No effective screening test for ovarian cancer, yet

A recent study found that annual transvaginal ultrasounds with annual blood tests for a tumor maker CA125 did not pick up ovarian cancer at an earlier stage. A retrospective study, it looked at 341 women with a family history of ovarian cancer. Of the four that had ovarian cancer, only one was detected at surgery and the other three developed ovarian cancer between the screening tests.

The authors concluded that for women who are at average risk for ovarian cancer (i.e. no family history), that "ovarian cancer screening should not be offered unless it is within a clinical trial aimed at developing new methods for ovarian screening."

It is frustrating for both doctors and patients that there is no current effective screening test for this deadly disease. This is probably why in June 2007, the American Cancer Society as well as the Gynecologic Cancer Foundation, and the Society of Gynecologic Oncologists issued a press release about symptoms women should watch out for that could be early signs of ovarian cancer.

Specifically:

• bloating
• pelvic or abdominal pain
• trouble eating or feeling full quickly
• urinary symptoms, such as urgent or frequent feelings of needing to go

Although the above conditions are more likely to be due to other less serious conditions, patients are encouraged to see their doctors, preferably gynecologists, if the symptoms are present daily and last more than a few weeks. The fact that this is the best these expert groups can recommend means that there is still a lot more research that needs to be done.

NY Times mention of my book!

I'm absolutely thrilled that Jane E. Brody, writer of the personal health section of the New York Times, briefly mentioned my book Stay Healthy, Live Longer, Spend Wisely - Making Intelligent Choices in America's Healthcare System in her weekly column which appeared in the Christmas Day edition. Titled "On the Same Wavelength With the Doctor", it provides tips on how to get the most out of increasingly shorter office visits.

I'm hopeful that she and others will find value in my book. What she discusses is just a very small section in the book, which is loaded with critical information everyone needs to stay healthy and well while spending wisely.

Medical Myths - Revealed!

A recent article in the British Medical Journal reveals commonly that the repeated medical myths that may individuals and doctors repeat as true have little to no scientific basis. Sometimes an opinion becomes a fact if repeated often enough. Some of the medical myths include:

• People should drink at least eight glasses of water a day
• We use only 10% of our brains
• Hair and fingernails continue to grow after death
• Shaving hair causes it to grow back faster, darker, or coarser
• Reading in dim light ruins your eyesight
• Eating turkey makes people especially drowsy
• Mobile phones create considerable electromagnetic interference in hospitals

A Simple Checklist - Can It Save Lives?

Atul Gawande, a surgeon at Harvard as well as staff writer for the New Yorker, has penned a couple of excellent books, Complications: A Surgeon's Notes on an Imperfect Science and Better: A Surgeon's Notes on Performance. His most recent piece, The Checklist, is no exception. Improving the delivery of care isn't so much about overhauling it with radical changes, but simply looking at how to little steps enhance the process of delivering that care.

Excepts from his most recent article:

• A decade ago, Israeli scientists published a study in which engineers observed patient care in I.C.U.s for twenty-four-hour stretches. They found that the average patient required a hundred and seventy-eight individual actions per day, ranging from administering a drug to suctioning the lungs, and every one of them posed risks. Remarkably, the nurses and doctors were observed to make an error in just one per cent of these actions—but that still amounted to an average of two errors a day with every patient.
• Here, then, is the puzzle of I.C.U. care: you have a desperately sick patient, and in order to have a chance of saving him you have to make sure that a hundred and seventy-eight daily tasks are done right—despite some monitor’s alarm going off for God knows what reason, despite the patient in the next bed crashing, despite a nurse poking his head around the curtain to ask whether someone could help “get this lady’s chest open.” So how do you actually manage all this complexity? The solution that the medical profession has favored is specialization.
• Substantial parts of what hospitals do—most notably, intensive care—are now too complex for clinicians to carry them out reliably from memory alone. I.C.U. life support has become too much medicine for one person to fly.
• In 2001, though, a critical-care specialist at Johns Hopkins Hospital named Peter Pronovost decided to give it a try. He didn’t attempt to make the checklist cover everything; he designed it to tackle just one problem, the one that nearly killed Anthony DeFilippo: line infections. On a sheet of plain paper, he plotted out the steps to take in order to avoid infections when putting a line in. Doctors are supposed to (1) wash their hands with soap, (2) clean the patient’s skin with chlorhexidine antiseptic, (3) put sterile drapes over the entire patient, (4) wear a sterile mask, hat, gown, and gloves, and (5) put a sterile dressing over the catheter site once the line is in. Check, check, check, check, check. These steps are no-brainers; they have been known and taught for years.
• Pronovost asked the nurses in his I.C.U. to observe the doctors for a month as they put lines into patients, and record how often they completed each step. In more than a third of patients, they skipped at least one.
• The next month, he and his team persuaded the hospital administration to authorize nurses to stop doctors if they saw them skipping a step on the checklist; nurses were also to ask them each day whether any lines ought to be removed, so as not to leave them in longer than necessary. This was revolutionary...The new rule made it clear: if doctors didn’t follow every step on the checklist, the nurses would have backup from the administration to intervene.
• Pronovost and his colleagues monitored what happened for a year afterward. The results were so dramatic that they weren’t sure whether to believe them: the ten-day line-infection rate went from eleven per cent to zero. So they followed patients for fifteen more months. Only two line infections occurred during the entire period. They calculated that, in this one hospital, the checklist had prevented forty-three infections and eight deaths, and saved two million dollars in costs.

Don't Tell

Doctors are human after all, so perhaps the findings from the Annals of Internal Medicine titled, "Professionalism in Medicine: Results of a National Survey of Physicians" isn't that surprising. A summary from Reuters illustrated the following:

• 46 percent of physicians surveyed admitted they knew of a serious medical error that had been made but did not tell authorities about it.
• 96 percent of those surveyed said they should report all instances of significant incompetence or medical errors to the hospital clinic or to authorities.
• 85 percent of most doctors said they should tell patients or relatives about significant errors.

the reality was far different.

• Forty percent of the doctors said they knew of a serious medical error in their hospital group or practice but 31 percent admitted they had done nothing about it at least once.

The article also found that nearly a quarter of the 1600 doctors surveyed didn't feel that periodic certification was desirable.

Conclusion? Doctors are human as well and naturally do things in their best interest. Is the lack of reporting due to a medical culture where error and omissions aren't openly talked about? Why would a good number of doctors oppose periodic re-certification? Medicine changes constantly and what was good a few years ago is no longer the standard of care. Concerning but perhaps not surprising. This behavior needs to change for significant improvement to occur in patient safety.

Antibiotics Aren't Necessary

Not a surprising report, except perhaps to many patients, that antibiotics aren't generally needed for sinus infections. Earlier this year the professional society of otolaryngologists, that's ear, nose, and throat doctors, had a similar statement. Sinus infections generally are caused by viruses. Those infections that need antibiotics are often those where a head cold was improving and then suddenly got worse.

Don't be shocked if your doctor doesn't prescribe antibiotics before for something which was done in the past. With more resistant bacteria, like MRSA, it is important that we save antibiotics only for conditions that require it. If you do get antibiotics, finish it completely even if you are feeling better. Not completing a full course of treatment is another cause of increasing bacterial resistance.

With all of this knowledge, don't you feel better already?

Adults Often Skip Doctor's Treatment

In a Harris Interactive / Wall Street Journal survey titled Many U.S. Adults Disregard Doctors' Course of Treatment a surprising number of individuals (44 percent) reported not following a doctor's recommendations because they felt the treatment was unnecessary or overly aggressive. One in five sought a second opinion because the recommended treatment was perceived as too aggressive.

Over half believed the reason for this over treatment was due to doctors protecting themselves from potential lawsuits. Over 40 percent felt it was because doctors were catering to patient demands or for doctors to make more money. One out of four felt the unnecessary added care was due to faulty medical diagnosis or fast and easy decisions.

Are the results surprising? It sounds like plenty of miscommunication between patients and doctors. With face to face time with doctors getting shorter, it is even more important that you say the right things and that you are heard otherwise you may get more than you ask for.

High Cost of Health Care

A New York Times editorial titled the High Cost of Health Care succinctly and correctly identifies the factors resulting in current predicament of the American healthcare system. We pay more for our doctors and our hospitals. We use more specialists who utilize more expensive tests and procedures. The issue is at the current rate of spending, the federal program Medicare, will bankrupt the budget, much the same way healthcare costs has done with employers, who now are reducing benefits or dropping health insurance offerings completely.

The solutions are mainly to do what is known to work.

• Practice effective evidence based medicine consistently and regularly throughout the country. This is only being done about half the time. There is no difference in medical outcomes and it is done at less cost.
  
• Improve how primary care doctors are compensated. Industrialized countries that have lower healthcare costs have a robust system of these preventive medicine specialists.
• Implement information technology widely so that the healthcare system benefits from the same efficiencies that other industries have uncovered.

A single payer system isn't the perfect solution. The "Medicare for all" as some have portrayed the single payer system to cover the 47 million uninsured isn't as simple as it sounds. Medicare and social security are the largest federal entitlement programs and without major reform, both will bankrupt the federal budget. The editorial correctly identified the potential pitfall of relying completely on consumer driven healthcare. Do consumers really know what they are getting when it comes to their health?

Solving the healthcare crisis in America requires a uniquely American solution. To understand what needs to be done you must understand the fundamentals about our healthcare system. The NY Times editorial objectively describes the issues and potential solutions and is an important read for all.