Clinician's Roundtable

Host: Leslie P. Lundt, MD Guest: Donald Robinson, MD Many commonly used medications are being implicated in increased risk of osteoporotic fractures, for example proton pump inhibitors. Psychotropics are getting scrutiny as well. Dr. Donald Robinson, professor of pharmacology and medicine at the University of Vermont and the author of more than 175 scientific papers on neuroscience topics, joins host Dr. Leslie Lundt to explain which psychotropics are especially risky and why.

Host: Leslie P. Lundt, MD Guest: David Sarwer, PhD Patients that undergo bariatric surgery may expect to lose up to 35 percent of their body weight in the first year. What if that doesn't happen? Host Dr. Leslie Lundt, talks about the problem of post-op suboptimal weight gain with Dr. David Sarwer, director of clinical services at the Center for Weight and Eating Disorders at the University of Pennsylvania School of Medicine.

Host: Leslie P. Lundt, MD Guest: David Sarwer, PhD We know that the weight loss outcome following bariatric surgery can be impressive - patients lose as much as 35% of their initial body weight in the first 18 months post-op. Does their psychosocial outcome also improve? Host Dr. Leslie Lundt welcomes Dr. David Sarwer, director of clinical services at the Center for Weight and Eating Disorders at the University of Pennsylvania School of Medicine to discuss what happens after bariatric surgery.

Host: Larry Kaskel, MD Guest: Owen J. Dahl, MBA Do you know what it costs you to see a patient? How can you improve the profitability of your practice? Owen Dahl, author of Think Business! Medical Practice Quality, Efficiency, Profits, talks with host Dr. Larry Kaskel about the costs of running a medical practice, and provides real-world advice.

Host: Larry Kaskel, MD Guest: Owen J. Dahl, MBA Many successful Fortune 500 companies have used 'Six Sigma' for years to systematically increase their revenue and operational efficiencies. Mr. Owen Dahl, president of Owen Dahl Consulting, discusses with host Dr. Larry Kaskel how those same proven principles can be applied to patient scheduling and other medical office operations. Mr. Dahl specifically outlines how a physician could analyze the patient scheduling process by focusing on the quality of each process step.

Host: Larry Kaskel, MD Guest: Christopher Ruhm One would think that the health of the nation would suffer during an economic downturn. But strange as it may seem, bad times can be good for the health of entire societies. Forgetting about individual health, Christopher Ruhm, professor of economics, explains the results of his study that showed that during a recession, traffic accidents, obesity, alcohol consumption, smoking and even deaths from heart disease go down. Professor Ruhm discusses these counterintuitive results with host Dr. Larry Kaskel, which also shows this interesting relationship between the health of an economy and its population.

Host: Jennifer Shu, MD, FAAP Guest: H. Gilbert Welch, MD, MPH Physicians need to be knowledgeable about both the potential benefits and possible harms of early screening and detection. What should we do when a healthy patient comes to our office requesting a full-body CT scan, genetic testing for cancer markers, or other screening measures that may not be suitable for their condition? How can we put health risks into perspective and give our patients basic information about the overdiagnosis and unnecessary treatment that may follow screening? For an interesting discussion about these questions and much more, host Dr. Jennifer Shu welcomes Dr. H. Gilbert Welch, professor of medicine and community and family medicine at Dartmouth Medical School, and author of Should I Be Tested for Cancer? Maybe Not, and Here's Why.

Host: Jennifer Shu, MD, FAAP Guest: H. Gilbert Welch, MD, MPH Preventive medicine in primary care has traditionally focused on health promotion and disease prevention. Due to advances in technology, a typical well visit may now include a series of tests to detect early disease. How is this shift toward preventive medicine affecting patient care, survival outcomes and health care costs? And how can physicians decide when is the optimal time to screen for cancer and other conditions? Dr. H. Gilbert Welch, professor of medicine and community and family medicine at Dartmouth Medical School, and author of Should I Be Tested for Cancer? Maybe Not, and Here’s Why, joins host Dr. Jennifer Shu to examine the realities behind our growing expectations of preventive care.

Host: Bruce Japsen Guest: Robin Rudowitz, Ms. With the economy in a downturn, more Americans are turning to Medicaid and related government health insurance programs as they lose private coverage. This may lead to some serious repercussions for medical-care providers and their patients. Robin Rudowitz, principal policy analyst for the Kaiser Commission on Medicaid and the Uninsured tells the Chicago Tribune's Bruce Japsen about how health benefit program cuts and reduced government spending in a slow economy could impact patients and their medical-care providers.

Host: Bruce Japsen Guest: Bianca Dijulio, MHS Healthcare costs for family coverage continue to rise. But what are the trends this year faced by US workers? Bianca DiJulio, senior policy analyst for the Health Care Marketplace Project at the Henry J. Kaiser Family Foundation, tells the Chicago Tribune's Bruce Japsen how cost shifts will impact consumers and patients as they deal with rising deductibles and co-payments.

Host: Mary Leuchars, MD Guest: Christine Ren, MD Surgical weight loss: what are the recent advances in this exploding field, and what can patients expect from today's evolving procedures? Joining host Dr. Mary Leuchars to speak on bariatric surgery's emergence and development in practice is Dr. Christine Ren, founder and director of the NYU Program for Surgical Weight Loss and assistant professor of surgery at NYU School of Medicine. Dr. Ren talks about the history of gastric bypass procedures, and the past to current trends of practice for bypass, banding, and malabsorptive operations.

Host: Shira Johnson, MD Guest: Scott E. Rudkin, MD, MBA Do you understand the financial impact of the on-call crisis and how it affects the emergency department? Dr. Scott Rudkin, associate professor of emergency medicine in the department of emergency medicine at the University of California, Irvine School of Medicine explains his research findings about the on-call crisis as well as solutions explored in California and across the nation. Learn why ambulance diversion may soon end while a fee for on-call service may be implemented. Dr. Shira Johnson hosts.

Host: Shira Johnson, MD Guest: Scott E. Rudkin, MD, MBA Who will be there to take call in your emergency department? Dr Scott Rudkin associate professor of emergency medicine at the University of California, Irvine School of Medicine, is interviewed by Dr. Shira Johnson to discuss the on-call crises which may be impacting your emergency department. Dr. Rudkin discusses the instrumental causes which include low financial reimbursement, an increased risk of litigation in trauma cases, and a desire for a better lifestyle, all of which have taken their toll on emergency department call schedules.

Host: Larry Kaskel, MD Guest: Brian Rank, MD Executive physicals are marketed widely as the ultimate medical checkups for discerning consumers. Dr. Brian Rank, the medical director of HealthPartners Medical Group and Clinics of Minnesota, discusses with host Dr. Larry Kaskel the basis for his belief that the popularity of executive physicals isn't good for medicine or the patients who undergo them. Tune in to hear Dr. Rank explain why executive physicals can be harmful to one's health, are a waste of healthcare resources, and create anxiety and a false sense of wellness.

Host: Larry Kaskel, MD Guest: Theodore Eisenberg, JD According to the results of a recent study, the use of statins for primary prevention in women is not supported by clinical-trial data. Theodore Eisenberg, a law professor at Cornell University, discusses the scope of the meta-analyses of the primary prevention clinical statin trial, and the conclusion, which found no statistically significant evidence of cardioprotective effect for women. Mr. Eisenberg explores with host Dr. Larry Kaskel the important questions raised by these findings, including whether the drugs should be used in the primary prevention in women and how the unqualified marketing and advertising claims of protection are misleading to physicians and consumers.

Host: Larry Kaskel, MD Guest: Neal Goldstein, JD On October 30, 2008, the Centers for Medicare & Medicaid Services (CMS) published the 2009 Physician Fee Schedule, which includes revisions to the Stark regulations that tighten the prohibition on physician referrals and the anti-markup rules for diagnostic testing. Attorney Neal Goldstein explains that the changes made by CMS are an attempt to create a formulation that preserves the legitimate provision of in-office diagnostic services, while also cutting back on the proliferation of arrangements that have allowed physicians to profit from the diagnostic work of pathologists, radiologists and other specialists. Mr. Goldstein highlights the key tests for establishing compliance with the new anti-markup rules, though acknowledges that these revised regulations may unwittingly cause controversy within the pathology laboratory industry. Host Dr. Larry Kaskel explores the practical implications of these changes for the private and group physician

Host: Leslie P. Lundt, MD Guest: Edward Shorter, PhD Recently-trained physicians may consider barbiturates and tricyclic antidepressants footnotes in history. But have they dismissed the most effective therapeutics in psychiatry? Dr. Edward Shorter, professor of psychiatry and the Hannah Chair in the History of Medicine and at the University of Toronto, joins host Dr. Leslie Lundt to talk about the evolution of antidepressants

Host: Leslie P. Lundt, MD Guest: David R. Spiegel, MD Patients who are not forthcoming about their alcohol history jeopardize our ability to provide the best possible clinical care. Many instruments such as the CAGE rely only on the patient's self-report. Luckily, we have several biomarkers to assist us. How and when to use which test? Dr. David Spiegel, associate professor of clinical psychiatry and behavioral sciences and director of the consultation-liaison service at Eastern Virginia Medical School in Norfolk, Virginia, joins host Dr. Leslie Lundt to discuss the specifics of blood tests to detect alcohol misuse.

Host: Leslie P. Lundt, MD Guest: Christopher Drake, PhD Can cardiovascular stress research teach us anything about insomnia? Dr. Christopher Drake, assistant professor of psychiatry and behavioral neurosciences at the Wayne State University School of Medicine in Detroit and a bioscientific staff investigator at the Henry Ford Hospital Sleep Disorders and Research Center joins host Dr. Leslie Lundt to discuss his research into the insomnia stress test.

Host: Mary Leuchars, MD Guest: Daniel Alford, MD, MPH Treating pain is rarely an absolute science, and where opioid use is concerned, it is never risk-free for patients. How can physicians safely prescribe opioids for chronic pain, and what are the risks of addiction? Dr. Daniel Alford, associate professor of medicine and director of Chief Resident Immersion Training in Addiction Medicine section of general internal medicine at Boston University School of Medicine, speaks with host Dr. Mary Leuchars about opioid use for chronic pain.