Archive for the ‘Medical topics by Paul Goldfinger’ Category

By Alex Merto, NY Times, to illustrate this article below.

By Alex Merto, NY Times, to illustrate this article below.

By Paul Goldfinger, MD, FACC.    (I wrote this piece in 2014 but it could have been written yesterday.)

Since 2014, the damage being done to quality care is becoming much more clear.  By now most of you have gotten a taste of what the ACA has wrought. Yet there has been no discernible public outcry, but just speak privately to nurses, doctors and patients.

I do realize that as long as patients have insurance, they will put up with almost anything.

When someone I know was recently (2018)  in a horrible car crash and wound up at Jersey Shore hospital with serious injuries, he was tended to by a “trauma team” but no physician saw him until the next day;  and mistakes were made.

Here is the 2014 post:

In our Blogfinger series about the Affordable Care Act, I said that practice guidelines without flexibility for physicians to make individual decisions for patients would compromise quality. But since the details of how medicine would be practiced under the ACA was not available, I predicted that once care was actually provided under the new system, we would begin to see the worrisome truth.

Now, in an opinion piece published yesterday  (2014) in the New York Times*, and written by two doctors from the Harvard Medical School faculty, we find out that “financial forces largely hidden from the public are beginning to corrupt care and undermine the bond of trust between doctors and patients. Insurers, hospital networks, and regulatory groups have put in place both rewards and punishments that can powerfully influence your doctors decisions.”

This quote (above) is from the article written by Drs. Pamela Hartzband and Jerome Groopman, both well known authors on the subject of what’s right in the care of patients.

When I was learning to become a competent practicing physician, I was taught that patients should be viewed as individuals. In fact, it is those individual differences that make the practice of medicine so fascinating and demanding. For example, consider hypertension (high blood pressure.) Between the different causes, complicating factors, various manifestations, and the myriad of drug combinations and interactions, each patient poses a unique challenge.

High blood pressure, a extremely common condition, cannot possibly be reduced to guidelines that are suitable for the group as a whole. Doctors must be able to treat each case individually, and, their professionalism must be trusted to make the right decisions. What is the point of spending about 10 years of one’s life becoming a doctor if bureaucrats turn the profession into a mindless field governed by mandatory robotic rules, financial priorities, and staffed by unsupervised non-physicians?

It is now becoming apparent that the new health plan is providing regulations and incentives that compromise the doctor-patient relationship. Physicians have a moral imperative to place the patient’s best interests first. That is one of the prime values for the practice of medicine. But to adhere to that imperative is becoming more difficult.

The cat is now out of the bag.  The public must pay heed  to what their doctors are saying about this situation.  My own doctors, almost uniformly, say to me, “You got out just in time.”  Many have become employees of large corporations.

According to Drs. Groopman and Hartzband, “The power now belongs, not to physicians, but to insurers and regulators that control payment”   In other words, the bottom line is becoming the top line.

To help patients understand what conflicts of interest may be occurring in their care, the authors say, “We propose a …..public website to reveal the hidden coercive forces that may specify treatments and limit choices through pressures on the doctor.”

The Times opinion piece concludes by saying, “Medical care is not just another marketplace commodity.  Physicians should never have an incentive to override  the best interest of their patients.”

NYTimes article    *

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Normal electrocardiogram. Dreamstime.com

Normal electrocardiogram. Dreamstime.com.   Re-posted 2014.


By Paul Goldfinger MD, FACC

Cyanosis: a bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood.


The patient was a middle aged woman who worked in the bank on Blackwell Street in Dover , New Jersey, where I had recently opened my practice.   People began to notice a change in her appearance: she had developed a bluish discoloration of her skin. Each day it became worse and worse until her friends and family became alarmed. Everyone was amazed that she had no symptoms other than the striking blue face which was looking at her in the mirror. Finally she called her family physician.


I got a call about the case from her doctor, a kindly older man who smoked cigarettes in his office and dropped ashes on his vest. “Paul” he said, “I want you to see this lady who’s turning blue.”


I was shocked by the call. Middle aged females don’t just turn blue out of the blue. I could see why he might want a cardiologist, but how could his patient have a heart condition when she felt fine?


She came to the ER at Dover General Hospital where I met her. She was indeed cyanotic, but the cause was not obvious. I admitted her to the hospital where it became clear that she had neither heart disease or lung disease—the two leading causes of cyanosis.


All the tests were negative, so I decided to go back to basics—an old fashioned approach: a meticulous detailed history was required. As I was going over all the particulars again, she mentioned something that she hadn’t disclosed when I first met her: she was being treated for a urinary tract infection. When I looked up her medication, I discovered that her pyridium could cause a change in her blood hemoglobin to produce a compound called methemoglobin. So instead of red blood, her blood was turning blue.


Eureka! The lab ran a methemoglobin level on her blood , and we had the diagnosis: methemoglobinemia—the first and last case I ever saw.


We stopped that medication and we kept her in the hospital, and each day, when I made rounds, I became more and more relieved—she was turning light blue: lighter and lighter each day. Finally I became confident enough to tell her that she was cured; and I sang her a few bars of the chorus to this song: (performed here by Ethel Waters in 1929)






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Good Morning Dr. Paul Goldfinger. Here are today’s top stories. Wednesday, September 7, 2016:

NY Times by John Krause. Sept. 5, 2016.

NY Times by John Krause. Sept. 5, 2016.


Fort Hancock at Sandy Hook. Undated photo by Paul Goldfinger. ©

Fort Hancock at Sandy Hook. Undated photo by Paul Goldfinger. ©


“AMA Morning Report:”

On the front of its Science Times section, the New York Times (9/6)  reports in a nearly 1,800-word article on the physical and mental effects of loneliness experienced by the elderly. In the UK and in the US, “roughly one in three people older than 65 live alone.” Investigators “have found mounting evidence linking loneliness to physical illness.”  Loneliness, “as a predictor of early death” even surpasses obesity.

“The profound effects of loneliness on health and independence are a critical public health problem,” said Dr. Carla M. Perissinotto, a geriatrician at the University of California, San Francisco. “It is no longer medically or ethically acceptable to ignore older adults who feel lonely and marginalized.”

Blogfinger Medical Commentary  by Paul Goldfinger, MD, FACC

The mind-body relationship was rarely mentioned when I was in medical school and postgraduate training.  But we were aware of certain things such as how stress might cause a stomach ulcer  or cardiovascular problems;  or how anger and pent-up hostility could aggravate high blood pressure or heart disease. Over the years of practice, my awareness of these issues was growing.  In writing our 2011 book about prevention, we put a spotlight on the depression issue:

“Mental Health: It has been known for some time that stress, anxiety, social isolation and hostility/anger may increase the risk of heart disease. Now there is evidence that depression is also a “potent” risk factor for coronary disease and has been linked to increased risk of stroke, hypertension and carotid artery disease. (Harvard Men’s Health Watch, Nov. 1999). These observations have been made in both men and women.

“Similarly, for those who have had heart attacks, the risk of dying during the 6-12 months after the attack is greater in those with depression, and the adverse risk can extend for years later. Research is trying to determine if psychiatric drugs such as Prozac can make a difference in the risk after a heart attack. It should be noted that not all experts agree regarding the role of psychological factors in causing coronary heart disease. A study from Walter Reed Medical Center found no relationship between depression, anxiety, hostility and stress in promoting coronary artery disease (New England Journal of Medicine. 11/2/2000)”

Now, 5 years later, we see a greater awareness that is summarized in Katie Hafner’s NY Times piece which points out that “loneliness is a quiet devastation” which adversely effects physical well being as well as cognitive and emotional functions.  She points out that loneliness often yields functional and social decline.   People need contact with others–it is “a basic need.”

In the US, Ms. Hafner says that most of us do not know about the relationship of loneliness to health including risk of early death, hypertension, reduced immiune responses and reduced blood flow to vital organs.

I know that the electronic medical records screenings do ask about signs of depression, but a social issue such as loneliness is rarely mentioned in physician offices. In England they are much more active in looking for this problem in their communities and trying to intervene.  But families need to recognize the issue and become proactive with their loved ones.


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Good Morning Dr. Paul Goldfinger. Here are today's top stories.Friday, January 22, 2016

Good Morning Dr. Paul Goldfinger. Here are today’s top stories. Friday, January 22, 2016

Fasting blood sugar chart

Fasting blood sugar chart

CBS News reports on a public service ad campaign to encourage people to be checked for prediabetes launched by the American Medical Association, the American Diabetes Association, the Centers for Disease Control and Prevention, and the Ad Council.

HealthDay (1/21,)  reports the message of the campaign is “no one is excused from diabetes.” It also includes “a short online test at DoIHavePrediabetes.org.” that “can also be taken through texts and interactive TV and radio announcements.” The CDC issued a news release announcing the campaign, in which AMA President-Elect Dr. Andrew W. Gurman, MD, said, “As soon as someone discovers they may be at risk of prediabetes, they should talk with their physician about further testing to confirm their diagnosis and discuss the necessary lifestyle changes needed to help prevent type 2 diabetes.”

MedPage Today (1/21, ) reports that Dr. Gurman explained the reason for the campaign: “There are 86 million people in this country who have prediabetes, and 90% don’t know it,” adding, “we need to do something to make people aware of this condition and its risk.” The AMA is also seeking to raise awareness among physicians, “because they may have lots of people coming into their office and saying, ‘I just took the prediabetes test and I think I have it,’” said Gurman.

Blogfinger medical commentary:  By Paul Goldfinger, MD, FACC.

This public service ad campaign is about “prediabetes,” the latest medical issue to strike fear into the hearts of the public. Above, a doctor calls this a “diagnosis.”  Another calls it a “condition.”  But they are all careful not to call prediabetes a “disease.”  It actually is a state of awareness where early detection can result in a prevention program to reduce the risk of  type II diabetes.     In fact, 15-30% of prediabetics eventually get type II diabetes.

Prediabetes  is a name given to a borderline abnormal blood test coupled with the threat that the abnormality will give rise to overt diabetes and to heart disease.Those who are at highest risk of having prediabetes are obese, sedentary, hypertensive males, age 40-60, with a positive family history of diabetes.   The PR buildup will include a massive barrage of ads on TV, internet, doctors offices and elsewhere which will scare people with what amounts to a real concern, but it is not actually a disease, making this PR campaign somewhat unusual.   Maybe it is like the campaign to take BP readings in dental offices or shoe stores.  That way you can identify those with borderline high blood pressure readings who are not quite hypertensive—-ie prehypertensive.

In fact prediabetes has no symptoms, no physical findings, no medicines to take,  and no clear endpoint for therapeutic success except for a normalization of blood sugar levels.  It is really an idea about preventing a disease, diabetes, which can cause death and disability.  Prediabetes, a circumstance that can be found in millions of people,  is certainly a situation worth your attention.  So let’s put it into perspective.

There is type I  diabetes (insulin dependent) and the much more common, but less serious,  type II  (non-insulin dependent or “maturity onset” diabetes.)    The main worry with diabetes is generally not the elevated blood sugar levels (although that could become a problem; ) it is the risk of vascular complications including heart attack, kidney failure, stroke, blindness or amputation. Treating prediabetes is supposed to reduce the risk of clinical diabetes–type II.

The diagnosis of prediabetes is made with blood tests that measure blood sugar levels in a few different ways.  The best test is the A1C  (aka glycohemoglobin test) which averages blood sugar levels over time instead of in a snapshot as occurs with the fasting blood sugar test.  Normal A1C is less than 5.7%; prediabetes is 5.7-6.4% and diabetes is over 6.5%.

If you are said to have “prediabetes,” the usual recommendations include preventive measures which you  would want to do anyhow.  Number one is weight reduction.   Then comes exercise and specific dietary advice.  Control of all cardiac risk factors would be advisable also including BP control, stop smoking, cholesterol treatment, stress reduction, etc.

The Joslin Diabetes Center ( www.joslin.org/info/what_is_pre_diabetes.html  )   at Harvard Med. School says that weight reduction is the most important preventive measure.  They say that calorie reduction is more important than sugar intake. Below is their simple dietary advice if you have prediabetes, but it is good advice for anyone:

—-eating more foods that are broiled and fewer foods that are fried.

—-cutting back on the amount of butter you use in cooking.

—-eating fish and chicken more, and only lean cuts of beef.

—-eating more meatless meals, or re-orienting your meals so that your dinner plate has more vegetables, fruit and starches on it, and less meat.

This is what they say at Joslin, “The solution isn’t “avoid foods with sugar in them.” Rather, you need to lose weight if you are overweight, cut back on portion sizes, and plan for those occasions when you eat a small piece of cake or pie.”

So the latest celebrity disease is upon us, and the treatment is the same as what prevention minded docs have been advocating right along, but another dose of awareness and education could wake up a lot of future diabetics.


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Click to read the small print.

Click to read the small print.

From MarketWatch.com:

“Down to your last belt loop and your last penny? These seemingly unrelated phenomena may have more in common than you think, a new survey shows.

“Dining out is the No. 1 thing that Americans blow their budgets on, according to the Principal Financial Group’s annual Financial Well Being Index, which will be released Wednesday (Market Watch got an early look at the data). The company surveyed more than 1,100 employed American adults.

‘Those restaurant meals are also adding to our growing waistlines: On days when people dine out, they tend to consume 200 more calories than when they eat at home, according to a study of more than 12,500 people published by Public Health Nutrition last year, and government research shows that “when eating out, people either eat more or eat higher calorie foods — or both — and that this tendency appears to be increasing.” Other studies show that eating out more frequently is associated with obesity and higher body fat.”

And the problem is getting worse. While 22% of Americans blew their budgets on dining out in 2014, this year, 24% did so.

In the Huffington Post a few years ago, Mark Hyman, MD wrote a fascinating piece which is very important.  Here is an excerpt and a link:

“Research shows that children who have regular meals with their parents do better in every way, from better grades, to healthier relationships, to staying out of trouble. They are 42 percent less likely to drink, 50 percent less likely to smoke and 66 percent less like to smoke marijuana. Regular family dinners protect girls from bulimia, anorexia, and diet pills. Family dinners also reduce the incidence of childhood obesity. In a study on household routines and obesity in U.S. preschool-aged children, it was shown that kids as young as four have a lower risk of obesity if they eat regular family dinners, have enough sleep, and don’t watch TV on weekdays.”


Blogfinger Medical Commentary:  By Paul Goldfinger, MD, FACC

For the first time, data reveals that Americans spend more money on eating out than they do at  grocery stores.  Processed foods and restaurant foods tend to contain more salt, fat, and sugar than you might think.  The food industry plays up the addictive properties of certain ingredients including sugar, salt and fat.     Eating at home brings more fresh fruits and vegetables as well as low fat proteins and less calories to the table.

The issue is not only calories, which goes to the obesity issue, but it also involves prevention from cardiovascular disease, strokes, high blood pressure, cancer and diabetes.  In our book Prevention Does Work: A Guide to a Healthy Heart, we go over every nutrition issue that we could think of including good/bad fats, coffee, chocolate, nuts, salt, statins and many others.

In addition, for you modern men and women who don’t know how to cook, Eileen provides 36 easy-to-prepare evidence- based original recipes with an emphasis on seafood, and it’s all about home cooking.  You young families should try to eat most  of your meals at home, for a variety of reasons.

Our book is an inexpensive way to get on a better nutritional road. Don’t rely on unsubstantiated Internet claims.  We provide the scientific evidence  in a way that you can understand.

Go to Barnes and Noble and type Paul Goldfinger, MD.  They have it for $12.95 in paperback.  It is also on Amazon.com.

Good diets, exercise, good music, low stress, and a good lifestyle will help keep you young.  Here is Frank Sinatra who would have been 100 yesterday, joining Charles Aznavour with another way to feel young:


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Internet graphic

Internet graphic

Paul Goldfinger, MD, FACC.   Editor @Blogfinger.

Some of you have berated me for having a negative attitude regarding Obamacare. The truth is that many good things will come out of our new healthcare, but I am alarmed by the negatives which continue to slowly drip out the cracks and insinuate themselves seemingly overnight and unannounced into our experiences with doctors, hospitals, drug companies, etc.   I am concerned that the negatives will outweigh the positives and cause damage to our loved ones as they seek care.

So I will have an ongoing project to report on pluses and minuses as they occur. Here are two that appeared on my radar screen this week. Since I am no longer practicing medicine, I go by the experiences of family, friends and myself. Yes it is anecdotal but I also keep watch on the media, especially when clinical trials look at these matters, when doctors speak about the situation, and by watching the AMA reports which I receive regularly.  Hopefully some of you will share your observations.

Here are my recent findings.   It may not seem like much, but cumulatively, there may  be substance, and I do believe that smoke might indicate a fire.

#1. A man approached the front desk at a surgeon’s office. He asked that the surgeon’s report be sent to his doctor. He was told that he would have to pay $15.00 for that service.

Whenever a specialist sees a patient, it is his obligation to send a consultation report to the primary doctor. Ideally he should also call the referring physician. I believe that communication of this type is deteriorating because of the expectation that electronic medical records will fill that void, but they won’t because they are lacking in specificity, and when our society allows time-honored individualized medical practices to fall by the wayside in the interest of time and money, quality will suffer.

Patients should request copies of their consultation notes and they should read those notes carefully.   They should find a history, physical exam, test results, a diagnosis and a narrative discussion/analysis, with an individualized plan, regarding the problem;  and no one should be charged for those reports.

#2. A doctor orders a blood test for a patient. He orders it, not on a whim, but because it is needed for proper patient care. The patient goes to the lab and is informed that the insurance company may not pay for the test. He is required to sign a form to indicate that he may have to pay personally.

Subsequently he receives a bill for $115.00 from LabCorps for that routine test. Evidently the diagnostic codes supplied by the doctor did not justify the test.   The patient complained to the doctor’s office and asked that the bill be resubmitted by the doctor for consideration, using “better” codes. The office tells the patient that this is not the doctor’s problem. Ouch!

Sorry, but this is the doctor’s problem, and he should help so the patient doesn’t get stuck with the bill. This is an example of interference in the practice of medicine by insurance companies  and indifference on the part of the doctor.

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newest ama


Nearly 9 million Americans gained health coverage last year according to  Census Bureau reports.  The New York Times (9/17 ) reports that the number of Americans without health insurance dropped by 8.8 million last year, to a total of 33 million.

The Census Bureau reported Wednesday n its annual report “on income, poverty and health insurance coverage, and that the percentage of people without insurance was 10.4 percent last year, down from 13.3 percent in 2013.” According to the Times, officials attributed much of the change to the Affordable Care Act.
The Washington Post (9/17,) reports on its front page that the new figures from the Census Bureau “are the most solid evidence to date of the impact that the Affordable Care Act has had since its main coverage provisions took effect in 2014.”
The Washington Times (9/17, ) reports that Medicaid coverage “saw an uptick of 2 percentage points and now covers nearly one in five Americans.”
The Wall Street Journal (9/17)  reports that the findings also reveal the extent of the health law’s impact for some groups that have historically had lower rates of health coverage. In 2014, the insured rate increased by about 4 percentage points for Hispanics, as well as for blacks and Asians.
The Los Angeles Times (9/17, Lee) says analysts “expect the nation’s overall share of the uninsured to drop further as more people become familiar with the mandate and the federal and state marketplaces.”

Blogfinger Medical Commentary. Paul Goldfinger, MD, FACC

One of my former partners had been working part time as a cardiologist at a free clinic in Georgia.  Recently the clinic closed because there weren’t enough patients without health insurance.  I have no doubt but that the increased numbers of insured patients are straining the healthcare system significantly.

Among the indicators:  long waits to get an appointment with a doctor, rushed care at in and out patient settings, stressed /burned out physicians and nurses, especially among ER and primary care doctors, under-staffing in hospitals terrorizes nurses trying to do their jobs correctly, difficulty getting to speak to a doctor on the phone, inappropriate substitutions of nurse practitioners for doctors, assigning clerical people in medical offices to triage medical complaints, inability to get doctors to see patients who are acutely ill,  difficulty finding a primary care doctor, long waits to schedule surgeries and tests, barriers at doctors offices that make it difficult for patients to get care, indifference by some doctors who are frustrated in their rolls as employees of corporate entities,  doctors rushing to get through busy office hours,  a greater risk of sloppy care and mistakes in offices and hospitals, frustration over electronic medical records by doctors and nurses , doctors going bankrupt and/or closing their practices, etc.

This is all anecdotal now, but I predict that this will become a huge story once some data rolls in. The emphasis on the bottom line has become the top priority which supersedes quality care. Too many bureaucrats in the healthcare field are making wrong decisions as physicians and nurses are becoming marginalized.  Watch for an uptick in malpractice cases.

Healthcare professionals:  What do you think?  Comment below:

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newest ama

Internet illustration

Internet illustration

The New York Times (8/12, Reynolds) “Well” blog reported that a study published last month in PLoS One suggests that “overall, ‘a small dose of exercise’ may be sufficient to improve many aspects of thinking, and more sweat may not provide noticeably more cognitive benefit,” although it will improve aerobic fitness. The study of “101 sedentary older adults, at least 65 years of age,” revealed that “briskly walking for 20 or 25 minutes several times a week” appeared to be enough to help keep “brains sharp as the years pass.”

Blogfinger Medical Commentary:  By Paul Goldfinger, MD, FACC

There have been so many studies about the value of excercise, that I have come to the conclusion that this therapeutic modality exceeds every other that is advocated to prevent all sorts of medical problems.

Whenever exercise is used for prevention, such as in cardiology, the mechanisms are never clearly elucidated. But all doctors and most people in general believe in the benefits of exercise.   At a basic common sense level, it makes sense. Our bodies are so complex and with so many moving parts that it seems logical that “use it or lose it” is a reasonable mantra.

I recall other studies in the past that I raised my eyebrows over when they said that even small doses of exercise can be helpful, but I see now that it is  likely to be true. You can benefit even if all you do is take a walk. Exercise makes the heart work harder and increases blood flow throughout the body, and from an evolutionary point of view, it makes sense that more blood is good for survival of the fittest, even if the fittest only get up from their computers and walk around the block.

The effects on the brain, as noted in this trial, are fascinating and believable although I don’t know why.  Here  is what we said about exercise in our book  (2011):   front cover

Exercise: Physical inactivity is associated with increased risk for coronary disease (CHD) and is considered a major risk factor. Increased physical activity results in  a reduced risk for CHD.  Advantages of exercise include a lower risk of diabetes, less tendency for blood to clot, improved lipids including higher HDL levels, improved sleep patterns, and reduced anxiety and depression. Other benefits reported include reduced colon cancer, reduced gallstones, reduced arthritis symptoms, lower blood pressure, less prostate enlargement and less osteoporosis (weak bones in the elderly).

A regular aerobic exercise program is a necessary adjunct to a good diet. It is very difficult to lose weight without exercise, but don’t be discouraged if the weight loss is slow. Exercise does not burn a lot of calories. Walking or running a mile will burn only about 100 calories, but exercise improves fitness and thus allows you to do more exercise and burn more calories. Also, the calories that are burned are more likely to be from fat than from carbohydrates, and the ability to keep weight off after losing is easier with regular exercise.

The amount of exercise necessary is controversial; however, a brisk walk 4-5 times per week can offer some protection. In the Nurses Health Study from Harvard, women who regularly engage in brisk walking reduced their risk of heart disease to the same degree as women who engaged in vigorous exercise. Some studies suggest that strenuous efforts are probably better.

An exercise prescription based on your heart rate is a good technique for judging how hard to exercise and your doctor can give you advice about this. Pulse monitors, (e.g. by Polar at polarusa.com or FitBit) are available in sporting goods stores. If you are healthy, you can get a fitness evaluation at the local YMCA and receive advice regarding an exercise program, or, if there were concerns about coronary risk, then a formal exercise stress test ordered by your physician would be appropriate. The Centers for Disease Control suggests that people should get at least 30 minutes of moderate activity on most, or preferably all, days of the week.

If someone has underlying heart disease, vigorous physical exercise can be risky, especially if the patient is not accustomed to regular exercise. Sometimes people who have no awareness that they have heart trouble can be at risk for complications during exercise. Individuals with heart disease or who are at risk for heart disease should speak to their doctors before engaging in strenuous forms of exercise. According to Barry Maron, MD, an expert on the subject of cardiac events during exercise, “The balance of the evidence supports the value and importance of participation in regular exercise regimens (NEJM.11/9/2000).”


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AMA new banner


McClatchy (5/8, Pugh) reports that a growing number of “walk-in health clinics, with late-night and weekend hours, on-site prescription drugs and cheaper prices, are proving a hit with busy patients who’ve grown tired of getting medical treatment when it’s most convenient for doctors.”

Walk-in clinics include the more than 1,900 retail health clinics and 6,400 urgent care centers nationwide. McClatchy adds that with “a national shortage of doctors, higher rates of chronic illness and more people with health insurance under the Affordable Care Act, it’s no surprise that walk-in clinics are booming.”:

Blogfinger report from May, 2014:   Blogfinger report on urgent care centers

Blogfinger Medical Commentary by Paul Goldfinger, MD, FACC

During my earlier reporting on the Affordable Care Act, I pointed out that there will be a shortage of primary care doctors as well as other healthcare providers such as nurses. Now that many people have health insurance that didn’t have it before, doctors’ offices as well as other providers such as ER’s are having trouble stemming the tide.

Patients are finding that quality is sometimes being compromised because of these shortages..  In addition, many patients still don’t have a doctor.  They are called “the medically homeless.”

If you try to reach your doctor, you often find that barriers have been erected to discourage your contact with the physician.  Poorly trained individuals often screen your calls into the office, and you may not even get a call back. If you are sick, you may be told that there are no openings—period!   Sometimes you are greeted with a recording that tells you to go to an ER if you are having a genuine medical emergency.   Many physicians are becoming salaried employees of big hospital corporations, and that causes a myriad of changes and issues regarding availabity and quality.

Patients crave the way that they used to be the top priority at the doctor’s office whereas now, efficiency, cost cutting,  and electronic records are at the top of the priority list.  Patients  want “patient first consumerism.”

At first I was unsure how things would evolve regarding shortages, but now it is obvious  that a flood of urgent care centers and “retail clinics” are moving into the vacuum, and patents are happy with the results. I’ve become frustrated myself with access and quality issues in physician offices, and I don’t hesitate to go to an urgent care center.

But urgent care centers are not well suited to following patients with chronic conditions or serious medical matters.  For that you need a regular doctor who is the “quarterback” of your care.    But the urgent care centers are great for so many health issues that are common and not life threatening.  Also, I would suggest that patients be sure that an actual physician will see them when they seek help at such a facility.

What remains to be seen in the future is how these facilities  rate when quality parameters are assessed.  Initial reports are hopeful.

Carol Rizzo of OG, an expert on healthcare, often helps us out with our discussions on new health care models, and she provides us with the link below where the CEO of Kaiser Permanente lists 5 concepts regarding the future of US healthcare. I suggest you all read it.

link to future of US healthcare

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AMA new bannerACC

The Blond Pharmacist

The Blond Pharmacist

Scott Pelley reported in the CBS Evening News (2/10) that according to the Dietary Guidelines Advisory Committee, a government advisory panel, “we don’t have to worry so much after all about cholesterol in our diets.”


Dr. Jon Lapook noted that while “the amount of cholesterol in your blood is still important,” the panel found that “the amount of cholesterol in your food doesn’t necessarily translate to a higher level of cholesterol in your blood.”


While the current recommendations “say people should have less than 300 milligrams of cholesterol in their diet a day,” that number is “likely to change when the recommendations come out later this year.” Linsey Davis noted on ABC World News (2/10, ) that while the panel said that “eating some foods that are high in cholesterol like eggs and seafood may not be so bad after all,” foods like “meats and cheeses, because they contain saturated fats, are still on the list.”


The Washington Post (2/11)  reported in its “Wonkblog” blog that this “does not reverse warnings about high levels of ‘bad’ cholesterol in the blood, which have been linked to heart disease,” adding that “some experts warned that people with particular health problems, such as diabetes, should continue to avoid cholesterol-rich diets.”


The blog stated that “a group from the American Heart Association and the American College of Cardiology who looked at the issue in 2013 said there is simply not enough evidence of danger to call for limiting cholesterol in diets.”
USA Today (2/11, ) reports that “the committee will send its final recommendations to the Department of Health and Human Services and the U.S. Department of Agriculture, which issue the dietary advice.” HHS and the USDA “are expected to issue Dietary Guidelines for Americans, 2015 later this year.”


The AP (2/11, Jalonick) reports, however, that “it’s unclear if the recommendation will make it into the final guidelines.”


Blogfinger Medical Commentary by Paul Goldfinger, MD, FACC

The cholesterol story began in the 1960’s when it was found that high blood cholesterol levels were associated with heart disease. But we also found out that dietary cholesterol does not increase blood levels of “bad” cholesterol, unlike lab models where heavy intake of cholesterol leads to plaque formation.

When it came to dietary advice, early on in the cholesterol era, most experts favored diets low in saturated fats without stressing cholesterol so much.  In our book, in the chapter called “Concepts: Cholesterol Risks and Treatment,” we did not even mention dietary cholesterol. As it turns out, many foods that are high in fats, such as red meats, are also high in cholesterol. But eggs, rich in yolk cholesterol, contain no fats and do not raise blood cholesterol.

What hasn’t changed is the fact that lowering bad blood cholesterol levels does save lives, but restricting dietary cholesterol is not the way to do it.

As time went by, we learned that even severe dietary fat restriction often doesn’t lower bad cholesterol levels enough to produce a clinical benefit, and that has led the prevention community to stress Mediterranean style diets which we discuss in depth in Prevention Does Work: A Guide to a Healthy Heart by Eileen and myself.

If the guidelines change, as described above, I don’t think it will make much of a difference in what people do or doctors advise. Maybe there will be a loosening of restrictions on eggs, lobsters or shrimp, but otherwise, not much change.

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