This list represents my arbitrary ranking of the top ten stories covered which I covered this year. Factors which I used to develop the ranking concern the health of patients and the medical community. Limiting and ranking the list proved much more difficult than I first thought. Readers will disagree with my list, and I invite you to submit your own. I ranked stories higher that I thought had “legs”, i.e., we would continue to rant about this story in 2004.

Honorable mention

Increasing HIV in young gay males in the US – this story should scare all

The pharmaceutical industry – it was very difficult to leave this issue of the list, however, many stories on the list relate to the pharmaceutical industry

The COMET trial – very important, but also fairly specialized information

Quality assessment – I had some interesting rants on this issue and it may emerge as even more important over the next few years

Alternate payment structures for outpatient practice – these include a return to fee for service with no insurance billings and retainer medicine

And now for my list:

10. The influenza epidemic - this story shows the challenge of prevention. The CDC had to guess on the strains to include in the influenza vaccine. They guessed wrong, but seemingly made the best guess possible given the data they had.

9. SARS – this story reminds us once again how vulnerable we are to infectious diseases. We are unlikely to consistently defeat infections. The potential infecting agents are too numerous, and therefore we become susceptible to mutations that naturally occur – some of which are deadly.

8. ALLHAT – I ranted extensively on this subject. This study asked a the wrong question. The principle investigators overhyped the results. The study certainly reminds us to include a diuretic as the first or second line drug. It also reminds us that the most important variable is hypertensive control. Finally, it demonstrates that we should not take results at face value.

7. Preventing type II diabetes mellitus - this should rapidly become a major focus for preventive health. We have three major avenues – weight loss, exercise and medications. Future studies will help us learn how to approach “prediabetics” and how aggressively to screen for “prediabetes”. This story gain improtance due to the epidemic numbers of affected patients.

6. Obesity – this is a curse of Western civilization. We must develop positive programs to decrease obesity. Obesity puts patients at great risk for many problems, including type II diabetes mellitus. This story will not shrink anytime soon.

5. Medical marijuana – one could argue that I ranked this story too high. However, I believe that the intrusion of government into palliation represents a serious dilemma. The story about pain control that I ranted about yesterday represents the corollary issue. We must be able to better study and understand the benefits of marijuana in patients. Many citizens agree, and have voted in favor of these laws.

4. Dietary supplements – we have an illogical law pertaining to supplements. The ephedra fiasco represents the tip of the iceberg. Too many patients take too many supplements without any understanding of how they may effect their bodies, interact with pharmaceuticals, and even interact with each other.

3. The Medicare Bill – we are just starting to understand this bill, its strengths and weaknesses. Regardless of ones opinion, we all recognize this bill as a sea change. Future Congresses will likely modify features of the bill. I expect to rant often in 2004 on the bill’s effects

2. Medical Malpractice – we need true tort reform. We need a totally different system for insuring high quality care. We need a system which does not resemble a lottery. We need a system that protects patients and physicians alike. Our current system is broke – therefore we must fix it.

1. The time pressures on outpatient generalist practice – this is my number one story because I consider myself an advocate for generalist physicians. We ask our generalists to do more each year, and then structure a reimbursement system that pays them a fixed amount for a visit – regardless of the time necessary. It takes time to follow guidelines for prevention. It takes time to explain disease and management to patients. We must fix this problem to provide better quality care.

Many non-physicians think we can fix this with midlevel providers. To that I say “balderdash”! As we learn better how to care for patients the complexities of patient care increase exponentially. It does take a physician to do it right – and a physician with enough time. Not solving this problem will continue to have a major impact on overall patient care. This is our true health care crisis.

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Thank you for reading my blog. The readers continually stimulate me. I hope that I give you food for thought. I hope that medical blogging will eventually provide the grassroots for improving the medical care system. But then I am eternally optimistic.

Happy New Year’s to all. May the coming year bring you health and happiness.

Related posts:

1. Stories and teaching medicine
2. Happy’s daily checklist for medical inpatients
3. Listen to the stories
4. Every patient tells a story
5. Breaking bad news

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