Monday, May 30, 2011
Sunday, May 22, 2011
Monday, May 16, 2011
The editors of AFP would like to believe that our online collections of selected content on topics such as hyperlipidemia, hypertension, and coronary artery disease have similar lifesaving benefits for your patients, but the truth is, we don't know. So how can we find out? As recently reported in AAFP News Now, journal CME quizzes for content published after the July 1st issue must be submitted online only, in order to meet new AMA requirements regarding CME credit. Although this will be a change for many readers, it presents an opportunity to think about how we might redesign CME content to better meet physicians' needs and improve measurable outcomes for their patients. If you have any thoughts or suggestions, please post them in a comment or send an e-mail to firstname.lastname@example.org.
Thursday, May 12, 2011
A physician reader of AFP submitted the following post.
I enjoyed reading and cannot agree more with the editorial in the April 15, 2011 issue on the appropriate use of magnetic resonance imaging for evaluating common musculoskeletal conditions. In many ways, the overuse of MRI is like the overuse of antibiotics for viral syndromes. Everyone knows we shouldn’t do it, but nobody seems to be able to stop.
Almost every specialist I refer to orders an MRI, often requiring them before they will even schedule a consult. Patients come in demanding an MRI after watching a professional sports event in which the sideline reporter let folks know what the MRI showed on the star who was injured during the game.I’ve had many patients come in letting me know that their personal trainer, therapist, or next door neighbor as well as their neurologist, chiropractor or other health care professional had advised them to come in and request an MRI.
The radiologists where I practice review all MRI requests for appropriateness based on the clinical history and reported physical findings. This review process has significantly cut down on the number of MRIs that are being done at our facility, although the number of complaints has risen. In contrast, there are no financial disincentives to performing inappropriate MRIs in fee-for-service health systems.William T. Sheahan, MD
Orlando VA Medical Center
Monday, May 9, 2011
Overuse of screening colonoscopy provides no additional health benefits to patients, but increases the risk of adverse effects, causes unnecessary medical expenses, and diverts resources that might otherwise be available to assist the nearly 40 percent of eligible Americans who are not up-to-date on colorectal cancer screening. Although more adults are being screened today than ever before, much work remains to be done, as family physician Doug Campos-Outcalt wrote in a previous editorial in AFP:
Although [colorectal cancer screening] trends show improvement, significant disparities persist. Racial or ethnic minorities and those with no health insurance, low incomes, or less than a high school education have significantly lower rates of use of colorectal cancer testing. There are several hypothesized reasons to explain low adherence to recommendations. These include lack of a medical home, lack of health insurance, lack of awareness of the need, and failure of physicians to recommend screening. Family physicians can address the last two issues; policy makers need to address the first two.
Fecal occult blood testing and flexible sigmoidoscopy are also recommended options for reducing colorectal cancer mortality in adults 50 to 75 years of age. However, evidence suggests that colonoscopy has become the colorectal screening cancer test of choice for many family physicians. What has been your experience with referring patients for screening colonoscopy? Has your practice observed excessive colonoscopy use for patients without indications other than screening?
Sunday, May 1, 2011
In the May 1st issue of AFP, Drs. Carla Perissinotto and Victor Valcour review the numerous gaps in the evidence for preventing dementia that complicate public health strategies for reducing the rising incidence and morbidity from this chronic disease. They argue that current knowledge supports a tertiary prevention strategy:
It is reasonable to look to prior public health campaigns as models for our educational and prevention efforts for dementia. Educational efforts should first focus on ensuring that the public understands that a diagnosis of dementia represents a spectrum of cognitive impairment, and that Alzheimer disease is only one of several subtypes. Until strategies targeting primary and secondary prevention emerge, our greatest impact may be in tertiary prevention—in the prevention of dementia morbidity. Such work may require early recognition, in which strategies targeting home and financial safety have a clear impact on those at highest risk.
Family physicians have always played an important role in caring for patients with dementia and their caregivers. For more current information on the diagnosis and management of the various forms of dementia, see our AFP By Topic collection.