Friday, November 27, 2009

Happiest doctors treat children, elderly -

The happiest doctors care for children and the elderly, according to a study on physician job satisfaction that found significant differences among medical specialties.

That doctors treating seniors are among the most satisfied contradicts trends in medical schools, where students mostly avoid the specialty because it's perceived to be unprofitable and unglamorous.

"Satisfaction ought to be a factor to students when they select their specialty," said Paul Leigh, lead author and a professor in the University of California Davis Center for Healthcare Policy and Research.

Neurosurgeons reported the lowest job satisfaction, followed by specialists in obstetrics and gynecology. The researchers pointed to four possible factors: irregular hours, malpractice lawsuits, loss of autonomy, and a relative decline in pay.

Specialties with low job satisfaction could face a doctor shortage down the road, the researchers warned.

The study, which culled data from a 2004 to 2005 nationwide survey of 6,500 physicians across 42 specialties, was published in BMC Health Services Research.

Geriatrics, a specialty within internal medicine dealing with the elderly, had the second-most satisfied doctors, behind pediatric emergency medicine.

Yet last year, nationwide, there were only 250 medical school graduates trained in geriatrics, said Dr. Cheryl Phillips, president of the American Geriatrics Society.

"We don't do a very good job of exposing students to geriatrics," she said. "And when medical students are exposed to it, they say, 'Gee I could be a geriatrician and make $160,000 or a dermatologist and make $500,000.' "

Yet geriatricians are happy.

"We work very closely with the rest of the health care team, as opposed to many other specialties where physicians are often isolated," said Phillips.

This "team sport" idea also is reflected in pediatric emergency medicine.

Additionally, researchers found work-life balance is becoming more important among doctors, Leigh said.

"In the past medical students have been very attracted to income," Leigh said. "But having a controllable lifestyle is becoming more important."

Geriatrics is one specialty where doctors have control over their work hours, because elderly patients in nursing homes have flexible hours, Phillips said.,0,2005356,print.story

New Techniques in Brain Surgery Mix Hope With Risk - Series -

One was a middle-aged man who refused to get into the shower. The other was a teenager who was afraid to get out.

The man, Leonard, a writer living outside Chicago, found himself completely unable to wash himself or brush his teeth. The teenager, Ross, growing up in a suburb of New York, had become so terrified of germs that he would regularly shower for seven hours. Each received a diagnosis of severe obsessive-compulsive disorder, or O.C.D., and for years neither felt comfortable enough to leave the house.

But leave they eventually did, traveling in desperation to a hospital in Rhode Island for an experimental brain operation in which four raisin-sized holes were burned deep in their brains.

Today, two years after surgery, Ross is 21 and in college. "It saved my life," he said. "I really believe that."

The same cannot be said for Leonard, 67, who had surgery in 1995. "There was no change at all," he said. "I still don't leave the house."

Both men asked that their last names not be used to protect their privacy.

The great promise of neuroscience at the end of the last century was that it would revolutionize the treatment of psychiatric problems. But the first real application of advanced brain science is not novel at all. It is a precise, sophisticated version of an old and controversial approach: psychosurgery, in which doctors operate directly on the brain.

In the last decade or so, more than 500 people have undergone brain surgery for problems like depression, anxiety, Tourette's syndrome, even obesity, most as a part of medical studies. The results have been encouraging, and this year, for the first time since frontal lobotomy fell into disrepute in the 1950s, the Food and Drug Administration approved one of the surgical techniques for some cases of O.C.D.

While no more than a few thousand people are impaired enough to meet the strict criteria for the surgery right now, millions more suffering from an array of severe conditions, from depression to obesity, could seek such operations as the techniques become less experimental.

But with that hope comes risk. For all the progress that has been made, some psychiatrists and medical ethicists say, doctors still do not know much about the circuits they are tampering with, and the results are unpredictable: some people improve, others feel little or nothing, and an unlucky few actually get worse. In this country, at least one patient was left unable to feed or care for herself after botched surgery.

Moreover, demand for the operations is so high that it could tempt less experienced surgeons to offer them, without the oversight or support of research institutions.

And if the operations are oversold as a kind of all-purpose cure for emotional problems — which they are not, doctors say — then the great promise could quickly feel like a betrayal.

"We have this idea — it's almost a fetish — that progress is its own justification, that if something is promising, then how can we not rush to relieve suffering?" said Paul Root Wolpe, a medical ethicist at Emory University.

It was not so long ago, he noted, that doctors considered the frontal lobotomy a major advance — only to learn that the operation left thousands of patients with irreversible brain damage. Many promising medical ideas have run aground, Dr. Wolpe added, "and that's why we have to move very cautiously."

Dr. Darin D. Dougherty, director of the division of neurotherapeutics at Massachusetts General Hospital and an associate professor of psychiatry at Harvard, put it more bluntly. Given the history of failed techniques, like frontal lobotomy, he said, "If this effort somehow goes wrong, it'll shut down this approach for another hundred years."

More ...

Shopping Around for the Best Prices in Medical Care -

CAN you really shop for doctors and hospitals the way you would for airfares and flat-screen TVs?

Health care consumers are encouraged to comparison-shop on things like doctor's fees and heart surgery rates. But unfortunately, most of us have little clear or useful information to go shopping with.

"When you go to the doctor, how much you fork over when all is said and done is often just a mystery," said Dr. Anthony P. Geraci, a Manhattan neurologist who is trying to buck that trend by posting his prices on his Web site.

With the growing number of uninsured people, the increase in high-deductible insurance plans and big jumps in co-payments, just about everybody is paying more out of pocket for health care nowadays. An estimated 15 percent of adults younger than 65 now pay with their own money medical costs greater than 5 percent of their annual household income, according to the Center for Studying Health System Change, a nonpartisan research group in Washington.

So the typical person is probably far more motivated to ask how much an M.R.I. or a hip replacement costs. And just as often, people are asking — or should be — "How can I get a better price?"

Take Katie Kyser, 30, the mother of a year-old daughter, who lives north of Seattle. She and her husband, Jason, who works in construction, recently moved from California. They have no health insurance, so they pay all costs out of pocket.

When Ms. Kyser needed a routine gynecological exam, she called a handful of local doctors, all of whom were charging $200 or more. "There's no way we could pay that," Ms. Kyser said. "I had to find another way."

Having seen an ad for, a new Web site that lists doctors throughout the country who are willing to post their prices and negotiate with patients, she decided to try it. Ms. Kyser found a nearby clinic where doctors charged only $75 for the exam.

"I was a little nervous at first because the price was so cheap, but when I got there, it was wonderful," Ms. Kyser said. "Everyone was so professional and helpful."

The crucial part of shopping wisely for health care (or anything else for that matter) is comparing prices the way Ms. Kyser did.

But that is also where problems arise. Medical pricing is a quagmire, oozing with jargon and current procedural terminology codes. Just look, if you dare, at your latest "explanation of benefits" from your insurer.

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Sunday, November 22, 2009

Shaken and Stirred - Barkeep, a Placebo on the Rocks, Please -

On Oct. 11, 1918, during the flu pandemic, a Public Health Service physician in Baltimore, alarmed by a trend he'd noted, sent an urgent note to Surgeon General Rupert Blue. "Sir," he began, "a strong and growing belief exists in the minds of the public in this city ... that alcoholic drinks act as a preventative of influenza." This belief, he went on, "is now so strong among the laity that alcoholic drinks are being purchased and consumed in enormous quantities for the purpose of preventing influenza."

Ninety-one years later, hardly anyone believes a stiff cocktail can prevent the flu. Treating its symptoms, however, is another matter.

Many grandmothers still swear by a hot toddy (a warm mixture of whiskey, lemon and honey) for cold and flu relief. And bartenders, normally dispensers of pleasure, have lately been playing doctor behind the bar.

Consider the Flu Shot, a drink on the menu at Drop Off Service, a bar on Avenue A in Manhattan. It's a mixture of garlic-infused honey, jalapeño-infused tequila, orange-lemon-ginger purée and a few drops of liquid echinacea. The Flu Shot — which is meant to be slugged, not sipped — sounds like a cheeky gimmick. But its creator, Signe Grant, is earnest.

"You've got your vitamin C in there, and the garlic is an antiviral, and the ginger is also an antiviral and an immunity booster," she said. Ms. Grant is also the creator of another remedy, the Throat Coat, in which honey-and-pepper-infused vodka and B&B, a French liqueur, are combined in a snifter with a spoonful of honey. This one is meant for sipping, and is tasty enough for taking with symptoms or without — which is decidedly more than one can say about Robitussin.

As a prescription-writing bartender, Ms. Grant is not alone. Albert Trummer, whose Chinatown bar, Apotheke, specializes in pharmaceutically themed cocktails, has been busy formulating new drinks for the current flu season. One involves yellow Chartreuse, thyme, lavender and a stick of cinnamon "for the throat"; another involves warm rum, hibiscus and rosehips.

At the Harrison, on Greenwich Street, the beverage director, Adam Petronzio, has been prescribing a drink called the Western Smash to his sniffling customers. Lemon balm, which infuses a syrup that Mr. Petronzio mixes with whiskey and mint, is the medicinal ingredient, due to its purported antioxidant and antiviral properties.

Time to consult a doctor. Can there be any therapeutic benefit to a cocktail? "From a pathophysiologic perspective, there's no data that will support that," said Dr. Ronald B. Turner, a cold researcher and pediatrics professor at the University of Virginia School of Medicine. But Dr. Turner did allow a little wiggle room for the basis of Ms. Grant's Throat Coat.

"There is some evidence that honey, or other sweet demulcent compounds, can have a benefit to coughs," he said. O.K. then. How about a honey-heavy cocktail?

"A placebo at best," Dr. Turner said. "But I don't think there's any reason to avoid it. If it makes you feel better, go for it."