Category Archives: Doctors

A surgeon with a history of complications, a felony past

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Toumbis' booking photo and an excerpt from the police report.

Toumbis’ booking photo and an excerpt from the police report.

by Marshall Allen and Olga Pierce
ProPublica

Officer Richard Walter looked out the window of his patrol car and saw two young men trading punches outside Sutter’s Saloon.

It was 2 a.m. on what should have been a forgettable night shift in 1989. Sutter’s was near the State University of New York at Buffalo 2013 a student hangout, not a rough dive. Walter, now a seasoned detective, still can’t shake the bizarre and bloody memory of that night.

The men didn’t notice the cop pull into the parking lot. Walter grabbed his baton and approached, then saw a glint of metal. One of the men held a knife, the blade protruding three inches from his clenched fist.

Instantly a geyser of blood spurted from the unarmed man’s neck onto Walter’s uniform 2013 10 feet away. The man collapsed, his neck slashed open “from his ear to his Adam’s apple,” Walter said, recalling what he wrote in the police report. Blood pulsed onto the pavement from his severed carotid artery and jugular vein.

Walter drew his gun and pointed it. The attacker dropped the knife and clasped his hands around his victim’s gashed neck to stanch the bleeding.

“I’m a medical student,” the attacker said. “I know what I’m doing.” Continue reading

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Online scorecard helps you pick a surgeon

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surgeons performing surgery in operating roomThe independent investigative journalism website ProPublica has created online “Surgeon Scorecard” that you can use to find out a surgeon’s complication rate for eight commonly performed operations.

To learn about the complication rates of surgeons working at hospitals in Washington state go here.

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Do cell phones belong in the OR?

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Next time you’re on the operating table and you have one last look around as the anesthesiologist approaches, don’t be too sure that that person in scrubs looking at a smartphone is pulling up vital health data.

He or she might be texting a friend, or ordering a new carpet.

Cellphone use is not generally restricted in the operating room, but some experts say the time for rules has come. In interviews, many described co-workers’ texting friends and relatives from the surgical suite. Some spoke of colleagues who hide a phone in a drawer and check it when they think no one is watching.

Cellphone use is not generally restricted in the operating room, but some experts say the time for rules has come.

“Sometimes it’s just stuff like shopping online or checking Facebook,” said Dwight Burney, an orthopedic surgeon from Albuquerque. “The problem is that it does lead to distraction.” This can result in medical errors or lax safety procedures, such as forgetting to check a patient’s identity, he said.

In one 2011 incident, a Texas anesthesiologist was accused of sending text messages and e-mails while monitoring a patient. Her oxygen levels dropped, which the anesthesiologist allegedly didn’t notice for close to 20 minutes, and she died in surgery. The woman’s family sued the anesthesiologist. The case was settled before going to trial. Continue reading

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Uninsured rate falls to historic low – Gallup survey finds

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The uninsured rate among U.S. adults aged 18 and older was 11.4% in the second quarter of 2015, down from 11.9% in the first quarter.

The uninsured rate has dropped nearly six percentage points since the fourth quarter of 2013, just before the requirement for Americans to carry health insurance took effect.

The latest quarterly uninsured rate is the lowest Gallup and Healthways have recorded since daily tracking of this metric began in 2008.

Full story here.

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‘A terrible way to end someone’s life’

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By Stephanie O’Neill, Southern California Public Radio

Nora Zamichow says if she and her husband, Mark Saylor, had known how doctors die, they may have made different treatment decisions for him at the end of his life (Maya Sugarman/KPCC).

“I felt like I was beating up people up at the end of their life,” she says.

It looks nothing like what people see on TV. In real life, ribs often break and few survive the ordeal.

A Stanford University study shows almost 90 percent of doctors would forgo resuscitation and aggressive treatment if facing a terminal illness.

“I felt like I was beating up people up at the end of their life,” she says.

It looks nothing like what people see on TV. In real life, ribs often break and few survive the ordeal.

Gorlitsky now teaches medicine at the University of Southern California and says these early clinical experiences have stayed with her.

“I would be doing the CPR with tears coming down sometimes, and saying, ‘I’m sorry, I’m sorry, goodbye.’ Because I knew it very likely was not going to be successful. It just seemed a terrible way to end someone’s life.”

Gorlitsky wants something different for herself and for her loved ones. And most other doctors do too: A Stanford University study shows almost 90 percent of doctors would forgo resuscitation and aggressive treatment if facing a terminal illness. Continue reading

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Doctors order fewer preventive services for Medicaid patients – study finds

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Blue doctorMichelle Andrews
KHN

Gynecologists ordered fewer preventive services for women who were insured by Medicaid than for those with private coverage, a recent study found.

The study by researchers at the Urban Institute examined how office-based primary care practices provided five recommended preventive services over a five-year period.

The services were clinical breast exams, pelvic exams, mammograms, Pap tests and depression screening.

The study used data from the National Ambulatory Medical Care Survey, a federal health database of services provided by physicians in office-based settings.

It looked at 12,444 visits to primary care practitioners by privately insured women and 1,519 visits by women who were covered by Medicaid between 2006 and 2010.

That difference reflects the fact that the share of women who are privately insured is seven times larger than those on Medicaid, the researchers said. Pregnancy-related visits and visits to clinics were excluded from the analysis.

Overall, 26 percent of the visits by women with Medicaid included at least one of the five services, compared with 31 percent of the visits by privately insured women. Continue reading

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For doctors who take a break from practice, coming back can be tough

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Family practitioner Kate Gibson checks 4-year-old Ashley del Torro’s throat for an infection at the Eisner Pediatric Medical Center in Los Angeles, California, on Friday, June 5, 2015. Gibson completed a re-entry program in order to return to practice medicine after a 10-year break to raise her four children (Photo by Heidi de Marco/KHN)

Family practitioner Kate Gibson checks 4-year-old Ashley del Torro’s throat for an infection at the Eisner Pediatric Medical Center in Los Angeles, California, on Friday, June 5, 2015. Gibson completed a re-entry program in order to return to practice medicine after a 10-year break to raise her four children (Photo by Heidi de Marco/KHN)

By Anna Gorman
KHN

After taking a 10-year break from practicing medicine to raise four sons, Kate Gibson was ready to go back to work.

The family practitioner had been reading about a shortage of primary care doctors and knew she could help. But when Gibson, 51, applied to work at her former hospital near Los Angeles, she was turned away. She’d been out of clinical practice too long.

“I really thought it was not going to be that hard,” she said.

Like many professionals, physicians take time off to raise children, care for sick family members or to recover from their own illnesses. Some want to return from retirement or switch from non-clinical jobs back to seeing patients. But picking up where they left off is more difficult in medicine than in most careers.

In medicine, change occurs quickly. Drugs, devices and surgical techniques that were standard a decade ago may now be obsolete. Or a returning doctor’s skills may simply be rusty.

In medicine, change occurs quickly. Drugs, devices and surgical techniques that were standard a decade ago may now be obsolete. Or a returning doctor’s skills may simply be rusty.

“My hands feel like those of an intern,” said Molly Carey, 36, an Ivy-League educated doctor who recently enrolled in a Texas retraining program after four years away from patients.

After extended leaves, doctors must convince medical boards to reissue their licenses, hospitals to grant admitting privileges and malpractice insurers to provide coverage. Only a handful of programs around the country are set up to help physicians brush up on their skills, and they can cost doctors thousands of dollars.

“Medical schools do a fantastic job graduating brand new medical students,” said Humayun J. Chaudhry, president of the Federation of State Medical Boards. “But what about people who have already graduated and need to get some retraining? There is a clearly a dearth of those kind of training programs.”

Policymakers and professional organizations are pushing to make the process less burdensome and costly – in part because it may help ease shortages of primary care doctors. Continue reading

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One Nation, Under Sedation: Medicare Paid for Nearly 40 Million Tranquilizer Prescriptions in 2013

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Three red and white capsulesBy Charles Ornstein
ProPublica

This story was co-published with the Boston Globe, the Miami Herald and Health News Florida.

In 2012, Medicare’s massive prescription drug program didn’t spend a penny on popular tranquilizers such as Valium, Xanax and Ativan.

The following year, it doled out more than $377 million for the drugs.

Screen Shot 2015-06-10 at 8.59.21 AMWhile it might appear that an epidemic of anxiety swept the nation’s Medicare enrollees, the spike actually reflects a failed policy initiative by Congress.

More than a decade ago, when lawmakers created Medicare’s drug program, called Part D, they decided not to pay for anti-anxiety medications.

Some of these drugs, known as benzodiazepines, had been linked to abuse and an increased risk of falls and fractures among the elderly, who make up most of the Medicare population.

But doctors didn’t stop prescribing the drugs to Medicare enrollees. Patients just found other ways to pay for them.

When Congress later reversed the payment policy under pressure from patient groups and medical societies, it swiftly became clear that a huge swath of Medicare’s patients were already using the drugs despite the lack of coverage.

In 2013, the year Medicare started covering benzodiazepines, it paid for nearly 40 million prescriptions, a ProPublica analysis of recently released federal data shows.

Generic versions of the drugs 2014 alprazolam (which goes by the trade name of Xanax), lorazepam (Ativan) and clonazepam (Klonopin) 2014 were among the top 32 most-prescribed medications in Medicare Part D that year.

And it appears these were not new prescriptions. Continue reading

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Doctor’s office research – What is it? What’s it to you?

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SEATTLE COMMUNITY CONVERSATION SERIES JUNE 9, SEATTLE.

“DOCTOR’S OFFICE RESEARCH. WHAT’S IT TO YOU?”

Facilitated by Benjamin Wilfond MD, Seattle Children’s Research Institute

speech-bubbleJoin us for an engaging and intimate discussion about research that happens in your doctor’s office.

What? You thought research only happened at universities or hospitals, right?

It turns out that plenty of decisions, like which hand gel to use or which blood pressure medicine to prescribe, vary by a lot without much rhyme or reason.

Doctors want better evidence for these decisions.  But how much should patients know and be able to agree to?

Learn more at rompethics.iths.org

Each Conversation in the series explores a topic in biomedical science and its role in society, connecting people to the biomedical research community

Details  and REGISTRATION

WHEN?

Tuesday June 9
5:45 – 7:30 PM

WHERE?

Kakao Chocolate + Coffee
415 Westlake Ave. N.
Seattle, WA 98109

HOW MUCH?

$5 NWABR members| $10 General admission, Includes discussion, appetizers, espresso and first glass of beer or wine if 21+

Everyone is welcome.  No science background necessary.

SUGGESTED READINGS AND RESOURCES

Description of research in your doctor’s office

Influence of doctors’ demographic on their medical practice

Making evidence-based medicine doable in everyday practice

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Bring doctors to patients who need them most

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Jennifer Vargas, a second year resident at Riverside County’s Regional Medical Center, treats patient Maria Sanchez, 54, at Riverside County’s Regional Medical Center on April 21, 2015.    Sanchez says she feels comfortable with Vargas because she speaks Spanish (Photo by Heidi de Marco/KHN).

Jennifer Vargas, a second year resident at Riverside County’s Regional Medical Center, treats patient Maria Sanchez, 54, at Riverside County’s Regional Medical Center on April 21, 2015. Sanchez says she feels comfortable with Vargas because she speaks Spanish (Photo by Heidi de Marco/KHN).

By Andrew L. Wang and Heidi de Marco

MORENO VALLEY, Calif. — Jennifer Vargas’ path toward becoming a doctor took her from UCLA to Guadalajara before it ultimately led back home, to California’s vast Inland Empire east of Los Angeles.

“Today, our country is largely training the sons and daughters of wealthy people to be physicians… You wonder why we have a problem with people not serving in underserved communities; it’s because they don’t know what an underserved community looks like.”

When the Chino Hills, Calif. native graduated from medical school in Mexico, her first choice for residency training was Riverside County’s public medical center, which serves among the fastest growing and most medically deprived parts of California.

It was just what she wanted:  To serve a vulnerable patient population facing high barriers to care, particularly immigrant patients from Mexico who would benefit from a Spanish-speaking physician.

“It offered the best fit for me,” said Vargas, 32, a second-year resident in family medicine at Riverside County Regional Medical Center. Continue reading

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What patients gain by reading their doctor’s notes

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Shelves packed with medical records

By Shefali Luthra

During a recent physical, Jeff Gordon’s doctor told him he may be pre-diabetic. It was a quick mention, mixed in with a review of blood pressure numbers, other vital statistics like his heart rate, height and weight, and details about his prescription for cholesterol medication.

Normally, Gordon, 70, a food broker who lives in Washington, D.C., would have paid it little attention.

But his physician, who recently joined MedStar Health, uses the system’s Web portal that allows him to share his office notes with patients. For Gordon, seeing the word “pre-diabetic” in writing made it difficult to ignore, and he took action.

He contacted MedStar about joining a pre-diabetes clinical study. In the course of taking the tests required to participate, the otherwise healthy septuagenarian found out his blood sugar wasn’t elevated enough to qualify.

Still, the experience of seeing the term in his doctor’s notes was a “wake-up call,” inspiring him to pay more attention to his diet and exercise. “It’s harder to ignore when it’s in your face,” he said. Continue reading

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Top medical school revamps requirements — to lure English majors

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Dr. David Muller, a professor and dean at Mount Sinai Medical School, helps first-year students prepare to do physical exams on each other as part of a class called “The Art and Science of Medicine.” (Photo: Cindy Carpien for KHN)

Dr. David Muller, a professor and dean at Mount Sinai Medical School, helps first-year students prepare to do physical exams on each other as part of a class called “The Art and Science of Medicine.” (Photo: Cindy Carpien for KHN)

By Julie Rovner
KHN

NEW YORK — You can’t tell by looking which med students at Mount Sinai were traditional pre-meds in college and which weren’t. And that’s exactly the point.

Most of the class majored in biology or chemistry or some other “hard” science; crammed for the MCAT (the Medical College Admission Test) and did well at both.

But a growing percentage came through Icahn School of Medicine at Mount Sinai’s “Hu-Med” program, which stands for Humanities in Medicine. They majored in things like English, history or medieval studies. And they didn’t even take the MCAT because Mount Sinai guaranteed them admission after their sophomore year of college.

Adding students who are educated in more than science to the mix is a serious philosophy at Mount Sinai.

David Muller is Mount Sinai’s Dean for Medical Education.  One full wall of his cluttered office is a massive whiteboard almost totally full with to-do tasks and memorable quotes. One reads: “Science is the foundation of an excellent medical education, but a well-rounded humanist is best suited to make the most of that education.”

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Mount Sinai Dean of Medical Education Dr. David Muller stands in front of a whiteboard in his office filled with notes along side memorable quotes. (Photo: Cindy Carpien for KHN)

The Hu-Med program dates back to 1987, when then-Dean Nathan Kase wanted to do something about what had become known as “pre-med syndrome.” That’s the idea that the drive for straight As and high test scores was actually producing sub-par doctors. Students were too single-minded. Continue reading

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Facing death but fighting the aid-in-dying movement

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Stephanie Packer (Photo by Stephanie O’Neill / KPCC)

By Stephanie O’Neill
Southern California Public Radio

Stephanie Packer was 29 when she found out she has a terminal lung disease.

It’s the same age as Brittany Maynard, who last year was diagnosed with terminal brain cancer. Maynard, of northern California, opted to end her life via physician-assisted suicide in Oregon last fall.

Maynard’s quest for control over the end of her life continues to galvanize the “aid-in-dying” movement nationwide, with legislation pending in California and a dozen other states.

But unlike Maynard, Packer says physician-assisted suicide will never be an option for her.

“Wanting the pain to stop, wanting the humiliating side effects to go away – that’s absolutely natural,” Packer says. “I absolutely have been there, and I still get there some days. But I don’t get to that point of wanting to end it all, because I have been given the tools to understand that today is a horrible day, but tomorrow doesn’t have to be.”

A recent spring afternoon in Packer’s kitchen is a good day, as she prepares lunch with her four children.

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The Packer family gathers in the kitchen to cook dinner. From left: Jacob, 8; Brian Sr. ; Brian Jr., 11; Savannah, 5; Scarlett, 10; and Stephanie. (Photo by Stephanie O’Neill / KPCC)

“Do you want to help?” she asks the eager crowd of siblings gathered tightly around her at the stovetop.

“Yeah!” yells 5-year-old Savannah.

“I do!” says Jacob, 8.

Managing four kids as each vies for the chance to help make chicken salad sandwiches can be trying. But for Packer, these are the moments she cherishes. Continue reading

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