Clinician's Roundtable

Host: Larry Kaskel, MD Guest: Neal Goldstein, JD On October 30, 2008, the Centers for Medicare & Medicaid Services (CMS) published the 2009 Physician Fee Schedule, which includes revisions to the Stark regulations that tighten the prohibition on physician referrals and the anti-markup rules for diagnostic testing. Attorney Neal Goldstein explains that the changes made by CMS are an attempt to create a formulation that preserves the legitimate provision of in-office diagnostic services, while also cutting back on the proliferation of arrangements that have allowed physicians to profit from the diagnostic work of pathologists, radiologists and other specialists. Mr. Goldstein highlights the key tests for establishing compliance with the new anti-markup rules, though acknowledges that these revised regulations may unwittingly cause controversy within the pathology laboratory industry. Host Dr. Larry Kaskel explores the practical implications of these changes for the private and group physician practice.

Host: Leslie P. Lundt, MD Guest: Edward Shorter, PhD Recently-trained physicians may consider barbiturates and tricyclic antidepressants footnotes in history. But have they dismissed the most effective therapeutics in psychiatry? Dr. Edward Shorter, professor of psychiatry and the Hannah Chair in the History of Medicine and at the University of Toronto, joins host Dr. Leslie Lundt to talk about the evolution of antidepressants

Host: Leslie P. Lundt, MD Guest: David R. Spiegel, MD Patients who are not forthcoming about their alcohol history jeopardize our ability to provide the best possible clinical care. Many instruments such as the CAGE rely only on the patient's self-report. Luckily, we have several biomarkers to assist us. How and when to use which test? Dr. David Spiegel, associate professor of clinical psychiatry and behavioral sciences and director of the consultation-liaison service at Eastern Virginia Medical School in Norfolk, Virginia, joins host Dr. Leslie Lundt to discuss the specifics of blood tests to detect alcohol misuse.

Host: Leslie P. Lundt, MD Guest: Christopher Drake, PhD Can cardiovascular stress research teach us anything about insomnia? Dr. Christopher Drake, assistant professor of psychiatry and behavioral neurosciences at the Wayne State University School of Medicine in Detroit and a bioscientific staff investigator at the Henry Ford Hospital Sleep Disorders and Research Center joins host Dr. Leslie Lundt to discuss his research into the insomnia stress test.

Host: Mary Leuchars, MD Guest: Daniel Alford, MD, MPH Treating pain is rarely an absolute science, and where opioid use is concerned, it is never risk-free for patients. How can physicians safely prescribe opioids for chronic pain, and what are the risks of addiction? Dr. Daniel Alford, associate professor of medicine and director of Chief Resident Immersion Training in Addiction Medicine section of general internal medicine at Boston University School of Medicine, speaks with host Dr. Mary Leuchars about opioid use for chronic pain.

Host: Lisa Dandrea Lenell, PA-C, MPAS, MBA Guest: William Leinweber, MBA Chief executive officer of the American Academy of Physician Assistants, Bill Leinweber, discusses the developments and goals of the organization with host Lisa D'Andrea Lenell. Mr. Leinweber highlights the professional responsibilities of physician assistants, the need to ensure physician assistants fill the increasing demand for primary care services, and the issues arising out of specialization within the profession. The conversation outlines the organization's goals in terms of addressing the needs of its membership and supporting the medical community.

Host: Lisa Dandrea Lenell, PA-C, MPAS, MBA Guest: Vic Germino, PA-C Guest Vic Germino, a member of the 1961 first graduating class of the physician assistant program established at Duke University, discusses the history of the profession with host Lisa D'Andrea Lenell. Mr. Germino explains how Dr. Eugene Stead, Jr., then chairman of the department of medicine at Duke University, conceived of the program and the obstacles confronting the first physician assistants. Mr. Germino also discusses the development of the practice and the changes he has observed of the physician assistant's role in providing healthcare services.

Host: Bruce Bloom, DDS, JD Guest: Yuri Danilov, PhD Patients with brain damage can learn to see and balance through sensory substitution using the tongue. Join host Dr. Bruce Bloom for a fascinating look into new research with Dr. Yuri Danilov, senior scientist at the Tactile Communication & Neurorehabilitation Laboratory at the University of Wisconsin-Madison. A new understanding of the anatomy and physiology of the central nervous system can help patients with neurological and neuromuscular diseases such as multiple sclerosis and Parkinson's disease regain visual and motor skills.

Host: Susan Dolan, RN, JD Guest: Sue Ann Thomas, PhD, RN Should terminally ill patients have implantable cardioverter defribrillators (ICDs)? Join Dr. Sue Thomas, assistant dean for PhD studies and professor at the University of Maryland School of Nursing, as she discusses the implications of ICDs for terminally ill patients. Dr. Thomas tells host Susan Dolan how the ICDs is deactivated. They also talk about whether an ethics committee should be involved in the decision to deactivate an ICD, and the nurse's role in caring for patients with these implanted devices.

Host: Susan Dolan, RN, JD Guest: Sue Ann Thomas, PhD, RN What is the psychological impact of having an ICD? Dr. Sue Thomas, assistant dean for PhD studies and professor at the University of Maryland School of Nursing, shares her research as principal investigator on the PRHAT trial, in which she investigated long-term changes in anxiety and depression amongst patients post-MI. Dr. Thomas also outlines a holistic model of cardiovascular health. Susan Dolan hosts.