Clinician's Roundtable

Guest: John McConnell, PhD Host: Shira Johnson, MD The reality of the Emergency Medical Treatment and Active Labor Act is that patients can not be turned away. But the economics of providing emergency care to all is overburdening hospital resources. Our guest, healthcare economist specializing in ED care and associate professor of emergency medicine at Oregon Health and Science University, Dr. John McConnell, joins host Dr. Shira Johnson to talk about the economics of emergency care. Learn strategies and solutions that could solve the on-call crisis in hospitals.

Host: Shira Johnson, MD Guest: John McConnell, PhD The concept of the surgicalist was born of economic and practical necessity. Dr. John McConnell is a health economist and an assistant professor of emergency medicine at Oregon Health and Science University whose research has focused on emergency and trauma care as well as health policy. He is interviewed by Dr. Shira Johnson to discuss how and why the role of the surgicalist evolved. Tune in to find out who may be seeing your next surgical consult from the ED. It may not be the surgeon on call.

Host: Mary Leuchars, MD Guest: Brian Kelly, MD Recent advancements in hip arthroscopy and magnetic resonance imaging have elucidated several sources of non-arthritic hip abnormalities which, if left untreated, could result in chronic disabling symptoms. What are the current indications for hip arthroscopy, and what management issues should clinicians be made aware? Host Dr. Mary Leuchars examines these questions with Dr. Brian Kelly, assistant professor of orthopedic surgery at the Weill Medical College of Cornell University and attending physician at the Hospital for Special Surgery in New York.

Host: Mary Leuchars, MD Guest: Brian Kelly, MD In sports medicine, the hip has traditionally received less attention from physicians than other joints. What are the types of non-arthritic hip pain that clinicians need to recognize in order to make accurate diagnoses for both recreational and professional athletes? Dr. Brian Kelly, assistant professor of orthopedic surgery at the Weill Medical College of Cornell University and attending physician at the Hospital for Special Surgery in New York, examines this issue from two vantage points: as clinician researcher, and as team physician for the NFL's New York Giants. Dr. Mary Leuchars hosts.

Host: Mary Leuchars, MD Guest: Scott Rodeo, MD What are the latest research and treatment modalities orthopedic surgeons use for meniscus-deficient patients? Dr. Scott Rodeo, professor of orthopedic surgery at Weill Cornell Medical College in New York and co-chief of the Sports Medicine and Shoulder Service at the Hospital for Special Surgery, discusses synthetic meniscal replacement in the knee joint with host Dr. Mary Leuchars.

Host: Maurice Pickard, MD Guest: Thomas Barr Graboys, MD Dr. Thomas Graboys, professor of medicine at Harvard Medical School and president emeritus of Lown Cardiovascular Research Foundation in Brookline, Massachusetts, discusses his new book Life in the Balance: a Physician's Memoir of Life, Love and Loss with Parkinson's Disease and Dementia. Dr. Graboys talks to host Dr. Maurice Pickard about his struggles to live with illness without letting illness control his life. He hopes others will find in his story comfort, inspiration, and validation of their own struggles.

Host: Larry Kaskel, MD Guest: Kathleen Franco, MD Imagine being told on the first day of medical school that your graduate education would be at no charge. You may think this is impossible unless you are a student at The Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. Dr Kathleen Franco, associate dean for Admissions, explains to host Dr. Larry Kaskel the decision of Clinic's medical school to offer a tuition free medical education, the funding mechanisms instituted to support this decision indefinitely, and the impact on the students and medical community.

Host: Leslie P. Lundt, MD Guest: Larry Young, PhD Autism has garnered much attention in recent years. One of the most interesting areas of research is the exploration of oxytocin. Could it improve social interaction? Dr. Larry Young, the William P. Timmie Professor at the Center for Behavioral Neuroscience and the Department of Psychiatry at the Emory University School of Medicine, outlines his latest research with host Dr. Leslie Lundt.

Host: Leslie P. Lundt, MD Guest: Stephen Ross, MD Ketamine is a schedule III drug with a long history as an anesthetic. It also is a well-known club drug in the party circuit. How can it be that it has anti-addictive properties and might it be useful to treat alcoholism? Dr. Stephen Ross, director of the Division of Alcoholism & Drug Abuse at Bellevue Hospital in New York, joins host Dr. Leslie Lundt to discuss the latest research into ketamine and addiction treatment.

Host: Leslie P. Lundt, MD Guest: Joe Sam Robinson Jr., MD In 1999 the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) declared pain the fifth vital sign. Chronic pain affects more people than diabetes, heart disease and cancer combined. Has there been any real improvement in identifying and treating pain since the JCAHO edict? Join us to hear from neurosurgeon Dr. Joe Sam Robinson, clinical professor at the Medical College of Georgia, explore the treatment of pain with host Dr. Leslie Lundt.

Host: Leslie P. Lundt, MD Guest: Marc Galanter, MD Medicine and spirituality have always been linked, we have struggled as a profession with how to introduce spirituality and religion into the general hospital setting. Host Dr. Leslie Lundt discusses such a program with Dr. Mark Galanter, professor of psychiatry at New York University School of Medicine, and author of Spirituality and the Healthy Mind: Science, Therapy and the Need for Personal Meaning.

Host: Leslie P. Lundt, MD Guest: Alan Astrow, MD All the technology and advances in medical science hasn't changed the most difficult thing we do as physicians - relay emotionally charged diagnostic and prognostic information to our patients. How can we do a better job? Communication skills do not automatically improve with increasing physician experience. Dr. Alan Astrow, the director of the division of hematology and medical oncology at Maimonides Cancer Center in New York City explains how we can break bad news to patients in a more effective and supportive way.

Host: Michael Epstein, MD Guest: Peter Adamson, MD In all fields of medicine, we have all encountered patients who are ultra-challenging to manage. There can be those who can find dissatisfaction in any outcome that isn't ‘perfect,' according to their standards. There are others who have seen a series of healthcare providers who, despite their efforts, haven't been able to meet their needs and requests. Host Dr. Michael Epstein welcomes Dr. Peter Adamson, professor of otolaryngology-head and neck surgery, and head of facial plastic and reconstructive surgery at the University of Toronto, to talk through a range of these potentially sticky situations, and how they impact our practice and in some cases, our practice habits.

Host: Michael Epstein, MD Guest: Peter Adamson, MD Avoiding potential problem patients in cosmetic surgery: It's a concern that many practitioners face on a regular basis, reminding us of the importance of patient selection and informed consent. How can we minimize the number of problem patients in our practice, and how can we limit the influence of those who are already in our practice? On the flipside, who is an ideal candidate for surgery? Dr. Peter Adamson, professor of otolaryngology-head and neck surgery, and head of facial plastic and reconstructive surgery at the University of Toronto, shares advice for staying on the lookout for the various categories of patients. Dr. Michael Epstein hosts.

Host: Michael Epstein, MD Guest: Peter Adamson, MD There may be many reasons for a patient to consider elective aesthetic surgery, but whatever the reason, they are often linked to the patient's expectations for the surgical outcome. While we know that most patients maintain a reasonable outlook for their care, how can we work to maintain an affable relationship with those who have unrealistic post-surgery expectations? Dr. Peter Adamson, professor of otolaryngology-head and neck surgery, and head of facial plastic and reconstructive surgery at the University of Toronto, details his experiences and his extensive research on patient relations with host Dr. Michael Epstein. How often does the thought of turning away a patient come into play in a typical practice? Are more of the so-called "problem patients" specific to certain procedures?

Host: Mark Nolan Hill, MD Guest: David Felson, MD, MPH A patient in your office describes the knee pain they have been feeling for an extended period of time. The MRI that you order on their knee reveals meniscal damage. New research is telling us that meniscal tears may be more common than we realize, and further, raises questions as to whether the meniscal tear is really the source of your patient's knee pain. Dr. David Felson, professor of medicine at the Boston University (BU) School of Medicine and professor of epidemiology at the BU School of Public Health, explains that damaged meniscal cartilage may not be directly linked to knee pain. Dr. Mark Nolan Hill hosts.

Host: Mark Nolan Hill, MD Guest: David Felson, MD, MPH Despite previous evidence to suggest that arthroscopic surgery does not improve symptoms associated with osteoarthritis of the knee, the procedure continues to be a common treatment for arthritis. Now, novel data is backing up this earlier research on arthroscopy. Going forward, how will this development impact practice? Host Dr. Mark Nolan Hill talks with Dr. David Felson, professor of medicine at the Boston University (BU) School of Medicine and professor of epidemiology at the BU School of Public Health, about the utility of the procedure, and explores alternative thoughts on the pathogenesis of the pain experienced by this class of patients.

Host: Bruce Japsen Guest: Kurt Mosley It seems fewer and fewer physicians want to go into internal medicine, with a recent study showing only two percent of 4th-year medical students elect to enter this field. Kurt Mosley, Vice President of Business Development for Merritt, Hawkins & Associates, the largest physician search and consulting firm in the country with more than two decades in the business, tells the Chicago Tribune's Bruce Japsen about the trend away from internal medicine, despite the national movement toward finding patients a medical home and the continued emphasis by policy makers on the importance of primary care medicine.

Host: Bruce Japsen Guest: Kurt Mosley More than 90 percent of new physicians coming into the job market received at least 10 job solicitations and face a much different employment dynamic than older doctors. Kurt Mosley, vice president of business development for Merritt, Hawkins & Associates, the largest physician search and consulting firm in the country, tells the Chicago Tribune's Bruce Japsen what doctors face in today's complex employment market and shares his insights into navigating it.

Host: Lisa Dandrea Lenell, PA-C, MPAS, MBA Guest: Carolyn Zaumeyer, NP, RN Carolyn Zaumeyer, a nurse practitioner, discusses with host Lisa D'Andrea the key barriers for a nurse practitioner to establish an independent practice. The nurse practitioner must ensure the practice structure and operations are in compliance with the applicable laws. Ms. Zaumeyer also highlights the importance of establishing a relationship with a collaborating physician for the success of one's practice. Another hurdle that Ms. Zaumeyer examines is the nurse practitioner's relationship with the insurance company to assure the services billed by the nurse practitioner are properly processed and reimbursed.