Using an antibiotic to prevent a secondary infection does not work. It just kills the normal bacteria and allows bacterial that are resistant to the antibiotic to colonize you. Those more resistant bacteria can cause secondary infections just as well as the original.
Multiple studies have shown over and over again, that the course of a cold, sinus infection, bronchitis are in no way altered by treating with antibiotics. Yes, we have given people placebos to people and compared the results to those given antibiotics. Guess what? no difference. So your theory about preventing ER visits and such is just wrong.
I'd like to know where these financial incentives are for prescribing antibiotics because I've never received one. The drug reps do push there meds, but I don't know anyone that takes them seriously. They're usually just eye candy or a person to be made fun of after they leave.
I'll give you the heckling thing tho. Occasionally after 5 cold visits in a row and multiple demands for antibiotics, some mothers literally screaming at you for not giving their kids antibiotics, one can become weak and may give into a demanding patient later. We are only human after all. I actually very rarely cave like that, but it happens.
Agreed. Patient education would go a long way. Too many parents and adult patients believe they need an antibiotic for every sinus infection, cold, ear infection or episode of 'bronchitis' they have when in most of these cases an antibiotic is actually not needed. Unfortunately, many docs also have been led to believe some of these problems need an antibiotic, too
I'm not sure what financial incentives physicians have to prescribe abx. God knows I have have never been given any of these financial 'incentives'. The only incentive I have is to prescribe it when I feel it is warranted or because the patient is being a such a pain in my ass and I just need them to leave. The latter rarely happens.
It depends on the screening test. Some are very good - like colonoscopy. Others can cause more harm than good on average - PSA is a great example.
Early detection is absolutely the way to go, how to do it for any given condition is the hard part. Many cancers have no screening tests because it is a hard to develop good, quality tests (good sensitivity and specificity). Just testing because it can be done is usually a very bad idea.
"The problem is important in any area where a less-than-perfect screen is used to detect a rare event in a population"
Unfortunately, there is no such thing as a perfect screening test for anything in medicine. Some are better than others, but none are perfect. This is a very difficult concept for most people, unfortunately, and for many insurance companies.
It is not such an issue for the better screening tests such as colonoscopy but it is very difficult for things like PSA where there is a large body of evidence it can do more harm than good on average if used routinely even within the recommended ages. For a patient, you're lucky if you can have a meaningful discussion in 5-10 minutes which is an awful large chunk of an office visit that usually has >4 talking points.
It is a problem for doctors and insurance companies because some well intended person with the insurance company will decide to measure the quality of its doctors (which I support in theory) by measuring, for instance, the percentage of age and gender appropriate patients under the care of a given physician that have their PSA checked annually. The problem is, there is absolutely no concensus in medicine that it should be checked regularly as a screening test. I'm not sure I want mine tested when the time comes around unless my family history changes between now and then. So to measure a physician by this marker or other screening tests is fraught with problems, since many patients might opt out for very good reasons. Also, I'm not going to recommend any test because an insurance company wants me to, only if it is right for any given patient.
Bottom line is there are no perfect tests and testing is not always the right thing to do. Most people do not understand that because it is a hard concept to grasp.
I read the article. I did not see that part having read it now several time It said that new customers and those that qualify will get the discount. The 'those that qualify' it implied were the people at the end of their contract. I'm not sure how this is any different then other cell phone providers.
I have to agree. I'm not a cell phone guru by any measure, but only offering the discount rate every two years seems to be a fairly standard term in my experience.
Please. A significant number of MD's do other things that purely practice clinical medicine, such as research. Plus, many PhD's never really contribute in any meaningful way to society or their field of practice. "A few years of residency" can range from 3 years to 7 or even 10 years depending on the training. One year of residency is much more time consuming and stressful than any PhDs I've known. I'm not trying to make this a PhD vs MD rant, you did that, I'm just trying to point out some gross exaggerations and factual errors in your comment. I have quite a few PhD friends I have nothing respect for, actually. They agree you're making some way over-the-top gross exaggerations.
Besides, cash-only doesn't prevent a doctor from working with the poor - nothing stops a doctor from donating time and services to those who can't afford it and making it up on the paying patients. Well nothing except the current system that funnels the poor into, and is currently chasing doctors away from, medicare/medicaid because treatment is generally a net loss for the doctor.
If you are going to see medicaid patients, you have to bill all people consistently otherwise you are potentially committing fraud. (medicaid patients are typically poor and many doctors will not even see them because of the problems they bring with them). That is, you can't due 'boutique medicine' and charge cash up from from one part of your patient population and then use the standard billing system for others. I'll admit, i'm not up on the ins and outs of this, but that would basically be fraud in the eyes of government insurance programs. The only way around it would be to do services for free or a sliding scale, but that would only be for my fees and those without insurance entirely. Believe it or not, most poor patients do have medicaid or medicare. I have a large percentage of this type of patient and they would no longer be able to see me if I changed to a cash only type of system. Doesn't make sense, but that's the way it works (or so I'm told)
That's simply not true. There are a number of live vaccines, including MMR, varicella, oral polio vaccine (not used in the US anymore), and the flu nasal spray vaccines. That's just off the top of my head. These virus's are alive as a virus can be and do propagate themselves in the host.
While you are probably right, that is, that vaccinated kids won't get shingles when they are older, we actually do not know that for sure and won't know until these kids are much older. Remember, the chicken pox vaccine is a live virus vaccine. We are essentially giving them a 'weaker' version of the virus. Rarely, it will cause chicken pox is some people. How much it reduces the rate of shingles (as far as I know) is unknown. I would bet shingles will also be a thing of the past with the vaccine, but only time will tell.
cash-only patients = boutique medicine. Many are doing it. I have some ethical issues because again it will essentially exclude poorer patients. That's not why I went into medicine.
If someone comes in for an 'annual exam' (which isn't billable) you usually can bill for any individual problems that are addressed, but it does not come close to reimbursing for the amount of time spent addressing all the preventative stuff.
But a little more seriously, I think many people are getting suspicious of doctors who are too quick with the prescription pad, and don't spend much time actually doing preventative, or even curative, medicine.
As a doctor, I agree wholeheartedly. There are a number of reasons for this, but, honestly, the biggest reason is this is just not paid for. The biggest insurers in this country - medicaid and medicare do not pay for annual preventative health visits except for children. Also, they pay per visit, not what you did or how good a job you did as a doctor. I can spend 30 minutes discussing stuff with my patents about non-medicine treatments, about vaccines or whatever (and I do because I consider it my job to do what is best for my patients), but I won't get paid a dime to do it by their insurance for all that extra time with them or for many of the preventative health visits. That costs me quite a bit of money actually. I have to pay staff and office cost so it comes straight out of my families pocket. Many docs, are understandably (to a certain degree) not willing to make that sacrifice.
This also might lead you to understand why docs get upset with the Jenny McCarthy types. If we spend more time talking about why vaccines are safe, we either have less time to talk about stuff that might be more important or just sacrifice and lose more money ourselves and at the same time make other patients wait longer.
I do make this sacrifice and build it into my schedule, but I make about 30-50% of most my colleuges for it and I spend more time than most of them working because of it. Most of my patients would agree I'm a much better doctor than most for it. Other than knowing I do a good job, I am essentially punished for it. Our system in the US is screwed. My only recourse to maintain this type of care and make a competitive salary is to do boutique medicine. I'm not sure I'm willing to do that because it would exclude all of my poorer patients.
In order to understand autism, you have to understand what it is. It is a type of congitive/developmental disorder of the brain. People with it have extraordinarily poor social skills. Frequently they have other disorders as well, but not always. If you think of it as a type of learning disability or mental retardation for social skills or interaction with other people, it makes much more sense.
As you can imagine, there is not one cause of mental retardation or any one learning disability. We still don't know most of the causes of these things. The same holds true for autism. It is a very generic diagnosis for certain pattern of clinical manifestations. I can assure you it has many causes, and vaccines are not one of them.
Depends on the journal your reading. Read my other post in this thread. Say principles apply. There are plenty of basic science medical journals out there. Most practitioners would not be reading those, however.
That's a bit erroneous but partially true. Its mostly just an oversimplification and/or over generalization.
What you are saying is sort of like if I was talking about scientists and implying they should all be biologists but are not in some sort of derogatory way. Of course, not all scientists are biologist and that is not expected. But some scientist trained in say environmental science might drawn on biology for what they are working on.
Doctors draw from many disciplines in order to do what we do. I believe we mostly try to use science as our foundation but that is not always possible. We are very much trained in the ways of science. That's pretty much what most of use focus on in undergrad and the 1st two years of medical school. Are most of us PHDs? No, of course not, but much of what we do draws from directly from science. Those of us who primarily practice in a community environment later in life will draw much less on the basic science part and focus more on the other disciplines of medicine. Those who primarily practice rely on those doing the research to guide principles put into practice.
Those of us who stay in academics tend to stay more in touch with basic science because most of us are educators or do research ourselves that drives practice. Some of us also have PHDs, some of use don't.
So it just depends on the doctor you are talking about. Since the public mostly interacts with practicing community doctors, I can see where you are coming from but I'd argue that does not accurately reflect the scope of what many of us do.
Skin cancer is only one bad outcome of sun exposure. UV light directly causes skin damage which causes advance aging of the skin. This is readily demonstarted on any one person by looking at skin under a microscope. Ignoring this is somewhat myopic when, again, appropriate supplementation is adequate.
Its just like beer, smoking or anything else, it is a balancing act based on personal preference in the end considering the realities of the situation. When ever I talk to a patient, its my role to make sure they understand the realities and options, anyway....
Personally, I want to look and feel young as long as possible so I'll error on the side of protecting myself from the sun since it plays a big role in skin aging and I make sure I get enough vitamin D. Always avoid sun burns. If I'm going to out in the sun for more than 10-15 minutes, I wear a hat and sunscreen.
Oh, and just because she has vitamin D deficiency does not mean she does not have osteoporosis. Vitamin D deficiency is a potential cause of osteoporosis. It is very common to have both at the same time.
Correcting the deficiency can help prevent progression of osteoporosis and even strengthen the bones in some cases. Anyone with osteoporosis should, at a minimum, be on calcium and vitamin supplements anyway, which, again is not why it is always tested for. They should probably be on a bisphosphate as well unless their is a reason they can't take one.
Fortunately good doctors don't use usatoday as a reference. Fortunately I read peer-reviewed journals that are more recent than 2005 and can tell you there is somewhat of a religious type war going on with this topic with dermatologist on one side and endocrinologists on the other. I would suggesting reading the whole article you referenced. You will see even in it, there are two sides presented with someone else arguing the opposite.
I can tell you that most practitioners do not believe what you are suggesting and I would agree with them. Appropriate supplementation is generally all that is needed. See my other posts in the discussion for details on what is appropriate. Prescribing UV light for this is generally not thought of as good practice and it makes you wonder what the motivations are for the person prescribing it, that is, do they own the treatment center?
Slashdot Mirror
Using an antibiotic to prevent a secondary infection does not work. It just kills the normal bacteria and allows bacterial that are resistant to the antibiotic to colonize you. Those more resistant bacteria can cause secondary infections just as well as the original.
Multiple studies have shown over and over again, that the course of a cold, sinus infection, bronchitis are in no way altered by treating with antibiotics. Yes, we have given people placebos to people and compared the results to those given antibiotics. Guess what? no difference. So your theory about preventing ER visits and such is just wrong.
so because you have had crappy jobs and crappy doctor visits, an antibiotic will fix your cold? I'm not following your logic here.
I'd like to know where these financial incentives are for prescribing antibiotics because I've never received one. The drug reps do push there meds, but I don't know anyone that takes them seriously. They're usually just eye candy or a person to be made fun of after they leave.
I'll give you the heckling thing tho. Occasionally after 5 cold visits in a row and multiple demands for antibiotics, some mothers literally screaming at you for not giving their kids antibiotics, one can become weak and may give into a demanding patient later. We are only human after all. I actually very rarely cave like that, but it happens.
Agreed. Patient education would go a long way. Too many parents and adult patients believe they need an antibiotic for every sinus infection, cold, ear infection or episode of 'bronchitis' they have when in most of these cases an antibiotic is actually not needed. Unfortunately, many docs also have been led to believe some of these problems need an antibiotic, too
I'm not sure what financial incentives physicians have to prescribe abx. God knows I have have never been given any of these financial 'incentives'. The only incentive I have is to prescribe it when I feel it is warranted or because the patient is being a such a pain in my ass and I just need them to leave. The latter rarely happens.
It depends on the screening test. Some are very good - like colonoscopy. Others can cause more harm than good on average - PSA is a great example.
Early detection is absolutely the way to go, how to do it for any given condition is the hard part. Many cancers have no screening tests because it is a hard to develop good, quality tests (good sensitivity and specificity). Just testing because it can be done is usually a very bad idea.
"The problem is important in any area where a less-than-perfect screen is used to detect a rare event in a population"
Unfortunately, there is no such thing as a perfect screening test for anything in medicine. Some are better than others, but none are perfect. This is a very difficult concept for most people, unfortunately, and for many insurance companies.
It is not such an issue for the better screening tests such as colonoscopy but it is very difficult for things like PSA where there is a large body of evidence it can do more harm than good on average if used routinely even within the recommended ages. For a patient, you're lucky if you can have a meaningful discussion in 5-10 minutes which is an awful large chunk of an office visit that usually has >4 talking points.
It is a problem for doctors and insurance companies because some well intended person with the insurance company will decide to measure the quality of its doctors (which I support in theory) by measuring, for instance, the percentage of age and gender appropriate patients under the care of a given physician that have their PSA checked annually. The problem is, there is absolutely no concensus in medicine that it should be checked regularly as a screening test. I'm not sure I want mine tested when the time comes around unless my family history changes between now and then. So to measure a physician by this marker or other screening tests is fraught with problems, since many patients might opt out for very good reasons. Also, I'm not going to recommend any test because an insurance company wants me to, only if it is right for any given patient.
Bottom line is there are no perfect tests and testing is not always the right thing to do. Most people do not understand that because it is a hard concept to grasp.
I read the article. I did not see that part having read it now several time It said that new customers and those that qualify will get the discount. The 'those that qualify' it implied were the people at the end of their contract. I'm not sure how this is any different then other cell phone providers.
I have to agree. I'm not a cell phone guru by any measure, but only offering the discount rate every two years seems to be a fairly standard term in my experience.
Isn't this what relakks already is? I thought the same guys the run TPB run relakks and relakks is nothing but an encrypted VPN, right?
I would argue you survive because you have students who are willing to pay to be taught by you, not the other way around.
You made an educated decision, I would guess, when you decided to do what you did. That was your decision, live with it.
Please. A significant number of MD's do other things that purely practice clinical medicine, such as research. Plus, many PhD's never really contribute in any meaningful way to society or their field of practice. "A few years of residency" can range from 3 years to 7 or even 10 years depending on the training.
One year of residency is much more time consuming and stressful than any PhDs I've known. I'm not trying to make this a PhD vs MD rant, you did that, I'm just trying to point out some gross exaggerations and factual errors in your comment. I have quite a few PhD friends I have nothing respect for, actually. They agree you're making some way over-the-top gross exaggerations.
The shingles vaccines is not that same vaccine. Same antigen/virus is used, but in much larger concentration
Besides, cash-only doesn't prevent a doctor from working with the poor - nothing stops a doctor from donating time and services to those who can't afford it and making it up on the paying patients. Well nothing except the current system that funnels the poor into, and is currently chasing doctors away from, medicare/medicaid because treatment is generally a net loss for the doctor.
If you are going to see medicaid patients, you have to bill all people consistently otherwise you are potentially committing fraud. (medicaid patients are typically poor and many doctors will not even see them because of the problems they bring with them). That is, you can't due 'boutique medicine' and charge cash up from from one part of your patient population and then use the standard billing system for others. I'll admit, i'm not up on the ins and outs of this, but that would basically be fraud in the eyes of government insurance programs. The only way around it would be to do services for free or a sliding scale, but that would only be for my fees and those without insurance entirely. Believe it or not, most poor patients do have medicaid or medicare. I have a large percentage of this type of patient and they would no longer be able to see me if I changed to a cash only type of system. Doesn't make sense, but that's the way it works (or so I'm told)
That's simply not true. There are a number of live vaccines, including MMR, varicella, oral polio vaccine (not used in the US anymore), and the flu nasal spray vaccines. That's just off the top of my head. These virus's are alive as a virus can be and do propagate themselves in the host.
While you are probably right, that is, that vaccinated kids won't get shingles when they are older, we actually do not know that for sure and won't know until these kids are much older. Remember, the chicken pox vaccine is a live virus vaccine. We are essentially giving them a 'weaker' version of the virus. Rarely, it will cause chicken pox is some people. How much it reduces the rate of shingles (as far as I know) is unknown. I would bet shingles will also be a thing of the past with the vaccine, but only time will tell.
cash-only patients = boutique medicine. Many are doing it. I have some ethical issues because again it will essentially exclude poorer patients. That's not why I went into medicine.
If someone comes in for an 'annual exam' (which isn't billable) you usually can bill for any individual problems that are addressed, but it does not come close to reimbursing for the amount of time spent addressing all the preventative stuff.
But a little more seriously, I think many people are getting suspicious of doctors who are too quick with the prescription pad, and don't spend much time actually doing preventative, or even curative, medicine.
As a doctor, I agree wholeheartedly. There are a number of reasons for this, but, honestly, the biggest reason is this is just not paid for. The biggest insurers in this country - medicaid and medicare do not pay for annual preventative health visits except for children. Also, they pay per visit, not what you did or how good a job you did as a doctor. I can spend 30 minutes discussing stuff with my patents about non-medicine treatments, about vaccines or whatever (and I do because I consider it my job to do what is best for my patients), but I won't get paid a dime to do it by their insurance for all that extra time with them or for many of the preventative health visits. That costs me quite a bit of money actually. I have to pay staff and office cost so it comes straight out of my families pocket. Many docs, are understandably (to a certain degree) not willing to make that sacrifice.
This also might lead you to understand why docs get upset with the Jenny McCarthy types. If we spend more time talking about why vaccines are safe, we either have less time to talk about stuff that might be more important or just sacrifice and lose more money ourselves and at the same time make other patients wait longer.
I do make this sacrifice and build it into my schedule, but I make about 30-50% of most my colleuges for it and I spend more time than most of them working because of it. Most of my patients would agree I'm a much better doctor than most for it. Other than knowing I do a good job, I am essentially punished for it. Our system in the US is screwed. My only recourse to maintain this type of care and make a competitive salary is to do boutique medicine. I'm not sure I'm willing to do that because it would exclude all of my poorer patients.
In order to understand autism, you have to understand what it is. It is a type of congitive/developmental disorder of the brain. People with it have extraordinarily poor social skills. Frequently they have other disorders as well, but not always. If you think of it as a type of learning disability or mental retardation for social skills or interaction with other people, it makes much more sense.
As you can imagine, there is not one cause of mental retardation or any one learning disability. We still don't know most of the causes of these things. The same holds true for autism. It is a very generic diagnosis for certain pattern of clinical manifestations. I can assure you it has many causes, and vaccines are not one of them.
Depends on the journal your reading. Read my other post in this thread. Say principles apply. There are plenty of basic science medical journals out there. Most practitioners would not be reading those, however.
That's a bit erroneous but partially true. Its mostly just an oversimplification and/or over generalization.
What you are saying is sort of like if I was talking about scientists and implying they should all be biologists but are not in some sort of derogatory way. Of course, not all scientists are biologist and that is not expected. But some scientist trained in say environmental science might drawn on biology for what they are working on.
Doctors draw from many disciplines in order to do what we do. I believe we mostly try to use science as our foundation but that is not always possible. We are very much trained in the ways of science. That's pretty much what most of use focus on in undergrad and the 1st two years of medical school. Are most of us PHDs? No, of course not, but much of what we do draws from directly from science. Those of us who primarily practice in a community environment later in life will draw much less on the basic science part and focus more on the other disciplines of medicine. Those who primarily practice rely on those doing the research to guide principles put into practice.
Those of us who stay in academics tend to stay more in touch with basic science because most of us are educators or do research ourselves that drives practice. Some of us also have PHDs, some of use don't.
So it just depends on the doctor you are talking about. Since the public mostly interacts with practicing community doctors, I can see where you are coming from but I'd argue that does not accurately reflect the scope of what many of us do.
Skin cancer is only one bad outcome of sun exposure. UV light directly causes skin damage which causes advance aging of the skin. This is readily demonstarted on any one person by looking at skin under a microscope. Ignoring this is somewhat myopic when, again, appropriate supplementation is adequate.
Its just like beer, smoking or anything else, it is a balancing act based on personal preference in the end considering the realities of the situation. When ever I talk to a patient, its my role to make sure they understand the realities and options, anyway....
Personally, I want to look and feel young as long as possible so I'll error on the side of protecting myself from the sun since it plays a big role in skin aging and I make sure I get enough vitamin D. Always avoid sun burns. If I'm going to out in the sun for more than 10-15 minutes, I wear a hat and sunscreen.
Oh, and just because she has vitamin D deficiency does not mean she does not have osteoporosis. Vitamin D deficiency is a potential cause of osteoporosis. It is very common to have both at the same time.
Correcting the deficiency can help prevent progression of osteoporosis and even strengthen the bones in some cases. Anyone with osteoporosis should, at a minimum, be on calcium and vitamin supplements anyway, which, again is not why it is always tested for. They should probably be on a bisphosphate as well unless their is a reason they can't take one.
Fortunately good doctors don't use usatoday as a reference. Fortunately I read peer-reviewed journals that are more recent than 2005 and can tell you there is somewhat of a religious type war going on with this topic with dermatologist on one side and endocrinologists on the other. I would suggesting reading the whole article you referenced. You will see even in it, there are two sides presented with someone else arguing the opposite.
I can tell you that most practitioners do not believe what you are suggesting and I would agree with them. Appropriate supplementation is generally all that is needed. See my other posts in the discussion for details on what is appropriate. Prescribing UV light for this is generally not thought of as good practice and it makes you wonder what the motivations are for the person prescribing it, that is, do they own the treatment center?