Lab Soft News

Russians Commemorate the Enema with a Public Statue

Sometimes we fail to celebrate in a conspicuous way the more mundane but helpful elements of our lives. The good people of Zheleznovodsk, Russia, are doing their small part to help correct this problem (see: Regular Russian City Immortalizes Enema With $42,000 Statue Held Aloft By Angels). Below is an excerpt from this article with a photo (boldface emphasis mine):

For the Russians, [the enema] is something more, because one city there erected an 800-pound, $42,000 statue to honor the device for its many years of unsung service to the backside of mankind. "There is no kitsch or obscenity, it is a successful work of art," said Alexander Kharchenko, a resident of the regularity-loving Zheleznovodsk. "An enema is almost a symbol of our region." ...When you dig a little deeper into this story, you start to see that Zheleznovodsk is in fact the perfect location for this statue. Nestled deep within the Caucasus Mountains region, the city is best known for its spas, and their mineral water-infused enemas drawn from mountain springs. A banner declaring, "Let's beat constipation and sloppiness with enemas" was posted on one of the spa's walls to commemorate the statue.

Commenting at greater length on this story would certainly not improve it and might get me into serious trouble, so I will restrain myself. However, here's a link to a PubMed article in Russian entitled: Errors in directing children to Zheleznovodsk spa. Zheleznovodsk does not sound like a town for the young or faint-hearted. Although, come to think about it, I don't know what the name of the town sounds like at all.

Pathology Is Not Disintegrating in Canada!

Today's guest blog has been written by the very distinguished Canadian pathologist, Dr. Michael McNeely. Mike is currently the President of the Association for Pathology Informatics (API) and Past-President of the Canadian Association of Pathologists. He lives in Victoria, British Columbia, Canada.

No, Pathology in Canada is NOT “coming apart at the seams”.  Our country continues to enjoy exemplary clinical laboratory service. The situation is tight and, in certain instances, is dangerous.  Recent newsworthy events and an editorial in the CMAJ (see:  Canada's pathology) speak to two issues which I would like to clarify: (1) “lack of a national QA program” and (2) a shortage of laboratory professional staff.

Quality Assurance: This part of the report has caused some to believe that Canada does not use QA. This is clearly not correct. Although Canada has government-funded health care, each individual province is responsible for the administration and management of health care within its own jurisdiction. With some provincial variation, lab accreditation and mandatory QA has been standard across the country for 30+ years.  What has not been routinely available (until several recent notable projects were launched) has been scrutiny of the professional work of pathologists.  This has been compounded by situations where pathologists work alone. 

Professional Staffing: During the 1960s and early 70s, Canada was the beneficiary of an influx of highly trained pathologists from other countries (mainly the UK). This bolus took up the open positions but neutralized the need to develop a full stream of residents. Twenty-seven years ago (commenting on research conducted by the late Vern Waldorf), I wrote an editorial in the Canadian Association of Pathologists Newsletter (Vol 24: March 1982; p. 18) in which I stated “It is probable that retirement will produce a manpower shortage that will start in about five years and will reach crisis proportions around the year 2000.”  Since, the early 80s, medical school output was curtailed and pathology residencies not expanded to meet the declining requirements. Today, we are “holding on” but all groups are stretched thin and specific locations are inadequately serviced.

BariatricEdge: A Web Site Focusing on Bariatric Surgery

I have published a number of blog notes about bariatric surgery (one example: "Curing" Diabetes with Bariatric Surgery). I have also commented at length in the past about the value of the web for healthcare consumer education, frequently in notes related to Health 2.0 (example: Introduction to Health 2.0). I encountered a web site recently called BariatricEdge that is designed for consumers who are considering bariatric surgery. The sponsor of this site is Ethicon Endo-Surgery. Here is a brief summary about the company taken from the home page of its web site:

Ethicon Endo-Surgery...develops and markets advanced medical devices for minimally invasive and open surgical procedures. The company focuses on procedure-enabling devices for the interventional diagnosis and treatment of conditions in general and bariatric surgery, as well as gastrointestinal health, gynecology and surgical oncology.

I found the BariatricEdge web site to be interesting on a number of different counts. First of all, the home page is captioned Real Patient's Stories and features video testimonials by patients who have undergone bariatric surgery. Needless to say, all of them are enthusiastic about the surgical procedure. The search options on the web site are also interesting. There is an As Told By search field with only two choices, Patients and Professionals, and a Topics search field with 11 choices including Diet, Fear of Surgery, Complications, Moment of Truth, and Paying for Surgery. Along the left-hand margin of the home page are a list of general category that you can click-through, including About Morbid Obesity, Qualifying for Bariatric Surgery, Health Benefits, and Risk of Surgery.

In general, I was impressed by this web site and the quality of the information available on it, considering the fact that the sponsor of the site is most interested in selling endoscopic instruments. One aspect of the web site that interested me was that the search options for the web site were predetermined. I suspect that such a feature would be welcomed by a consumer trying to understand bariatric surgery and unsure about where to start. Obviously, the web site also paints a relatively rosy picture of bariatric surgery. However, the more sophisticated consumer browsing the web can get a more complete picture by merely searching the web for complication + bariatric surgery (example: Bariatric Surgery Risks).

Physican Blogs Criticized on Basis of Privacy Issues

Blogs authored by physicians are starting to attract more attention, particularly with regard to patient privacy issues (see: Doctor Blogs Raise Concerns About Patient Privacy). Below is an excerpt from this article with boldface emphasis mine:

[Physician-authored] blogs have raised concerns about privacy issues on the Web.....One physician blogger, who draws about 12,000 readers a day, is New Hampshire internist Dr. Kevin Pho. His blog, "Kevin, M.D.," offers a doctor's eye view on medical issues that appeal to both his peers and the public."...Blogging can be a great marketing tool for raising a physician's profile and attracting new patients, says [a healthcare consultant]. But not all physician blogs are geared toward marketing. In fact, just the opposite seems to be the case in some extremely candid blogs, like "White Coat Rants," "Cancer Doc" and "M.D.O.D.," which bills itself as "Random Thoughts from a Few Cantankerous American Physicians." These are more like diaries in which doctors vent about reimbursement rates, difficult cases and what a "bummer" it is to have so many patients die....Dr. Deborah Peel, a psychiatrist and founder of the group Patient Privacy Rights, thinks physician blogs often step too close to the limits of patient privacy."The problem with physicians blogging about patients is the danger that that person will be able to identify themselves, or that others that know them will be able to identify them," she says.

My own thoughts about physician bloggers are mixed. On the positive side, I think that they put a human face on physicians and the practice of medicine. They thus enable patients to better understand some of the complexities and pressures facing physicians on a daily basis. Clearly, none of the physician bloggers would ever name the patients whose cases they might reference in the blog. Nevertheless, a patient referred to even anonymously may be able to identify himself or herself. I personally would view this as a breach of confidentiality. I don't follow these physician blogs but the best strategy for them, I think, would be to refer to patients only in a veiled and abstract manner if at all. I will make it a point to follow Kevin M.D. more closely in the future. His numbers suggest that he has developed an enthusiastic groups of readers.

Search Engine for Healthcare Professionals

Search engines have been a critical factor in making the web so useful. I am personally partial to Google. I also find Google Scholar useful when researching complex medical topics. I often tend to use it even before PubMed. In fact, Google Scholar can be used as a portal to search medical article archived in PubMed. Here is a brief description of PubMed:

PubMed is a service of the U.S. National Library of Medicine that includes over 17 million citations from MEDLINE and other life science journals for biomedical articles back to the 1950s. PubMed includes links to full text articles and other related resources.

Now comes news about some recent refinements of a search engine designed specifically for healthcare professionals but also available to healthcare consumers (see: SearchMedica Offers Medical Professionals Six New Specialized Clinical Web Searches). Below is an excerpt from the article with boldface emphasis mine:

SearchMedica.com, the leading search engine for medical professionals, today unveiled six new searchable disease categories. Now, medical professionals can search the Web for credible, clinical information within general medicine or eight more specific categories....Although SearchMedica encourages medical professionals to register to receive updates about new content and tips on how to use various advanced tools, registration is not required....SearchMedica provides free, open access to the Web's most authoritative content for medical professionals. The new organization of disease categories keeps with this mission and simplifies the search process for medical professionals....Medical professionals consistently use SearchMedica with a patient's symptom or disease state in mind....Specialists, however, can refine their search into one of eight therapeutic categories. These categories...include cardiovascular, diabetes/endocrine, infectious, musculoskeletal, cancer/hemic, pediatric, mental/nervous system and respiratory disorders.

I found SearchMedica.com to be sophisticated and very well organized. For example, searching for the keyword anemia in the cancer/hemic category yielded 102,760 results. The opportunity is then provided on the data retrieval page to further refine the search using the following categories: Research/Reviews (15684); Evidence-based Articles (1799); Practice Guidelines (995); Practical Articles/News (4884); Patient Education (3575); Clinical Trials (8142); CME (301); Complementary Medicine (97); and Practice Management (269). In the left hand column of the retrieval page, the option is also provided to narrow the search on the basis of the following types of anemias: normocytic anemia, hemoglobinopathy, infectious anemia, aplastic anemia, cell anemia, chlorosis, spastic anemia, deficiency anemia, macrocytic anemia, and gaucher disease.

I am definitely going to turn to SearchMedica more in the future when the need arises for me to learn more about various diseases. It's a wonderful resource.

On the Corrosive Influence of Big Pharma on Academic Physicians

Although I am not generally enthusiastic about the need for more rules and regulations, I believe that the relationship between some academic physicians and some pharmaceutical companies has gotten completely out of control. The final straw for me was the recent news that scientists in some of these companies have been ghost-writing medical articles about clinical drug trials for academic physicians (see: Merck Wrote Drug Studies for Doctors). The Association of American Medical Colleges (AAMC) recently published a model policy governing interactions between the schools and the pharmaceutical industry (see: Group Urges Ban on Medical Giveaways). I quote from the article describing this news below with boldface emphasis mine:

Drug and medical device companies should be banned from offering free food, gifts, travel and ghost-writing services to doctors, staff members and students in all 129 of the nation’s medical colleges [according to recommendations from the Association of American Medical Colleges]....Drug companies spend billions wooing doctors — more than they spend on research or consumer advertising. Medical schools, packed with prominent professors and impressionable trainees, are particularly attractive marketing targets. So companies have for decades provided faculty and students free food and gifts, offered lucrative consulting arrangements to top-notch teachers and even ghost-wrote research papers for busy professors....In addition to the gift, food and travel bans, the report recommended that medical schools should “strongly discourage participation by their faculty in industry-sponsored speakers’ bureaus,” in which doctors are paid to promote drug and device benefits....Dr. Vagelos, formerly of Merck, said that the report’s recommendations were certain to face resistance among faculty who liked the present system.

Although I believe that medical school faculty is a good place to start cleaning house, the process of disengaging from some of the pharmaceutical company perks should not stop here. However, the AAMC does wield extensive influence over the nation's medical schools so that this was an appropriate organization to launch this reform effort. Don't you just love the quote from Dr. Vagelos to the effect that this new set of regulations will be opposed by medical school faculty who "like the present system." Duh!

General Surgeons as the Primary Care Docs of the Operating Room

I have published a number of previous notes about primary care physicians (PCPs), two recent ones in particular that suggested the need for them to upgrade their skills in order to survive (see: Have PCPs Become Obsolete?; More on Redefining the Role of the PCP). It had never occurred to me until reading a recent blog note (see: Are General Surgeons the Primary Care Docs of the Operating Room?) that general surgeons may be in somewhat the same boat as PCPs. Below is an excerpt from the note with boldface emphasis mine:

The number of general surgeons per capita has fallen by about 25% in the past quarter century...One key driver of this trend is a move toward specialization by young docs. In 1992, 55% of surgeons did a subspecialty fellowship after finishing surgical residency; now that figure is over 70%, the authors report. This sounds a lot like what’s happening on the medical side of the profession, as younger docs increasingly head for medical subspecialties that often pay more and give doctors more control over their work life than primary care jobs. The primary care version of surgery seems to be general surgical call at the hospital for things such as abdominal emergencies and trauma; [researchers have noted that] surgical subspecialists are qualified as general surgeons, [but] they sometimes seek to avoid this burden [of hospital surgical call].

When you think about the professional role that has evolved for PCPs and now, apparently, general surgeons, it's no wonder that young trainees seek to subspecialize. Throw into this mix the fact that performing a " procedure" can double your income (see: Performing Procedures Can Be Lucrative for Physicians) and its a wonder that we have any generalist physicians at all.

For me, the on-call issue is a distraction that can be solved relatively easily. The hospitals can hire their own surgicalists about which I have previously blogged (see: The Emergence of the Surgicalist) and taking a fair amount of call will be a condition of their employment by the health system. In terms of referral patterns and with a shortage of general surgeons, I envision that the PCPs will refer to the surgical subspecialists. But what happens if there is a shortage of PCPs?

 

A Web Site for Calculating Radiation Exposure

Radiology and radiologists seem to be on the defensive on two separate fronts. The first is that the cost of medical imaging procedures is being closely scrutinized by payors (see: Some Dark Clouds on the Medical Imaging Horizon). The second is that various groups, including consumers, are paying more attention to radiation exposure during such procedures. Despite the fact that the radiation dose associated with any individual procedure may be relatively small, the number of procedures per patient over a lifetime of care is increasing. The number of procedures per each complex workup is also increasing.

A recent note by David Williams of Health Business Blog (see: Chastizing Aimee) discusses a web site that provides a tool for for calculating patient exposure during medical imaging procedures called Aimee. Below is an excerpt from his note with boldface emphasis mine:

American Imaging Management (AIM), a radiology cost containment company owned by health insurer WellPoint, has a web-based patient exposure tool called Aimee that provides information for doctors and patients about the amount of radiation associated with various scans. The site is well-designed and easy to use. Simply click on the relevant scan and portion of the anatomy and the site provides a summary of the purpose of the exam and suggests safer alternatives when appropriate. At the bottom of the page is a display that expresses the radiation exposure in millisieverts (mSv) and as its equivalent in chest x-rays and background exposure. I like the site because it raises awareness about radiation exposure and provides alternative recommendations patients could discuss with their physicians.According to AuntMinnie, a radiology news and information site, some physicians [i.e., radiologists] are less sanguine [about the value of the site].

The criticisms that are being leveled at this radiation exposure website by radiologists include the following: (1) the ownership of the site by a radiology cost-containment company that has a stake in reducing imaging costs; ( 2) the oversimplification of a complex scientific topic; (3) the lack of relevance of the tool for pediatric patients who receive lower exposures; and (4) the lack of discussion or promotion on the web site of the myriad benefits of medical imaging.

I agree with David on this matter that some of these criticisms are valid but the general goals and values of this patient-oriented tool are beneficial for healthcare consumers. For me, this goal is to increase consumer awareness of exposure to radiation in diagnostic studies. The notion of a well-informed medical consumer is pivotal to the concept of Health 2.0 that I have previously discussed in Lab Soft News. If I were a radiologist, I would work through my professional societies to try improve the quality of Aimee based on some of the criticisms listed above.

CAP Foundation's Futurescape Coming Up Soon

The CAP Foundation launched a conference called Futurescape of Pathology last June (see: CAP Foundation Futurescape Lectures Now Available). It served to fill a critical niche in the world of PLM (pathology and lab medicine) continuing education -- a forward-looking view about how these disciplines will evolve in the future. The various lectures stimulated me to post a number of notes including the following: The Future of Medicine and, Therefore, of Pathology and Lab Medicine. I also posted a critique of the conference written by a pathology resident who attended on the basis of a travel award; see: CAP Futurescape Conference: A Pathology Resident's Perspective.

The second conference in this series, entitled Transforming Pathology will be held on June 6-8, 2008, at the Westin O’Hare Hotel near the Chicago ariport. The speaker and topic lineup is once again excellent. The entire program can be viewed here. On-line registration is available. You can also register by fax (847-832-8324) or mail: Futurescape Conference, 325 Waukegan Road, Northfield, IL 60093. The conference is being held over the weekend to accommodate to the schedule of the busy pathologist. It's definitely worth attending.

Once Again Mr. HIStalk Clears the Air

Mr. HIStalk has responded to my blog note of yesterday (Alphabet Soup and the HIMSS Leadership). I had cited one of his recent notes pertaining to the HIMSS execs and challenged the readers of Lab Soft News to decode the alphabet soup following their names on the HIMSS web site. Here is his comment in its entirety (boldface emphasis mine):

I'm sorry to say that I know all of them except two first hand:

CAE: Certified Association Executive
SPHR: Senior Professional in Human Resources
CISM: Certified Information Security Manager
FHIMSS: Fellow (HIMSS)
CPHIMS: Certified Professional in Healthcare Information and Management Systems
PMP: Project Management Professional
MALA - guessing it's either a master's in legal administration or some kind of medical librarian
RN-BC - registered nurse board certified (passed an ANCC exam, I think)
MPA - master of public administration

It's the dirty secret of member organizations - making up some credential means you can charge for the test, renewals, and the prep courses, PLUS make it nearly impossible to renew without attending that same organization's conferences or meetings. It carries a mixed incentive: make it easy enough to sell enough of them so that the market recognizes the credential, but just hard enough not to be a complete joke that doesn't even require study or experience.

Only two of the alphabet soup components you listed are approved degrees; the rest are private industry certifications. There is at least one for-profit organization selling EHR [electronic health record] certifications (and the related prep materials, training sessions, etc.) without any real oversight except their own. I don't know if it has real-world value, but if somebody thinks employers will like it, they'll pay.

For the record, I have no problem with professional organizations providing (selling?) certificates of achievement or mastery of some topic. I just think that the initials representing such certifications don't belong in the same company as formal advanced degrees awarded by accredited colleges and universities and requiring years of study. I really have no knowledge or appreciation of the real-world market value of such certificates, a topic raised by Mr. HIStalk. However, if HIMSS is selling them, then their execs will certainly be buying and using them. In other words, eating their own dogfood.