How primary care doctors choose the specialists to refer their patients

Dr. Kirsch, a blogging gastroenterologist lists some of the reasons why certain medical specialists are chosen:

- Reciprocity - patients are referred in both directions
- Personal relationships
- Corporate enforcement keeping consultations within the network
- Economic pressure exerted by consultants to maintain referrals. I have seen this happen.
- Specialist willingness to do tests and procedures on request
- Habit
- Patient or family request

References:
How doctors choose which specialists they refer to. KevinMD.com

Image source: OpenClipArt.org, public domain.

The Lancet: Commonest cause of maternal death is post-partum haemorrhage - one woman dies every 7 minutes

99% of all deaths in childbirth are in the least developed countries - 45 million women deliver without a skilled birth attendant every year, a situation in which the greatest number of maternal deaths occur.

The commonest single cause of maternal death is from post-partum haemorrhage, from which one woman dies every 7 minutes.


Health Technologies to Save Mothers. PATH.org video.

References:
Maternal mortality: one death every 7 min. The Lancet, Volume 375, Issue 9728, Pages 1762 - 1763, 22 May 2010.

Acupuncture Is Popular with Patients but Insurance Does Not Cover It

From the NYTimes:

Because her insurer did not cover acupuncture, Ms. Kumar had to pay for the $70 weekly treatments she hoped would put her cycle on a more normal schedule.

Acupuncture remains a largely out-of-pocket form of health care. Sessions with an acupuncturist run about $65 to $120, depending on where you live (and some leading acupuncturists charge as much as $300). Most ailments require at least three treatments, while some chronic issues like arthritis might require biweekly or monthly sessions, depending on the situation.

In a 2007 survey, 3.1 million adults reported using acupuncture in the previous 12 months, up from 2.1 million in a 2002 survey.

References:

Patient Money - Acupuncture May Help, but You’ll Need to Pay - NYTimes.com.

Acupuncture can spread serious diseases: bacterial infections, hepatitis B and C, even HIV
Does traditional Chinese medicine have a place in the health system? http://goo.gl/RH04o

Image source: Needles being inserted into a patient's skin, Wikipedia, public domain.

"Choose primary care, give up $2.5 million"

Researchers at Duke University modeled the earning potential of cardiologists and primary care physicians between the ages of 22 and 65, taking into account medical school debt, earning potential and the age at which doctors begin earning an income. They conducted similar analyses for the average b-school, physician assistant and college graduate.

Over a career, a typical cardiologist earns more than $5 million, primary care physicians earn $2.5 million and business school grads earn $1.7 million. Meanwhile, physician assistants earn about $846,000 and college graduates earn about $340,000.

References:

Choose primary care, give up $2.5M. MedCityNews.

Primary Care Doctors Make $3 Million Less Than Cardiologists Over The Course Of Their Careers. Kaiser Health News' Daily Report.

Image source: OpenClipArt.org, public domain.

What the Average American Consumes in a Year

Average size

The average American is 36.6 years old and eats 1,996.3 lbs. of food per year. The average man is 5’9” and weighs 190 lbs. The average woman is 5’4” and weighs 164 lbs.

Meat consumption

Each year, Americans eat 85.5 lbs. of fats and oils. They eat 110 lbs. of red meat, including 62.4 lbs. of beef and 46.5 lbs. of pork. They eat 16.1 lbs. of fish and shellfish and 32.7 lbs. of eggs.

Americans eat 31.4 lbs. of cheese each year and 600.5 lbs. of non-cheese dairy products. They drink 181 lbs. of beverage milks. They eat 141.6 lbs. of caloric sweeteners, including 42 lbs. of corn syrup.

Fruit and vegetables

Americans consume 56 lbs. of corn each year and eat 415.4 lbs. of vegetables. Americans eat 273.2 lbs. of fruit each year.

Coffee

Every year, Americans consume 24 lbs. of coffee, cocoa and nuts. Americans consume 0.2 lbs. of caffeine each year, about 90,700 mg.

Fast food

The foods include 29 lbs. of French fries, 23 lbs. of pizza and 24 lbs. of ice cream. Americans drink 53 gallons of soda each year, averaging about one gallon each week.

They eat an average of 2,700 calories each day.

Salt

Americans consume 2.736 lbs. of sodium, which is 47 percent more than recommended. Some pizzas are 'saltier than the sea' (NHS blog).

References:
Food Consumption in America - VisualEconomics.com.

The Stroke Robot Will See You Now - Mayo Clinic Video

Mayo Clinic — April 30, 2010 — Imagine this: you're eating dinner with your family and suddenly your left arm feels numb. Your speech is slurred. It could be a stroke, so you've got to get to the hospital fast. But what if your hospital doesn't have a stroke specialist or what if that doctor is out of town? The answer may be telemedicine. Doctors at Mayo Clinic are using a telemedicine robot that allows them to be face to face with patients who are miles away.

Are doctors required to get patient permission to use non-identifiable X-rays, CTs, EKGs for medical education online?

Sam Ko, MD, MBA asked this pertinent question on Twitter. My answer is below. Feel free to correct me and please provide references for your opinion.

Question: "Are Drs required to get Pt permission to use non-identifiable images for medical education?"

Answer: According to most journals, no.

The NEJM policy is here:

"If a photograph of an identifiable patient is used, the patient should complete and sign our Release Form for Photographs of Identifiable Patients. Any information that might identify the patient or hospital, including the date, should be removed from the image."

This is the BMJ policy:

Images – such as x rays, laparoscopic images, ultrasound images, pathology slides, or images of undistinctive parts of the body – may be used without consent so long as they are anonymised by the removal of any identifying marks and are not accompanied by text that could reveal the patient’s identity through clinical or personal detail.

Case Reports and HIPAA

Physicians must assure that the case report does not contain any of the 18 health information identifiers noted in the HIPAA regulations, unless authorization from the individual (s) has been obtained. The authorization is not required if neither of the 18 identifiers below are used in the case report.

List of 18 Identifiers:

1. Names;

2. All geographical subdivisions smaller than a State, including street address, city, county, precinct, zip code, and their equivalent geocodes, except for the initial three digits of a zip code, if according to the current publicly available data from the Bureau of the Census: (1) The geographic unit formed by combining all zip codes with the same three initial digits contains more than 20,000 people; and (2) The initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000.

3. All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older;

4. Phone numbers;

5. Fax numbers;

6. Electronic mail addresses;

7. Social Security numbers;

8. Medical record numbers;

9. Health plan beneficiary numbers;

10. Account numbers;

11. Certificate/license numbers;

12. Vehicle identifiers and serial numbers, including license plate numbers;

13. Device identifiers and serial numbers;

14. Web Universal Resource Locators (URLs);

15. Internet Protocol (IP) address numbers;

16. Biometric identifiers, including finger and voice prints;

17. Full face photographic images and any comparable images; and

18. Any other unique identifying number, characteristic, or code (note this does not mean the unique code assigned by the investigator to code the data)

References:

Author Center - NEJM Images in Clinical Medicine.

Patient confidentiality. BMJ.

Case Reports and HIPAA Rules

The Human Research Protection Program - UCSF.edu.
HIPAA Resources - The Privacy Rule - NIH.gov.
Single Case Report Policy - Johns Hopkins Medicine.
Medical Case Report Policy - Louisville.edu.
Privacy of Individually Identifiable Health Information. Code of Federal Regulations.

Image source: Bone fracture, from Wikipedia, the free encyclopedia (public domain).