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Mandating MOC to practice medicine is an appalling overstep of nonexistent authority Print E-mail
Written by Carlos J. Cardenas, MD | KevinMD   
Monday, 15 May 2017 00:00

Maintenance of certification (MOC) for something as significant as the practice of medicine seems like a harmless enough idea. But for physicians across the country who dedicate thousands of hours to study, earn licensure, achieve board certification, and practice medicine, MOC is not only unnecessary but also a resource-consuming mandate that does nothing to improve patient outcomes and quality of care.
 
According to the American Board of Medical Specialty's (ABMS) own website: "Board certification is a voluntary process, and one that is very different from medical licensure ... Board certification demonstrates a physician's exceptional expertise in a particular specialty and/or subspecialty of medical practice." In other words, physicians who pursue board certification self-identify as professionals committed to ongoing learning and subject-matter mastery. The vast majority of Texas physicians willingly pursue and obtain their initial certification for just that reason.

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Should Physicians Provide Futile Care? Print E-mail
Written by MD Whistleblower   
Tuesday, 09 May 2017 17:04

I was covering for my partner over the weekend and saw his patient with end stage liver disease, a consequence of decades of alcohol abuse. He was one of the most deeply jaundiced individuals I have ever seen. His mental status was still preserved. He could converse and responded appropriately to my routine inquiries, although he was somewhat sluggish in his thinking. It's amazing that even after the majority of a liver is dead, that a person can still live.

When I do my hospital rounds, it is rare that one of my patients is not suffering some complication of chronic alcoholism. In the hospital, the disease is rampant. In my office, this addiction is much more easily disguised. I know that many of the high functioning alcoholics whom I see there have kept their addiction a secret. Some lie and others deny.

There was a dispute with regard to the jaundiced patient referenced above. There was no disagreement among the medical professionals on treatment options. At this point, there was no medical treatment to offer beyond his current medications. A palliative care specialist advised that hospice care was the most appropriate option.

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Last Updated on Saturday, 20 May 2017 10:48
 
Mission to Ghana: Restoring function through caring & expertise Print E-mail
Written by Alejandro Badia, MD, FACS   
Thursday, 04 May 2017 00:00

In Late March, 2017  I was humbled to share the experience of co-leading a surgical team to Koforidua, inner Ghana, West Africa.

The trip was largely organized by Dr. Philippe Cuenod, of Geneva, Switzerland, and his team, who had been there several times before and developed an effective infrastructure in the St Joseph Orthopedic Hospital  so that our goals could be efficiently met. We were serving under the auspices of GICAM, founded by an Italian colleague and friend some years ago, committed to restoring hand/upper limb function in underserved countries.

The all orthopedic hospital had sparse surgeon coverage and I soon realized that their was essentially no hand/upper limb expertise. I had been to some other missions prior, but this was the first time in deep Africa; a novel culture and region to me. However, I quickly found the commonality of the human spirit and the intense wish to overcome challenges amongst our grateful and well motivated patients.

Our team evaluated most patients while in their hospital beds, essentially making rounds in large open wards where grateful patients lie, awaiting our comments on whether something could be done and when. That night, we made a rough “OR schedule” scribbling names/diagnoses on scrap paper.

Monday morning came, and we worked as a team, intermixed with Ghanian nurses, orderlies and very able anesthesiologists, doling out reconstructive procedures working 3 operating rooms like musical chairs. Philippe and I would tag team the big cases, and work separately on what we called the “little cases”. I assure you, there were actually no minor cases unless you consider a severe elbow burn contracture or a forearm malunion, a jaunt in the orthopedic park. We worked tirelessly, usually till 8 or 9 PM, sometimes midnight, usually eating a quick dinner in a makeshift lounge, besides the recovery room. The brothers from the St. Joseph Orthopedic Hospital would have the food brought to us in 2 large casserole containers, plates/silverware in a baggie.

One case comes to mind that perhaps represents the range and severity of pathology. A young man presented to us without ability to use either arm for over two years. He had broken both humeri (upper arm bones) in a scooter accident and developed non-unions bilaterally. He had no ability to lift his arms since the bones had never healed, and his left hand was largely dysfunctional due to a palsy of the radial nerve. I took the left side, Philippe and his assistant, the right. We simultaneously plated both bones, approximately 10 hole titanium plates/screws and dissected out the scarred nerves. On his side, he used a block of bone graft from the pelvis (iliac crest) and on mine, I performed releases of joint capsules and first webspace of the hand in order to place it in a more functional position. I did not proceed with planned tendons transfers to restore wrist/finger extension since too much scarring was present. That would be for the next surgeon team that comes to Ghana…perhaps us.

However, the cases that struck the deepest cord within us were the children. Whether correcting severe congenital deformities like clubhand, or reversing longstanding contractures from burns, we gave these children their first chance at a functional hand and limb. This would allow them to gain future employment, or perhaps create a family someday, perhaps reversing the rejection they might experience in their communities.

Much like Operation Smile, we give these children and adults a chance to rejoin the mainstream in their cities and villages. They restore smiles and acceptable social appearance, while we restore function and independence. I can hardly wait to go back…
~~~~~~~~~~
Alejandro Badia, MD, FACS is the Owner and Founder of  Badia Hand to Shoulder Center  and Co-founder, OrthoNOW Orthopedic Urgent Care Centers. Both businesses are headquartered in Doral, FL.

Last Updated on Friday, 05 May 2017 09:37
 
Will Robots Ever Be Able to Perform Surgery Independently? Print E-mail
Written by Skeptical Scalpel via KevinMD   
Tuesday, 25 April 2017 12:43

And if they can, should they?

In a recent post, I wrote about some unresolved issues with driverless cars and ended by saying "So are you ready to have an autonomous robot perform your gallbladder surgery? I'm not."

But the robots are coming. A recent paper in Science Robotics proposed six different levels of autonomy for surgical robots.

The authors say some devices are already at level 3. A surgeon can tell a robot to put in a row of sutures, and the robot will do so without hands-on control by the surgeon.

Major issues - cyber security, privacy, risk of malfunction resulting in harm to the patient - arise as the robots approach complete autonomy. The cost of satisfying FDA regulations escalates as the robots take on more high-risk activities. For such a device, the cost of premarket approval approaches $100 million and takes 4 1/2 years to accomplish.

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Last Updated on Tuesday, 25 April 2017 12:44
 
An Expert Witness Goes the Extra Mile Print E-mail
Written by Skeptical Scalpel   
Saturday, 01 April 2017 00:00

A Canadian dermatologist was found guilty of professional misconduct by a disciplinary committee of the Ontario College of Physicians and Surgeons. He had been accused of rubbing his penis against the legs of two patients he was examining.

In his defense, the doctor said it couldn't have happened because he was so obese that his penis was covered by abdominal fat.

After 38 days of testimony, the committee was in effect a "hung" jury regarding the penis allegation but found against the doctor for rubbing his abdomen against the patients without "any form of warning, apology or excuse." The committee found the conduct "disgraceful, dishonorable or unprofessional."
Last Updated on Tuesday, 04 April 2017 16:56
 
A comprehensive healthcare redesign for the United States Print E-mail
Written by FHI's Week in Review   
Monday, 06 March 2017 16:49

Thomas Birch, MD in a March 4, 2017 KevinMD post, immodestly asserts:

I can envision a comprehensive design for health care in the United States that will expand access and control costs while conforming to our shared national values of personal responsibility, care for thy neighbor and free enterprise.

Thomas Birch, an infectious disease physician, lays out a plausible plan for real health reform. This short article is definitely worth a read!

Read more in the current issue of Week in Review>>

Last Updated on Monday, 27 March 2017 17:26
 
Emergency Physicians Are Slaves to Highway Billboards Print E-mail
Written by Sandra Scott Simons, MD | KevinMD   
Monday, 06 March 2017 00:00

"Mom, that's a little unreasonable," piped up my 9-year-old from the backseat as we drove by an ER billboard that prominently displayed an average wait time of four minutes. "That would be stressful, seeing everyone that fast." Even my kids understand how absurd some of today's time metrics are. "Hospitals probably make more money showing shorter wait times on a billboard because people want to go there because it's faster," he concluded. Out of the mouths of babes.

EPs are never more stressed about time than when we're in the ED, where every move is timed, tracked, and reported to the guys in suits to make us move even faster (as if we are sitting around eating bonbons). Each time we meet their time metric for door-to-physician greet, they lower it again.

I had a rare slow shift recently, and two patients complimented my bedside manner, and a third asked me to be her doctor. Sadly, this isn't the norm because I'm usually too rushed to establish rapport.

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Last Updated on Tuesday, 07 March 2017 19:07
 
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