Medicare and the Neurosurgeon

Congress and the President decided to give physicians and the American citizens a month reprieve from the 20% Medicare cuts proposed.  This is a battle that has been waged for the last decade with the SGR (sustainable growth rate) equation being the focus of much debate.  Most years, Congress realizes such a cut will end medicine as Americans have known it and finds a way to reverse the cuts, and if we are "lucky" give doctors a 0.5-2% raise (still well below the annual increased cost of doing business).  Increasingly, specialists such as neurosurgeons are finding it impossible to provide Medicare patients with services at the reimbursements provided.  A close colleague, Dr. Ed Kornel, was recently interviewed by CNN and provides a concise, cogent discussion of the issues.  I encourage all to watch this piece-this is an increasing problem in our health care system that impacts ALL of us: physicians, patients, business.  With an increasing percentage of Americans over 65, this is not a problem that will go away.  If you are not over 65, I bet you know someone (parent, aunt, uncle, friend) who is!  Dr. Kornel on CNN
Dr. Kornel can also be heard weekly on his own radio show talking about the spectrum of back problems and the politics of medicine. http://backtalkonair.com/ and can be followed on his blog ezrielkornelmd.blogspot.com

Oustanding Art II

I love this picture because this woman seems so comfortable, so completely sanguine.  It makes me feel peaceful. I appreciate the animal because it has such a human feel while not divorcing the true animal.  I also adore the artist.  Shelly Timmons is a neurosurgeon with so much talent-as a surgeon, thinker, organizer, motivator, educator and then I find out...as an artist and writer.  No surprise she is also active outside neurosurgery as well (mother, wife, etc).  It has been such an honor to get to know this remarkable woman, to work closely with her within organized neurosurgery, and to be able to showcase her "other talents" in our book. I hope her art brings joy to others as it has to me.

Sofia Ionescu

The woman most often credited as “the first” female neurosurgeon is Sophia Ionesco (photo left), who trained and practiced in Romania (deceased March 21, 2008, age 88).  Her father preferred her to be a "young lady and housewife" but fortunately she had a supportive mother and when a close friend died from a brain infection, her career choice was set. She started medical school in Bucharest in 1939 and after training in neurosurgery, practiced for nearly 50 years before failing vision (!) forced her retirement. 
She was instrumental in establishing Romanian neurosurgery as part of "The Golden Team" (including her husband). 
She received numerous honors in her lifetime-and left a legacy that inspired many women to consider careers in neurosurgery, especially those throughout eastern Europe and the former Soviet Union (more on these inspiring women will follow soon).

Flat Head News

A paper in Pediatrics has linked "flat head syndrome" with early neurodevelopment disadvantage. http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-0052v1
Ever since the fear of SIDS led to the recommendation that babies be put to sleep on their backs (unlike when I raised my kids and the exact opposite was recommended), there has been a dramatic rise in "flat head syndrome" usually felt to be positional and correctable in the majority of cases with positional correction and other simple interventions.  At the same time a recent study have linked SIDS to a brain stem abnormality. http://www.sciencedaily.com/releases/2010/02/100202171811.htm
So one might ask if all this insistence on putting babies on their backs is really a good thing? Or, in fact, given that most Western babies are placed almost continuously on their backs and only a relatively small percentage get "Flat head syndrome", might these infants have some type of genetic predisposition to developmental delay and as such the syndrome is just that-a linked group of features rather than cause and effect.

Medical Education: Attention Long Overdue

JAMA recently published a review of a very important book (http://jama.ama-assn.org/cgi/content/extract/303/5/458): Radiology Education: The Scholarship of Teaching and Learning.  while the educational aspects of medicine have gotten increasing attention on many levels during the last decade, this book focuses on some critic elements.  In fact the book is organized around three key elements: Education for NonEducators (unfortunately, the majority of doctors who are training the next generation fall into this category), Educational Insights from Practitioners (finally some recognition that some teach better than others and may have an inside tract), and Radiology Education Global Outreach (synthesizing lessons learned from many educational milieu).
Those who direct residency training in all specialties should take note of this book and look long and hard about how to effect similar educational  innovation and introspection within their own training programs.

First Ladies of Neurosurgery: Karin Muraszko

Helicoptering: she introduced me to that phrase and I have since realized there are few that do it better!  Karin holds a special place within neurosurgery-she was the first woman in the US to gain the position of Chair with an RRC approved residency training program  at the University of Michigan.  http://www.med.umich.edu/opm/newspage/2004/neurosurgerychair.htm

Her journey there has been anything but easy but at every step of her enormously successful journey she has literally and figuratively "risen above" and in doing so, gained the ultimate advantage of "helicoptering", the ability to see the whole picture, to better understand how the little pieces come together as a whole, and to avoid getting mired in the minutae of the moment.http://www.icyou.com/topics/medical-fields/neurology/harder-brain-surgery+

While her list of accomplishments are many, I would like to comment specifically on one.  Karin has dedicated herself tirelessly to mentoring.  She has taken enormous amounts of time to guide, nurture, and assist more women than any other neurosurgeon (she also mentors men regularly but for better or worse, men have a surfeit of mentors available).  She has guided me through many difficult moments and I know she has done this for others.  Somehow, she always has the time to help with a difficult clinical problem, put a job decision in perspective, see an answer to an organizational dilemna. 

For more than 15 years she has also donated her time and resources to Project Shunt.

Detailed career highlights:
Graduated Yale, 1977
Graduated Columbia Medical School, 1981
President, Women in Neurosurgery (WINS), 1991
Associate Professor, 1996
Assistant Professor, University of Michigan Neurosurgery, 1990
Associate Professo, University fo Michigan Neurosurgery, 2004
Chair, Department of Neurosurgery (First woman in US), 2005
Society of NS, member 2005
Nina Starr Braunwald Award (AWS), 2005
ABNS, Director (First woman), 2008

Patients, patient families, women doctors, women surgeons, neurosurgery, the disadvantaged, the disabled-and more-all have benefitted from the dedication, compassion and expertise of this amazing First Lady of Neurosurgery!

Pop, Pop, Fizz, Fizz: No Relief

The stupidity of some involved in the wide world of medicine never ceases to amaze me.  Today I read that the makers of Maalox in their infinite wisdom created a product called Maalox Total Relief that actually contains a substance that may exaccerbate bleeding (http://www.google.com/hostednews/ap/article/ALeqM5iJ_Wvve3Fl8Wrb6Wf6zjVPRxsYJwD9DU61D81.  And we wonder why so many are calling for health care reform! and why there is such a strong "underground" patient movement (sometimes broadly referred to as Health 2.0 (see http://www.health2con.com/)).
As phsycians, we need to wake up, smell the roses: take control so we do provide RELIEF, not confusion.