How Often Should Women Be Screened For Osteoporosis?

Kenneth Lin

Posted 1/31/12 on Common Sense Family Doctor

Last year, the U.S. Preventive Services Task Force updated their recommendation statement on screening for osteoporosis, which advised dual-energy x-ray absorptiometry (DEXA) in “women 65 years or older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman with no additional risk factors.” However, the USPSTF statement left one important question unanswered: when should a woman be re-screened if her first test shows normal or slightly decreased bone mineral density (BMD)? Put another way, what are the chances that a woman without osteoporosis today will develop it in the future?

Continue reading “How Often Should Women Be Screened For Osteoporosis?”

Curbing Overuse of CT Scans – And Other Interventions

Kenneth Lin

Posted 1/18/12 on Common Sense Family Doctor

The urban public hospital where I completed most of my training as a medical student had a single CT scanner. To ensure that this precious resource was put to effective use, any physician ordering a non-emergent CT scan was required to personally present the patient’s case to the on-call Radiology fellow and explain how the result of the scan would potentially change management. Since my attending surgeons were usually too busy to trudge down to the Radiology suite, they deputized their residents to do so, and most of the time my residents passed this thankless task down to the students. Thus, my classmates and I learned early on the difference between appropriate and inappropriate reasons for ordering CT scans.
Continue reading “Curbing Overuse of CT Scans – And Other Interventions”

Strengthening the Primary Care Pipeline

Kenneth Lin

Posted 1/11/12 on Common Sense Family Doctor

Recently, I had a vivid dream in which I and several family physician colleagues had gathered in a lecture hall to watch the results of the National Residency Match on a huge real-time video screen. On the right side of the screen were the names of all the graduating medical students; on the left was a smaller list of those matching to residency programs in Family Medicine. A bar graph positioned in between showed the overall percentage of our graduates matching into Family Medicine programs, which in previous years had been around 5 percent.

Continue reading “Strengthening the Primary Care Pipeline”

Striking Back at Care’s True Rationers

Kenneth Lin

Posted 12/08/11 on Common Sense Family Doctor

In February, I predicted that Don Berwick would not survive the partisan politics surrounding his recess appointment as administrator of CMS (Centers for Medicare and Medicaid Services), and regrettably, Dr. Berwick indeed stepped down from that position last week despite a number of notable accomplishments in his too-short tenure. Speaking yesterday at the annual national forum of the Institute for Healthcare Improvement, which he led for nearly two decades, Dr. Berwick struck back fiercely at politicians who have used the myth of “death panels” to oppose health reform efforts, and others who he called the “true rationers” of health care. In his own words:

Cynicism grips Washington. It grips Washington far too much, far too much for a place that could instead remind us continually of the grandeur of democracy. … Cynicism diverts energy from the great moral test. It toys with deception, and deception destroys. Let me give you an example: the outrageous rhetoric about “death panels” – the claim, nonsense, fabricated out of nothing but fear and lies, that some plot is afoot to, literally, kill patients under the guise of end-of-life care. That is hogwash. It is purveyed by cynics; it employs deception; and it destroys hope. It is beyond cruelty to have subjected our elders, especially, to groundless fear in the pure service of political agendas.

Continue reading “Striking Back at Care’s True Rationers”

PSA and the Presidential Physical

Kenneth Lin

Posted 11/04/11 on Common Sense Family Doctor

Earlier this week, the White House released the results of President Obama’s periodic physical examination. Pronounced “fit for duty” by his personal physician, the President, who turned 50 earlier this year, had an unremarkable examination and normal blood sugar and cholesterol levels. Also, it seems that he’s finally managed to stop smoking – good for him. Interestingly, President Obama went against the advice of the U.S. Preventive Services Task Force and chose to receive a screening prostate-specific antigen test (which was normal), but, perhaps in recognition of the Task Force’s recent finding that the PSA’s harms outweigh its benefits, his physician felt it necessary to note in parentheses that this was an “informed patient request.” There’s no indication whether or not the President used any shared decision aids (such as this one from the Family Medicine department at Virginia Commonwealth University) to decide to undergo screening, but given the lengths his Administration went to prevent the new prostate recommendations from being released in the first place, this surely represents a small victory of science over politics.

Here’s what I wrote on March 1, 2010 about the President’s previous physical examination. Continue reading “PSA and the Presidential Physical”

A Proposal to Reform the Children’s Health Insurance Program (CHIP)

Kenneth Lin

First posted on 8/05/11 on Common Sense Family Doctor

As a modest expansion of public health insurance coverage that followed President Clinton’s failed comprehensive 1994 reform proposal, the Children’s Health Insurance Program (CHIP, formerly known as SCHIP) has led to substantial reductions in the percentage of uninsured, low-income children since its enactment in 1997. Due to aggressive CHIP outreach efforts, the percentage of eligible children who received Medicaid coverage also increased during this time period, a phenomenon known as the “spillover effect.” Compared to uninsured children, children covered by Medicaid and CHIP are more likely to have a usual source of care and fewer unmet health needs; there is also evidence that children with public insurance coverage receive higher quality care for chronic conditions such as asthma. The CHIP Reauthorization Act of 2009 continued federal funding of this successful program through 2013 and added dental benefits.

Continue reading “A Proposal to Reform the Children’s Health Insurance Program (CHIP)”