Clinician's Roundtable

Host: Shira Johnson, MD Guest: Mitchell Levy, MD Who delivers the best critical care, the critical care specialist or the physician without those credentials? Dr. Mitchell Levy, Professor of Medicine at Brown Medical School and Medical Director of the Medical Intensive Care Unit at Rhode Island Hospital discusses his recent study on the association between critical care management and patient mortality in the ICU. The answer may surpise you! Join host Shira Johnson.

Host: Maurice Pickard, MD Guest: Jonathan Kimmelman, PhD What should be done if research subjects become ill from phase 1 clinical trials? Dr. Jonathan Kimmelman, assistant professor of the Biomedical Research unit at McGill University says most programs do not provide health care or compensation from loss of time from work or for pain and suffering. He also tells host Dr. Pickard that data is viewed as proprietary and is not shared. With trials continuing to move to for-profit companies, is federal oversight being lost? Furthermore, does this lead to increased risk for all those concerned?

Host: Maurice Pickard, MD Guest: Jonathan Kimmelman, PhD Dr. Jonathan Kimmelman, assistant professor of the Biomedical Research unit at McGill University, discusses with host Dr. Maurice Pickard what appears to be a ‘job' that may exploit the underclass in Phase 1 clinical studies. The poor in the studies are less likely to have access to the drugs when approved, which calls the risk/benefit ratio into question. Do for-profit research companies and for-profit Institutional Review Boards provide adequate protection for the rights of the volunteers?

Host: Cathleen Margolin, PhD Guest: Andrea Asnes, MD, MSW A patient's palpable anger during a clinical visit can create uniquely challenging situations for the clinician. Whether or not the emotions are justified, how can a practitioner keep their cool and diffuse the tension? Even when proper medicine is practiced, are there certain situations where apologizing is the most effective course of action? Dr. Andrea Asnes, practicing pediatrician and assistant professor of pediatrics at Yale University School of Medicine, joins host Dr. Cathleen Margolin to share practical advice for managing anger during clinical visits.

Host: Larry Kaskel, MD Guest: Kerri Remmel, MD, PhD Late in 2007 the University of Louisville began utilizing an RP7 robot system to provide neurology support to surrounding county hospitals without on site neurologists. Dr. Kerri Remmel, interim chair of the Department of Neurology and director of the University of Louisville Stroke Program joins us host Dr. Larry Kaskel to discuss the successes of this program since its onset. Dr. Remmel provide an inside look at how physicians, staff and patients have implemented and adapted to telemedicine as a tool to evaluate and treat neurology patients.

Host: Bill Rutenberg, MD Guest: Thomas Saving, PhD "If consumers care about the cost of healthcare, innovations will be directed at making things less costly," says guest Dr. Thomas Saving, the director of the Private Enterprise Research Center at Texas A&M University about how to fund healthcare. In this segment, Dr. Saving discusses with host Dr. Bill Rutenberg how Medicare can pay for itself. They discuss budget based capitation, limited healthcare provisions for retirees and overall reform in the way we pay for healthcare.

Host: Mark Nolan Hill, MD Guest: Beverly Green, MD, MPH By the year 2025, it is predicted that more than 1.5 billion people around the world will have hypertension, accounting for nearly half of heart disease risk and three-quarters of stroke risk. With new Web-based technologies emerging as potential treatment options, how will we change our approach to care? How might these programs impact the treatment of hypertension on a global scale? Dr. Beverly Green, an affiliate investigator at the Group Health Center for Health Studies in Seattle, and the lead author of research published in JAMA on innovative Web-based interventions for patients with uncontrolled hypertension, peers into the future of hypertension care during this discussion with host Dr. Mark Nolan Hill.

Host: Mark Nolan Hill, MD Guest: Beverly Green, MD, MPH The Internet plays such an integral role in so many of our lives, it's only natural to consider expanding its position in medicine. This process is underway, and moving rapidly in some areas, with the first large-scale, randomized clinical trial probing web-based hypertension interventions. How can we, as clinicians, adapt to new digital mechanisms for providing care? Does this particular hypertension concept mesh with the idea of a fee-for-service payment plan? Dr. Beverly Green, an affiliate investigator at the Group Health Center for Health Studies in Seattle, and the lead author of research published in JAMA on innovative web-based interventions for patients with uncontrolled hypertension, explains more about this collaborative approach to care with host Dr. Mark Nolan Hill.

Host: Mark Nolan Hill, MD Guest: Beverly Green, MD, MPH For each 10 millimeter drop toward normal systolic blood pressure, research tells us that heart disease mortality risk drops by an average of 30 percent. New internet-based hypertension interventions are proving they could produce this steep, impressive decline. How can these web initiatives help our patients take a more active role in their care? If patients are based at home, how can we ensure that they are following proper protocol for taking blood pressure measurements? Host Dr. Mark Nolan Hill takes a closer look at these issues and more with Dr. Beverly Green, an affiliate investigator at the Group Health Center for Health Studies in Seattle, and the lead author of research published in JAMA on innovative web-based interventions for patients with uncontrolled hypertension.

Host: Maurice Pickard, MD Guest: Kristine A. Rapp Kristine Rapp, vice president of global ethics & compliance at Hospira, Inc., discusses with host Dr. Maurice Pickard the new PhRMA Code and the significant limitations on gifts to healthcare professionals. The hope is that marketing practices will be held to a higher ethical level.