In the News

Do proton pump inhibitors cause heart attacks?

shutterstock_180109973

shutterstock_180109973

There has been concern for several years about commonly prescribed antacid drugs called proton pump inhibitors (PPIs) and the heart.  PPIs are used to treat gastroesophageal reflux disease (GERD), peptic ulcer disease, and other acid-related diseases.  Common drugs in the PPI class are omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix), lansoprazole (Prevacid), and dexlansoprazole (Dexilant), among others.

Specifically, there is a potential interaction between certain PPIs and clopidogrel (Plavix), where the net result is that the effectiveness of clopidogrel may be lowered by coadministration with PPIs.  Clopidogrel is an antiplatelet drug that is often given to patients who receive cardiac stents, and it happens to be metabolized to its active form by the same liver enzyme that metabolizes most PPIs.  The drugs compete for the enzyme, and this can lower the effect of clopidogrel.  Theoretically, this can lead to adverse cardiac outcomes in patients with stents.  This in vitro effect was not found clinically meaningful in a recent randomized controlled trial, however the PPI-Plavix interaction is still a controversial topic and further details are beyond the scope of this article.

I bring up the PPI/clopidogrel issue because it becomes important in understanding a new study published this month in the journal PLoS ONE.  This study used a technique called “data-mining” to extract information from years of electronic medical records (EMRs) and included about 70 thousand patients in their primary analysis.  They describe the data-mining technique in the article, which seems to boil down to assigning a mathematical function to certain defined variables (patients taking PPIs) and an outcome (heart attack) to see if the two events are associated.

Continue reading …

Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.


Advertisements

What is pediatrics? It’s more than just runny noses.

shutterstock_144352681

shutterstock_144352681

When I chose a career in pediatrics, everyone had something to say about my decision. While most of my friends and colleagues were supportive, there were more than a few that just couldn’t understand why I would sign up for a lifetime of “ear infections and runny noses.”

Even among other medical professionals, it’s not uncommon for pediatrics to be viewed as a less-than-serious specialty. Maybe it’s the sea horses on the walls. Or the bow ties. Or the fact that we really do see a lot of runny noses. And to be fair, most of our patients aren’t all that sick, and many of them would get better without us. We field a lot of questions about choosing car seats, potty training, and making babies sleep. We handle concerns about school performance and behavioral problems. We explain to new moms why those little red bumps on their baby are really nothing to worry about.

And most of the time, even when things are scary to parents, we don’t get worked up. For instance, children will frequently have seizures caused by a fever. These are terrifying to parents, but medically speaking, once we rule out the scary stuff, they’re usually not a big deal. Even a fever by itself can be scary to parents, although it’s almost always a non-issue. A huge part of a pediatrician’s job is sorting out the child with a potentially dangerous condition from the much larger volume of self-limited problems that will go away with time. Another crucial skill is the ability to explain to parents why they don’t need to worry — without downplaying their concerns.

Continue reading …

Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.


Can reference pricing be the answer to soaring health costs?

shutterstock_271375967

shutterstock_271375967

California is in the middle of an historic drought, with the government setting limits on how long people can sing in the shower. Farmers in the state may soon need to cut back on planting or production, as ground water dries up. But California is still fruitful ground for testing promising ways to improve how health care consumers, otherwise known as patients, shop for health care services. Specifically, California has shown that health care markets can be whipped into shape through the power of reference pricing.

In reference pricing, patients are given a maximum number of dollars from insurance to cover a given health care procedure with the understanding that if they choose to receive care from a more expensive provider, they will be responsible for any charges exceeding that limit. As I wrote in a previous post, California already used reference pricing to address high costs for knee and hip replacement. While many health care providers were charging $25,000 or $30,000 for the procedure, some were charging $60,000, $70,000, even $100,000.

The state of California realized it couldn’t continue to pay these exorbitant prices. It could have decided to force people to receive care from affordable providers. It could have regulated the price of these procedures. But instead the state took a different approach. It set a $30,000 limit on what it would reimburse patients. Overnight, state employees became discerning shoppers, avoiding high cost providers. Almost as quickly, providers began lowering their prices.

The wonders of efficient marketplaces.

Continue reading …

Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.


The darker side of being a doctor

shutterstock_229830739

shutterstock_229830739

I recently read an article written by a human physician about her personal feelings and other people’s reactions to her decision to quit practicing medicine.

The author frames the article around how her choice was made after she recognized how detrimental her career was to her own health. The irony of a doctor abandoning her profession because it was causing her to become physically and emotionally ill was not lost on me.

Continue reading …

Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.


Can a surgeon operate while sitting down?

shutterstock_144006859

shutterstock_144006859

A loyal reader alerted me to news of a lawsuit brought by an obstetrician in South Carolina who is suing a hospital for suspending his privileges. He had performed a cesarean section while sitting on a stool because he had a foot fracture secondary to diabetes. Several witnesses said that the doctor “had been unable to properly view the surgical field, unable to properly handle the baby and unable to address hemorrhaging.” The patient later developed a serious infection.

Continue reading …

Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.


A physician respects the low-yield. See how that changed her life.

shutterstock_194126468

shutterstock_194126468

I took ten years off to play in rock bands before I applied to medical school. So when, at 31, I found myself drowning as I drank from the fire hose of medical school information, I knew I had to make a change.

I discovered the concept of high-yield and it seemed like the answer to my prayers. It is a simple idea: Some facts are heavily tested on national board exams and generally more applicable to practice as a physician. If you focus on the high-yield and eliminate the low-yield, you will have more time and less stress. Innumerable books claim to have the key to separating high-yield from low-yield. But I found those books didn’t go far enough.

Soon I was discovering ways to implement the concept of high-yield in my everyday life. All junk email was low-yield; I embarked on an aggressive “unsubscribe” campaign. Unwanted phone calls were low-yield; I signed up for the National Do Not Call Registry.

Continue reading …

Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.