54% of Physicians Agree with SCOTUS Birth Control Decision

SCOTUS birth control poll

A recent SermoSays Physician Poll shows a narrow majority of physicians support the Supreme Court decision to allow closely held corporations an exemption from covering contraception on religious grounds.

The question asked, “Do you agree with the Supreme Court’s ruling that closely held corporations can be exempt from covering the cost of birth control if they are opposed to doing so on religious grounds?”

  • 54% said yes, they support the ruling
  • 46% said no, they do not support the ruling

More Women Receive Birth Control Coverage

Despite the decision, recent data from IMS Institute show a sharp increase in coverage for women with birth control due to changes from the Affordable Care Act (Obamacare).

In 2012, only 14 percent of women received birth control pills without a copayment. By the end of 2013, that number had surged to 56 percent. The ACA requires most health plans to cover birth control as prevention, at no additional cost to women.

The Institute estimates the savings at about $269 per woman annually. Some have speculated increased access to free or inexpensive birth control would spur an uptick in use. However, their research indicates there has been only a modest increase since the law was enacted, consistent with growth from prior years.

As an M.D. or D.O. what do you think about corporations making decisions for employees about birth control? Have you noticed an increased demand for birth control from your patients? If you’re a physician we’ll be discussing this further inside the community, come join us.

A Calling Laid Bare: Practicing Medicine in Egypt

credit:  Linda Girgis, MD

credit: Linda Girgis, MD

The Hippocratic Oath states: “I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.” Most doctors take this oath very seriously and for many of us, medicine is truly a calling rather than just a profession.

Sometimes, this oath is a brutal task and impossible to fulfill.

I recently had a chance to visit a home for the disabled in Rashid, Egypt, a very poor town outside Alexandria.  What started out as a medical mission visit became an exceedingly humbling experience.  There are 50 residents in this home, 30 who have no family whatsoever.  They all have some mental malady. Patients must travel to a nearby town to receive medical care. This has been working out for them, although not the most convenient way of seeking medical care.

While there, an elderly woman asked to speak to me. “My hand is frozen,” she told me or at least what I understood in my limited Arabic. She said she had fallen and broken her arm, in a remote area of Upper Egypt, an area so removed she did not receive medical care immediately. She ended up having three surgeries to try to repair the damage the delay caused. After speaking with her, I became increasingly convinced she was suffering from RSD (Reflex Sympathetic Dystophy) and that she would never get better.

I met another woman who was so poor, her kids took turns eating breakfast. It is hard to imagine how a child’s medical care would be a priority when food was not even available. People there are struggling to eat and have adequate clothing and shelter.  Diseases come and go with little attention to treating them.

In, Egypt, there is no healthcare insurance, no Obamacare, no prior authorizations. However, diagnostic tests are not readily available like in the US. People can see a private doctor and pay the costs out-of-pocket. Or they can go to one of the few public hospitals, which have clinics, for treatment. These are available only in the larger cities such as Cairo and Alexandria. Many people travel far and then wait hours just to receive basic clinic care. Even more people simply choose to go without any medical care. Preventive medicine simply doesn’t exist.

credit: Linda Girgis, MD

credit: Linda Girgis, MD

There are also no social services, welfare, food stamps, WIC programs or any government sponsored assistance.  An eight-year old boy I met, never knew his father. His father was murdered while his mother was pregnant with him. Unable to work, the mother went to live with her parents, who were very poor. The boy’s mom now works as a teacher, but in Egypt, teachers like many other professions, are poorly paid. Her parents are now sickly, and she needs to support them. There is no Medicare or retirement savings in Egypt. They struggle just to have enough to eat.  While eight-year olds in the USA are dreaming of their favorite electronic toys or are asking for updated laptops, this boy has little chance to escape his poverty.

Outside the home for the disabled, I walked through streets of abject poverty. As I climbed back onto the microbus for the ride back to Alexandria, I could no longer hold back the tears. My thoughts wondering who would remember those the rest of humanity forgot?

My oath lain trampled on the ground too heavy to carry.  Who could feed all these people, yet alone help them with their medical health.  My heart shattered remembering the faces of the kids I had just visited.  My calling completely laid bare knowing there are many forgotten corners of humanity and too few people who care.

Perhaps, if we all pause, not just the doctors among us, and all stepped up to remember one forlorn person, the world would be a better place. It is a good reminder to all those given the responsibility of treating medical diseases to look for the humanity in each of our patients.  We all need to keep in mind that many suffer from the illnesses of society, as well as the body. Some people are too poor to pay for their medications. Keeping our oath in mind, we need to do no harm while we alleviate suffering.  Many people doing small things can achieve greatness together. Imagine the world if everyone just tried to help alleviate the suffering of one person? Wouldn’t that be a much better world for all of us to live?

credit:  Linda Girgis, MD

credit: Linda Girgis, MD

Bio:  Dr. Linda Girgis MD, FAAFP is a family physician that treats patients in South River, New Jersey and its surrounding communities. She holds board certification from the American Board of Family Medicine and is affiliated with both St. Peter’s University Hospital and Raritan Bay Hospital. Dr. Girgis also collaborates closely with Rutgers University, University of Medicine and Dentistry of New Jersey (UMDNJ), and other universities and medical schools where she teaches medical students and residents.  She recently completed a medical mission in Egypt.

Poll: Who is your favorite fictional doctor?

credit: IMDB.comWe had a little fun with our latest poll.  We asked our physicians, what is your favorite fictional doctor of all time?  The favorites were “Hawkeye” Pierce from “M*A*S*H,” Gregory House, MD from “House M.D.” and “Bones” McCoy from “Star Trek.”

The results are below:

  • Dr. Benjamin Franklin “Hawkeye” Pierce 29%
  • Dr. Gregory House 19%
  • Dr. Leonard H. “Bones” McCoy 15%
  • Dr. John H. Watson (Sherlock) 13%
  • Dr. Percival “Perry” Ulysses Cox (Scrubs) 9%
  • Dr. Quinn Medicine Woman 4%
  • Dr. Beverly Crusher (Star Trek, Next Gen) 4%
  • Dr. Henry Jekyll 3%
  • Dr. Kerry Weaver (ER) 1%

Both Pierce and House are flawed characters who showed their struggles with real issues as they cared for patients.  Pierce, famously dealt with PTSD (post-traumatic stress disorder) as the series final story line and House wrestled with drug addiction through part of the show.  Both men always showed a deep commitment to their patients and a commitment to giving the best care to patients.  And yes, even McCoy in his way, did the same.

For more information about PTSD and veterans, our post about what medical symptoms doctors look for in patients with PTSD is insightful.

As a physician, what do you consider compelling attributes for fictional doctors?  Do you think showing flaws is a good thing?  While we do have some lighter topics inside Sermo, about 60 percent of the discussion is about clinical and practice management topics.  If you’re an M.D. or D.O. please join us.

Photo credits:  IMDB.com

 

Local Chikungunya Cases Reported In US

chikungunya virus, virus in st martens243 travel-related cases of Chikungunya have been reported in the US this year. Our neighbors in the Caribbean and Central America have witnessed an explosion of over 355,000 cases and 21 deaths since the virus was introduced to the region in December of last year.

As of yesterday, the first two cases of home-grown Chikungunya were announced by the CDC. The two patients live 70 miles apart in Southern Florida, neither had traveled recently. The virus causes headache, joint pain, rash and fever. It is similar to dengue fever but with a much smaller mortality rate. Recovery is painful and can take weeks. There is no cure only rest and pain relief for symptoms.

What physicians should look for

A Navy physician inside Sermo talked about the disease last night.

“Because many infections have similar presentations, they are very challenging to diagnose. It is always important to ask about travel in anyone with a fever, what activities they engaged in while on travel (swimming in fresh water, eating local foods, etc.), what vaccinations and prophylactic medications, i.e. doxy or Malarone for malaria they did or did not take. Knowing what diseases are endemic to that area of travel is paramount. There are many great resources you can refer to, such as the CDC and Travex websites.”

According to the CDC, as of July 15th, 73 people in Florida were diagnosed with Chikungunya. The disease spreads by a mosquito biting an infected person and then biting a second uninfected person. The best line of defense is insect repellent.

“CDC officials believe there will be sporadic local transmission but not a widespread outbreak.

“None of the more than 200 imported chikungunya cases between 2006 and 2013 have triggered a local outbreak. However, more chikungunya-infected travelers coming into the U.S. increases the likelihood that local chikungunya transmission will occur,” said officials.

Two different mosquito species carry the virus, the Aedes aegytpi and A albopictus. They reside in the southeastern part of the US, up the East Coast through the Mid-Atlantic, the lower part of the Midwest, and parts of the Southwest.

Puerto Rico declares epidemic

While the US mainland is just beginning to see local cases, the virus is firmly established in Puerto Rico which has just declared an epidemic to free up resources to help combat the problem.

So far over 200 cases have been reported as of June 25th. Officials are urging people to drain standing water, cover skin with clothing and repellent and make sure doors and windows have proper screens.

As a physician, have you seen a case of Chikungunya yet? What do you think about the disease’s spread since its arrival in the Caribbean in December? Will you change your screening process for suspicious cases?

We will be discusses this and more inside Sermo, our physician community. If you’re an M.D. or D.O., please join us.

 

 

Doctor Curmudgeon: It’s High Noon at the Front Desk

doctor curmudgeon, dr curmudgeon

Ah yes.  The Front Desk.

A smile in the voice, a welcoming, “Doctor Curmudgeon’s Office.  This is Scheherazade.  How may I help you?”

Stop! Listen!

It can be a War Zone.

It can be a Funny Zone.

It can be an Idiocy Zone.

But, whatever it is, at that moment, it is a Zone where calmness, patience and professionalism must prevail.

I have culled and combined some choice things that my assistant has heard and may well hear in the future. There are no names presented here and they are not exact quotes, but are mused upon from the sometimes imperfect memory of a practicing curmudgeon.

AND NOW FOR SOME OF WHAT IS HEARD AT THE FRONT DESK, EITHER ON THE TELEPHONE OR IN PERSON (UNFORTUNATELY, IN MONTY PYTHON TERMS, IT IS NOT “TIME FOR SOMETHING COMPLETELY DIFFERENT,” BECAUSE THESE ARE NOT UNIQUE)

My dog ate my prescription.

My Vicodin fell in the toilet

My pills fell on the floor and the cat peed all over them.

I met a nice guy in a bar, so I took him home and he had no right to look in my medicine cabinet, but he did, and then I realized he stole all my pills.

My jeans were tight and I reached into my pocket to pull out my pill bottle and all the pills rolled out and I was in line at Kmart and everybody stepped all over them.

When I got out of the car, my purse was open and the car started to roll and crushed all my pills.

I have to talk to the doctor immediately, this second.  I finished my last blood pressure pill yesterday and she has to call it in right now because I am waiting at the pharmacy and I have no time to sit around because I’m supposed to go to lunch with my best friend, and we want to make a movie…so you have to get her right away…I am waiting.  And I need my medicine.  So tell her to hurry up.

And, of course, there is the patient who calls every half hour to review his/her lab work.  And each time this person calls, she/he is told that the doctor is returning calls after five and the message is on the doctor’s desk. Yet this patient keeps calling all day…all day….all day….

Welcome to the World of the Front Desk where it is always High Noon.

~~

Read Doctor Curmudgeon as she talks about “Yes Virginia, there is still joy in medicine.”

Bio:

Diane Batshaw EismanDoctor Curmudgeon is Diane Batshaw Eisman MD, FAAFP, a Family Physician, writer, voiceover artist, and medical educator. It was in the Neolithic Era that the doctor became renowned for expertise in Trephination. After so much time in practice, Doctor Curmudgeon is now cranky and has rightfully earned the honorific of “Curmudgeon.”

Doctor Curmudgeon has no idea of what will appear in this space. It depends on the Good Doctor’s mood and whatever shamans and doctors are channeled at the moment.

As a curmudgeon, I may stray from what I observe happening in medicine and slink into other areas. But that is the prerogative of a Curmudgeon.  Please check out my first book, “No Such Agency.”