Clinician's Roundtable

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.

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.

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.

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.

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 practice.

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

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.

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.

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.

Chief executive officer of the American Academy of Physician Assistants, Bill Leinweber, discusses the developments and goals of the organization with host Lisa D'Andrea Lenell. Mr. Leinweber highlights the professional responsibilities of physician assistants, the need to ensure physician assistants fill the increasing demand for primary care services, and the issues arising out of specialization within the profession. The conversation outlines the organization's goals in terms of addressing the needs of its membership and supporting the medical community.