets like those would allow them to make better, more healthful choices, he says.

Other doctors will argue with some of Newman's views. For example, he says routine mammograms don't save lives, a conclusion at odds with those of the American Cancer Society, the National Cancer Institute and other medical groups.

But the idea that Americans get worse medical care than they realize — often because they get too many, not too few, tests, drugs and procedures — is gaining ground.

Think about this summer's recommendation from the U.S. Preventive Services Task Force that men over 75 should stop getting blood tests for prostate cancer (because they are more likely to be harmed by prostate cancer treatment than to die from the disease). Or readOvertreated, a 2007 book by former health journalist Shannon Brownlee, just out in paperback. She writes that the biggest problem is doctors and hospitals "get paid more for doing more."

Whatever the causes, part of the cure must be straight talk, Newman says: "There is a lot of personal responsibility in this. It's all about patients and doctors communicating."

READERS: Do you trust your doctor? If not, who or what do you blame? Share your experiences below:

As a doctor, stories like this and posts like some of those below are frustrating. I myself, and every doctor I personally know, go out of our way for the health of our patients. I spend a lot of time trying to educate my patients about medications and tests. However, about 50% of the time, even after I spend time explaining that antibiotics don't work for viral infections, patients want an antibiotic anyway, and view me as a bad doctor for not giving it to them. I always explain the pro's and con's of tests and whether they are recommended or not. Frequently patients want them even if I explain that there is little benefit in doing a particular test. I do not personally know any physician that is out to harm patients, or is just trying to make as much money as possible. 

 Most of the physicians I know actually lose a lot of money by writing off patient bills and under billing medicare. I have lost $80,000 in four years on patient non-payment. However, a lot of these patients I still treat so that they can continue to get there medication. How many industries do you know that knowingly lose money but still serve those customers that owe them for services? Most of the doctors I know will tell you the same thing. In taking some Medicare patients, I lose about $15,000 from what I could make seeing the same patient numbers with full insurance. But I take some Medicare because I feel it is the right thing to do. 

Physicians that take more Medicare lose more money. Then congress talks about cutting Medicare every year. Most doctors go to school at least 8 years with at least 3 years of residency (and at no time was I ever taught to harm patients), work 12 plus hours a day, are available 24 hours a day (on call), make about $200, 000 (on average) and can get sued at the drop of a hat. I don't know of many other professions that fit that description. However, the public still thinks that we are greedy and out to harm people, then they go to GNC and buy whatever vitamins the kid behind the counter tells them are good for them (I wonder how many years he went to school?). 

I am not in medicine to get rich (I'd go into another field if that were the case), but rather because it is what I love to do, and feel I can help patients lead healthier lives. And all the other physicians I know will tell you the same. If we wanted to make a lot of money and not worry about getting sued all the time we should have become lawyers.

Simon & Schuster: Hippocrates' Shadow: Secrets from the House of Medicine

Everyone knows of the Hippocratic Oath, the famous invocation sworn by all neophyte physicians. But most don't realize that the father of modern medicine was an avid listener and a constant bedside presence. Hippocrates believed in the doctor-patient connection and gained worldwide renown for championing science over mysticism while respecting and advocating the potency of human healing. Today, argues Dr. David H. Newman, medicine focuses narrowly on the rewards of technology and science, exaggerating their benefits and ignoring or minimizing their perils. Dr. Newman sees a disconnect between doctor and patient, a disregard for the healing power of the bond, and, ultimately, a disconnect between doctors and their Oath.

The root of this divergence, writes Dr. Newman, lies in the patterns of secrecy and habit that characterize the "House of Medicine," modern medicine's entrenched and carefully protected subculture. In reflexive, often unconscious defense of this subculture, doctors and patients guard medical authority, cling to tradition, and yield to demands that they do something or prescribe something. The result is a biomedical culture that routinely engages in unnecessary and inefficient practices, and leaves both patient and doctor dissatisfied. While demonstrating an abiding respect for, and a deep understanding of, the import of modern science, Dr. Newman reviews research that refutes common and accepted medical wisdom. He cites studies that show how mammograms may cause more harm than good; why antibiotics for sore throats are virtually always unnecessary and therefore dangerous; how cough syrup is rarely more effective than a sugar pill; the power and paradox of the placebo effect; how statistics and studies themselves are frequently deceptive; and why CPR is violent, invasive -- and almost always futile.

Through an engaging, deeply researched, and eloquent narrative laced with rich and riveting case studies, Newman cuts to the heart of what really works -- and doesn't -- in medicine and rebuilds the bridge between physicians and their patients.

Diagnosis - The Strep Throat That Wasn’t -

"I — can't — breathe," the boy gasped. There was panic in his voice and face. He moved restlessly in his hospital bed, tugging at the clear plastic mask covering his nose and mouth. An alarm sounded distantly, alerting the nurses to the boy's distress in the pediatric intensive-care unit of the Cardinal Glennon Children's Medical Center in St. Louis. Before the nurses could respond, the boy's mother replaced the oxygen mask, stroking his face and murmuring reassurances as if he were 7 years old rather than 17.

Dr. Jeremy Garrett, an associate professor of pediatrics at St. Louis University School of Medicine, was worried about the boy. When Garrett first saw him, early that morning, he wondered what this robust man-child was doing in the ward reserved for the very sickest children. At that point, the patient had a fever but otherwise looked well.

Since then, the boy's symptoms had become significantly worse. The amount of oxygen in his blood was terrifyingly low despite getting 100 percent oxygen through the mask covering the lower half of his face. (The air we typically breathe contains about 20 percent oxygen.) And he was breathing rapidly, at nearly three times the normal rate. He had episodes of shuddering, body-wrenching chills — where blanket after blanket couldn't warm him — followed by fevers as high as 105 degrees.

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