Back to Blogging

Blogging Again!!!!

I started this page well over five years ago.  The intent was to create a fun, informative avenue to attempt to begin blogging.  It lasted a short while.  However,  I never took it too seriously nor did I put in the time and/or effort to make it something of value.  Once again I have the urge!!!!

Without a doubt healthcare and medicine has changed drastically since my last post.  This trend will not stop.  Whether we are in a better place now can be debated on both sides.  However, the one thing I believe all will agree on is that changes have occurred and will continue to occur.

We shall see how long my attempt at blogging lasts this time.  I'm planning on posting regularly.  I'm also planning on the subject matter being extremely variable.  I intend to incorporate my personal life and experiences frequently, helping you to get to know me.  Often times expressing opinions where I'd love to hear feedback and your opinions (both in agreement and disagreement).  Hopefully, this will create an informative and entertaining dialogue for everyone involved.

Hope you will enjoy and engage!!

Patient Receptivity to Spiritual Subjects

How do patients feel about the subject? Not surprisingly, it depends. World War II Army Chaplain William T. Cummings famously declared, "there are no atheists in fox holes." Patients seem to have the same sentiment when it comes to talking to physicians about their spirituality.

In a survey published in 2003 in the Journal of General Internal Medicine, researchers asked 456 outpatients in North Carolina, Florida, and Vermont whether they wanted their doctor to ask them about their spirituality. Only one third of respondents interviewed in a clinic setting liked the idea, but the number climbed to 40% in a hospital setting and 70% in hospice.^[2]

"Should we do this in every primary care practice and patient interaction?" asks Drew Rosielle, MD, director of the University of Minnesota's Hospice and Palliative Medicine Fellowship. "Realistically, of course not."

But when a doctor has a little more time, such as during an annual physical, or when a patient is faced with a major diagnosis, working a question or two about spirituality into the conversation can help a physician better understand and support a patient, he says. Rosielle routinely asks a couple of questions about spirituality as part of his initial palliative care consultation with patients so he can refer them to the chaplain on his care team if necessary.

"For patients who are not interested, it's a non-issue," he says. "You just move on. I've never had a patient get offended about being asked."

But for patients with spiritual concerns, the conversation helps him connect them with the support they need. "When you get sick -- especially when you're facing a terminal illness or a life-changing situation, it affects your entire being emotionally, spiritually, existentially," he says. "Patients are hungry for any support they can get."

Puchalski sites an example from her own experience. Several years ago her father, a devout Catholic, underwent surgery for colon cancer. Prior to the procedure, the nurse asked him whether he was spiritual and what that meant to him. A retired opera singer, he responded that he couldn't live without music. Intrigued, she asked him to sing and he responded with a heart-felt aria. Afterward he felt more relaxed and uplifted. The nurse noted his love of singing on his chart. After the operation, other clinicians read her notation and encouraged her father to sing as a way of exercising his lungs.

For her father, Puchalski says, bringing music into the hospital was a profoundly positive experience, "but how would the doctors and nurses have known that if the nurse hadn't asked the question?" she asks.

Assessing Spiritual Outlook

Still, fitting spiritual assessments into practice is a hodgepodge. "From what we've seen in our research almost nobody is using those acronyms," says Farr Curlin, MD, co-director of the Program on Medicine and Religion at the University of Chicago. "It's the rare physician who uses these pneumonic tools. Rather they try to pay attention to signs from the patient and then they try to query them to bring those issues out and connect the patient with spiritual resources in the community or their organization's pastoral care department."

Taylor, says clinicians are caught in a theory-practice gap.

"The problem is we say, 'spiritual care matters,' but we haven't gotten to the point where clinicians can identify spiritual need," she says.

Should Physicians Be Involved With Patient's Spiritual Care?

Science and religion have always had a complicated relationship, so it's not surprising that, as interest in holistic care grows, physicians are trying to come to grips with whether they should play a role in patients' spiritual care.

"We've always talked about the limitations of the biomedical model that would reduce people to our physiology," says Carol Taylor, PhD, director of the Center for Clinical Bioethics at Georgetown University. "When we talk about holistic health, we talk about biological, psychological, and social needs and now we're talking about spiritual needs as well. They're all interrelated."

More than half of physicians believe that religion and spirituality affect patient health in some way, according to research conducted by the University of Chicago. In a survey of 2000 physicians, 56% believed that religion and spirituality have much or very much influence on health, but only 6% believed they often changed "hard" medical outcomes.  Rather, respondents suggested that religion and spirituality help patients cope, give them a positive state of mind, or provide emotional and practical support via the religious community.

While doctors might believe religion and spirituality influence health, acknowledging a connection raises some fundamental and tricky questions. The American College of Physicians' ethics manual encourages physicians to explore a patient's religion and spirituality as part of an overall physical. But how are they to do that? What does it mean, and what are they to do with the information?

Stethoscope and Spiritual Care?

Spirituality, broadly defined, is what gives a person's life meaning. Religion may or may not factor into the picture. In asking about spirituality, clinicians are seeking to identify a patient's source of hope, strength, and values, not their dogma or doctrine.

Research indicates that roughly 80% of medical schools now offer spiritual care courses or integrate spirituality into their curricula, according to Christina Puchalski, MD, an internist at George Washington University and director of the George Washington Institute for Spirituality and Health. But what's included and how it's taught differs tremendously from one institution to the next. In an effort to bring consistency to the spiritual history and assessment process, various proponents have development of myriad tools represented by apropos acronyms such as FAITH, SPIRIT, and HOPE as well as the slightly less catchy FICA and FACT.

Assessing a patient's spiritual health is important, because spiritual issues can not only impact a patient's health, but they can impact a patient's medical compliance and treatment choices as well, says Puchalski.

"What if they don't want to take medicines because they believe God will heal them? What if they're very nature-centric and don't want to put medications in their body? What if they don't believe in blood transfusions?" she asks. "Physicians need to know these concerns if they're going to treat a patient."

However, not everybody believes spiritual care belongs in the examination room. Indeed, those who oppose the idea present a litany of arguments: Spirituality is a private matter. Over-zealous physicians might abuse their position and proselytize to their patients. Pragmatically, many note that in the real world of 15-minute office visits, taking the time to ask questions about spirituality would come at the expense of addressing clinical issues.

Most worrisome says Richard Sloan, professor of behavioral medicine at Columbia University Medical Center and author of Blind Faith: The Unholy Alliance of Religion and Medicine, taking a spiritual history sets a doctor up to be a spiritual guide, "which they are completely untrained and unequipped to do."

"Nobody should deny that spirituality is important to a great many people, but I don't think it's grist for the physician's mill," he says. Doctors need to know about all facets of their patients' lives, he says, but shouldn't ask more than "Is spirituality important to you?" A simple "yes" or "no" answer suffices, he says.

As for the possibility that patients' spirituality might impact their care, Sloan notes that spiritual, financial, transportation, and other potential barriers to care are more likely to surface if a doctor asks, "Is there anything that would keep you from taking this medication?"

Has your physician ever asked you about your spirituality??

My next blog will be how this is recieved/percieved by the patient.  Please make comments.  I'd love to hear your thoughts.

Big Physician Pay Cut in 2012

In the category of not exactly good news, the Centers for Medicare and Medicaid Services (CMS) yesterday announced that it would cut Medicare reimbursement for physicians by 27.4% on January 1, 2012, instead of 29.5% as previously planned

To physicians, this resembles telling a condemned man that his firing squad will consist of 5 riflemen instead of 6.

The slightly lower reduction in reimbursement appears in the final regulations that CMS released yesterday regarding the 2012 Medicare Physician Fee Schedule. Medicare sets these fees using the so-called sustainable growth rate (SGR) formula, which organized medicine wants to abolish. The SGR formula establishes an annual target for Medicare spending on physician services based in part on annual growth of the gross domestic product. If actual spending exceeds the target, the difference is taken out of next year's outlays for physician services.

In March 2011, CMS estimated that physicians would be subject to a 29.5% reduction in reimbursement. The change to 27.4% reflects the fact that Medicare costs this year have grown more slowly than expected, according to the agency's announcement.

The SGR has triggered annual pay cuts for physicians since 2002, but starting in 2003, each one has been postponed by an act of Congress. The postponed cuts then accumulate, leading to the deep one scheduled for January 1. Organized medicine has warned that such a steep drop in revenue would cause droves of physicians to stop seeing new Medicare patients or drop out of the program altogether.

The slightly lower reduction announced yesterday is not changing anybody's tune. Robert Doherty, senior vice president of governmental affairs and public policy for the American College of Physicians, told Medscape Medical News that "27.4% isn't going to make doctors any happier than nearly 30%."

Glen Stream, MD, president of the American Academy of Family Physicians, said in a written statement that the 27.4% reduction "poses a serious threat to the financial viability of physician practices." He cited a survey showing that even a 25% cut would put nearly 13% of family physicians at risk of shutting their doors.

The American College of Physicians, American Academy of Family Physicians, and other medical societies have pressed the new Congressional Joint Select Committee on Deficit Reduction, known as the "super committee," for short, to include a repeal of the SGR formula in its recommendations to Congress.

Tort Reform...A Legal Critics Opinion

A day after 3,000 "Occupy Chicago" discontented protesters gathered outside the Art Institute of Chicago—where members of the Futures Industry Association and the Mortgage Bankers Association were holding a reception—about 50 people gathered nearby to hear activist, attorney and author Philip K. Howard declare "Nothing is working the way it should."
According to Howard, one step to help set things right would be to implement special health courts—a concept he has worked on with the Harvard School of Public Health.

Speaking away from the lectern and without a microphone, Howard noted that there are nine medical categories for injuries caused by sea lions and 12 for bee stings, and that a doctor can't say "How are you, Mr. Howard?" in a hospital for fear of violating federal privacy laws.
But it's not just healthcare that's suffering, Howard argued. He said fear of litigation has caused school playgrounds to be "stripped of anything fun."

Howard told the audience of doctors, lawyers, healthcare administrators, civic leaders and Columbia College journalism students that these problems are caused or exacerbated by people feeling powerless to oppose nonsensical legal or bureaucratic rules imposed on them by well-meaning politicians—many of them now dead—who sought through the rules to keep anything bad from ever happening. And now legislators lack the will to amend rules to fit current circumstances, he said. Howard urged the students to question and make fun of the rules and "write about this with clear eyes."

The current environment won't be changed by caps on malpractice damages or other simple fixes, he said.

Tort reform, he asserted, will not put seesaws back in playgrounds. Texas physicians still admit to engaging in costly defensive-medicine practices even after that state's much ballyhooed malpractice caps were put in place, Howard noted.

The system Howard envisions would not have juries but would be led by full-time health judges with a budget to hire neutral experts to testify on the merits of a malpractice case.
Jerry Latherow, president of the Illinois Trial Lawyers Association and the husband of a physician, "respectfully disagreed" with just about every point Howard made—especially with regard to the scope and cost of defensive medicine. He also questioned the ability of the courts to remain impartial, saying health judges would most likely travel in the same social and business circles as defendants rather than plaintiffs.

But health courts are just a part of Howard's crusade to "restore the capacity for humans to take responsibility." He gave several plugs for Project Start Over, the campaign launched by his not-for-profit organization.

He urged audience members to join the fight, and noted that former New Jersey Sen. Bill Bradley and current Indiana Gov. Mitch Daniels have expressed interest in the cause as has Jon Stewart.

American Medical Association Fails According to Physicians

A New Doctors’ Survey Says AMA Fails on Health Reform, New Voice Needed. Seventy-Seven Percent of Doctors Surveyed say AMA No Longer Represents Their Views.

Almost 18 months after President Obama signed healthcare reform into law, America’s physicians have not forgiven the American Medical Association for supporting the Patient Protection and Affordable Care Act, according to a new survey released by Jackson & Coker, a division of Jackson Healthcare.

Post Mortem CT instead of Autopsy??

Sorry everyone its been so long since i've posted.  I've just been super busy lately with starting an MBA program for physicians. So...expect to see some posts involving medicine and business now...Anyway, this caught my attention since I'm a pathologist and have done plenty of autopsies (thank God I don't do them anymore).  Hope ya'll enjoy!!!!


Several research groups champion the potential for postmortem CT (PMCT) to replace the invasive postmortem (PM), however, many questions still remain. Perhaps the two most important questions are whether PMCT can provide the same level of information as an invasive PM autopsy?  Arguably more important is the question, can it meet the needs of the end users of the PM report.  The authors of a recent study show that PMCT is good at providing accurate causes of death and that the interpretation of cases is not significantly altered by the absence of histology or actualy autopsy. The authors show that in straightforward trauma deaths such as road traffic incidents, there exists the potential for the replacement of the invasive PM by PMCT examination. However, as yet, PMCT cannot provide all of the information that is expected by the criminal justice system in complex forensic cases.


So needless to say post mortem CT may have a role in certain "autopsies" in the future.