Clinician's Roundtable

Host: Larry Kaskel, MD Guest: Xavier Sevilla, MD, FAAP What makes a medical home any different than the primary care model in which we have practiced for years? Join host, Dr. Larry Kaskel speak with our guest, Dr. Xavier Sevilla, Practicing Pediatrician and the Academy of Pediatrics representative to NCQA's Advisory Panel on the Patient Centered Medical Home. Dr. Sevilla warns, "This is the last time for us to get it right to practice primary care." We need to get rid of fragmented care and provide patients with superb access with their primary clinician. Learn the key elements that make a practice a medical home and also how fee structures work in a medical home.

Host: Maurice Pickard, MD Guest: Steven Greenberg, MD, PhD Dr. Steven Greenberg, associate professor of neurology at Harvard Medical School and director of the Hemorrhagic Stroke Research Program at Massachusetts General Hospital in Boston, talks with host Dr. Maurice Pickard about the somewhat unexpected finding of an increased frequency of cerebral microbleeds, and explains the potential impact of this discovery on cases of uncontrolled hypertension and cognitive changes. How might this complicate decisions to use antithrombotic therapy? Does this research add a new dimension to certain unexplained phenomena, such as lacunar infarcts or cerebral atrophy?

Host: Gary Kohn, MD Guest: Robert C. Fifer, PhD Dr. Robert C. Fifer, associate professor and director of audiology and speech-language pathology at Mailman Center for Child Development, in the department of pediatrics at University of Miami School of Medicine, talks with host Dr. Bruce Bloom about what physicians need to know about speech and language development. What are other likely causes of slow development? When should chronic otitus media be a concern?

Why do headaches often persist after taking a one-cent aspirin, yet disappear after taking a fifty-cent aspirin? Dan Ariely, behavioral economist and author of Predictably Irrational: The Hidden Forces that Shape Our Decisions, refutes the common assumption that clinicians and patients behave in fundamentally rational ways. From ethics of least harm in pain management to recommendations for conservative vs aggressive therapies, from paying for 'premium' care services to choosing our providers or patients, we consistently overpay, underestimate, and procrastinate. Yet these misguided behaviors are neither random nor senseless. They're systematic and predictable—making us predictably irrational.

You see and hear a patient screaming. You feel the pain they are experiencing. Then soon, something quiets the screams, and quells the suffering. At the core of this transformation? A simple shot of saline. Dr. Dan Ariely, a professor of behavior economics at Duke University, who also holds an appointment at the media lab at the Massachusetts Institute of Technology, joins host Dr. Gary Kohn to discuss the observable evidence behind placebos.

Host: Maurice Pickard, MD Guest: Gary Becker, PhD Dr. Gary Becker, Nobel laureate and professor of economics and sociology at the University of Chicago, joins host Dr. Maurie Pickard to discuss the connection between the gap in supply and demand in the economic market and the same gap in the organ transplant market. Dr. Becker presents a solution and answers the critics.

Host: Maurice Pickard, MD Guest: Gary Becker, PhD Nobel Prize recipient for Economic Science, Dr. Gary Becker, professor of economics and sociology at the University of Chicago, explains how monetary incentives would sufficiently increase the supply of organs for transplant surgery, eliminating the very long queues in the donor market. Undoubtedly the suffering of those on the waiting list would be significantly decreased, but are there costs that might not be immediately obvious? Join Dr. Becker and host Dr. Maurie Pickard for this fascinating discussion.

Host: Maurice Pickard, MD Guest: Nortin Hadler, MD Dr. Nortin Hadler, professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, joins host Dr. Maurice Pickard to discusses his book, Worried Sick: A Prescription for Health in an Overtreated America. Dr. Hadler's book examines the reach of medical treatment in America and the degree to which health is determined by socioeconomic factors that are out of a doctor's hands.

Host: Maurice Pickard, MD Guest: Nortin Hadler, MD Dr. Nortin Hadler, professor of medicine and microbiology/immunology at the University of North Carolina discusses his new book Worried Sick. A prescription for Health in an Overtreated America. He documents how the consumer needs to adopt an attitude of skepticism regarding the claims of modern medicine and arm themselves with enough information to make some of their own decisions about what care is truly necessary. Hosted by Dr. Maurice Pickard

Host: Bill Rutenberg, MD Guest: Bertha Madras, PhD According to Dr. Bertha Madras, deputy director of demand reduction in the White House Office of National Drug Control Policy under President George W. Bush, random drug testing gives young people a good reason not to succumb to peer pressure. But the implementation of random drug testing in schools has stirred a controversial public health debate. Is this an invasion of privacy? Is school an appropriate environment for these measures? Dr. Madras provides a detailed explanation of current policy, and responds to critical comments from groups that oppose the widespread implementation of random drug testing in schools. Dr. Bill Rutenberg hosts.