"Family practitioners in the US are facing extinction. In their place must come nurse-practitioners" - The Lancet

From the Lancet review of the University of Pennsylvania nursing school:

Family practitioners in the US are facing extinction. In their place must come nurse-practitioners. Nurses are better educated to navigate and refer patients to specialists. They don't have any illusions about managing complex illness. Their lower threshold for referral means less risk of missing diagnoses or delaying expert care.

This is one vision for nursing to be found at the University of Pennsylvania's extraordinary School of Nursing.

I'm not sure if this is the best model for primary care in the U.S. What do you think?

References:

Offline: Nursing, but not as you know it. The Lancet, Volume 378, Issue 9805, Page 1768, 19 November 2011.
Image source: OpenClipArt.org, public domain.

Comments from Twitter:

@scanman: Looks like doctors will be an endangered genus in the US within this century

@MGastorf: so disagree. I know that is being pushed but I can provide far more complete care than nurse practitioner.

@davisliumd: Umm, No -> RT @DrVes Family practitioners in the US are facing extinction. In their place must come nurse-practitioners

@davisliumd: Agree -> RT @drves: @davisliumd that was actually a quote from The Lancet, not my opinion: j.mp/w33Kvq.

1 in 5 Americans have trouble communicating with their doctor and 1 in 10 feel disrespected. How to help?

A 2001 survey by the Commonwealth Fund found that doctor-patient communication often fell short. One in 5 American adults had trouble communicating with their doctors, and 1 in 10 felt they had been treated disrespectfully during a recent health care visit.

Just funded through a generous $42-million grant, the University of Chicago aims to fix the communication errors and bring the patient-physician relationship back where it belongs.

Here is the example that started the whole process:

Kay Bucksbaum, whose husband made multi-billion fortune developing shopping centers around the world, said she was inspired by Dr. Mark Siegler, a medical ethicist at the University of Chicago who became the couple's internist when they moved to Chicago from Iowa 10 years ago.

In contrast, she recalled a doctor years ago who didn't listen to her when she told him what she thought was wrong with her -- and didn't apologize when she turned out to be right.

When her husband needed surgery, she said, Siegler "took my husband by the hand to meet the surgeon, introduced him, and told the surgeon something about my husband. He even scrubs up and watches his patients' surgeries when he can, she said. "And he encourages patients to call him "Mark."

The video below introduces the Bucksbaum Institute for Clinical Excellence which is funded through $42 million grant to the University of Chicago to create a unique initiative that aims to improve the doctor-patient relationship and communication in medicine:



Disclaimer: I am an Allergist/Immunologist and Assistant Professor of Medicine and Pediatrics at the University of Chicago.

NBC video:



References:

New Bucksbaum Institute fosters doctor-patient communication
Benefactor Gives U of Chicago $42 Million to Work on Bedside Manner
A $42 Million Gift Aims at Improving Bedside Manner
The first three Bucksbaum scholars at UChicago http://goo.gl/gR7Pj
Do 'Nice' Doctors Make Better Doctors? http://goo.gl/uUn7C -- The Downside of Doctors Who Feel Your Pain - NYTimes http://goo.gl/VdSev

Cigarette smokers have lower IQs than non-smokers, and the more a person smokes, the lower their IQ

From Reuters:

Young men who smoked a pack of cigarettes a day or more had IQ scores 7.5 points lower than non-smokers in a study of over 20,000 Israeli military recruits.

"Adolescents with poorer IQ scores might be targeted for programs designed to prevent smoking," concluded the researchers in the journal Addiction.

The average IQ for non-smokers was 101, while it was 94 for men who had started smoking before entering the military. IQ steadily dropped as the number of cigarettes smoked increased, from 98 for people who smoked one to five cigarettes daily to 90 for those who smoked more than a pack a day. IQ scores from 84 to 116 are considered to indicate average intelligence.

The study may suggest that lower IQ individuals are more likely to choose to smoke, rather than that smoking makes people less intelligent.

References:

http://www.reuters.com/article/idUSTRE61M3UQ20100223
The Physician in US Cigarette Advertisements, 1930–1953 (illustrated review) http://1.usa.gov/VcuA7W via @Skepticscalpel

Comments from Google Buzz:

Dr Mike Cadogan - By definition non-smokers smarter than smokers...

Ben Ferguson - That's a weird conclusion to come to, in my opinion. They associated essentially pack-years with intelligence, which would seem to indicate a dosage effect, but then the suggestions were that they had lower IQs to begin with? It's a bit of a non sequitur. That there's a dosage effect would suggest that most of them had equal IQs before starting smoking; to conclude that they started smoking as a result of having lower intelligence to begin with has nothing to do with their aims and even undermines their findings.

Lakshman Swamy - Smoking is an addiction, and the smoking population is marginalized as it is. Obviously smoking is terrible for you... but let us not forget that smokers need healthcare and health advice more than most. I worry that this will further a "judging" attitude on the part of physicians.

Arin Basu - There is a problem in reducing entities like intelligence to single numbers like IQ scores (this is an offhand comment, I have not read /this/ particular article), but talking of programme targetting on the basis of studies that go to suggest "if you have low IQ then you smoke", in other words, implicitly accepting low IQ as /cause/ of smoking is dangerous. Well spotted though.

Image source: Wikipedia, Tomasz Sienicki, Creative Commons Attribution ShareAlike 2.0 License.

Physically fit students score higher on tests than their less fit peers

Test scores dropped more than one point for each extra minute it took middle and high school students to complete a 1-mile run/walk fitness test.

65% of the students were below the state fitness standard. Compared with these students, students who met or exceeded fitness standards had higher average test scores. Overweight and obese students also scored significantly lower on tests.

Schools may have to reverse their recent disinvestment in physical education ostensibly for the purposes of boosting student achievement.

Exercise slows telomere shortening (and aging). Telomeres are the chromosome tips which shorten each time a cell divides, making them a possible marker of aging. A study of 2400 twins showed that physically active people had longer telomeres than sedentary people.


Human chromosomes (grey) capped by telomeres (white). Image source: Wikipedia, public

domain.

If you need any more convincing, please see this "health promotion" video that clearly shows the benefits of exercise:

"Health Promotion" video: Benefits of exercise.

Participation in sport is associated with a with a 20—40% reduction in all-cause mortality compared with non-participation. Exercise might also be considered as a fifth vital sign, according to the Lancet: http://goo.gl/gyxYf

References:
Physical, academic fitness tied at the hip: study. Reuters, 2010.

The Journal of Pediatrics, published online January 25, 2010.

"Doctors should blog with their real name." Agree or disagree?

From KevinMD:

"Martin Young still has "nagging doubts about doctors who post blogs or replies about healthcare issues without giving their names.

My blog as an extension of who I am as a doctor, putting a carefully considered face to the experience of caring for the sick, as a means of drawing attention to issues that do not get into medical journals. As do most other doctors who host their own blogs.

I often look at those replies to my postings that are anonymous and think, “Who are you? Why do you think the way you do? Why will you not put a name and face to your thoughts?” My personal belief is that the anonymous person may lack conviction, confidence or courage.

I would not accept a referral from an anonymous doctor, or give advice to one. In the same way, I may read anonymous replies to my postings, but they carry much lower weight."

Although I encourage physicians to blog under their own name, I do not think we should "force" them to do so. They should not feel obliged to host their own blog either if they can use such perfectly reasonable free services such as Blogger.com by Google and WordPress.

I assembled a short list of suggestion for medical bloggers several years ago. Here it is:

Tips for Medical Bloggers

- Write as if your boss and your patients are reading your blog every day
- Comply with HIPAA
- Consider using your name and credentials on your blog and other social media accounts
- If your blog is work-related, it is probably better to let your employer know.
- Inquire if there are any employee blogging guidelines. If there are, comply with them strictly.
- Use a disclaimer, e.g. "All opinions expressed here are those of their authors and not of their employer. Information provided here is for medical education only. It is not intended as and does not substitute for medical advice."
- Get your blog accredited by the Heath on the Net Foundation

References:

Why doctors should blog with their real name. KevinMD.
How to write a medical blog and not get fired?

As A Busy Physician, Why Do I Even Bother Blogging? http://goo.gl/fSF3 - Excellent summary.

Image source: public domain.

Twitter comments:

@DrJenGunter (Jennifer Gunter): depends on blogging agenda.

@DoctorNatasha (Natasha Burgert): I blog and tweet with my real name because it keeps me accountable to my work, honest with my patients, and real with my intent.

@DrElizabethLee: I sign my name to anything I write.

@DrVes: Doctors need to understand the basics, and address the irrational fear of using social media.

Couple addicted to the internet let their baby starve to death while raising a virtual daughter online

From BBC:

A South Korean couple who were addicted to the internet let their three-month-old baby starve to death while raising a virtual daughter online, police said.

An autopsy showed her death was caused by a long period of malnutrition.

The couple had become obsessed with nurturing a virtual girl called Anima in the popular role-playing game Prius Online.

Some psychiatrists still have doubts if Internet addiction exists but it looks pretty much for real in this video:



References:

S Korea child 'starves as parents raise virtual baby'. BBC.

Why doctors should use social media: it benefits their patients enormously

Wendy Sue Swanson, who blogs as Seattle Mama Doc, is a pediatrician in Seattle who recently gave a keynote at the Swedish Medical Center as part of their 2010 Health Care Symposium. See for yourself why doctors must use social media to stay uptodate and educate the public:



Link via KevinMD

How primary care doctors choose the specialists to refer their patients

Dr. Kirsch, a blogging gastroenterologist lists some of the reasons why certain medical specialists are chosen:

- Reciprocity - patients are referred in both directions
- Personal relationships
- Corporate enforcement keeping consultations within the network
- Economic pressure exerted by consultants to maintain referrals. I have seen this happen.
- Specialist willingness to do tests and procedures on request
- Habit
- Patient or family request

References:
How doctors choose which specialists they refer to. KevinMD.com

Image source: OpenClipArt.org, public domain.

People who brush their teeth less than twice a day have a 70% increased risk of heart disease

A Scottish national population based survey examined if self reported toothbrushing behaviour is associated with cardiovascular disease and markers of inflammation (C reactive protein) and coagulation (fibrinogen).

Participants were 12,000 men and women, mean age 50. Oral hygiene was assessed from self reported frequency of toothbrushing. There were a total of 555 cardiovascular disease events over an average of 8 years of follow-up, of which 170 were fatal.

Participants who reported poor oral hygiene (never/rarely brushed their teeth) had an increased risk of a cardiovascular disease event (hazard ratio 1.7).

They also had increased concentrations of both C reactive protein and fibrinogen.

Poor oral hygiene is associated with higher levels of risk of cardiovascular disease and low grade inflammation, though the causal nature of the association is yet to be determined.

References:
Toothbrushing, inflammation, and risk of cardiovascular disease: results from Scottish Health Survey. BMJ 2010;340:c2451.

Image source: Cross-section of a tooth with visible gums, or gingiva, Wikipedia, GNU Free Documentation License.

Blogs read by 20% of UK medical students, but only 8% write their own

A wide range of social media tools has become readily available in recent years, to the extent that the use of Facebook in particular is perceived as "second nature" by many students. There is increasing interest in the possibilities of using this social media services for medical education - blogs, wikis, Twitter and Facebook.

This UK study included a self-administered questionnaire survey of 212 first year medical students.

Over 90% used instant messaging. Social networking sites were also highly used - by 70%. There was no significant difference between males and females.

Blogs were read by 20% of students and a small number (8%) wrote their own blogs.

20% of males were users of media sharing and contributed to wikis.

Social bookmarking was rarely used by either gender.

Medical educators need to recognise the potential of social software in medical education but it is essential that students maintain the informality and privacy of these sites. The challenge is how to integrate social software into current curricula and institutional Virtual Learning Environments.

References:
Web 2.0 and social software: the medical student way of e-learning. Sandars J, Homer M, Pell G, Crocker T. Med Teach. 2010 Jun 18.

Comments from Twitter:

@DrVes I didn't expect that 8% of med students in the study wrote blogs - this is not my experience from teaching students and residents at Cleveland Clinic, Case Western and Creighton University.

@sandnsurf Medical education blog vs tumblr/posterous blog possibly. My students are at 10% for blog writing but 1% are actually medical.

@DrVes This is way higher than the stats here in the U.S. "Everybody's on Facebook, nobody has a blog"... :)

@doctorwhitecoat Not to jump mid convo, but at my school, I can say that most don't have blogs... at most maybe 3-5% and those that do... don't update.

@DrVes 2-5% is high. There was only one blogging student at Cleveland Clinic medical school who stopped after 1-2 years.

Related reading:

Assistant professor uses Twitter to teach students dental anatomy at Ohio State University - 113 of 200 students signed up, 56% http://goo.gl/jvyq7

Image source: Blogger.com.

There are 25,400 scientific journals and their number is increasing by 3.5% a year

More scientific and medical papers are being published now than ever before. Is it possible to be an expert nowadays, asks BMJ.

Every doctor has an ethical duty to keep up to date. Is this just getting more difficult or has it already become impossible? Since Alvin Toffler coined the phrase “information overload” in 1970, the growth of scientific and medical information has been inexorable.

There are now 25 400 journals in science, technology, and medicine, and their number is increasing by 3.5% a year; in 2009, they published 1.5 million articles. PubMed now cites more than 20 million papers.

One response of the medical profession to the increasing scientific basis and clinical capacity of medicine has been to increase subspecialisation. This may restrict the breadth of knowledge of the ultraspecialist, but can such subspecialists still maintain their depth of expertise?

I described my approach in 5 Tips to Stay Up-to-Date with Medical Literature:

1. RSS Feeds for Medical Journals.

2. Podcasts.

3. Persistent Searches on PubMed, Google News and Google.

4. Text-to-speech (TTS) for journal articles.
5. Blogs and Twitter accounts.

If you have a blog or Twitter account, you can try to deal with the information overload from blogs, RSS and Twitter more efficiently by using this:

The circle of online information (click to enlarge).

References:

On the impossibility of being expert. BMJ 2010; 341:c6815 doi: 10.1136/bmj.c6815.

How to deal with the information overload from blogs, RSS and Twitter?

5 Tips to Stay Up-to-Date with Medical Literature
The scientific journal through the centuries - a little bit of history from Health Librarian (HL) Wiki http://buff.ly/WZqP2S

Comments from Twitter:

MediaMed @MediTwitt: Isn't it too much? @DrVes: 25,400 scientific journals and their number is increasing by 3.5% a year buff.ly/OxDvev

Anand Segar @drsegar_nz: that is crazy. Totally unnecessary.

Automatic tracker ensures your doctor washed their hands

The University of Illinois Medical Center has installed a system called HyGreen (Hand Hygiene Recording and Reminding System) which acts as a reminder to health care workers before they ever enter a patient's room.

The provider begins by cleaning his hands, then placing them under a sensor that recognizes the cleaning, and transmits a signal to a badge the provider is wearing. When they walk into the patient's room, that badge transmits an "all clean" signal to a sensor above the bed.

If a caregiver walks into a room without washing their hands, the sensor won't get that all clean signal and the badge will start buzzing.



References:
Tech Ensures Your Doc Washed Their Hands. NBC Chicago.