Clinician's Roundtable

Host: Mark Nolan Hill, MD Guest: Randi Hagerman, MD It's responsible for more than five percent of all cases of autism, and it's the most common cause of inherited mental retardation. But are we as familiar as we need to be with Fragile X syndrome, and a series of genetic conditions related to Fragile X? Host Dr. Mark Nolan Hill welcomes Dr. Randi Hagerman, professor and endowed chair of Fragile X research, and medical director of the Medical Investigation of Neurodevelopmental Disorders (MIND) Institute at the University of California, Davis School of Medicine, for a stimulating conversation about our rapidly expanding knowledge of these genetic conditions. How do the signs and symptoms manifest in children, and how does Fragile X impact our elder generations?

Host: Mark Nolan Hill, MD Guest: Jamie Hutchison, MD A young patient is brought into the emergency department having suffered a traumatic brain injury. Hypothermia may be considered as part of the treatment regimen. If so, how soon after the injury should treatment begin, and how long should treatment last? Dr. Jamie Hutchison, associate professor of critical care medicine and pediatrics at the University of Toronto, and research director of critical care medicine at the Hospital for Sick Children in Toronto, explains the mechanism used for cooling and examines potential links between data on hypothermia treatment for adults and similar therapy for children. Dr. Mark Nolan Hill hosts.

Host: Mark Nolan Hill, MD Guest: Jamie Hutchison, MD Traumatic brain injuries can present a lifetime of consequences. Previous studies indicate that hypothermia may be a viable treatment option, but little data has demonstrated efficacy for our youngest patients. Is hypothermia effective in treating pediatric brain trauma patients in a more rigorous research setting? What are the key mechanisms behind this query? Dr. Jamie Hutchison, associate professor of critical care medicine and pediatrics at the University of Toronto, and research director of critical care medicine at the Hospital for Sick Children in Toronto, evaluates the utility of hypothermia treatment for pediatric traumatic brain injuries with host Dr. Mark Nolan Hill.

Host: Mark Nolan Hill, MD Guest: Jim Hu, MD, MPH We are still working to minimize the major risks of complications involved in minimally invasive prostatectomy. This becomes even more important as more patients undergo these procedures. How has the training and certification process impacted our success? What improvements can we expect in this minimally invasive technique to treat prostate cancer in the years to come? For answers to these questions and many more, host Dr. Mark Nolan Hill welcomes Dr. Jim Hu, assistant professor of surgery at Harvard Medical School, and director of minimally invasive urologic oncology at Brigham and Women's Hospital and the Dana Farber Cancer Institute in Boston.

Host: Mark Nolan Hill, MD Guest: Jim Hu, MD, MPH Research indicates that demand for minimally invasive prostatectomy is growing, from 12 percent to more than 30 percent of our candidate patients over a recent two-year span. But research also tells us that there are still drawbacks to a laparoscopic approach to prostate cancer. What are the immediate and enduring pitfalls to laparoscopy, and are these concerns outweighed by the perceived benefits? Dr. Jim Hu, assistant professor of surgery at Harvard Medical School, and director of minimally invasive urologic oncology at Brigham and Women's Hospital and the Dana Farber Cancer Institute in Boston, explains why some surgeons may stick with the open procedure, even as others move ahead with the laparoscopic approach. Dr. Mark Nolan Hill hosts.

Host: Mark Nolan Hill, MD Guest: Dana Christian Lynge, MD Dropping reimbursement for general surgical procedures and increased everyday expenses are two issues, in addition to many others, that make the future viability of a general surgery practice a more difficult proposition. What if this disturbing trend continues? Could medicine withstand the loss of general surgery altogether? Dr. Dana Christian Lynge, associate professor of surgery at the University of Washington School of Medicine, and practicing general surgeon, peers into a theoretical future without general surgeons. What does he see? Dr. Mark Nolan Hill hosts.

Host: Mark Nolan Hill, MD Guest: Dana Christian Lynge, MD Training, recruiting and retaining general surgeons are key workforce issues for many hospitals across the United States. In a broad sense, these concerns impact the entire field of surgery, from students interested in surgery, to the most established surgeons in practice. What can our profession do to reconcile these issues? Dr. Dana Christian Lynge, associate professor of surgery at the University of Washington School of Medicine, and practicing general surgeon, details his research, published in the Archives of Surgery, that has served to highlight much of the unease surrounding this issue. It used to be that many surgeons with subspecialty certifications also trained in general surgery, but now, their time in general surgery has decreased significantly: how is this trend affecting the matters at hand?

Host: Mark Nolan Hill, MD Guest: Dana Christian Lynge, MD A nationwide survey reveals that the number of general surgeons has dropped 25 percent in the past 25 years. A continuation of this decline could have profound implications on patient populations that depend on general surgeons. What are the key demographic concerns surrounding a potential national shortage of general surgeons? Dr. Dana Christian Lynge, associate professor of surgery at the University of Washington School of Medicine, and practicing general surgeon, details his research, published in the Archives of Surgery, on a nationwide shortfall of general surgeons. Dr. Mark Nolan Hill hosts.

Host: Mark Nolan Hill, MD Guest: Dana Christian Lynge, MD Thirty to forty years ago, the field of general surgery was truly flourishing. General surgeons treated patients for an array of surgical conditions, as the concept of present day sub-specialties had yet to take hold. What has led to this significant shift in the focus of general surgery? Host Dr. Mark Nolan Hill welcomes Dr. Dana Christian Lynge, associate professor of surgery at the University of Washington School of Medicine, and practicing general surgeon, to discuss the evolution of general surgery in the context of Dr. Lynge's research in the Archives of Surgery on the national shortage of general surgeons.

Host: Michael Greenberg, MD Guest: Sharon Mitchell, PhD Dr. Sharon Mitchell joins host Dr. Michael Greenberg to detail her role in addressing healthcare for the adult film industry. Known to many as 'Dr. Mitch,' she describes her own transformation from adult film star to sexual health expert and founder of the Adult Industry Medical (AIM) Healthcare Foundation. She'll also give us an idea of the unique healthcare challenges of caring for adult film workers, and how the AIM Foundation is able to cater to the specific needs of these patients.

Host: Bruce Japsen Guest: Gail Rosseau, MD More than half of all students accepted into medical schools are women, but only a fraction of neurosurgeons are female. Dr. Gail Rosseau, of the American Association of Neurological Surgeons, tells host Bruce Japsen about a new paper that highlights these challenges and provides recommendations on how to improve the profession and care for patients.

Host: Bruce Japsen Guest: Winifred Hayes, PhD The health technology assessment, something gaining momentum in hospitals as a way to improve patient care, can be a challenge to implement. Dr. Winifred Hayes, founder and chief executive officer of Hayes Inc. tells host Bruce Japsen how this can be done and what the doctor's role should be in this process.

Host: Bruce Japsen Guest: Winifred Hayes, PhD Evidence-based technology assessment may be an unfamiliar term to most of us, but it is gaining momentum in the health-care industry. Dr. Winifred Hayes, chief executive of Hayes Inc., tells the Chicago Tribune's Bruce Japsen why it may be a solution to controlling health care costs, and how it has gained the support of such varied sources as Federal Reserve Chairman Ben Bernanke and the prestigious Institute of Medicine.

Host: Larry Kaskel, MD Guest: Xavier Sevilla, MD, FAAP Dr. Xavier Sevilla, practicing pediatrician and the Academy of Pediatrics representative to NCQA's Advisory Panel on the patient-centered medical home, walks us through the experience of building a medical home from the ground-up. From staffing to record-keeping, he considers the components that have helped him to develop a pediatric practice with the elements of a medical home. How can you use his experience to shape your practice? Hosted by Dr. Larry Kaskel.

Host: Larry Kaskel, MD Guest: Xavier Sevilla, MD, FAAP What makes a medical home any different than the primary care model in which we have practiced for years? Join host, Dr. Larry Kaskel speak with our guest, Dr. Xavier Sevilla, Practicing Pediatrician and the Academy of Pediatrics representative to NCQA's Advisory Panel on the Patient Centered Medical Home. Dr. Sevilla warns, "This is the last time for us to get it right to practice primary care." We need to get rid of fragmented care and provide patients with superb access with their primary clinician. Learn the key elements that make a practice a medical home and also how fee structures work in a medical home.

Host: Maurice Pickard, MD Guest: Steven Greenberg, MD, PhD Dr. Steven Greenberg, associate professor of neurology at Harvard Medical School and director of the Hemorrhagic Stroke Research Program at Massachusetts General Hospital in Boston, talks with host Dr. Maurice Pickard about the somewhat unexpected finding of an increased frequency of cerebral microbleeds, and explains the potential impact of this discovery on cases of uncontrolled hypertension and cognitive changes. How might this complicate decisions to use antithrombotic therapy? Does this research add a new dimension to certain unexplained phenomena, such as lacunar infarcts or cerebral atrophy?

Host: Gary Kohn, MD Guest: Robert C. Fifer, PhD Dr. Robert C. Fifer, associate professor and director of audiology and speech-language pathology at Mailman Center for Child Development, in the department of pediatrics at University of Miami School of Medicine, talks with host Dr. Bruce Bloom about what physicians need to know about speech and language development. What are other likely causes of slow development? When should chronic otitus media be a concern?

Why do headaches often persist after taking a one-cent aspirin, yet disappear after taking a fifty-cent aspirin? Dan Ariely, behavioral economist and author of Predictably Irrational: The Hidden Forces that Shape Our Decisions, refutes the common assumption that clinicians and patients behave in fundamentally rational ways. From ethics of least harm in pain management to recommendations for conservative vs aggressive therapies, from paying for 'premium' care services to choosing our providers or patients, we consistently overpay, underestimate, and procrastinate. Yet these misguided behaviors are neither random nor senseless. They're systematic and predictable—making us predictably irrational.

You see and hear a patient screaming. You feel the pain they are experiencing. Then soon, something quiets the screams, and quells the suffering. At the core of this transformation? A simple shot of saline. Dr. Dan Ariely, a professor of behavior economics at Duke University, who also holds an appointment at the media lab at the Massachusetts Institute of Technology, joins host Dr. Gary Kohn to discuss the observable evidence behind placebos.

Host: Maurice Pickard, MD Guest: Gary Becker, PhD Dr. Gary Becker, Nobel laureate and professor of economics and sociology at the University of Chicago, joins host Dr. Maurie Pickard to discuss the connection between the gap in supply and demand in the economic market and the same gap in the organ transplant market. Dr. Becker presents a solution and answers the critics.