A survey of 276 Colorado physicians was published in the May 2002 issue of Archives of Internal Medicine. Physicians were asked about their attitudes toward alternative medicine and their pattern of recommendation and personal use. Here are the interesting findings:

At the doctor’s office, patients are sometimes asked about their use of alternative therapies.

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8% always ask about alternative therapy use
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23% asked their patients about alternative therapy use more than half of the time
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52% asked about alternative therapy use less than half of the time
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17% never ask

Many doctors do not feel comfortable discussing alternative therapies with their patients.

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9% had a very positive attitude toward discussing alternative therapies with patients
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35% had a somewhat positive attitude
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40% were neutral
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14% had a somewhat negative attitude
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2% had a very negative attitude

Patients want information from their doctors about the safety and effectiveness of alternative therapies.

In this study, 59% of the doctors had been asked about alternative therapies. Patients requested information about:

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Acupuncture (59%)
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Herbal (botanical) medicine (55%)
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Chiropractic (52%)
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Alternative medicine in general (49%)
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Massage therapy (41%)
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Special diet (35%)
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Megavitamins (32%)
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Biofeedback (29%)
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Relaxation (28%)
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Homeopathy (21%)
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Folk Medicine (17%)
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Yoga (16%)
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Hypnosis (14%)

Nearly half (48%) of the doctors surveyed had recommended alternative medicine to a patient.

Interestingly, 24% of the doctors had personally used alternative medicine, and this was strongly associated with the likelihood of recommending alternative medicine to patients. Some of the therapies doctors personally used were: massage therapy (24%), relaxation techniques (17%), alternative medicine in general (16%), herbal therapy (14%), yoga (11%), and acupuncture (10%).

Doctors are interested in learning more about alternative medicine to address patient concerns.

In this survey, 60% of doctors wanted to learn more, 24% said they were unsure or maybe wanted to learn more, and 16% said they did not want to learn more. The doctors recommended these therapies to their patients:

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Massage therapy (48%)
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Relaxation techniques (41%)
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Acupuncture (35%)
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Biofeedback (35%)
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Chiropractic (30%)
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Alternative medicine in general (28%)
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Herbal medicine (21%)
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Yoga (16%)
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Hypnosis (15%)

Note: Surveys were delivered to 705 physicians. Of these, 302 (43%) were returned. This must be considered when interpreting the survey results because they may not accurately reflect the physician population.

Reference
Corbin Winslow L, Shapiro H. Physicians want education about complementary and alternative medicine to enhance communication with their patients. Archives of Internal Medicine. 2002:162:1176-81.

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In the modest building that houses Shore Memorial Hospital in this town of about 600 people between the Chesapeake and Hog Island bays, a health care crisis is brewing.

It’s a problem rooted in the 1980s and 1990s, when U.S. medical schools put a cap on enrollments, believing that managed health care, among other factors, would create a glut of doctors.

They were wrong. And now the impact of a national shortage of surgeons and family practice doctors is echoing across the country.

The shortage of surgeons is a particular threat to the health care of 54 million rural Americans, medical specialists say, including the “watermen” who catch crabs, scoop clams and grow oysters here.

Shore Memorial, which on average has 61 patient admissions a day, was built 70 years ago to save lives being lost to simple ills such as appendicitis. Having a surgeon is vital to keeping open the doors of Shore Memorial and thousands of other small hospitals like it.

But as local doctors have moved away from this community or retired during the past 10 years, the ranks have fallen from seven full-time surgeons to two. There also are only two anesthesiologists; one is nearing retirement.

Medical schools were “woefully wrong” in their calculations, says Josef Fischer, who as chairman of surgery at Beth Israel Deaconess Medical Center in Boston trains new surgeons every year. “It’s going to be tough in this situation to make it better.”

From the late 1970s to the mid-1990s, several national advisory groups, including the Institute of Medicine and the Council on Graduate Medical Education, issued reports forecasting a surplus of physicians. As a result, medical schools voluntarily held enrollment relatively constant at about 16,000 new students a year. From 1980 to 2005, enrollment was flat while the U.S. population grew by more than 70 million, according to the Association of American Medical Colleges (AAMC).

After educators realized the forecasting mistake, medical schools began accepting more applicants. Last year nearly 17,800 students entered U.S. medical schools, the largest entering class ever.

However, Fischer says there’s “a perfect storm” forming for a shortage of doctors and surgeons because of the time it takes to train doctors — typically three to seven years — and the fact that the number of senior citizens in the USA is growing rapidly.

As the 79 million baby boomers begin entering retirement age, so are their doctors. From 1985 to 2006, the percentage of doctors 55 and older rose from 27% to 34%, and the AAMC predicted in a 2006 report that members of this group — roughly 250,000 active physicians — will retire by 2020.

The impact often is most severe in rural America, where only 9,334 of 211,908 physicians are general surgeons, according to AMA data. The Census Bureau defines “rural” as open country or small towns with fewer than 2,500 residents.

David Lingle, 43, chief of surgery at Shore Memorial, says he is happy doing the work of several doctors. He answers calls for help when he’s in his yard playing with his children or chopping wood. He can venture farther to fish for flounder or speckled trout only when he is not on call.

Because Lingle is a general surgeon in a small town, the alarm from his hospital pager could mean that a stranger needs help following a crash on the highway that connects North Carolina’s Outer Banks to the New Jersey shore, or a friend from church might be having an aneurysm.

“I like the variety,” says Lingle, who grew up in Arnold, Mo., a suburb of St. Louis. “We’ve figured out a way to make this work, but access to surgery in the periphery is in jeopardy.” He says that he is worried that “nobody will want to sign up for this job anymore.”

Thomas Russell, executive director of the American College of Surgeons, says there are not enough new doctors going into general surgery. Surgeons such as Lingle “have no one to sign off to, they are on call all the time,” Russell says. “They can burn out after doing this year after year after year.”

‘They want balance in their life’

The shortage of surgeons is part of a larger shortage of medical professionals that has been recognized as a threat for more than five years. Medical schools have been enrolling more and more students annually to achieve a 30% increase in enrollment over 2002 levels by 2015.

But even a growing corps of young doctors may not help those who need general medical care, particularly if they live in rural areas, because of the career paths physicians are choosing.

Many of today’s young doctors start their careers $150,000 to $250,000 in debt in education costs, so they often go where they can make the most money, Fischer says. And critical areas such as general surgery and family practice medicine are less lucrative than some specialties, such as bariatric or orthopedic surgery.

A typical new surgeon makes about $165,000 in his or her first year, Fischer says. After five years, he or she will earn $220,000 to $300,000 or more a year, depending on whether the practice is private or in an academic setting.

In rural areas, however, surgeons generally make less, Fischer says, especially if their hospitals don’t supplement their salaries.

The number of physicians in specialties such as thoracic surgery and emergency medicine has more than doubled since 1990, according to the AMA.

However, “fewer and fewer are going into family medicine and primary care,” says James King, president of the American Academy of Family Physicians. And “many are not willing to go” to rural areas.

After an industry-wide review of allegations that surgeons were charging too much, Medicare lowered the amounts that the U.S. government pays doctors during the 1990s. For some common procedures, general surgeons now get about half the money they received 20 years ago, Fischer says.
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A SHY surgeon is facing being struck off for prescribing sex drug Viagra to himself under a WOMAN’S name because he was too embarrassed to go to a doctor.

Bungling medic Jonathan Bala claimed the pills were for a female relative – even though she could not have a use for them.

But Nigerian-born Dr Bala, an intestinal surgeon who worked an 84-hour week in Llandudno hospital’s accident and emergency department, was caught out when a pharmacist in the town’s Asda store became suspicious because he wanted so many of the tablets. She raised the alarm. He had already successfully got hold of the medicine twice.

Last year at Caernarfon Crown Court, the married dad-of-three was given a six-month sentence, suspended for two years, after admitting two charges of obtaining property by deception and one of attempted deception.

Now the doctor’s career is at stake. The General Medical Council will be meeting at a hearing in Manchester to discuss the case on Wednesday and Thursday.

The doctor, who lived in Conwy Road, Ormskirk, and was 42 at the time of the prosecution, is currently suspended but his area of practice is listed as Cumbria on the GMC’s website.

In a statement, the GMC said: “It is alleged that Dr Bala failed to inform the GMC of this conviction. It is further alleged that Dr Bala failed to disclose the conviction when he took up employment with the North Cumbria Acute Hospitals Trust.

“It is alleged that Dr Bala’s actions were misleading and dishonest.”
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The U.S. Government is no more qualified to advise doctors on medical treatments than the health insurance companies are. Unfortunately in both cases this is a situation that is occurring all too frequently. The U.S. Government feels compelled to interject itself into every aspect of our lives, whether it is warranted or whether it is qualified to do so or not. Each and every day we give up a little more of our freedom by allowing the government a little more control over our lives when we do not stand up for ourselves.

In the case of medical treatments your doctor should have the final say in what is best for his patients. All too often doctor’s choices are limited either by the government or by the health insurance company. People and entities that do not have the medical qualifications to treat patients should not be involved in the decision of treatments. This is a simple fact, one that the government takes seriously in the malpractice lawsuits that are forever appearing before the court system. Yet this is something the government seems to fail to enforce when it comes to both itself and the insurance companies.
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There was a poll taken among doctors recently that indicated doctors thought there were too many doctors in the United States.

Well, of course doctors think there are too many doctors. It’s like asking real estate salesmen whether they think there are too many real estate salesmen.

I’d like to have a poll taken among patients to see if patients think there are too many doctors.

My position is that until every American has his own personal physician in constant attendance to take care of any hangnail that might occur during the day, there aren’t too many doctors.

We all want the kind of care President Bush gets. If I have a heart attack and start to fall, I want a doctor right there to catch me and start giving me nitroglycerin before I hit the floor.

I don’t have a lot of complaints with doctors. As a matter of fact, I have a high regard for them.

My wife’s father was a doctor. I admired him greatly and learned a lot about the medical profession from him.

I was skiing years ago at Lake Placid and took a bad, head-over-heels fall. I had made friends in the lodge with a doctor and we were skiing together when I went down. I didn’t have any idea what my new friend’s medical specialty was, but I knew I’d done something serious to my shoulder. So, when he came up to where I was lying in the snow, I asked him to see if my collarbone was broken. He looked anguished and said, “Gosh, Andy. I’ve been practicing psychiatry for 18 years. I don’t know one bone from another.”

Most of us think that until we beat the whole ugly business of dying, there are NOT too many doctors. I have no business giving doctors advice but I’m going to anyway.

Doctors should never talk to ordinary people about anything but medicine.

Doctors should never talk politics because just as soon as a doctor does he reveals an average mind. He sounds like an idiot – just like the rest of us when we talk politics. We don’t want our doctors to sound like everyone else. We want our doctors to be special – smarter than all the rest of us about everything.

I have a great friend I grew up with. We studied together and played football together. Hundreds of times I sat next to him on a locker room bench and watched him tie his shoelaces. He did not know how to tie his shoelaces. His laces always ended up with the loops parallel to the shoe instead of with the bow across.

This is a doctor who knows how to do the most sophisticated things with the organs inside a human body…but can’t tie his shoelaces?

My wife’s father was one of the first surgeons in the United States to do the hip replacement operation in the 1930s. However, I clearly remember watching him trying to replace the lock and knob on the front door of his house. He bungled it so badly that he finally had to call a carpenter who replaced the whole door because it was so screwed up.

So doctors should not only avoid conversations with ordinary mortals about everyday subjects, they should also avoid doing small, common jobs that might expose an ineptness that their patients would never otherwise observe.

A few years ago, a university medical research group announced that two aspirin taken every other day reduced the risk of heart attacks in older people. Being, as I am, one of them, I started taking two aspirin. Three weeks later, another medical group announced that aspirin taken regularly might increase the risk of cancer of the colon.

I’ve stopped taking aspirin frequently. I’ll probably die of a heart attack while being treated for cancer of the colon – all because of good advice from my doctor.

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