Grand Rounds Vol. 7 No. 10

Welcome to Grand Rounds.  As we get back into the work week routine after the Thanksgiving weekend, we have a great collection of health care articles for you to browse through.  Enjoy!

Dr Pullen is taking a stand against drug coupons in an effort to keep the pharmaceutical industry honest and to keep health care costs in control. He describes a visit from a drug rep who was trying to convince him to prescribe a “new” drug – Silenor – for patients who have trouble sleeping.  The drug is $200 for 30 pills, and is basically just a smaller dosage of the already-available generic doxepin (available at most pharmacies under the ubiquitous $4 generics programs).  The rep was trying to convince Dr. Pullen that although Silenor would have a much higher copay for most patients, the coupons provided by the drug company would reduce those copays significantly.  Dr. Pullen wasn’t buying it, so the rep just moved on to the next doctor.  To bad not all physicians have Dr. Pullen’s critical evaluation skills…

Dr. Phil Hickey from Behaviorism And Mental Health explains that our desire to understand things can sometimes lead us to invent explanations.  This was usually the case in times gone by, before the scientific method was developed.  Unfortunately, it often continues to be the case in mental health treatment, where the concept of “illness” (and, of course, a myriad of drugs to treat those “illnesses”) has taken a firm hold without much in the way of evidence or critical scientific review.

Dr. Jaan Sidorov of the Disease Management Care Blog gives us a Hippocratic Oath for Accountable Care Organizations.  Something tells me that the ACO administrators might not be eager to recite Dr. Sidorov’s Oath, as it takes a few jabs at their style of managing care.  If you’re curious, you can go here to see more of Dr. Sidorov’s thoughts on ACOs.

Hank Stern from InsureBlog also weighs in on ACOs.  He’s not at all convinced that ACOs are a good idea, mainly because of the potential for doctors and hospitals to cut corners when it comes to patient care in order to save money and keep their bonuses intact.

The Happy Hospitalist explains that providers have to document a social history for their patients if they want to get paid under Medicare’s evaluation and management rules.  He goes on to note that some providers put in a less-than-stellar effort when it comes to documenting a patient’s social history.

Dr. Jordan Grumet of In My Humble Opinion describes why he loves internal medicine, and expresses some concern about the future of the profession, and whether it will continue to be the challenging job that he finds so rewarding.

Stephen Wilkins of Mind The Gap explains that the structure of office visits tends to limit the window of opportunity for patients to ask questions of their doctors.  He notes that conversation in a doctor’s office is very different from social conversation, and patients often feel apprehensive about interrupting the normal flow of the visit to ask questions.  Both doctors and patients have a responsibility to remedy this problem, although I would place a bit more of the responsibility on the physicians, as they are the ones who tend to lead the conversation during the visit.

Dr. Rich of The Covert Rationing Blog writes a warning to newly-elected Republicans who may want to repeal the PPACA.  He explains that the health insurance industry isn’t likely to let that happen, as the new law provides a pretty good niche for private health insurance carriers.  Of course, some states are attempting to repeal portions of the PPACA – namely, the individual mandate – but not the whole thing.  This line of attack is even more likely to generate insurer ire, as there’s no feasible way to carry out the guaranteed issue aspect of the PPACA without the individual mandate.  It remains to be seen what will happen with the 112th Congress, but there will likely be at least some continued debate about health care reform.

Bongi from Other Things Amanzi describes a thyroidectomy on a patient with Graves disease before the advent of modern surgical devices that help doctors control bleeding during the removal of the thyroid.

Occam Practice Management’s Michelle R. Wood delves into the details around the new EHR Event website, designed as a forum “…to improve EHR [electronic health records] and patient safety and to reduce professional liability…”  She has done quite a bit of research regarding the site’s funding, agendas, and legal protections for users.  With electronic health records serving as a major cornerstone of health care reform, there’s no doubt that we’ll hear more about sites like EHR Event as time goes on.

Health Business Blog’s David Williams reminds us that nothing is free.  When it comes to websites, services can often be used free of charge, but most of the time the site is being funded by advertisers, and the sites might be selling consumer data to the advertisers.  This can be the case even with sensitive information like that collected on health care sites, and the data can end up being used by pharmaceutical companies looking for customers.

Tony Chen of FDA Zilla uses an FDA employee directory to see details about who works for the FDA.  It’s somewhat reassuring to see that they employ more consumer safety officers than any other type of professional.  And it looks like they’re hiring…

Dr. Elaine Schattner of ACP Internist brings us a very thoughtful post about the potential problems surrounding the full body airport scanners and/or pat-downs for people with disabilities or disfigurements.  Although medical professionals are used to seeing things like colostomy bags and prosthetics, TSA screeners probably are not, and the potential exists for both humiliation and physical damage for travelers with health conditions.

Be sure to check out the next edition of Grand Rounds at Highlight Health on December 7th.

-Louise