Archive for February, 2007

ER cartoon full size

I’d like to thank everyone who graciously emailed and expanded my education on this issue (see previous post, “Disposable Docs”) In that post, I asked the question, “Is there no remedy for the situation of my ER friends? Are they and others like them (competent, experienced, non ER trained docs) supposed to just sit on their hands while the powers-that-be decide their fates?”

Apprently not, I’m happy to report that something is being done!
First, a short history lesson for those like me, who are unfamiliar with the ER boards controversy:

    -The specialty of Emergency Medicine was first recognized by the American Board of Medical Specialties in 1979. Before this, the Emergency Department was manned by a variety of physicians trained in various fields such as Internal Medicine, Surgery, Family Medicine, and Pediatrics.
    – Certification or recognition of expertise in the specialty of Emergency Medicine was achieved by passing a certification exam given by the American Board of Emergency Medicine (ABEM).
    The ABEM exam was first offered in 1980. From 1980 to 1988, there were two ways for physicians to qualify for the examination. One could either complete a residency in emergency medicine, or satisfy the requirements of a “practice track” pathway. The prerequisites of this option were 7,000 hours and 60 months of emergency department practice experience, with a specified number of CME credits in emergency medicine.
    -In 1988, this alternative pathway or the “practice track” was terminated, sparking considerable controversy and dissension. Some felt that this closure was arbitrary and premature. This act essentially divided emergency room physicians into those who are ABEM certified, whether they had gone through EM residency training or not, and those who are not ABEM certified. Right now, 38% or approximately 13,000 ER doctors in the US are not ABEM certified, and it is estimated that there will not be enough EM residency trained, ABEM certified ER docs for at least the next 10 years according to the Institute of Medicine.
    – Lack of recognized EM certification has serious consequences for these physicians in terms of significantly lower compensation and disappearing job opportunities. Limitations on the supply of available ER physicians also has significant consequences on the US Emergency Health Care system, concerns which have been addressed in the IOM report and by the American Academy of Family Physicians.
    – The non-ABEM certified ER physicians have fought back. Instead of seeking ABEM certification, which is closed to them, they have acquired certification through the American Board of Physician Specialties examination(ABPS), the third largest multispecialty physician certifying body in the country. This alternative ER certification, called BCEM (Board of Certification in Emergency Medicine) is recognized in Florida, Utah, and Oklahoma, and has been vigorously opposed by groups representing the ABEM certified docs such as AAEM.

In December 2006, the ABPS filed a complaint against the New York Department of Health and Department of Education claiming arbitrary denial of recognition as a legitimate certifying body in New York State.

If they win, hopefully this will be an avenue for non-ER trained, non-ABEM certified ER physicians to continue their livelihood and careers, at least in New York, Florida, Oklahoma, and Utah.

What about the other 47 states? Maybe this will wake up the non-ABEM ER physicians to finally do something before it’s too late.

*NEWSFLASH* Feb 14, 2007
There is currently a bill pending in Florida which states the following:

A physician licensed under this

chapter may not hold himself or herself out as a

board-certified specialist unless the physician has received

formal recognition as a specialist from a specialty board of

the American Board of Medical Specialties or other recognizing

agency approved by the board which requires completion of an

approved residency or fellowship training program from the

Accreditation Council for Graduate Medical Education in the

specialty of certification.

If this bill (which is being pushed by ACEP) passes, it means that ONLY physicians who underwent residency/ fellowship training in a specialty can say that they are board-certified in that specialty. This leaves out all the emergency room doctors who did not do emergency medicine residency, whether they are ABEM or BCEM certified including all the doctors who were “grandfathered” in through the practice track. It also leaves out all the physicians who are certified by the American Board of Preventive Medicine, the American Board of Pain Medicine, and the American Board of Facial Plastic Reconstructive Surgery all of whom allow non-specialty trained physicians to be certified.
What the heck is ACEP doing and why isn’t anyone doing anything about it? Don’t they get that there is strength in numbers? If they were to welcome the 13,000 non-ABEM non-EM trained ER docs instead of fighting these turf wars all over the country, they would actually be able to improve the emergency care in this country (see IOM report).

Links:
Disposable Doctors 1
American Board of Physician Specialties
PUMA MD
US Alliance of Emergency Medicine
News from AAPS vs. NY-DOH

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Meditation and Health

Posted: February 1, 2007 by Doc in Medical, Meditation

meditation

Meditation is Good for Your Health

Link: How to Meditate

Full article at New York Times

Josef Astor for The New York Times

Is Buddhism Good for Your Health?

Published: September 14, 2003(Page 3 of 4)
The ”Monk experiments” at Madison are beginning to intersect with a handful of small but suggestive studies showing that Buddhist-style meditation may have not only emotional effects but also distinct physiological effects. That is, the power of meditation might be harnessed by non-Buddhists in a way that along with reducing stress and defusing negative emotion, improves things like immune function as well.

The power of the mind to influence bodily function has long been of interest to scientists, especially connections between the nervous, immune and endocrine systems. Janice Kiecolt-Glaser and Ronald Glaser, researchers at Ohio State University, for example, have done a series of studies showing that stress typically impairs immune function, though the exact woof and weave of these connections remains unclear.

Interestingly enough, the Buddhist subjects themselves are largely open to scientific explanation of their practices. ”Buddhism is, like science, based on experience and investigation, not on dogma,” Matthieu Ricard explained in an e-mail message to me last month. The religion can be thought of as ”a contemplative science,” he wrote, adding, ”the Buddha always said that one should not accept his teachings simply out of respect for him, but rediscover their truth through our own experience, as when checking the quality of a piece of gold by rubbing it on a piece on stone, melting it and so on.”

In July, I joined Davidson and several colleagues as they stood in a control room and watched an experiment in progress. On a television monitor in the control room, a young woman sat in a chair in a nearby room, alone with her thoughts. Those thoughts — and, more specifically, the way she tried to control them when provoked — were the point of the experiment.

Davidson hypothesizes that a component of a person’s emotional makeup reflects the relative strength, or asymmetry, of activity between two sides of the prefrontal cortex — the left side, which Davidson’s work argues is associated with positive emotion, and the right side, where heightened activity has been associated with anxiety, depression and other mood disorders.

His research group has conducted experiments on infants and the elderly, amateur meditators and Eastern adepts, in an attempt to define a complex neural circuit that connects the prefrontal cortex to other brain structures like the amygdala, which is the seat of fear, and the anterior cingulate, which is associated with ”conflict-monitoring.” Some experiments have also shown that greater left-sided prefrontal activation is associated with enhanced immunological activity by natural killer cells and other immune markers.

When one scientist in the control room said, ”All right, here comes the first picture,” the young woman visibly tensed, gripping her elbows. Electrodes snaked out of her scalp and from two spots just below her right eye. And then, staring into a monitor, the young woman watched as a succession of mostly disturbing images flashed on a screen in front of her — a horribly mutilated body, a severed hand, a venomous snake poised to strike. Through earphones, the woman was prompted to modulate her emotional response as each image appeared, either to enhance it or suppress it, while the electrodes below her eye surreptitiously tapped into a neural circuit that would indicate if she had successfully modified either a positive or negative emotional response to the images.

”What’s being measured,” Davidson explained, ”is a person’s capacity to voluntarily regulate their emotional reactions.”

Daren Jackson, the lead researcher on the study, added, ”Meditation may facilitate more rapid, spontaneous recovery from negative reactions.”

The visiting monks, as well as a group of meditating office workers at a nearby biotech company, have viewed these same gruesome images for the same purpose: to determine what Davidson calls each individual’s ”affective style” (if they are prone, for example, to hang onto negative emotional reactions) and if that style can be modulated by mental effort, of the sort that meditation seeks to cultivate. It is the hope of Davidson and his sometime collaborator Jon Kabat-Zinn that the power of meditation can be harnessed to promote not only emotional well-being but also physical health.

Since founding the Stress Reduction Clinic at the University of Massachusetts Medical School in 1979, Kabat-Zinn and colleagues have treated 16,000 patients and taught more than 2,000 health professionals the techniques of ”mindfulness meditation,” which instructs a Buddhist-inspired ”nonjudgmental,” total awareness of the present moment as a way of reducing stress. Along the way, Kabat-Zinn has published small but intriguing studies showing that people undergoing treatment for psoriasis heal four times as fast if they meditate; that cancer patients practicing meditation had significantly better emotional outlooks than a control group; and not only that meditation relieved symptoms in patients with anxiety and chronic pain but also that the benefits persisted up to four years after training. Kabat-Zinn is conducting a study for Cigna HealthCare to see if meditation reduces the costs of treating patients with chronic fatigue syndrome, fibromyalgia and irritable bowel syndrome.