MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'doctor'. Sat, 03 Sep 2011 01:49:51 +0100 http://www.medworm.com/index.php?rid=5181799&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fimproving-doctor-patient-communication-to-provide-patient-centered-care%2F2011.09.01 The first experience patients are likely to have with your hospital is not in an ER visit or inpatient stay.  A patient’s first experience will most likely be in one of your primary-care physician offices.  That because a person is 10 times more likely during a year to end up in the physician’s office for a routine visit than they are to require an overnight hospital stay. As a hospital marketer or patient experience officer this should raise an interesting question. How well do your physicians–particularly your primary-care physicians–represent your brand? Take “patient-centeredness.” Lots of hospitals these days are promoting themselves as providing patient-centered care.  You know … when the hospital and its staff try where possible to be sensitive to and honor the wish... Better Health blogs http://www.medworm.com/rss/comments.php?id=5181799 Thu, 01 Sep 2011 18:00:05 +0100 5181799 http://www.medworm.com/index.php?rid=5181802&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmisdiagnosis-happens-all-the-time-tips-to-avoid-it%2F2011.09.01 Billionaire Teddy Forstmann has apparently been diagnosed with a serious form of brain cancer.  There’s a tragic twist to the story: according to Fox Business News, Forstmann believes that for more than a year, he had been misdiagnosed with meningitis. ABC News wonders: How could such a misfortune befall a billionaire —- a man able to afford the best doctors, best technology and the most sophisticated diagnostic tests? They’re missing the point.  Misdiagnosis happens with shocking regularity – as much as (more…) *This blog post was originally published at BestDoctors.com: See First Blog* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=5181802 Thu, 01 Sep 2011 12:00:03 +0100 5181802 http://www.medworm.com/index.php?rid=5181943&cid=t_99909_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F09%2Fwhere-are-indian-medical-entrepreneurs.html The Indian healthcare industry has become sick and disruptive innovations are needed to heal it ! This is a huge business opportunity . We need to remember that healthcare spending in India today accounts for less than 4.2% of the GDP, whereas in most developed countries it is 6-9% and in the USA it is as much as 16%. This means there is immense growth potential in India in this sector ! Since doctors deal with patients daily, and see the problems and pain points firsthand, one would expect them to be leaders in creating fixes to heal the system. However, they are very few medical entrepreneurs in India today . I feel there are many reasons for this. For one, doctors are part of the problem themselves ! They are so used to making patients wait, that they don’t even realize that this u... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5181943 Thu, 01 Sep 2011 05:58:00 +0100 5181943 http://www.medworm.com/index.php?rid=5182237&cid=t_99909_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2011%2F08%2Fdr-google-or-what.html So I have written about googlechondria recently. We are all victims of it. Our mind takes over our fingers and we google away until we are sure we have stage IV brain cancer or the bubonic plague. Then we go to our doctor and they look at our symptoms, listen to our complaints (whines), and give us a diagnosis and treatment plan. But what about if there needs to be a little more? What if the patient self educates and asks a panel of experts for their thoughts? Take a look at www.cancergrace.org. I know the video is long - 10 minutes - but at the end it directs you to CancerGrace where you can ask a panel of experts about your cancer questions. I think this is very cool. My problem is then to remember about this site so that if (when) I have cancer questions again, I can go ask them the... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=5182237 Wed, 31 Aug 2011 11:05:00 +0100 5182237 http://www.medworm.com/index.php?rid=5174692&cid=t_99909_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F08%2Fputting-end-to-didnt-ask-didnt-tell.html This is a guest post from a clever medical student , Muthukar Ramanathan. If there are more like him, the future of medical practise holds a lot of promise ! ---------------- How many times have you felt that you forgot to mention something important after leaving your doctor’s clinic ? Unable to ask an embarrassing question or to did not remember to discuss your recent allergy? This familiar problem of "Didn't Ask Didn't Tell" among patients is due to multiple reasons - chiefly lack of recollection, stress or even laziness. But this inability to communicate well with physicians ultimately hurts patients due to incorrect diagnosis or treatment. As a medical student sitting as an observer in physician's office, I noticed that many times patients could not accurately provide much needed... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5174692 Mon, 29 Aug 2011 14:59:00 +0100 5174692 http://www.medworm.com/index.php?rid=5174614&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-beneficial-effect-of-laughter-on-your-health%2F2011.08.29 I stumbled upon the article ‘Laughter: gender-specific variations’ in Revista Clínica Española (‘Spanish Clinical Journal’) and I can’t help thinking about the need for taking this into account to improve doctor-patient relationships. The text can actually be read as a guide to understand how every person laughs and how to use it in clinical practice. Table 1. Laughter effect on health (more…) *This blog post was originally published at Diario Medico* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=5174614 Mon, 29 Aug 2011 14:00:27 +0100 5174614 http://www.medworm.com/index.php?rid=5174667&cid=t_99909_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F08%2F28%2Fthe-curious-case-of-phineas-gage-and-others-like-him%2F If you’ve ever taken an introductory psychology class, then you probably know the story of Phineas Gage, the 25-year-old railroad worker whose personality dramatically changed after a rod pierced his skull. Gage lost portions of his frontal lobe and went from being a kind and mild-mannered man to rude and unrestrained. On September 21, 1848, The Boston Post reported on the incident. The article was called “Horrible Accident” and said: As Phineas P. Gage, a foreman on the railroad in Cavendish, was yesterday engaged in tamping for a blast, the powder exploded, carrying an instrument through his head an inch in length, which he was using at the time. The iron entered on the side of his face, shattering the upper jaw, and passing back of the left eye, and out at the top of the head.... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=5174667 Sun, 28 Aug 2011 12:17:17 +0100 5174667 http://www.medworm.com/index.php?rid=5169553&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fgreat-clinical-care-and-excellent-bedside-manner-are-they-mutually-exclusive%2F2011.08.26 The New York Times recently published an article titled, Finding a Quality Doctor, Dr. Danielle Ofri an internist at NYU, laments how she was unable to perform as well as expected in the areas of patient care as it related to diabetes.  From the August 2010 New England Journal of Medicine article, Dr. Ofri notes that her report card showed the following – 33% of patients with diabetes have glycated hemoglobin levels at goal, 44% have cholesterol levels at goal, and a measly 26% have blood pressure at goal.  She correctly notes that these measurements alone aren’t what makes a doctor a good quality one, but rather the areas of interpersonal skills, compassion, and empathy, which most of us would agree constitute a doctor’s bedside manner, should count as well. Her articl... Better Health blogs http://www.medworm.com/rss/comments.php?id=5169553 Fri, 26 Aug 2011 14:00:00 +0100 5169553 http://www.medworm.com/index.php?rid=5158991&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fimproving-surgical-residents-bedside-manner%2F2011.08.25 I was alerted to this Archives of Surgery article (full reference below) by MedPage Today:  Role Playing Boosts Surgical Residents’ Bedside Manner. I find it intriguing.  Role playing gives you a chance for a “do-over” when you make a social or communication faux pas. So much of medicine is communication.  Those of us who have been at it for years, deliver bad news differently (learned the hard way) now than we did previously.  You choose your words more carefully (though I still occasionally screw up).  Some words are more emotionally charged than others.  Some patients want more information than others. The University of Connecticut Health Center conducted a prospective study  of a pilot project designed to  teach surgical residents patient-centered communication skills... Better Health blogs http://www.medworm.com/rss/comments.php?id=5158991 Fri, 26 Aug 2011 00:15:00 +0100 5158991 http://www.medworm.com/index.php?rid=5159258&cid=t_99909_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F08%2Fhow-can-we-get-patients-to-take-more.html It's extremely easy to criticize doctors for the sad state of health care today. Most patients are very articulate about the fact that their doctor spends very little time with them ; that he makes them wait unnecessarily for long hours ; and that he provides them with precious little information about their illness. This causes a lot of heartburn and frustration ; and many people believe that doctors are now behaving more like businessman rather than professionals. While there may be some truth in this criticism , it is also equally true that doctors are soft and easy targets. In fact , the press has played a major role in bashing doctors , and while it's true that stories about unethical doctors who indulge in corrupt acts help them to sell more newspapers , sadly all these stories also... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5159258 Tue, 23 Aug 2011 04:38:00 +0100 5159258 http://www.medworm.com/index.php?rid=5139736&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-physician-ratings-arent-quite-adequate-yet%2F2011.08.17 “Most physicians are competent and able to take care of most of the problems patients present with.  The standards for getting into medical school are high and for getting out are higher.  I think this call for patients to become experts in picking their doctors is overstated.”  – David Rovner, MD, Professor Emeritus, Michigan State University Most?  What does “most” mean?  Can most doctors treat me for the flu?  How about pancreatic cancer? Must I conduct the same type of research to choose a doctor to set my broken arm that I do to find one to treat my mom’s congestive heart failure?   Is the same level and type of research necessary to find a good surgeon as for a primary care clinician? (more…) *This blog post was originally published at Prepared Pat... Better Health blogs http://www.medworm.com/rss/comments.php?id=5139736 Wed, 17 Aug 2011 21:00:37 +0100 5139736 http://www.medworm.com/index.php?rid=5130747&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fshould-doctors-want-their-patients-to-use-the-web-to-stay-informed%2F2011.08.15 Recently, I’ve had an interview with a national newspaper and the woman who performed the interview told me she was surprised that I seemed to be the first doctor in her life who was happy about patients using the internet. Well, she surprised me with this statement as I’ve never thought about that before. But she must be right. There are many doctors who get upset when they find out the patient tried to find information online. They are frustrated as they don’t even know how to use these online tools and have no idea how to help the patients in this perspective. Myself, I’m pretty much happy about it. I love to hear patients (more…) *This blog post was originally published at ScienceRoll* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=5130747 Mon, 15 Aug 2011 14:00:41 +0100 5130747 http://www.medworm.com/index.php?rid=5118642&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpediatric-physician-joins-collaborative-network-and-sees-improvement-in-his-work%2F2011.08.11 I never thought I’d change the way I practice medicine.  But I recently enrolled as a provider in the Improved Care Now (ICN) collaborative network and I’m already working differently. ICN is an alliance of gastroenterologists and patients working in a new model of pediatric inflammatory bowel disease care based on the analysis of thousands of doctor–patient visits as well as the latest studies and treatments.  Doctors and patients apply this information, experiences are tracked in an open registry, the results are then shared and refined to improve care.  I can see what I’m doing well and where I’m falling short relative to other clinics and pediatric gastroenterologists. ICN is under the direction of Dr. Richard Colletti of the University of Vermont.  ICN is supported by t... Better Health blogs http://www.medworm.com/rss/comments.php?id=5118642 Thu, 11 Aug 2011 16:00:26 +0100 5118642 http://www.medworm.com/index.php?rid=5118746&cid=t_99909_113_f&fid=34634&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FEmrAndHipaa%2F%7E3%2FQcpbBa3mVII%2F This is the next in a series of EMR and EHR interviews that will be done on EMR and HIPAA and EMR and EHR. The full EMR interview with Dr. Ho can be found on the new EHR and EMR interviews website. The following is a summary of that interview written by Kathy Bongiovi. After completing a family practice residency at the University of Rochester in 1989, Dr. Ho worked in a variety of settings before making her decision to open her no-staff “micropractice” in 2004. Ho defines micropractice as being “a small, low overhead, no staff, hightech-high touch practice.” Because Ho believes the current financing model of delivering primary care by cranking up the volume of visits in order to meet overhead and salary is broken she wanted to move to a model that would be better for patients and ... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=5118746 Wed, 10 Aug 2011 19:18:04 +0100 5118746 http://www.medworm.com/index.php?rid=5107601&cid=t_99909_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F08%2F08%2Fantidepressants-overprescribed-in-primary-care%2F Antidepressants have long enjoyed a reputation as being a quick and “easy” treatment for all types of depression — from a mild feeling of being a little down, all the way up to severe, life-debilitating depression. But like all medications, they have side effects and instances where they should not be prescribed. Hence their continued need for a prescription after seeing a doctor. So what does it mean when primary care physicians are handing them out like candy? It suggests that your family doctor doesn’t really understand how antidepressants work, or what they are approved to treat. In short, it suggests that antidepressant medications are being over-prescribed by well-meaning doctors who are simply not using very good judgment. Melissa Healy, writing for the LA T... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=5107601 Mon, 08 Aug 2011 10:35:31 +0100 5107601 http://www.medworm.com/index.php?rid=5103336&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealth-care-attorney-discusses-the-use-of-disclaimers-on-facebook-pages%2F2011.08.06 This is the third part of a three part post addressing the legal concerns of social networking in the health care arena. In part one, legal expert David Harlow, Esq., Health Care Attorney and Consultant at The Harlow Group, LLC in Boston, answered questions regarding “The Legal Implications for Doctors, Nurses and Hospitals Engaging in Social Media?” In part two, Mr. Harlow answered questions related to the Pharma industry;  “Legal Concerns: What Steps can Pharma Take to Engage in Social Media?” The third part addresses a question from a follower on Facebook about the use of disclaimers. Q:  Barbara: A Healthin30 reader on Facebook writes:  “I’m looking for a good disclaimer to put on a couple of medical practices’ Facebook pages. The AMA social media guidelines aren’t h... Better Health blogs http://www.medworm.com/rss/comments.php?id=5103336 Sat, 06 Aug 2011 21:00:47 +0100 5103336 http://www.medworm.com/index.php?rid=5103529&cid=t_99909_177_f&fid=38137&url=http%3A%2F%2Fmissionimpossibleinfertile.wordpress.com%2F2011%2F08%2F06%2Fbrief-notes-from-the-land-of-the-knackered%2F 1. Normal Karyotype. 2. Interview done for College of Odds and Sods. Unfortunately I think number one above is probably the better item to dwell on for oh-so many reasons than the apty named number two because I theeenk I could have interviewed in a slightly less startled-rabbit manner. Well, I could have with a scotch or two on board and perhaps not directly on the back of huffing my pregnant high-heeled insane way fifteen minutes down a busy road and up a flight of stairs but I DID enjoy looking at my abdomen at the blessed end when the panel asked if I had any questions. I asked, as the least reproductively dangerous candidate on the grounds that I neither want to drive a mini-van or become a GP and I already own more children than the average female doctor even a GP, for their views o... Mission: Impossible (or adventures in infertility, pregnancy....parenting?) blogs http://www.medworm.com/rss/comments.php?id=5103529 Sat, 06 Aug 2011 12:07:00 +0100 5103529 http://www.medworm.com/index.php?rid=5103342&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhat-should-people-receiving-health-care-be-called-empowered-patient-vs-health-care-consumer%2F2011.08.05 “There is a better way – structural reforms that empower patients with greater choices and increase the role of competition in the health-care marketplace.” Rep. Paul Ryan (R-WI) August 3, 2011 The highly charged political debates about reforming American health care have provided tempting opportunities to rename the people who receive health services.  But because the impetus for this change has been prompted by cost and quality concerns of health care payers, researchers and policy experts rather than emanating from us out of our own needs, some odd words have been called into service.  Two phrases commonly used to describe us convey meanings that mischaracterize our experiences and undervalue our needs: “empowered patient” and “health care consumer.” As one who has done ... Better Health blogs http://www.medworm.com/rss/comments.php?id=5103342 Fri, 05 Aug 2011 21:00:35 +0100 5103342 http://www.medworm.com/index.php?rid=5096205&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwill-patients-accept-the-patient-portal-as-the-next-big-thing%2F2011.08.04 There seems to be an inverse relationship between the amount of spin one hears about “the next big thing”…and reality.    First it was EMRs and virtual e-visits, then social media, and now patient portals seem poised to be next big thing.  The drumbeat of vendors and pundits is unmistakable….physicians that don’t adapt will be toast.   It can all sound pretty convincing until you ask to see the evidence.  What do patients think? Take the physician patient portal.   If you read between the lines, patient portals are frequently being positioned as the new “front door” to physician practices.   By signing on to a secure website patients will have real time access to the electronic health record and will be able to communicate with their physicians by e-mail.   Addit... Better Health blogs http://www.medworm.com/rss/comments.php?id=5096205 Thu, 04 Aug 2011 16:00:59 +0100 5096205 http://www.medworm.com/index.php?rid=5086171&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fnew-program-at-usf-health-hopes-to-mold-more-empathetic-physicians%2F2011.08.01 Can we teach empathy to the next generation of physicians?  The University of South Florida Health thinks so and they’re putting it on the line this week with the launch of the SELECT program, a new curriculum intended to “put empathy, communication and creativity back into doctoring.” The SELECT (Scholarly Excellence. Leadership Experiences. Collaborative Training.) program will offer 19 select students unique training in leadership development as well as the scholarly tools needed to become physician leaders and catalysts for change. During their first week on campus, instead of the old-style medical school tradition of heading to the gross anatomy lab, SELECT students are immersed in leadership training centered in empathy and other core principles of patient-centered care. The h... Better Health blogs http://www.medworm.com/rss/comments.php?id=5086171 Mon, 01 Aug 2011 12:00:15 +0100 5086171 http://www.medworm.com/index.php?rid=5077684&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpatient-empowerment-has-the-potential-to-be-problematic%2F2011.07.29 Let me say first that I am a practicing primary care doctor who is very much focused on patient centered care.  Though I cannot go back to being a patient who is unaware about what a doctor does, the terminology she uses, or what the importance of certain test results are, I can empathize with the overwhelming amounts of information, challenges, and stressors patients and families can have in navigating the healthcare system to get the right care.  This is the reason I wrote my book. However, over the past few months I’ve noticed a particularly disturbing trend.  Patients are not consulting doctors for advice, but rather demanding testing for diagnoses which are not even remote possibilities.  A little knowledge can be dangerous particularly in the context of little to no clinica... Better Health blogs http://www.medworm.com/rss/comments.php?id=5077684 Fri, 29 Jul 2011 21:00:00 +0100 5077684 http://www.medworm.com/index.php?rid=5077685&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ftake-an-active-role-in-your-own-health-it-can-save-more-than-just-your-life%2F2011.07.29 Sometimes you need a published study to tell you what should be obvious in the first place. This time, researchers have discovered that: When physicians have more personalized discussions with their patients and encourage them to take a more active role in their health, both doctor and patient have more confidence that they reached a correct diagnosis and a good strategy to improve the patient’s health. Really? But wait, there’s more. (more…) *This blog post was originally published at See First Blog* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=5077685 Fri, 29 Jul 2011 18:00:07 +0100 5077685 http://www.medworm.com/index.php?rid=5077966&cid=t_99909_136_f&fid=36032&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-breast-cancer%2Fyou-get-to-choose-your-doctors%2F I write often about how it is important to work with doctors you like and can trust. I was reminded of this last week when I had my four-month oncologist appointment. I love my oncologist, Dr. Khan. He has a gentle spirit, he is always cheerful, and he is always happy to see me. I spend much of the appointment asking about the chances of cancer returning and reviewing the effects of all the treatment I had. He in turn spends much of the appointment reassuring me and reminding me that although he can never say that breast cancer is completely cured, he is convinced that I will be around for a long, long time. He can be so confident because even his patients who have had cancer return or metastasize tend to live a long time with the chronic condition. Dr. Khan is very aggressive in treating ... Life with Breast Cancer blogs http://www.medworm.com/rss/comments.php?id=5077966 Thu, 28 Jul 2011 16:22:26 +0100 5077966 http://www.medworm.com/index.php?rid=5077692&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fphysician-shows-gratitude-for-his-often-unappreciated-colleagues%2F2011.07.28 Today I would like to say thanks to a group of colleagues that too often go un-thanked. These would be my hospital-based internal medicine friends: hospitalists are what they are called. This idea came to me after reading Dr Robert Centor’s post on KevinMD. In his usual concise manner, he laments the lack of respect that many sub-specialists show hospitalists. I feel differently about my hard-working colleagues. As a sub, sub-specialist who works primarily in the hospital, I would like to say how grateful I am to have knowledgeable, hospital-based internists available. I believe, and write frequently about the importance of seeing the forest through the trees. A good doctor must see the big picture: a little atrial fib, for instance, isn’t a major problem if you can’t move, eat or ha... Better Health blogs http://www.medworm.com/rss/comments.php?id=5077692 Thu, 28 Jul 2011 14:00:54 +0100 5077692 http://www.medworm.com/index.php?rid=5077975&cid=t_99909_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2011%2F07%2Fbalancing.html So you were told once you had _____ (fill in with any nasty ailment, top of the list is cancer). For the rest of your life you try to balance the fear that you could be told you have it again with the rationale that the odds are on your side. The diagnosis turned you into a pessimist - I'm gonna die mentality - instead of being a healthy optimist. There is some theory that if you think you have something long enough you can actually give yourself the condition - I think that's a load of crap. But I do think that its all about learning to cope with your fears.This woman writes about trying to cope - of course swollen lymph nodes, sore back, and cough mean her cancer came back everywhere. When she finally reluctantly gets to the doctor she is told she has the same virus that is going around.... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=5077975 Thu, 28 Jul 2011 10:27:00 +0100 5077975 http://www.medworm.com/index.php?rid=5069471&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-physicians-fail-to-take-responsibility-for-their-own-orders%2F2011.07.27 A physician asked me a question regarding what should be the role of hospitalists in carrying out discharge orders written by other physicians. I have been following your blog since I was a resident and recommend it to a lot of people.  Thank you so much for enlightening me on so many day to day hospital issues.  I wanted to know your opinion about something that puzzles me.  When a specialist changes a medication or requires a lab to be done as outpatient after a discharge order is written (for example you write: okay to D/C if okay with cardiology, and they change a dose or request stress test out-pt) who is required to write the new scripts and arrange that test? Is it the hospitalist’s responsibility to do it? Or is the specialist who changed the dose after you rounded require... Better Health blogs http://www.medworm.com/rss/comments.php?id=5069471 Wed, 27 Jul 2011 21:00:00 +0100 5069471 http://www.medworm.com/index.php?rid=5069747&cid=t_99909_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2011%2F07%2Fdoctors.html Usually when you visit the doctor, the hospital personnel and medical staff all seem to be on the healthy side. There may be a few exceptions but hospitals seem to be full of doctors and nurses and other who have narrow waists, low BMI and you never catch a whiff of cigarette smoke near them. I can say that all my doctors are a healthy weight - except the pregnant ones. So when they start talking about weight and healthy eating and exercise, I do give them credit that they must follow that life style as well - they must walk the walk as well as talk the talk. I know about twenty years ago, I was treated by a nurse who had a pack of cigarettes in her pocket. I never see cigarettes around any more. The hospital now has a no smoking campus, so you see dwindling numbers of smokers hiding off t... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=5069747 Wed, 27 Jul 2011 10:09:00 +0100 5069747 http://www.medworm.com/index.php?rid=5069480&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-stories-in-medicine-that-need-to-be-told%2F2011.07.26 I can’t help but think that as time passes we’ll forget about how much medicine has changed with the introduction of the Internet.  We’re witnessing a transition that hasn’t been seen in generations.  We live with the end result but the memory of how we got here is fading quickly.  Like any kind of cultural shift, once we’ve arrived it’s hard to remember what it was like along the way. How did patients think before the information revolution?  And how did it go down when patients began to search?  How specifically did information clash with the old model of doctor and patient and how did we deal with it?  There are stories here that need to be told.  I think the real stories are in the small details of what went down between doctors and patients. But as early adopters, ... Better Health blogs http://www.medworm.com/rss/comments.php?id=5069480 Tue, 26 Jul 2011 12:00:15 +0100 5069480 http://www.medworm.com/index.php?rid=5062245&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fnew-blood-thinner-shifts-responsibility-to-patients%2F2011.07.24 I recently came across a very important blog post on the use of the novel new blood-thinner, dabigatran (Pradaxa). Fellow Kentucky cardiologist, and frequent TheHeart.org contributor, Dr. Melissa Walton-Shirley wrote this very detailed case presentation involving a cantankerous non-compliant rural patient with AF (atrial fibrillation) that sustained a stroke while “taking” dabigatran. Dr. Walton-Shirley details the very commonly done procedure of cardioversion (shock) for AF. As she clearly points out, the most important safety feature of shocking AF back to regular rhythm entails adequate blood thinning before and after the procedure. Thin blood prevents the possibility of clots dislodging after restoring normal contraction to the top chambers of the heart (atria). Herein lies the rub... Better Health blogs http://www.medworm.com/rss/comments.php?id=5062245 Sun, 24 Jul 2011 18:00:37 +0100 5062245 http://www.medworm.com/index.php?rid=5057721&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fone-physician-learns-to-efficiently-manage-her-electronic-medical-records%2F2011.07.23 My practice has been using the EPIC electronic medical record for 5 years now, and it’s taken about that long for me to figure out how to tweak the system to make myself more efficient, and for the system to evolve to a place where I could tweak it myself. Case in point – Quick Actions. EPIC’s most recent upgrade includes little self-made macros called “quick actions” that turn repetitive tasks into a mouse click. I’m using quick actions to manage my results in basket in much the same way you may be using Rules in Outlook to manage your email. Some of my macros are actually little work-arounds for a system that is not yet entirely integrated and a patient population that has not yet embraced online results communication. About half of my patients sign up for online results – ... Better Health blogs http://www.medworm.com/rss/comments.php?id=5057721 Sat, 23 Jul 2011 19:00:03 +0100 5057721 http://www.medworm.com/index.php?rid=5057726&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fhealthecommunications.files.wordpress.com%2F2011%2F07%2Ftime-and-money.jpg “I don’t have the time…I don’t get reimbursed for that.”  This is an all too common refrain from primary care physicians and practice managers when ever the subject of improving physician-patient communications comes up. I get it.   Primary care physicians in particular are under tremendous pressure to produce.   Just imagine…physicians in small primary care practices spend about 3.5 hours/week just on dealing with insurance-related paperwork.  Then there’s keeping up with recommended treatment guidelines, journals, and IT issues and routine staffing issues…not to mention routine patient care, much of which they in fact do not get paid for.  Physicians do have it rough right now. But Doctors Can Sometimes Be Their Own Worst Enemies Currently, in just about every St... Better Health blogs http://www.medworm.com/rss/comments.php?id=5057726 Fri, 22 Jul 2011 18:00:52 +0100 5057726 http://www.medworm.com/index.php?rid=5050775&cid=t_99909_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F07%2Fwhy-do-doctors-give-kickbacks-and-whats.html It's very easy for people to moralise and wax eloquent about the declining standards of ethics and morality amongst doctors in India today. However, rather than blame individuals or the medical profession, I think we need to focus on finding a solution.This is my viewpoint.Individually, most doctors are good people. They enter medicine because they want to be of service to others - and most are intelligent, conscientious, idealistic and hardworking when they enter medical college.However, as time goes by, they gradually become cynical and bitter. There are few positive role models they can look upto - and when they see their seniors indulge in unethical practises, they are quite resigned to toeing the party line. After all, how can you fight the "system" ? In India, isn't everyone corrupt,... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5050775 Fri, 22 Jul 2011 03:24:00 +0100 5050775 http://www.medworm.com/index.php?rid=5050955&cid=t_99909_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fcome-sit-in-my-seat-with-me%2F As most of you who read this blog regularly know, I am plagued by sacroiliac joint pain. I have other problems but today, since I am lying here on a painful behind and have been intensely trying to get out of this current flare, it is on my mind. I thought you might be interested in knowing what life is like in my shoes, my seat and my life right now. It’s been almost three months since I flew to California with my daughter to begin the process of cleaning out my mother-in-law’s house. I don’t fly well…at least without my wings. Even on an airplane I am bottom challenged and find them grossly uncomfortable. Three days after flying home I picked up our 31 pound rough-coated Jack Russell, Annie because she couldn’t get into the car to go to the vet’s. The combination of all of t... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=5050955 Thu, 21 Jul 2011 20:27:49 +0100 5050955 http://www.medworm.com/index.php?rid=5050776&cid=t_99909_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F07%2Fare-doctors-just-specialised-knowledge.html Lots of people believe that healthcare today is "mismanaged" - and that better management would allow more efficient and effective medical care to be provided ! After all, how can any argue against the statement that management is better than mismanagement - isn't this a no-brainer ?If you want to manage medical care, you need to manage doctors - and if doctors can be treated as "knowledge workers", then it's possible to use what we have learnt from the experience of managing engineers and computer programmers and then apply it to medicine. After all, aren't doctors just experts who deal with patients, just like computer programmers are experts who handle computers ? This seems to be entirely reasonable and logical - but it's precisely the seductiveness of the this argument which causes ma... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5050776 Thu, 21 Jul 2011 10:41:00 +0100 5050776 http://www.medworm.com/index.php?rid=5036235&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fshould-you-find-a-new-doctor%2F2011.07.16 Come  on people… you know what I am talking about.  Sure you are comfortable with your current doctor… after all you are still alive and kicking.  Besides it has taken you years to figure out what you can safely tell your doctor and when it’s ok to speak up.  Yes the fact that your doctor is often late and never seems to listen to you bothers you just a little.  But you aren’t displeased enough to stop giving your doctor high satisfaction scores.  After all who wants to upset their doctor?   But admit it; you have wondered if there isn’t a doctor out there that would be a better fit with you.   I know I have. Doctors probably feel the same way about many of their patients.   It can’t be easy everyday trying to help patients that don’t seem to want to help themselv... Better Health blogs http://www.medworm.com/rss/comments.php?id=5036235 Sat, 16 Jul 2011 14:00:02 +0100 5036235 http://www.medworm.com/index.php?rid=5036236&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fshould-psychiatrists-disclose-their-personal-history-to-patients%2F2011.07.16 Dr. Maureen Goldman talks about self-disclosure for psychiatrists and brings the topic up in the context of Marsha Linehan’s recent announcement that she was treated for a psychiatric disorder as a teenager. In Clinical Psychiatry News, Dr. Goldman notes: Psychiatric care and psychotherapy are different from the Alcoholics Anonymous fellowship, where the mutual sharing of personal experience is an integral part of helping people maintain sobriety. I believe that there is middle ground between disclosing personal information and presenting myself as a blank slate. In my practice, I show myself to be a real person. I make mistakes and admit them. I joke about my poor bookkeeping skills and inferior technological skills. I look things up during sessions if necessary, and I tell patients... Better Health blogs http://www.medworm.com/rss/comments.php?id=5036236 Sat, 16 Jul 2011 12:00:00 +0100 5036236 http://www.medworm.com/index.php?rid=5028213&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-age-of-medical-disconnect%2F2011.07.14 It’s the age of medical disconnect. The disconnect describes the emotional and intellectual detachment that physicians feel from their patients and patients from their doctors.  This disconnect is the result of a confluence of factors, some from within the profession itself, others are more broadly social and economic. To understand the disconnect you need look no further than your neighbor or your parents.  Dissatisfaction is evolving as the norm.  Patients feel increasingly marginalized in their experiences with physicians.  Shrinking length of visits, indifferent attitudes, poorly coordinated evaluations, difficulty obtaining test results, an institutional feel to the patient experience, and the overall sense of not feeling at all important. The truth is that many of us are really... Better Health blogs http://www.medworm.com/rss/comments.php?id=5028213 Thu, 14 Jul 2011 21:00:13 +0100 5028213 http://www.medworm.com/index.php?rid=5028749&cid=t_99909_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Flife-may-be-weird-but-you-dont-have-to-be%2F Those of us who live with chronic pain each day have many choices to make. I know from first hand or should I say my “First Tushy” experience that we all feel helpless and robbed of choices more times than not, but that isn’t totally true. I realize “First Tushy” doesn’t have quite the elevation of First Lady but there you have it; my life. We are not mere victims. We remain the pilots of our planes as well as the captains of our own ships. I know we often have our doubts. We feel more enslavement than freedom; more the conquered than the victors and finally, hopelessly weird. I think that’s enough metaphors to choke a good sized horse but I’m certain you sense my direction. Today, after five years of chatting with all of you who also suffer, I would like to share three of ... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=5028749 Thu, 14 Jul 2011 20:24:47 +0100 5028749 http://www.medworm.com/index.php?rid=5028521&cid=t_99909_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F07%2Fshould-i-be-operating-or-talking-to.html One of my friends is a highly skilled cardiac surgeon. He spends most of his day in the OT, and while his technical skills are superb, his patients often complain that he is brusque and has poor bedside manner. When I was talking to him about the importance of good doctor-patient communication, he got visibly irritated .“ Really , what do people expect me to do ? I am a highly skilled surgeon and I should be spending most of my time in the operation theater , helping my patients to get better. I have spent over 12 years learning how to do surgery and am extremely good at my job ! Should I be operating in the theater or should I be sitting and talking to patients ? I operate all the way from 8 o’clock in the morning to 8 o clock in the evening. How could I possibly find time to sit and ... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5028521 Mon, 11 Jul 2011 02:58:00 +0100 5028521 http://www.medworm.com/index.php?rid=5028337&cid=t_99909_93_f&fid=36531&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FJeffreyMD%2F%7E3%2F0Dy7doHsJ2E%2F Unfortunately, it seems that many nurses have a bitter feeling towards doctors. I can’t say I know why. But only because I don’t know their perspective. I can only speculate. But I’d venture to guess that at the core, it is an issue of feeling unappreciated and disrespected by doctors. Those feelings can then easily turn into resentment. Are those feelings unwarranted? Sadly, no. I’ve seen too many instances where a doctor brushes off a nurse. I’ve seen times when the nurse feel slighted about something a doctor has done. Most of the time, at least I hope, it was not intentional on the physician’s part. But these little things add up over time on a mental score card that is not always unbiased. They say that $h!t flows downward. This is especially true for hierarchies. In the ... JeffreyMD.com blogs http://www.medworm.com/rss/comments.php?id=5028337 Sun, 10 Jul 2011 01:02:44 +0100 5028337 http://www.medworm.com/index.php?rid=5008350&cid=t_99909_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F07%2Fwhy-dont-doctors-stand-up-for.html The press has had a field day writing about doctors in Indore who allegedly perform surgery on helpless little girls to change them into boys. This started off with a badly researched article in the Hindustan Times; and has become a big issue with everyone from the Prime Minister's Office downwards jumping onto the bandwagon, clamoring for an inquiry . In their pursuit of their ten minutes of fame and a few columns of press publicity, activists are happy to talk at length about the stringent measure which need to be taken to book the guilty doctors and punish them, so these innocent girl children can be protected.What amazes me is how willing we are to assume that Indian doctors are crooked criminals who are happy to perform mutilating surgery just to earn a few bucks ! Is this really the ... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=5008350 Wed, 06 Jul 2011 03:27:00 +0100 5008350 http://www.medworm.com/index.php?rid=4992691&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhow-to-be-a-good-doctor-10-rules-of-the-road%2F2011.07.01 He sat in a crisp white coat, staring at a computer screen, note cards in his lap. Occasionally, I noted him jot a note to himself as he compiled his list. A nurse sat next to him, pounding feverishly on the keyboard as she recorded her nurse’s note. He tentatively moved his mouse, then clicked, still staring. I recall my first day in clinical medicine: no computer, an ER rotation, a white board filled with names and abbreviated medical problems next to them with little magnetic color-coded labels nearby. Room 1: Head trauma. Room 2: Abscess. Room 3: UTI, Room 4: Rash. I got room 2. It was the biggest, bad-est infected sebaceous cyst on a guy’s back a newly minted doctor had ever seen. Can you say “softball?” “See one, do one,” they told me. And off I went. Much in medicine ha... Better Health blogs http://www.medworm.com/rss/comments.php?id=4992691 Fri, 01 Jul 2011 14:00:00 +0100 4992691 http://www.medworm.com/index.php?rid=4992937&cid=t_99909_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2011%2F07%2Fwaiting-for-doctors-and-others.html Yesterday I stumbled across this article which says doctors should pay you for wasted time waiting for them in waiting or exam rooms. I thought it had some basis because I despise tardiness (as anyone who knows me will say). Why shouldn't I be compensated if I have to sit around for hours and wait?Then I started reading the comments which made me see the other side. Doctors are often late for a variety of legitimate reasons - many of which are beyond their control:- A true medical emergency - should they walk away from a patient dripping blood or having a heart attack to stay on schedule? I think not.- They are forced by their employer to schedule patients so close together that they do not have a chance of giving patients any attention before they need to rush off to their next patient.- ... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4992937 Fri, 01 Jul 2011 09:57:00 +0100 4992937 http://www.medworm.com/index.php?rid=4992781&cid=t_99909_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F07%2Ftoday-is-doctors-day-so-what.html This is an article which I wrote for Times Wellness for Doctor's Day.---------------------------There used to be a time when the doctor was a highly regarded member of society. Doctors were treated as trusted professionals who could be counted upon to provide wise counsel in times of sickness.Sadly, times have changed. Doctors are now looked upon as mercenaries who run a business and are out to make a quick buck, often at the expense of the patient. The doctor has been knocked off his pedestal and part of the reason for this is because patients have unrealistic expectations from medical technology. They assume that there is a pill for every ill – and they jump to the conclusion that if the patient does not improve, this means the doctor was negligent.Doctors are also to blame for this sa... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4992781 Fri, 01 Jul 2011 06:18:00 +0100 4992781 http://www.medworm.com/index.php?rid=4975866&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdo-physicians-prefer-ventilated-and-sedated-patients%2F2011.06.28 You ever wonder what doctors really think but are afraid to say out loud?  Here’s one example: “I wish all my patients were on a ventilator” There’s a reason vented and sedated patients are considered desirable.  In addition to the obvious economic benefits of ROS unobtainable Billing critical care CPT 99291, 99292 There are the less talked about, but equally pleasant side effects most hospitalists, ER doctors, cardiologists, gastroenterologists, pulmonologists,  surgeons, infectious disease doctors, endocrinologists, psychiatrists, rheumatologists, dermatologists, nurses, respiratory therapists and physical therapists wouldn’t admit, but would agree, without hesitation.  As a general rule: Patients on ventilators are just faster, easier and more pleas... Better Health blogs http://www.medworm.com/rss/comments.php?id=4975866 Tue, 28 Jun 2011 15:00:00 +0100 4975866 http://www.medworm.com/index.php?rid=4968680&cid=t_99909_117_f&fid=37824&url=http%3A%2F%2Fwww.doctorkalitenko.com%2Fblog%2Fdoc%2F   We assume that because something claims to be all natural, that it is. We also assume that there is a higher level of safety in something that is natural, as opposed to something man-made. Maybe it’s a vitamin, or a supplement, even foods. But make sure you always look deeper, and before you start taking anything, you should consult your doctor. The New York City Department of Health recently issued a warning against Vita-Breath, a vitamin supplement, for containing dangerous amounts of lead. But how can that be, you ask? Isn’t it all-natural, and isn’t someone monitoring that? Read the whole story here Unfortunately, some manufacturers put heavy metals into their products, essentially and eventually poisoning us. Some of those symptoms to look out for include unexplained fat... Doctor Kalitenko antiaging blog blogs http://www.medworm.com/rss/comments.php?id=4968680 Thu, 23 Jun 2011 18:57:38 +0100 4968680 http://www.medworm.com/index.php?rid=4952844&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fhealthecommunications.files.wordpress.com%2F2011%2F06%2Fsatisifaction1.jpg While by no means a representative sample of how we think about physicians, there is a clear pattern to the comments.  A lot of people feel disrespected by their doctors…and they are pretty angry. Here’s what patients (including a lot of former patients) had to say.  I attempted to summarize the comments by category and included the top five categories of comments below. #1 – “Being on time is a two way street.” – patients are expected to be on time for their appointments – why aren’t physicians expected to be on time.   Doctors think and act as if their time is more valuable than the patient’s time. #2 – “Listen to what I have to say.” “Doctors should realize that many patients have more life experience and have done more research about a cond... Better Health blogs http://www.medworm.com/rss/comments.php?id=4952844 Tue, 21 Jun 2011 12:00:04 +0100 4952844 http://www.medworm.com/index.php?rid=4934586&cid=t_99909_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fsues-patient-rights-responsibilities-and-opportunities%2F You have the right to life as long as you realize it might not be quite as you planned. You have the opportunity to change what you can and accept that which you cannot change. Just remember the word impossible is a relative term. You have the responsibility to seek options, be they health care, marital status or parenthood. All three require early action rather than late. You have the responsibility to judge each situation you face with candor, good judgment, and valor. If you choose not to do the above, you have the right to screw things up. It is your life, after all. You have the responsibility to maintain your body even though it appears to not give a fig about you. Disloyal lot these physical shells. You have the responsibility to remember your brain and your heart are in charg... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4934586 Thu, 16 Jun 2011 22:46:43 +0100 4934586 http://www.medworm.com/index.php?rid=4934161&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-boundaries-between-doctor-and-patient%2F2011.06.16 This post from Kelly Young on Howard Luks’ blog asks when patients cross the line with respect to their own advocacy.  It’s worth a peek. The question of boundaries between doctor and patient is interesting.  All of my patients are empowered in some way.  The extent and level of that empowerment is personal.  On our own there are few lines and little with respect to boundaries.  We have effectively unlimited access to information and resources.  And how far we go to look after ourselves and our kids has few limits. But when we enter into a relationship with a provider, we’re no longer alone.  It’s unreasonable for a provider to tell a patient (more…) *This blog post was originally published at 33 Charts* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4934161 Thu, 16 Jun 2011 12:00:58 +0100 4934161 http://www.medworm.com/index.php?rid=4911776&cid=t_99909_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2011%2F06%2Fto-screen-or-not-to-screen.html Well they finally figured out that they can't detect ovarian cancer in regular screenings. In fact the women who were screened had false positives and surgical complications as well as more deaths than the women who weren't screened. Oops. So I'll scratch that one off my list.An annual mammogram, I can do that. A colonoscopy every ten years, I can do that. My husband who had that bad colonoscopy followed by surgery says he would rather have an annual colonoscopy than surgery again. I think prostate cancer screenings are up for debate these days. Annual skin checks I can cope with as well.After one cancer diagnosis, never mind more than that, you get privileged to get every regular cancer screening there is. Because 'with your medical history, they need to be sure'. Granted once you get on ... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4911776 Tue, 07 Jun 2011 09:59:00 +0100 4911776 http://www.medworm.com/index.php?rid=4921557&cid=t_99909_113_f&fid=34634&url=http%3A%2F%2Fwww.emrandhipaa.com%2Femr-and-hipaa%2F2011%2F06%2F05%2Femr-and-hipaa-quote-of-the-sunday%2F Lately I’ve been posting a number of tweets in a sort of Sunday Tweet roundup. I think it’s been fun to highlight some short Healthcare IT and EMR related tweets that people might find interesting. With a little bit of commentary of my own (let me know if you disagree). Today, I decided I’d just go with a small quote from a comment that Chris Paton made over on Neil Versel’s Meaningful Healthcare IT News. Here it is: We’re a long way from getting rid of doctors but they might find their role changes from being repository of all knowledge to being a trusted communicator and carer. I’d been trying to summarize this position in a coherent way and I think Chris hit it on the head. Not only the part about being a long way from getting rid of doctors, but his desc... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=4921557 Mon, 06 Jun 2011 06:59:22 +0100 4921557 http://www.medworm.com/index.php?rid=4902423&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-myth-of-the-rich-doctor%2F2011.06.05 This is my column in June’s EM News. ‘But you’re a rich doctor, right?’ Have you had that conversation? There’s a certain expectation of physicians, that we’re all just filthy rich, overflowing with boxes of cash tucked neatly away beneath our gilded beds. When we were building our house, our builder talked with my wife: ‘Jan, I want you to meet me to look for counters and cabinets. Don’t bathe the kids. Put them in dirty play clothes and don’t wear anything nice. Don’t ever tell them your husband is a doctor.’ He’s a wise man. What he knew was that the word ‘doctor’ means ‘cash.’ Or at least, means ‘cash’ to the popular mind. I wonder if this perception is the reason patients come to the emergency department and say things like this: ‘I don’t have ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4902423 Sun, 05 Jun 2011 17:00:02 +0100 4902423 http://www.medworm.com/index.php?rid=4893566&cid=t_99909_109_f&fid=34786&url=http%3A%2F%2Fdrmichelletempest.blogspot.com%2F2011%2F06%2Findependent-letter.html This letter was published in the Independent newspaper :Hospital doctors must have a roleYou report that Andrew Lansley is holding out on letting hospital doctors have a role in deciding what care the NHS provides to patients (10 May). Why? Modern medicine increasingly requires vertical integration of treatment, where specialist hospital doctors and GPs work together to provide both acute and chronic health provision. It is not only logical but vitally important that the skill of hospital doctors is not lost.Though the argument against hospital doctors having a role in commissioning is based on a perceived conflict of interest, a recent report in the GP magazine Pulse suggested that 10 per cent of GPs in consortia have declared private healthcare business interests. "Conflict of interest" ... The Psychiatrist Blog blogs http://www.medworm.com/rss/comments.php?id=4893566 Sat, 04 Jun 2011 13:51:00 +0100 4893566 http://www.medworm.com/index.php?rid=4893456&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoes-your-doctor-have-time-to-think-about-you%2F2011.06.02 At the New York Times’ City Room Blog, Joel Cohen writes: my wife and I are convinced that all medical students should have to pass Overbooking 101 before they can become doctors.Again and again, we arrive at a doctor’s aptly named waiting room on or before the scheduled time, only to learn that three or four others sitting there have been given the same appointment. He says doctors need to understand the impact of this on their patients.  I agree, but not just because it’s annoying. A typical doctor sees thirty patients a day.  Some see even more. Reflect on that math.  If your doctor sees 30 patients a day, that’s 150 a week, 600 a month, maybe 7,000 a year. It means that if it’s been even two months since you last saw your doctor, he has probably seen more than a thousand p... Better Health blogs http://www.medworm.com/rss/comments.php?id=4893456 Thu, 02 Jun 2011 15:00:57 +0100 4893456 http://www.medworm.com/index.php?rid=4893826&cid=t_99909_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2011%2F06%2Fanother-medical-adventure.html I hate medical adventure. Today's medical adventure does not sound exciting at all. They are going to stick a needle under my knee cap - and its the first of three. One person told me it was awful. Another person told me the first one she had was awful and then she had the series done later by someone else who was very good and it didn't hurt at all. I am hoping for this. I dislike needles to start with. I dislike medical adventures. I don't want to go to the hospital (again). I just had ten days with out a medical appointment - some kind of miracle. Today I have PT and then my medical adventure. Saturday I am having an Echocardiogram - another medical adventure. Monday I have PT, Tuesday I see my therapist, Wednesday I have PT, see my primary care for the rest of my annual physical (who k... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4893826 Wed, 01 Jun 2011 10:28:00 +0100 4893826 http://www.medworm.com/index.php?rid=4876384&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-doctors-and-dentists-start-requiring-mutual-privacy-agreements-with-patients%2F2011.05.28 We (especially doctors themselves) like to think docs are smart. While all are very well educated in medicine, it doesn’t mean they’re actually smart at much else. Docs are well known to lose gobs of money in stupid ‘investements’ like Avacado farms and ostrich ranches (and yes, there are those with the chicken ranch problems, as well). Here’s a dumb thing some docs are adopting I hope goes away quickly, as it’s actually not in the best interest of medicine: When I walked into the offices of Dr. Ken Cirka, I was looking for cleaner teeth, not material for an Ars Technica story. I needed a new dentist, and Yelp says Dr. Cirka is one of the best in the Philadelphia area. The receptionist handed me a clipboard with forms to fill out. After the usual patient information form, there... Better Health blogs http://www.medworm.com/rss/comments.php?id=4876384 Sat, 28 May 2011 21:00:21 +0100 4876384 http://www.medworm.com/index.php?rid=4872372&cid=t_99909_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2011%2F05%2Fgood-behavior-for-your-doctors-visit.html I guess there are idiots out there because they wouldn't tell us not to do these things unless someone already had. I am kind of sick and tired of all these lists of things on the Internet. I think it is believed internet users have no attention span because everything is a list of things, or a series of photos of something related, or in other ways formatted for those with brains of a gnat who can't stop and read a paragraph. Anyway, here is another list I like: Things not to do at your doctor's office:1. Talk on your cell phone - apparently this should be part of the hang up your phone campaign we need these days.2. Lie to your doctor - of course you don't drink, don't smoke, wear your seat belt, get 8 hours of sleep, don't stress, and eat your veggies and fiber.3. Can't describe your pa... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4872372 Fri, 27 May 2011 15:43:00 +0100 4872372 http://www.medworm.com/index.php?rid=4862545&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-physicians-have-to-say-no-does-patient-satisfaction-suffer%2F2011.05.25 The short answer: No. At least not in the context of a strong physician-patient relationship. Many physicians have legitimate concerns about the prospects of having their salary or level reimbursement linked to patient satisfaction. I would too given the way most health care providers go about measuring and interpreting patient satisfaction data. A major concern of physicians is the issue of patient requests – particularly the impact of unfulfilled (and unreasonable) requests upon patient satisfaction. According to researchers, explicit patient requests for medications, diagnostic tests and specialty referrals occur in between 25% to 40% of primary care visits. This figure is much higher when requests for information are factored in. (more…) *This blog post was originall... Better Health blogs http://www.medworm.com/rss/comments.php?id=4862545 Wed, 25 May 2011 14:00:01 +0100 4862545 http://www.medworm.com/index.php?rid=4862847&cid=t_99909_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2011%2F05%2Fsecond-opinions.html I am not a big fan of second opinions. I always feel like I am sneaking around my doctor's back to ask someone else if they were right. I know some people who get them routinely on just about everything. Me I have enough doctor appointments already not to want to go to any more. Sometimes my doctors send me off to see other doctors.Apparently there are times to get a second opinion - like when you get a nasty medical diagnosis. For me it was easy, where I am treated once you get a cancer diagnosis, you get to have a day of 'being poked and prodded' by multiple doctors. In my case it was a surgeon, a medical oncologist, and radiation oncologist and finally a social worker to tell me I wasn't losing it. Anyway, if the news from one doctor isn't good there is always the option of finding a do... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4862847 Tue, 24 May 2011 08:29:00 +0100 4862847 http://www.medworm.com/index.php?rid=4848021&cid=t_99909_113_f&fid=34625&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FNeilVerselsHealthcareItBlog%2F%7E3%2Fdqv94BfVb5c%2F David Doherty of 3G Doctor does it again. On his company’s aptly named mHealth Insight blog, Doherty has a list of dozens of mobile health events and conferences planned throughout 2011, all over the world. 3G Doctor, a telemedicine service, is based in beautiful County Kerry, Ireland, and serves Ireland and the U.K., but Doherty is plugged in to the mobile and wireless health industries worldwide. It looks like he’ll next be in the U.S. this October, for Wireless Health 2011 in San Diego. Related posts:‘Fierce’ events at HIMSS Europe ‘has no mobile health policy’ Embedded images in mobile messaging (Source: Neil Versel's Healthcare IT Blog) Neil Versel's Healthcare IT Blog blogs http://www.medworm.com/rss/comments.php?id=4848021 Fri, 20 May 2011 21:13:16 +0100 4848021 http://www.medworm.com/index.php?rid=4848022&cid=t_99909_113_f&fid=34625&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FNeilVerselsHealthcareItBlog%2F%7E3%2F2dCY8-XWSbI%2F It’s Friday afternoon, and I realize it’s been days since I’ve posted here. (Make sure you catch my posts on EMR and HIPAA every Thursday, including my latest on Dr. Larry Weed and his critiques of current health IT systems.) I think it’s time for a rundown of some interesting developments this week. Weed apparently is not the only one who’s disappointed in the pace of change in healthcare. Dr. Bill Crounse, senior director of worldwide health for Microsoft, was at the World of Health IT conference in Budapest, Hungary, to deliver some scathing remarks at about North American health IT. According to Canadian Healthcare Technology, Crounse called the U.S. and Canada the “worst of the worst in the industrialized world in the use of IT in healthcare.”... Neil Versel's Healthcare IT Blog blogs http://www.medworm.com/rss/comments.php?id=4848022 Fri, 20 May 2011 19:32:13 +0100 4848022 http://www.medworm.com/index.php?rid=4821007&cid=t_99909_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fchoices-for-good-or-choices-for-evil-its-up-to-you%2F Each day, as mere mortals, we have decisions to make. Choices surround us 24 hours a day. We are assaulted by choices even when we’re asleep. For instance, during the night, are we cold, are we hot, do we get up to urinate or is it worth the effort? Do we feel enough pain to check the clock and see if it’s time for a pain pill or perhaps, a muscle relaxant? Does that mean we have to get up or did we plan ahead and put some water or juice at the bedside, trying to avoid that long, long hobbling walk to the bathroom in the middle of the night? When we try to get back to sleep we wonder about life, decide we need a new mattress, or in my case, think of ways to get my spouse to stop snoring. I hate to bother the poor, tired man so I try not to wake him but I have found he will stop snoring... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4821007 Thu, 12 May 2011 19:23:27 +0100 4821007 http://www.medworm.com/index.php?rid=4813325&cid=t_99909_93_f&fid=36531&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FJeffreyMD%2F%7E3%2FKORo57PCQiQ%2F How do you hide a $100 dollar bill from a general surgeon? Put it in the patients notes. How do you hide a $100 dollar bill from an orthopedic surgeon? Put it in a textbook. How do you hide a $100 bill from a radiologist? Tape it to a patient. How do you hide a $100 bill from an internist? Hide it under a dressing. How do yo hide a $100 bill from a psychiatrist? Anywhere — just call a code and they’ll be headed away from it. How do you hide a $100 dollar bill from a plastic surgeon? It’s a trick question. You can’t. How do you hide a $100 bill from a neurosurgeon? Tape it to his kid. - Brought to you by the Internet Source: Mainly here but also from people who have told me. (Source: JeffreyMD.com) JeffreyMD.com blogs http://www.medworm.com/rss/comments.php?id=4813325 Wed, 11 May 2011 05:13:53 +0100 4813325 http://www.medworm.com/index.php?rid=4813326&cid=t_99909_97_f&fid=35606&url=http%3A%2F%2Fwww.theangriestpharmacist.com%2F2011%2F05%2F10%2Fthe-crap-people-send-me%2F I got the following email from "Pat" concerning a "pain contrtact." One side of me wants to say, you're an addict and you need help from a few different doctors. One side of me wants to say this poor woman's pain is being under treated by her physician. Still yet, one side, the prevailing side, doesn't give a flying f.. I present this email for your amusement. Readers, please tell her what you think. I get so many emails/contact notes from folks like this, that I no longer take the time to respond. It is up to this community to cull its nuts.   From: pat <d********y@yahoo.com> Subject: Pain Contrtact Title: Technician Message Body: Dear Sir, it is with deep shame, and not a little fear, that I compose this message. I'm a woman in her late thirties, and I'm a Pharmacy Tech. I als... The Angriest Pharmacist blogs http://www.medworm.com/rss/comments.php?id=4813326 Wed, 11 May 2011 04:04:04 +0100 4813326 http://www.medworm.com/index.php?rid=4803451&cid=t_99909_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2011%2F05%2Fit-all-catches-up-sometimes.html Today is the day I haven't been looking forward to, or maybe I have been looking forward to. I will spend the morning at doctor appointments.My first stop is my back pain doctor where I can tell him in some ways my back is better these days between my new meds and the additional exercise I have been getting at the new gym I am going to. That should be okay. I have a few areas of concerns with my back but overall I'm doing okay.My next stop involves a heavy dose of scanxiety as it is my annual mammogram. I was stupid (I have to stop doing this to my self but since I have this lovely blog I can look up my thoughts from anytime in the past four years.) But I digress, I was stupid, I looked up my results from last year's mammogram and some calcifications were found and while the radiologist re... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4803451 Tue, 10 May 2011 09:58:00 +0100 4803451 http://www.medworm.com/index.php?rid=4795027&cid=t_99909_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2011%2F05%2Fshould-your-doctor-tell-you-truth-or.html So you go to see your doctor because you have been sick for a week and you want some antibiotics so you can finally get better. Or you have a cough and are concerned its more than just a cough and think the doctor should give you a chest x-ray to make sure its nothing more. You get the point - you go to the doctor with an expectation of care you should receive.But the doctor doesn't agree and says what you want is unneeded. Your cold is a cold and will get better, antibiotics will do nothing. Your cough is a cough and you don't need an x-ray. Should the doctor agree with you and give you the antibiotics or x-ray or should they just tell you the truth? I want the truth.I don't want a doctor to sugarcoat anything (especially when they say 'you may feel a pinch' - I want them to say 'it will ... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4795027 Sat, 07 May 2011 10:54:00 +0100 4795027 http://www.medworm.com/index.php?rid=4795054&cid=t_99909_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2F7XNwRvu223Y%2F When it comes to the animal health business, the laws of the jungle are what matters. Consider the spat between Bayer and Eli Lilly. Over the past year, Lilly’s Elanco animal health unit allegedly used a smear campaign to discredit Bayer in hopes of convincing veterinarians and distributors to end their business relationships with its rival, according to a lawsuit filed in a New York federal court. Such fingerpointing complaints are, of course, not an uncommon event among drugmakers, especially when it comes to promotional activities. But this latest lawsuit underscores the extent to which the animal health world is an increasingly important business to companies that are finding it harder and harder to develop big-selling meds to treat those two legged-creatures known as humans. At ... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=4795054 Fri, 06 May 2011 20:23:48 +0100 4795054 http://www.medworm.com/index.php?rid=4794954&cid=t_99909_129_f&fid=36036&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Fkelly-building-a-crohns-disease-community%2Fmay-2011-how-is-your-crohns-today%2F Hello Everyone! I hope that you are doing well today! It is time for us to have another edition of How Is Your Crohn’s Today?. For those of you who are new to the blog, every now and then I like to check in with everyone for updates and your Crohn’s is holding up. I’ll tell you how I am doing, and you reply in the comments section about your current status. I finally went to see my rheumatologist and did my yearly bone scan. I was reluctant to go because I was so afraid that my bone density would be worse and I have been anxious about taking the Reclast medication again. As I wrote in a previous blog, I have been worried about some of the side effects of the medication. The bone scan actually showed that my bone density improved by 7.2 percent, which is really a lot if you think abo... Life with Crohn's blogs http://www.medworm.com/rss/comments.php?id=4794954 Fri, 06 May 2011 17:59:30 +0100 4794954 http://www.medworm.com/index.php?rid=4794896&cid=t_99909_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F05%2F06%2Fthe-greek-miracle-how-ancient-greek-philosophy-can-save-you-or-at-least-improve-your-life%2F Former nightclub owner Nicholas Kardaras died ten years ago. That’s right. For a few minutes his pulse was flat. Then he “pulled a Lazarus” as he describes it. He was revived and clung to life for a bit with the help of a respirator. When he finally emerged from his coma, he was a changed man. Plato, Pythagoras, and the other ancient Greeks saved him. That’s what he says in his new book, How Plato and Pythagoras Can Save Your Life. A drug addict living the glamorous life, rubbing elbows with the likes of John F. Kennedy, Jr., Tom Cruise, and Brooke Shields, he decided to turn all of his time and energy toward ancient Greek philosophy? Why? Kardaras writes: After my post-coma resurrection, I was desperate to better understand the universe and my purpose within it; I guess that a ne... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=4794896 Fri, 06 May 2011 17:45:18 +0100 4794896 http://www.medworm.com/index.php?rid=4794860&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhat-makes-a-great-oncologist%2F2011.05.06 I had a WOW experience yesterday when I accompanied my wife to interview a new doctor for her.   As some reader may know she is being seen by specialists at MD Anderson Medical Center in Houston for Stage IV lung cancer.   She has not had a local oncologist for the past 6 years…but she does now.   And we both love this guy! You need to understand that I have been very underwhelmed by the local oncologists I had met up till now.   I am sure they were clinically proficient…but as a group not a one could muster a smile….or any sense of interest or curiosity in my wife’s medical condition.  I held out little hope that this new doctor would be any different. After being ushered into the exam room, a Physician’s Assistant came into the room to get smart about my wife’s histo... Better Health blogs http://www.medworm.com/rss/comments.php?id=4794860 Fri, 06 May 2011 13:00:04 +0100 4794860 http://www.medworm.com/index.php?rid=4789540&cid=t_99909_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2011%2F05%2Fi-am-not-just-another-medical-chart.html So yet another study came along but this is one I like and will incorporate into my doctor interactions.This new study says that patients who bond with their doctors are more likely to get better and doctors who show hope and optimism have patients who are more likely to get better. While the study focuses on mental health issues the article goes on to add that it is applicable across all medical ailments and diseases.What does this mean to me? That I will be more active in who my doctors are and treat the first interactions more of interviews - where I am interviewing them - than as blind acceptance of in who ever's office I ended up. A doctor is someone who you (or your insurance) pay for a service. There is no reason to stick with one you don't like or who doesn't listen to you. If you ... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4789540 Wed, 04 May 2011 10:13:00 +0100 4789540 http://www.medworm.com/index.php?rid=4780324&cid=t_99909_93_f&fid=36531&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FJeffreyMD%2F%7E3%2FWnQVNNjd2Sg%2F Last month I received an advanced copy of this book. This book, Doctor Confidential: Secrets Behind the Veil by Dr. Richard Sheff, was released this past Sunday (May 1). Dr. Sheff is a family physician with over 30 years of experience in practice. In this book, Sheff eloquently and openly shares stories that have stayed with him through the his time as a student, then as an intern, then a junior resident, and finally as a senior resident. Readers who are unfamiliar with the world of medicine will be happy to know that this book should be understood by the lay person. When the story being recounted requires the use of medical jargon, footnotes offer a clear explanation. As a medical student, I couldn’t help but smile when reading through portions of the book recounting Sheff’s m... JeffreyMD.com blogs http://www.medworm.com/rss/comments.php?id=4780324 Wed, 04 May 2011 04:40:27 +0100 4780324 http://www.medworm.com/index.php?rid=4780462&cid=t_99909_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2011%2F05%2Finsurance-is-only-part-of-it.html Having health insurance is only part of the solution. Here in Massachusetts we have state health insurance so basically everyone has access to health insurance. This is a good thing and one of the things that went along with this was the premise that people would go to their regular doctors instead of emergency rooms. Well that part didn't work. ER rates are higher than in the past.The problem was insurance was made accessible but we didn't create an infrastructure so that people could get into see their doctors. We need to make doctors more accessible. There are too many patients for each doctor (I don't have the numbers so you can just take my word for it) and often people resort to ERs for medical care because they can't get into see their doctor in a reasonable amount of time. If you c... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4780462 Tue, 03 May 2011 10:00:00 +0100 4780462 http://www.medworm.com/index.php?rid=4771024&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhat-medical-condition-is-the-most-costly-to-employers%2F2011.04.30 Ok…here’s a brain teaser.  What medical condition is the most costly to employers?  I’ll give you a hint.  It is also a medical condition that is likely to go unrecognized and undiagnosed by primary care physicians. If you guessed depression you are correct. If you mentioned obesity you get a gold star since that comes in right behind depression for both criteria…at least in terms of cost and the undiagnosed part. Four out of every ten people at work or sitting in the doctor’s waiting room suffer from moderate to severe depression.  Prevalence rates for depression are highest among women and older patients with chronic conditions.  Yet despite its high prevalence and costly nature, depression is significantly under-diagnosed (<50%) and under-treated by physicians. For em... Better Health blogs http://www.medworm.com/rss/comments.php?id=4771024 Sat, 30 Apr 2011 19:00:08 +0100 4771024 http://www.medworm.com/index.php?rid=4747841&cid=t_99909_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2011%2F04%2Fmy-annual-medical-hell-day.html In a few weeks, I will have a 'wonderful' day. It starts at 8am with the back pain doctor, followed by a mammogram, bone density scan, annual physical, annual surgeon follow up, and something else I can't remember. And my primary care will probably send me back down to diagnostic radiology for a chest x-ray and for some blood work. On that day, I will probably get to get in and of a hospital gown at least 5 times. Maybe I should just show up in my pjs and a bathrobe and stay in them all day. How many follow up appointments will all those generate as well? I think I spend my life going to doctor appointments.Later today I have an MRI on my knee. Apparently if you need an MRI, the best time to go is on a holiday because no one wants to have an appointment then. I did ask if I wore clothes wi... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4747841 Sun, 24 Apr 2011 13:01:00 +0100 4747841 http://www.medworm.com/index.php?rid=4744845&cid=t_99909_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F04%2Fdoctors-as-online-trusted-patient.html " Guiding patients to better online sources of medical information should be a new physician responsibility for the digital age. Not only should doctors expect and be receptive to questions patients raise from Web research, they need to proactively engage patients online in order to dispel falsehoods and guide them to legitimate sites."This is why I feel every doctor should have their own website ! It forces them to search for reliable health websites ( to which they can link) so they can guide their patients intelligently, rather than getting upset when patients come with many sheets of internet printouts ! Even better, it will encourage thoughtful doctors who are not happy with the quality of the information they find on other sites , to publish better customised content on their own... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4744845 Sun, 24 Apr 2011 05:41:00 +0100 4744845 http://www.medworm.com/index.php?rid=4742657&cid=t_99909_175_f&fid=39258&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FInsidePaTraining%2F%7E3%2FpkqCP8bOeXY%2Fthink-like-a-doctor-or-pa Got a big endocrinology test this week, so I’ll keep things brief…   Do you think like a doctor (or a PA)?  If you aren’t either then the answer is probably, “Of course not.”  But slow down… Thinking like a medical professional is a skill that can be learned, even if you don’t have a [...]Visit us at Inside PA Training - Becoming A Physician Assistant (Source: Inside PA Training) Inside PA Training blogs http://www.medworm.com/rss/comments.php?id=4742657 Fri, 22 Apr 2011 16:53:55 +0100 4742657 http://www.medworm.com/index.php?rid=4742544&cid=t_99909_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fsues-official-rules-for-whining%2F When you’ve had chronic pain for many years whining becomes an art form, a sacred ritual while also becoming a bit repetitive. That’s why you have to jazz it a bit by coming up with new ways to whine. Sure, it sounds easy. If you’re new to all this you might think all you have to do is be the victim, I mean patient, then spot another victim, also known as the listener and you’re all set to go. It’s much more complex than that. Let me see if I can sum it up for you. You know I love a list so let’s try, shall we? Never whine when you’re with someone sicker than you are. They don’t give a rat’s ass and you will find it very unfulfilling. Whining is not a contest but if it were, you’d have to find someone without any problems of their own. Good luck with that. You might a... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4742544 Thu, 21 Apr 2011 21:36:19 +0100 4742544 http://www.medworm.com/index.php?rid=4704654&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwarning-dr-mehmet-oz-is-not-a-trustworthy-source-of-health-information%2F2011.04.12 When I was in medical school at Columbia University College of Physicians and Surgeons, Dr. Mehmet Oz had the reputation of being a competent and caring cardiothoracic surgeon whose research interest was reducing preoperative stress. I remember hearing about a music study of his in which soothing melodies reduced blood pressure and heart rates in patients preparing for heart surgery. I felt pleased that a surgeon was leading the charge in improving patients’ O.R. experiences, and had no inkling that 15 years later Dr. Oz would be America’s chief snake oil salesman. I have been slow to criticize Dr. Oz on my blog because of a sense of loyalty to my medical school, however yesterday he crossed the line when things got personal – a friend of mine was negatively impacted by h... Better Health blogs http://www.medworm.com/rss/comments.php?id=4704654 Tue, 12 Apr 2011 21:00:23 +0100 4704654 http://www.medworm.com/index.php?rid=4684380&cid=t_99909_93_f&fid=36531&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FJeffreyMD%2F%7E3%2F5B6gofJJeUo%2F I received my Advanced Reader’s Copy today. This book, Doctor Confidential: Secrets Behind the Veil by Dr. Richard Sheff, is scheduled to be released on May 1. I am hoping to be able to get a review of it out by that time. It looks like it should be a pretty interesting read. I’ll keep you posted. (Source: JeffreyMD.com) JeffreyMD.com blogs http://www.medworm.com/rss/comments.php?id=4684380 Tue, 05 Apr 2011 02:54:07 +0100 4684380 http://www.medworm.com/index.php?rid=4670109&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoes-your-doctor-trust-you%2F2011.04.02 Members of the  American public are frequently surveyed about their trust in various professionals.  Doctors and nurses usually wind up near the top of the list, especially when compared to lawyers, hairdressers and politicians.  Trust in professionals is important to us: they possess expertise we lack but need, to solve problems ranging from the serious (illness) to the relatively trivial (appearance). How much professionals trust us seems irrelevant: our reciprocity is expressed in the form of payment for services rendered or promised, our recommendations to friends and families and repeat appearances. So I was surprised to read an article in the Annals of Family Medicine describing a new scale to measure doctors’ trust in their patients.  This scale, based on input from focus grou... Better Health blogs http://www.medworm.com/rss/comments.php?id=4670109 Sat, 02 Apr 2011 18:00:08 +0100 4670109 http://www.medworm.com/index.php?rid=4670182&cid=t_99909_111_f&fid=39123&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fnursingcomments%2Ftdtc%2F%7E3%2FnFy2XanbhfQ%2F Good afternoon all!  It has been awhile and I’m sorry for the delay – today’s post is actually a guest post by Maryanne Osberg and her contact information is included in the post.  Good to be back!  Stephanie _______________________________________ If you’re interested in medicine and would like to work in this field, perhaps becoming a nurse is the best way to go.  Sure it’s great to be a doctor, but you must spend at least ten years of your life in school before you get to practice medicine on a full-time basis.  If you want to start earning in a shorter time (yet stay in the field of medicine), nursing is your best bet – you don’t have to go to college for more than four years initially.  Further, you’re all set to begin once you complete the certificat... Nursing Comments blogs http://www.medworm.com/rss/comments.php?id=4670182 Fri, 01 Apr 2011 19:36:05 +0100 4670182 http://www.medworm.com/index.php?rid=4664361&cid=t_99909_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fsharp-retorts-for-dull-people-in-a-life-of-chronic-pain%2F Each of us who lives a life of compromised health doesn’t do it on an island. Neither do we live in a gilded cage, whatever the heck that is. No, we live in a larger cage without any adornments as we struggle to make it through each day — each of us in different circumstances and conditions. Some of us are seriously disabled while others live with different degrees of equally serious pain. There is definitely one aspect of life we experience as we live in flocks, groups or herds. Yes, herds. Have you been to a large city lately? The only thing missing is the mooing. There is a certain insensitivity that has crept into our society as we bump up against others, going through life in our limited capacity or attempting full speed ahead. Most people do not understand what a life of chr... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4664361 Fri, 01 Apr 2011 14:53:31 +0100 4664361 http://www.medworm.com/index.php?rid=4631650&cid=t_99909_151_f&fid=35805&url=http%3A%2F%2Ftwelvestepfacilitation.com%2Fmedical-marijuana%2F American Society of Addiction MedicinePublic Policy Statement on Medical MarijuanaBackgroundIn the last twenty years, both the scientific community and the public have become interested in the therapeutic potential of cannabis and cannabinoids. Scientific interest has been based in large part on the discovery and elucidation of the endocannabinoid receptor system. Popular interest has focused on state initiatives and other legislation decriminalizing the use of smoked cannabis for personal medical use.  Because of this legislation, herbal cannabis in various forms is now being distributed by dispensaries to large numbers of individuals with a wide variety of medical conditions. This cannabis is not, in most cases, standardized or quality-controlled; the dosage forms (smoked, vaporized, ba... Twelve Step Facilitation.com blogs http://www.medworm.com/rss/comments.php?id=4631650 Fri, 25 Mar 2011 04:20:22 +0100 4631650 http://www.medworm.com/index.php?rid=4622270&cid=t_99909_97_f&fid=35606&url=http%3A%2F%2Fwww.theangriestpharmacist.com%2F2011%2F03%2F22%2Fdoctor-shopping-and-insurance-fraud-and-asshat-patients-oh-my%2F Man, these folks are coming out of the woodwork! Had a lady call me for a refill (on we'll say 3/19) on her (surprise) Norco 10/325 last week because she was (surprise) going out of town. It had been 9 days since we had refilled it. The prescription was for 50 tablets taken every 6 hours. I put it in as a 13 day supply. I told her that it would be "a few more days" before it could be filled. She, of course, did not agree with me. She tried to tell me that it was a 12-day supply and we, meaning my pharmacy, "always fill it three days early." Well, she's wrong...maybe two days early...on a 30 day supply...if the patient isn't a problem.... The fact that she argued with me about filling it early, about it being a 12 day supply versus a 13 day supply, and told me what MY pharmacy always does g... The Angriest Pharmacist blogs http://www.medworm.com/rss/comments.php?id=4622270 Wed, 23 Mar 2011 04:37:33 +0100 4622270 http://www.medworm.com/index.php?rid=4626836&cid=t_99909_88_f&fid=38129&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Flifeinthefastlane%2FWZHV%2F%7E3%2Fs7QfG5Ekrek%2F Studies show that 73.2% of people start to develop FFFF withdrawal symptoms 168 hours after receiving the previous dose. Thus it would be inhumane to delay any longer... Bring on the funtabulous frivolity! (Source: Life in the Fast Lane) Life in the Fast Lane blogs http://www.medworm.com/rss/comments.php?id=4626836 Fri, 18 Mar 2011 00:00:01 +0100 4626836 http://www.medworm.com/index.php?rid=4622253&cid=t_99909_88_f&fid=38129&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Flifeinthefastlane%2FWZHV%2F%7E3%2FtAxlbgxpFe4%2F Studies show that 73.2% of people start to develop FFFF withdrawal symptoms 168 hours after receiving the previous dose. Thus it would be inhumane to delay any longer... Bring on the funtabulous frivolity! (Source: Life in the Fast Lane) Life in the Fast Lane blogs http://www.medworm.com/rss/comments.php?id=4622253 Fri, 18 Mar 2011 00:00:01 +0100 4622253 http://www.medworm.com/index.php?rid=4605833&cid=t_99909_88_f&fid=38129&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Flifeinthefastlane%2FWZHV%2F%7E3%2FOBBO3euA5t4%2F Studies show that 73.2% of people start to develop FFFF withdrawal symptoms 168 hours after receiving the previous dose. Thus it would be inhumane to delay any longer... Bring on the funtabulous frivolity! (Source: Life in the Fast Lane) Life in the Fast Lane blogs http://www.medworm.com/rss/comments.php?id=4605833 Fri, 18 Mar 2011 00:00:01 +0100 4605833 http://www.medworm.com/index.php?rid=4600535&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fenough-about-physician-empathy%2F2011.03.16 Is anyone else tired of hearing about how important empathy is in the doctor-patient relationship? Every other day it seems a new study is talking about the therapeutic value of empathy. Enough already! It’s not that I don’t believe that empathy is important — I do. I also believe the data that links physician empathy with improved patient outcomes, increased satisfaction, and better patient experiences. A recent study released in Academic Medicine reported that “patients of physicians with high empathy scores were significantly more likely to have good control over their blood sugar as well as cholesterol, while the inverse was true for patients of physicians with low scores.” Findings from this study by Hojat, et al. are consistent with a 2009 study by Rakel, et al. which f... Better Health blogs http://www.medworm.com/rss/comments.php?id=4600535 Wed, 16 Mar 2011 19:00:36 +0100 4600535 http://www.medworm.com/index.php?rid=4575065&cid=t_99909_97_f&fid=35606&url=http%3A%2F%2Fwww.theangriestpharmacist.com%2F2011%2F03%2F11%2Fscaring-a-doctor-shopper-straight-before-its-too-late%2F Young lady brought in a prescription today for #14 Vicodin. I'm not sure why doctor shoppers haven't figured this out yet, but one of those ignorant comments you make is, "I DON'T WANT THIS RUN ON MY INSURANCE!" That comment immediately raises my suspicion level. Now, this young lady didn't say that -- it was a variant that can be equally suspicious, "How much does this cost? Cash Price. I no longer have insurance." The fact someone says this isn't always suspicious, but the fact she said it twice (and awkwardly at that) did set off my bullshit detector. She told me that she wasn't on file -- luckily she was -- and lookie there....A MEDICAID CARD! I, of course, didn't tell her that I had this information. I ran it, and low and behold, it rejects. I call up Medicaid to inquire about doses, ... The Angriest Pharmacist blogs http://www.medworm.com/rss/comments.php?id=4575065 Sat, 12 Mar 2011 04:19:23 +0100 4575065 http://www.medworm.com/index.php?rid=4570544&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fquestioning-the-annual-pelvic-exam%2F2011.03.10 A new article in the Journal of Women’s Health by Westhoff, Jones, and Guiahi asks “Do New Guidelines and Technology Make the Routine Pelvic Examination Obsolete?” The pelvic exam consists of two main components: The insertion of a speculum to visualize the cervix and the bimanual exam where the practitioner inserts two fingers into the vagina and puts the other hand on the abdomen to palpate the uterus and ovaries. The rationales for a pelvic exam in asymptomatic women boil down to these: Screening for chlamydia and gonorrhea Evaluation before prescribing hormonal contraceptives Screening for cervical cancer Early detection of ovarian cancer None of these are supported by the evidence. Eliminating bimanual exams and limiting speculum exams in asymptomatic patients would reduce cos... Better Health blogs http://www.medworm.com/rss/comments.php?id=4570544 Thu, 10 Mar 2011 22:00:48 +0100 4570544 http://www.medworm.com/index.php?rid=4565903&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmanaging-patient-uncertainty%2F2011.03.09 How comfortable are we with uncertainty? I struggle with this question every day. I treat children with abdominal pain. Some of these children suffer with crohns disease, eosinophilic esophagitis, and other serious problems. Some children struggle with abdominal pain from anxiety or social concerns. I see all kinds. But kids are tricky, and sometimes I can’t pinpoint the problem. Trudging forward with more testing is often the simplest option since it involves little thinking. And some parents perceive endless testing as “thorough.” The question ultimately becomes: When do we stop? Once we’ve taken a sensible first approach to a child’s problem and judged that the likelihood of serious pathology is slim, when and how do we suggest that we wait before going any furt... Better Health blogs http://www.medworm.com/rss/comments.php?id=4565903 Wed, 09 Mar 2011 20:30:46 +0100 4565903 http://www.medworm.com/index.php?rid=4560278&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmission-impossible-getting-a-medical-license-in-california%2F2011.03.07 I first applied for a license to practice medicine in the state of California on July 9, 2008. I was licensed on March 3, 2011 — a whopping 967 days after they first received my application. I haven’t had a problem getting a license in any other state, and I am licensed in six of them. Just to give you a sense of how long it usually takes to process the paperwork for a medical license, Maryland completed mine in under three weeks. So what’s going on in California? Dr. Val’s Experience I think the best way to tell this story is with a timeline, and let the facts speak for themselves. I know this represents just one physician’s experience (namely mine), so results may vary: July 9, 2008 – The Medical Board of California (MBC) received my licensure appl... Better Health blogs http://www.medworm.com/rss/comments.php?id=4560278 Mon, 07 Mar 2011 13:30:00 +0100 4560278 http://www.medworm.com/index.php?rid=4554651&cid=t_99909_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F03%2F06%2Fpsychiatry-doesnt-do-psychotherapy-anymore%2F Despite a trend that started as early as the late 1980s, Gardiner Harris writing in The New York Times yesterday seems to bemoan the fact that most psychiatrists don’t practice psychotherapy any longer. Perhaps Harris should have interviewed Dr. Danny Carlat, who nearly a year ago wrote about his experiences as a modern psychiatrist (in the The New York Times Magazine, no less). Psychiatrists nowadays are generally poorly trained in psychotherapy, so they spend most of their time prescribing psychiatric medications. (Dr. Carlat’s book, Unhinged is well worth the read for further background about modern psychiatry.) So I wasn’t sure why I was reading this in the “Money and Policy” section of the Times. Surely it’s not news that psychiatry is no longer pra... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=4554651 Sun, 06 Mar 2011 17:16:39 +0100 4554651 http://www.medworm.com/index.php?rid=4549751&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdefining-online-physician-conduct%2F2011.03.04 This week a reporter cornered me on the issue of professional behavior in the social space. How is it defined? I didn’t have an answer. But it’s something that I think about. Perhaps there isn’t much to think about. As a “representative” of my hospital and a physician to the children in my community, how I behave in public isn’t any different than a decade ago. Social media is just another public space. Sometimes it’s easy to forget that we’re in public. When I’m wrapped up in a Twitter thread it’s easy to forget that the world is watching. But the solution is simple: Always remember that the world is watching. On Twitter I think and behave as I do in public: Very much myself but considerate of those around me. I always think about how I might be perceived.... Better Health blogs http://www.medworm.com/rss/comments.php?id=4549751 Fri, 04 Mar 2011 20:00:27 +0100 4549751 http://www.medworm.com/index.php?rid=4545032&cid=t_99909_113_f&fid=34634&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FEmrAndHipaa%2F%7E3%2FuAAH2NXokHs%2F Today I’m happy to officially introduce readers of EMR and HIPAA to my latest project: The Healthcare Scene blog network. If you follow me on twitter (@techguy and @ehrandhit), then you’ve probably already come across one or more of the great blogs in this new healthcare IT blog network. I’m really excited with the group of bloggers that I have working on the network and the amazing content they’ve been creating and will create. Before I introduce you to the various websites on the network, here’s a little background in why I decided to do this. As I looked at the various healthcare IT and EMR bloggers producing content, I was disappointed that many of them were creating great content that wasn’t getting nearly as much attention and traffic as the conten... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=4545032 Thu, 03 Mar 2011 19:26:26 +0100 4545032 http://www.medworm.com/index.php?rid=4540564&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fit%25e2%2580%2599s-time-to-tango-impatient-with-progress-on-patient-physician-partnership%2F2011.03.02 The other day I came across this photo of a couple clasping each other in a dramatic tango on the cover of an old medical journal – a special issue from 1999 that was focused entirely on doctor-patient partnership. The tone and subjects of the articles, letters and editorials were identical to those written today on the topic: “It’s time for the paternalism of the relationship between doctors and patients to be transformed into a partnership;” “There are benefits to this change and dangers to maintaining the status quo;” “Some doctors and patients resist the change and some embrace it: Why?” Two questions struck me as I impatiently scanned the articles from 12 years ago: First, why are these articles about doctor-patient partnership still so relevant? And second, why ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4540564 Wed, 02 Mar 2011 22:00:43 +0100 4540564 http://www.medworm.com/index.php?rid=4536204&cid=t_99909_129_f&fid=27216&url=http%3A%2F%2Flifewithadhd.com%2Fadhd-medication%2Fadhd-medicine-just-what-the-doctor-ordered.php Just what the doctor ordered! Very often parents think that ADHD medicine will be the solution in dealing with a hyperactive child suffering from ADHD. That is just the tip of the iceberg because the harassed parent is often unaware that nutrition and certain behavioural therapy can work in tandem with medicine for ADHD to help the child through this difficult period. A Drugged Nation? We certainly live in a strange era – the American Academy of Pediatrics (AAP) is recommending that in certain cases of obesity in children (as young as 8 years old!) statins can be prescribed for lowering their cholesterol. That is an alarming reflection on the failure of nutrition programs at home and at school. Adults have jumped on the psychostimulant drug wagon and we now know that academics,... Life With ADHD blogs http://www.medworm.com/rss/comments.php?id=4536204 Wed, 02 Mar 2011 00:00:00 +0100 4536204 http://www.medworm.com/index.php?rid=4532207&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fyou-are-the-biggest-wasted-resource-in-health-care%2F2011.03.01 ABCNews.com has posted a great new piece by Dr. Roni Zeiger entitled, “The Biggest Wasted Resource in Health Care? You.” Subtitle: “How Your Internet Research Can Help Your Relationship With Your Doctor.” It’s well reasoned and clearly written, and continues the trend we cited a month ago, when Time posted Dr. Zack Meisel’s article saying that patients who Google can help doctors. Related notes: – Dr. Zeiger’s article title parallels what Dr. Charles Safran told the House Ways & Means Subcommittee on Health in 2004: Patients are “the most under-utilitized resource.” He was talking about health IT, quoting his colleague Dr. Warner Slack, who had said it many years earlier. I often quote it in my speeches for the Society for Participatory Medicine, assert... Better Health blogs http://www.medworm.com/rss/comments.php?id=4532207 Tue, 01 Mar 2011 16:00:16 +0100 4532207 http://www.medworm.com/index.php?rid=4532209&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-third-place-in-healthcare-what-we-can-learn-from-starbucks%2F2011.02.28 Media reports on misdiagnosis continue to mount. A recent study on patients with Alzheimer’s found that half had been misdiagnosed. Half. Another headline blared “4 out of 10 patients being misdiagnosed.” The article encouraged patients to “see another doctor” if they are worried about their diagnosis. You know what it makes me think about? Starbucks. Why? Because the way Starbucks revolutionized coffee drinking shows a way forward for healthcare. Starbucks realized that since our lives focus on two places — home and work — most of us don’t have a “third place” to go. A place where we can be free of everyday distractions and take care of ourselves. Starbucks set out to create that “third place” by making its shops comfortable, inviting places. It works... Better Health blogs http://www.medworm.com/rss/comments.php?id=4532209 Mon, 28 Feb 2011 23:00:22 +0100 4532209 http://www.medworm.com/index.php?rid=4532211&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdr-watson-and-the-7-human-qualities-of-an-ideal-physician%2F2011.02.28 After the computer known as Watson easily dispatched of the best two human Jeopardy! contestants in history, IBM announced that one of the first applications of their artificial intelligence technology would be in the medical field. We should soon expect virtual physician assistants in the exam room. At least one of my friends even speculated that the days of human doctors are numbered. Is it possible that machines will replace humans in the doctor-patient relationship? I doubt it. According to a study done by the Mayo Clinic in 2006, the most important characteristics patients feel a good doctor must possess are entirely human. According to the study, the ideal physician is confident, empathetic, humane, personal, forthright, respectful, and thorough. Watson may have proved his cognitive ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4532211 Mon, 28 Feb 2011 18:00:27 +0100 4532211 http://www.medworm.com/index.php?rid=4532212&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-headlines-bash-doctors%2F2011.02.28 While I know it grabs the eye, it really didn’t matter what the article was about. The headline says it all: Doctors are the problem, not the system, right? -WesMusings of a cardiologist and cardiac electrophysiologist. *This blog post was originally published at Dr. Wes* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4532212 Mon, 28 Feb 2011 16:00:00 +0100 4532212 http://www.medworm.com/index.php?rid=4532213&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhow-experienced-is-the-radiologist-who-reads-your-mammogram%2F2011.02.28 There’s a new study out on mammography with important implications for breast cancer screening. The main result is that when radiologists review more mammograms per year, the rate of false positives declines. The stated purpose of the research*, published in the journal Radiology, was to see how radiologists’ interpretive volume — essentially the number of mammograms read per year — affects their performance in breast cancer screening. The investigators collected data from six registries participating in the NCI’s Breast Cancer Surveillance Consortium, involving 120 radiologists who interpreted 783,965 screening mammograms from 2002 to 2006. So it was a big study, at least in terms of the number of images and outcomes assessed. First — and before reaching any concl... Better Health blogs http://www.medworm.com/rss/comments.php?id=4532213 Mon, 28 Feb 2011 14:00:57 +0100 4532213 http://www.medworm.com/index.php?rid=4527773&cid=t_99909_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F02%2F27%2Fj-raymond-depaulo-jr-on-getting-a-second-opinion%2F The following passage from J. Raymond DePaulo Jr.’s book, Understanding Depression, was helpful to me in knowing what to look for in a doctor, and when to go for a second (and third, and fourth, and fifth, and sixth, and seventh) opinion. My comments on his advice are in parantheses. The best patient care requires three components: A well-trained, dependable clinician who knows what to do and is accessible to the patient; A well-informed patient who actively participates in his or her care plan and follows it; and A trusting alliance between doctor, patient, and family. If you don’t understand or agree with a doctor’s diagnosis, you should ask for an explanation of how he or she came to the conclusion. What factors weight in favor of the diagnosis? What factors argue i... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=4527773 Sun, 27 Feb 2011 12:08:06 +0100 4527773 http://www.medworm.com/index.php?rid=4512398&cid=t_99909_88_f&fid=38129&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Flifeinthefastlane%2FWZHV%2F%7E3%2FzeCJlhjG5yw%2F If you're an overseas doctor seeking to work in an Australian hospital it is vital to make a good first impression. This is not always easy to achieve. (Source: Life in the Fast Lane) Life in the Fast Lane blogs http://www.medworm.com/rss/comments.php?id=4512398 Wed, 23 Feb 2011 10:55:37 +0100 4512398 http://www.medworm.com/index.php?rid=4512448&cid=t_99909_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F02%2Fmake-patients-do-more-of-work.html There is a shortage of doctors. This is true all over the world because of many reasons. Medical training is expensive and arduous, and not many people are capable of surviving the grind. Also, doctor are unevenly distributed, which means that there are too many in large cities, but not enough in the villages. Finally, a lot of the doctor’s time , energy and expertise is wasted in handling problems which do not really need their expert attention. These are problems which can easily be handled by the patient and his family himself.The standard solution to the chronic shortage of doctors has always been the standard knee-jerk response - train more doctors ! This solution comes in many different flavours - open more colleges; or create a new cadre of barefoot village doctors. However, these... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4512448 Wed, 23 Feb 2011 04:02:00 +0100 4512448 http://www.medworm.com/index.php?rid=4501585&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmore-physician-temps-needed-for-doctor-shortage%2F2011.02.21 The use of temporary physicians is rising, filling in until permanent physicians can be hired amid the ongoing shortage of doctors nationwide, a locum tenens firm has found. The company estimates between 30,000 and 40,000 physicians worked on a locum tenens basis in 2010. The survey, by Staff Care, polled hospital and medical group managers about their use of locum tenens. Eighty-five percent said their facilities had used temporary physicians sometime in 2010, up from 72 percent in 2009. Psychiatrists and other behavioral health specialists were the most sought-after specialty (22 percent of all requests), followed by primary care physicians, defined as family physicians, general internists and pediatricians (20 percent) and internal medicine subspecialists (12 percent). Hospitalists... Better Health blogs http://www.medworm.com/rss/comments.php?id=4501585 Mon, 21 Feb 2011 14:00:00 +0100 4501585 http://www.medworm.com/index.php?rid=4489743&cid=t_99909_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F02%2Fdr-malpani-shows-you-easy-way-of.html It takes a lot of courage to place your life in a doctor's hands ! How can you be sure your doctor is any good ? Or that he will take good care of you when you have a problem ? It's hard to judge a doctor's competence and doctor shopping takes a lot of time and energy. It's also not very smart to go purely by a friend's recommendation !Here's an easy test. Ask the doctor a question about your problem ( preferably an easy question which you already know the answer to !) and see how he responds.Does he get irritated ? Does he brush off your query ? Does he answer brusquely ? Does he use medical jargon ? Does he send you to his assistant for answers ?Does he take the time to explain in simple terms ? Does he bother to check that you have understood his answer ? Does he offer to give you educa... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4489743 Thu, 17 Feb 2011 17:32:00 +0100 4489743 http://www.medworm.com/index.php?rid=4489761&cid=t_99909_113_f&fid=34634&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FEmrAndHipaa%2F%7E3%2FmOy-3ebZ7bs%2F The other night I was thinking (I tried not to hurt myself in the process) about the various EMR voices that are found online. There’s a number of really interesting people that need to be heard more than they are now. Tomorrow I’m going to have a post that talks about my efforts to help give more exposure to some of these voices, but one thing I realized yesterday was that the doctors that love their EMR aren’t generally found online. It makes sense why many of the doctors who love their EMR don’t come online to discuss their EMR. They don’t really care. They’re happy with what they have and so they’re not online looking to find an EMR or to complain about the EMR that they have. I guess part of it might be that the EMR has become natural and so t... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=4489761 Wed, 16 Feb 2011 18:04:05 +0100 4489761 http://www.medworm.com/index.php?rid=4489678&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmedical-aspects-of-the-king%25e2%2580%2599s-speech%2F2011.02.16 Over the weekend I went to see “The King’s Speech.” So far the film, featuring Colin Firth as a soon-to-be-king-of-England with a speech impediment, and Geoffrey Rush as his ill-credentialed but trusted speech therapist, has earned top critics’ awards and 12 Oscar nominations. This is a movie that’s hard not to like for one reason or another, at least most of the way through. It uplifts, it draws on history, it depends on solid acting. What I liked best, though, is the work’s rare depiction of a complex relationship between two imperfect, brave, and dedicated men. At some level, this is a movie about guys who communicate without fixating on cars, football (either kind), or women’s physical features. Great! (Dear Hollywood moguls: Can we have more like this, please?) T... Better Health blogs http://www.medworm.com/rss/comments.php?id=4489678 Wed, 16 Feb 2011 17:00:11 +0100 4489678 http://www.medworm.com/index.php?rid=4477761&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmeasuring-the-patient-experience%2F2011.02.15 There’s a growing recognition within the medical-industrial complex that the patient is a key element of the enterprise, and that patient satisfaction, patient experience, patient engagement, patient activation, and patient-centeredness are very important. Some research shows that patient activation yields better patient outcomes, and that patient activation can be measured. Patient-centeredness and patient engagement are two of the key metrics to be used by the feds in describing Accountable Care Organizations (ACOs), if the internecine battles within government are resolved soon enough to actually release draft ACO regulations in time to allow for sufficient advance planning for the January 2012 go-live date. (Wearing one of my many hats, I’ve had the opportunity to submit ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4477761 Tue, 15 Feb 2011 14:00:44 +0100 4477761 http://www.medworm.com/index.php?rid=4472950&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fconsumer-health-information-the-new-third-party-in-the-exam-room%2F2011.02.13 It was sometime in the mid-nineties that parents started showing up in my office with reams of paper. Inkjet printouts of independently unearthed information pulled from AltaVista and Excite. Google didn’t exist. In the earliest days of the Web, information was occasionally leveraged by families as a type of newfound control. A young father and his inkjet printer One case sticks clearly in my mind. It was that of a toddler with medically unresponsive acid reflux and chronic lung disease. After following the child for some time, the discussion with the family finally moved to the option of a fundoplication (anti-reflux surgery). On a follow-up visit the father had done his diligence and appeared in the office with a banker box brimming with printed information. He had done his homewo... Better Health blogs http://www.medworm.com/rss/comments.php?id=4472950 Sun, 13 Feb 2011 16:00:39 +0100 4472950 http://www.medworm.com/index.php?rid=4464607&cid=t_99909_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fis-life-with-chronic-pain-a-reality-or-a-cartoon%2F As most of you already know I have been having a terrible time with some funky new virus this year. I feel like a turtle that got tipped and can’t get upright again. That could explain why the room keeps spinning. Some spirit with a sense of humor keeps rocking my shell and occasionally gives it a spin. On Saturday, I went into urgent care. It was cold and slow. The people were very kind but I had to wear my gloves and jacket to keep from shaking my teeth out of my mouth while shivering. I had a chest X-ray, was given an antibiotic and left there being told I would eventually be okay. The diagnosis was viral with bronchitis. Since, like many of you, I already had a satchel full of problems, all things were complicated. We got out into the parking lot and I could hardly wait to get home a... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4464607 Sat, 12 Feb 2011 00:46:51 +0100 4464607 http://www.medworm.com/index.php?rid=4459957&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoctors-and-patients-wish-their-relationship-was-better%2F2011.02.10 Physicians said in a survey that noncompliance with advice or treatment recommendations was their foremost complaint about their patients. Most said it affected their ability to provide optimal care and more 37 percent said it did so “a lot.” Three-quarters of patients said they were highly satisfied with their doctors. But they still had complaints ranging from long wait times to ineffective treatments. Those are just some of the findings from two surveys, the first a poll of 660 primary care physicians conducted by the Consumer Reports National Research Center in September 2010 and the second a poll of 49,000 Consumer Reports subscribers in 2009. The magazine reported its results online. In the doctors’ poll, physicians named these top challenges: – 76 percent o... Better Health blogs http://www.medworm.com/rss/comments.php?id=4459957 Fri, 11 Feb 2011 00:00:00 +0100 4459957 http://www.medworm.com/index.php?rid=4460063&cid=t_99909_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fis-life-with-chronic-pain-a-reality-or-a-cartoon%2F As most of you already know I have been having a terrible time with some funky new virus this year. I feel like a turtle that got tipped and can’t get upright again. That could explain why the room keeps spinning. Some spirit with a sense of humor keeps rocking my shell and occasionally gives it a spin. On Saturday, I went into urgent care. It was cold and slow. The people were very kind but I had to wear my gloves and jacket to keep from shaking my teeth out of my mouth while shivering. I had a chest X-ray, was given an antibiotic and left there being told I would eventually be okay. The diagnosis was viral with bronchitis. Since, like many of you, I already had a satchel full of problems, all things were complicated. We got out into the parking lot and I could hardly wait to get home a... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=4460063 Thu, 10 Feb 2011 22:13:54 +0100 4460063 http://www.medworm.com/index.php?rid=4455263&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fartificial-sweeteners-and-telling-pregnant-women-in-moderation%2F2011.02.09 I can already tell that this pregnancy is different from my first. When I was pregnant with Little Isis, I drank no caffeine and took no over-the-counter medication. I remember having a few headaches and Mr. Isis fighting with me to take a headache pill. I would then proclaim dramatically, “But I can’t! What if it hurts the baby?!” This morning, now pregnant with my second, I washed down a Zyrtec and two Tylenol with a cup of coffee. The little bugger is going to have to grow up with Little Isis. He might as well start building up his tolerance to exogenous substances at some point. I figure, now that its got a closed neural tube and a beating heart, we might as well begin. Still, you can’t blame a pregnant woman for being a bit neurotic. The feeling that one is solely res... Better Health blogs http://www.medworm.com/rss/comments.php?id=4455263 Wed, 09 Feb 2011 20:00:01 +0100 4455263 http://www.medworm.com/index.php?rid=4455266&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoctor-who-attempted-to-have-whistleblowing-nurses-prosecuted-is-put-on-probation%2F2011.02.09 From an AP article in the Dallas-Fort Worth Star-Telegram: AUSTIN — Texas medical regulators on Friday placed on probation a West Texas doctor involved in the unsuccessful prosecution of two nurses who complained anonymously that the physician was unethical and risking patients’ health. The Texas Medical Board technically suspended Dr. Rolando G. Arafiles Jr. but allowed him to continue to practice medicine while on probation for four years if he completes additional training. The board also said Arafiles must be monitored by another physician and submit patient medical and billing records for review. The monitor will report his or her findings to the board. In the mediated order signed in Austin, the board concluded that Arafiles failed to treat emergency room patients properly, did... Better Health blogs http://www.medworm.com/rss/comments.php?id=4455266 Wed, 09 Feb 2011 14:00:20 +0100 4455266 http://www.medworm.com/index.php?rid=4450531&cid=t_99909_177_f&fid=38133&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FTubalReversalBlog%2F%7E3%2FvCDSJoJb38E%2Ftubal-reversal-success-rate.html The success of tubal reversal can be quite high when patients choose the best tubal reversal doctors in America. To find out if you are a candidate for tubal reversal surgery and what discounts exists readers are encouraged to review the pregnancy statistics and to call and inquire about their chances of tubal reversal success. (Source: Tubal Reversal Blog) Tubal Reversal Blog blogs http://www.medworm.com/rss/comments.php?id=4450531 Tue, 08 Feb 2011 16:41:10 +0100 4450531 http://www.medworm.com/index.php?rid=4450294&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdifficult-patients%2F2011.02.08 Physicians see nearly one in five patients as “difficult,” report researchers. Not surprisingly, these patients don’t fare as well as others after visiting their doctor. Researchers took into account both patient and clinician factors associated with being considered “difficult,” as well as assessing the impact on patient health outcomes. They reported results in the Journal of General Internal Medicine. Researchers assessed 750 adults prior to their visit to a primary care walk-in clinic for symptoms, expectations, and general health; for how they functioned physically, socially and emotionally; and whether they had mental disorders. Immediately after their visit, participants were asked about their satisfaction with the encounter, any unmet expectations, and... Better Health blogs http://www.medworm.com/rss/comments.php?id=4450294 Tue, 08 Feb 2011 16:00:00 +0100 4450294 http://www.medworm.com/index.php?rid=4445803&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-doctors-brain-the-most-important-piece-of-healthcare-technology%2F2011.02.07 Some people may tell you that healthcare IT will solve many of the quality and cost problems in healthcare. I don’t believe them. I know a 70-year old man named Carlos (not his real name) who was hospitalized following a bout of hydrocephalus. Hydrocephalus is a build-up of fluid in the skull, which affects the brain. Among other things, people with hydrocephalus can be confused, irritable, and nauseous. Carlos had all of these symptoms. Carlos’ problem was fixable by inserting a special kind of drain in his head called a “shunt.” This kind of shunt is, essentially, a series of catheters that runs from the brain into the abdomen, and which drain the excess fluid. You can’t see it from the outside, so it’s meant to stay inside of you for a very long time. For a week after Ca... Better Health blogs http://www.medworm.com/rss/comments.php?id=4445803 Mon, 07 Feb 2011 17:00:08 +0100 4445803 http://www.medworm.com/index.php?rid=4424236&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-eroding-doctor-label%2F2011.02.01 It came as a Twitter “follow” from @coldfeet65, a self-proclaimed “Nurse Practitioner Hospitalist.” I had never heard this term before. Does it mean a nurse practitioner who cares for hospitalists? Or is it a hospitalist who is a nurse practitioner? Or maybe it’s a nurse practitioner who helps hospitalists? (Honestly, I think I know which one she means, but you get my point.) Perhaps this is a prescient glimpse to healthcare of the future, where our more typical nurse and doctor labels are supplanted by more and more monikers that serve to confuse, rather than clarify, each of our roles in healthcare delivery. As specialists in cardiology, we’ve seen a similar trend with cardiology hospitalists. But we should be clear what this means to the patients and ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4424236 Tue, 01 Feb 2011 16:00:00 +0100 4424236 http://www.medworm.com/index.php?rid=4419139&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpossible-5-million-fine-or-prison-for-doctors-who-ask-about-guns-in-the-home%2F2011.01.31 No photo for this post. You can imagine why. I’m a little stunned by the news that a politician in Florida is trying to stifle pediatricians from asking questions about guns in the home. My reaction is utterly predictable. Should I YELL IT or write it down or leave it up to your genius (and imagination)? (silence) The skinny on the Florida proposal: Florida Rep. Jason Brodeur said “he has heard about a number of cases in which doctors asked about guns. He thinks the topic should be off-limits.” Brodeur says he’s concerned about doctors asking patients about guns in the home. He’s concerned that information could get into the hands of the government or insurance companies. Under the proposed legislation, a doctor could face a fine of up to $5 million or be sent to prison for up t... Better Health blogs http://www.medworm.com/rss/comments.php?id=4419139 Mon, 31 Jan 2011 16:00:08 +0100 4419139 http://www.medworm.com/index.php?rid=4414521&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-money-isnt-everything-to-doctors%2F2011.01.29 I recently pointed to a BMJ study concluding that pay for performance doesn’t seem to motivate doctors. It has been picking up steam in major media with TIME, for instance, saying: “Money isn’t everything, even to doctors.” So much is riding on the concept of pay for performance, that it’s hard to fathom what other options there are should it fail. And there’s mounting evidence that it will. Dr. Aaron Carroll, a pediatrician at the University of Indiana, and regular contributor to KevinMD.com, ponders the options. First he comments on why the performance incentives in the NHS failed: Perhaps the doctors were already improving without the program. If that’s the case, though, then you don’t need economic incentives. It’s possible the incentives were too low. But I don’t... Better Health blogs http://www.medworm.com/rss/comments.php?id=4414521 Sat, 29 Jan 2011 17:00:01 +0100 4414521 http://www.medworm.com/index.php?rid=4405774&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-every-pregnant-woman-needs-to-do-a-background-check%2F2011.01.27 The journey to a healthy pregnancy and delivery begins with the selection of a healthcare provider, and the challenge is to find the right one. This is the person who will be in charge of your pregnancy up until the time of the delivery, so it certainly is not a casual date. For the next 280 days your life and the life of your unborn child will be in this person’s hands. A background check is therefore in order. One of the best ways to find the right healthcare provider is by word-of-mouth referral from neighbors, friends, or family members however please don’t stop there. Labor and delivery nurses are also a great source of referral because they have seen physicians and midwives under their most vulnerable and challenging moments. Don’t feel intimidated about checking a provide... Better Health blogs http://www.medworm.com/rss/comments.php?id=4405774 Thu, 27 Jan 2011 20:00:38 +0100 4405774 http://www.medworm.com/index.php?rid=4399524&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-second-opinion-is-good-but-a-third-or-fourth%2F2011.01.26 A few years ago I started writing a book on what it was like to be a cancer patient and an oncologist. This morning I came upon this section on second opinions: Is It OK To Get A Second Opinion? Definitely. And there’s no need to be secretive about it, or to worry about hurting the doctor’s feelings. Second opinions are routine in fields like oncology, and are often covered by insurance. Be up-front: Any decent oncologist can understand a cancer patient’s need to find a doctor who’s right for them, with whom they’re comfortable making important decisions. And in difficult cases, some specialists appreciate the chance to discuss the situation with another expert. So a second opinion can be beneficial to patients and physicians alike. When things can get out of hand, though, is whe... Better Health blogs http://www.medworm.com/rss/comments.php?id=4399524 Wed, 26 Jan 2011 14:00:50 +0100 4399524 http://www.medworm.com/index.php?rid=4394545&cid=t_99909_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F01%2Fwhy-i-love-talking-to-my-patients.html I had just finished seeing a patient who came to me from Bangalore for IVF treatment , and before leaving the room, he turned around and said - " Thank you so much for taking the time to listen to us so patiently ! "I was flummoxed ! After all, isn't listening to a patient a part of the doctor's job description ? Why was he thanking me for doing something which is so routine and mundane ?When I asked my next patient why I was being thanked, he said - That's because you are so different from most other doctors, doc ! Most doctors just rush like automatons through a long line of patients. It's like they are just processing an assembly line of people - and they have 7 minutes in which to listen to you . They are always rushed and harassed - and it's very hard to have a decent convesration wit... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4394545 Tue, 25 Jan 2011 07:11:00 +0100 4394545 http://www.medworm.com/index.php?rid=4394444&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-the-end-of-internal-medicine-as-we-know-it-might-be-a-good-thing%2F2011.01.24 A recent post on the Health Affairs blog proclaimed “The End of Internal Medicine As We Know It.” What the post is really asking about is the future of primary care in the world of healthcare reform and the creation of accountable care organizations (ACOs). While doctors should be naturally concerned about change, I don’t completely agree with this article. ACOs are organizations that are integrated and accountable for the health and well-being of a patient and also have joint responsibilities on how to thoughtfully use a patient’s or employer’s health insurance premium, something that is sorely lacking in the current health care structure. These were recently created and defined in the healthcare reform bill. Yet the author seems to suggest that this is a s... Better Health blogs http://www.medworm.com/rss/comments.php?id=4394444 Mon, 24 Jan 2011 20:00:00 +0100 4394444 http://www.medworm.com/index.php?rid=4386272&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmystery-providers-healthcare-professionals-and-identification-badges%2F2011.01.22 So I’m in the exam room recently with a new patient. After some initial dialog with the child and family, I launched into the business of problem solving. Ten minutes into my history the mother politely asks: “I’m sorry, and you are?…” I hadn’t introduced myself. I had left my ID badge at my workstation, and by order of some innocent distraction with the child or family, I hadn’t identified myself immediately on entering the room. This is rare. Sometimes I assume people will know who I am. But I don’t wear a white coat and my stethoscope is concealed. I wear clothes only good enough to sustain the barrage of regurgitation, urine, full-frontal coughs, and sloppy hugs that mark a successful clinic day. A colleague once told me I dress like an algebra teacher. I haven’... Better Health blogs http://www.medworm.com/rss/comments.php?id=4386272 Sat, 22 Jan 2011 20:00:56 +0100 4386272 http://www.medworm.com/index.php?rid=4382766&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhow-doctors-feel-about-patients-who-google-their-symptoms%2F2011.01.21 Many doctors roll their eyes whenever patients bring in a stack of research they printed out, stemming from a Google search of their symptoms. A piece by Dr. Zachary Meisel on TIME.com describes a familiar scenario: The medical intern started her presentation with an eye roll. “The patient in Room 3 had some blood in the toilet bowl this morning and is here with a pile of Internet printouts listing all the crazy things she thinks she might have.” The intern continued, “I think she has a hemorrhoid.” “Another case of cyberchondria,” added the nurse behind me. It’s time to stop debating whether patients should research their own symptoms. It’s happening already, and the medical profession would be better served to handle this new reality. According to the Pew Internet and ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4382766 Fri, 21 Jan 2011 14:00:37 +0100 4382766 http://www.medworm.com/index.php?rid=4372044&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhow-good-is-your-doctor-at-diagnosing-you%2F2011.01.19 We’ve all been there. It often starts with some kind of recurring pain or dull ache. We don’t know what’s causing the pain or ache. During the light of day we tell ourselves that it’s nothing. But at 3:00am when the pain wakes you, worry sets in: “Maybe I have cancer or heart disease or some other life-ending ailment.” The next day you make an appointment to see your doctor. So now you’re sitting in the exam room explaining this scenario to your doctor. Based on your previous experience, what’s the first thing your doctor would do? A. Order a battery of tests and schedule a follow-up appointment. B. Put you in a patient gown and conduct a thorough physical examination, including asking you detailed questions about your complaint before ordering any test... Better Health blogs http://www.medworm.com/rss/comments.php?id=4372044 Wed, 19 Jan 2011 22:00:07 +0100 4372044 http://www.medworm.com/index.php?rid=4372045&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fshould-doctors-be-banned-from-asking-if-a-patient-owns-a-gun%2F2011.01.19 Via an article entitled “Proposed Law Would Ban Docs From Asking If Patient Owns Gun” from First Coast News: TALLAHASSEE, Fla. — A state lawmaker has filed a bill that would ban doctors from asking their patients if they have a gun in the home. Rep. Jason Brodeur, R-Sanford, said he has heard of a number of cases in which doctors asked their patients that question, which he thinks should be off limits. “What we don’t want to do is have law-abiding firearm owners worried that the information is going to be recorded and then sent to their insurance company,” he said. “If they’re on Medicaid maybe it’s sent to the government. If the overreaching federal government actually takes over health care, they’re worried that Washington, D.C. is going to know whether or not... Better Health blogs http://www.medworm.com/rss/comments.php?id=4372045 Wed, 19 Jan 2011 20:00:29 +0100 4372045 http://www.medworm.com/index.php?rid=4361085&cid=t_99909_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F01%2Fpatient-education-in-india-times-of.html (Source: The Patient's Doctor) The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4361085 Mon, 17 Jan 2011 13:33:00 +0100 4361085 http://www.medworm.com/index.php?rid=4355716&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdo-patients-have-clinical-judgment%2F2011.01.16 I used to think they didn’t, but they do. Clinical judgment is the application of individual experience to the variables of a patient’s medical presentation. It’s the hard-worn skill of knowing what to do and how far to go in a particular situation. It’s having the confidence to do nothing. Clinical judgment is learned from seeing lots of sick people. Good clinical judgment is when the gifted capacity of reasoning intersects with experience. Some doctors have better judgment than others. Aristotle called this phronesis – or practical judgment. Patients have practical judgment. We often can tell when something’s amiss with our own body. Things feel different or look different. Taking action on these observations is how we exercise judgment as patients. Parents of chi... Better Health blogs http://www.medworm.com/rss/comments.php?id=4355716 Sun, 16 Jan 2011 23:00:49 +0100 4355716 http://www.medworm.com/index.php?rid=4349514&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-the-term-patient-is-so-important-in-healthcare%2F2011.01.14 An online friend, col­league, and out­spoken patient advocate, Trisha Torrey, has an ongoing e-vote about whether people prefer to be called a “patient,” a “con­sumer,” a “cus­tomer,” or some other noun to describe a person who receives healthcare. My vote is: PATIENT. Here’s why: Providing medical care is or should be unlike other com­mercial trans­ac­tions. The doctor, or other person who gives medical treatment, has a special pro­fes­sional and moral oblig­ation to help the person who’s receiving his or her treatment. This respon­si­bility — to heal, hon­estly and to the best of one’s ability — over­rides any other com­mit­ments, or con­flicts, between the two. The term “patient” con­stantly reminds the doctor of the spe­cialness of... Better Health blogs http://www.medworm.com/rss/comments.php?id=4349514 Fri, 14 Jan 2011 21:00:02 +0100 4349514 http://www.medworm.com/index.php?rid=4349515&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Freferral-communication-what-happens-to-handoffs-between-primary-care-physicians-and-specialists%2F2011.01.14 Far more primary care doctors report detailed referrals than do specialists report receiving them. The same applies in reverse. Specialists report returning quality consultations, while primary care physicians report receiving them far less often. Researchers reported in Archives of Internal Medicine that perceptions of communication regarding referrals and consultations differed widely. While 69.3 percent of primary care physicians reported “always” or “most of the time” sending a patient’s history and the reason for the consultation to specialists, only 34.8 percent of specialists said they “always” or “most of the time” received the information. And, while 80.6 percent of specialists said they “always” or “most o... Better Health blogs http://www.medworm.com/rss/comments.php?id=4349515 Fri, 14 Jan 2011 18:00:00 +0100 4349515 http://www.medworm.com/index.php?rid=4337934&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-doctors-and-patients-speak-different-languages%2F2011.01.12 I can’t say that I enjoy the patient encounter as much when it involves a translator. There’s just something about communicating through a third party that changes the experience. But there are some things you can do as a provider to bridge the language gap: Look. Even thought the translator is doing the talking, look at the patient just as if you are asking the question yourself. There’s a tendency to let the translator act as a surrogate with respect to eye contact and visual feedback. Smile. A smile doesn’t need translation. It conveys very clearly that have a sincere interest in making a connection. Touch. I never leave the exam room without some type of sincere physical contact. A firm handshake or a hand on the shoulder go a long way in closing the language barrier. Sa... Better Health blogs http://www.medworm.com/rss/comments.php?id=4337934 Wed, 12 Jan 2011 22:00:29 +0100 4337934 http://www.medworm.com/index.php?rid=4337935&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhat-if-all-patients-were-this-engaged-in-their-health%2F2011.01.12 This video is an excellent testimony of what a truly engaged and knowledgable patient with diabetes looks and sounds like. Kudos to the Mayo Clinic for sharing this wonderful piece about shared decision making. Pay particular attention to the fact that the patient in the video was treated for diabetes by her primary care physician for eight years before being referred to a clearly “patient-centered” endocrinologist. Also note her belief that a patient-centered approach to chronic disease management probably results in shorter, more productive visits in the long run. *This blog post was originally published at Mind The Gap* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4337935 Wed, 12 Jan 2011 20:00:14 +0100 4337935 http://www.medworm.com/index.php?rid=4337940&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fconsider-medical-conditions-before-jumping-on-the-new-years-resolution-diet-and-exercise-bandwagon%2F2011.01.11 The first week of January was full of news reports of giving advice on your new diet and exercise program to help you lose the weight you’ve always wanted to. In a previous post and video I talk about some do’s and don’ts when planning for your weight loss New Year’s resolution. In the video below, I talk about some medical issues to keep in mind before starting your program. For example, do you have a family history of medical problems like high blood pressure or diabetes? If so, you may want to schedule an appointment with your personal physician before jumping on the diet and exercise bandwagon. If you find this video helpful, I invite you to check out other TV interviews at MikeSevilla.TV. Enjoy! *This blog post was originally published at Doctor Ano... Better Health blogs http://www.medworm.com/rss/comments.php?id=4337940 Tue, 11 Jan 2011 20:00:00 +0100 4337940 http://www.medworm.com/index.php?rid=4331012&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoctors-patients-and-remote-third-parties%2F2011.01.10 From the ominously-titled book “New Rules” by Donald Berwick, M.D., and Troyen Brennan M.D.: “Today, this isolated relationship [between doctor and patient] is no longer tenable or possible. . . Traditional medical ethics, based on the doctor-patient dyad, must be reformulated to fit the new mold of the delivery of health care. . . The primary function of regulation in health care…is to constrain decentralized individualized decision making.” Unfortunately, Dr. Berwick’s straightforward formulation of the appropriate role of the individual physician in our reformed healthcare system is not isolated to thinkers of the Progressive persuasion. The notion that most clinical decisions can be usefully made by a centralized authority is attractive even to some conservatives. For examp... Better Health blogs http://www.medworm.com/rss/comments.php?id=4331012 Mon, 10 Jan 2011 22:00:27 +0100 4331012 http://www.medworm.com/index.php?rid=4322507&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpain-contracts-do-they-threaten-the-doctor-patient-relationship%2F2011.01.07 Doctors today are wary about treating chronic pain. One of the main worries is precipitating fatal opioid overdoses. Indeed, according to the CDC, and reported by American Medical News, “fatal opioid overdoses tripled to nearly 14,000 from 1999 to 2006 … [and] emergency department visits involving opioids more than doubled to nearly 306,000 between 2004 and 2008.” Requiring chronic pain patients to sign pain contracts is a way to mitigate this risk. But how does that affect the doctor-patient relationship? Indeed, a contract is an adversarial tool. Essentially, it states that a patient must comply with a strict set of rules in order to receive medications, including where and how often they obtain controlled substances, and may involve random drug testing. Break the contract and the ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4322507 Fri, 07 Jan 2011 20:00:11 +0100 4322507 http://www.medworm.com/index.php?rid=4322508&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fphysician-visibility-in-public-i-see-patients-and-they-see-me%2F2011.01.07 In the movie “The Sixth Sense,” there was that kid who saw dead people. I’m like that. But I see patients and their parents instead. They’re all around me. They’re watching at the grocery store when my kids act up. We meet during anniversary dinners, at Christmas Eve service, and on the treadmill at the Y. I bump into parents when buying personal effects and even during the early morning coffee run in my oldest sweats. I see patients. The follow-up dialog between the parents might go something like this: Dad: “Marge, don’t you think Billy’s colitis might be better managed by a doctor capable of pulling himself together?” Mom: “Don’t be ridiculous, Frank. DrV’s bedhead has nothing to do with his ability to care for Billy. And besides, I’ve heard tha... Better Health blogs http://www.medworm.com/rss/comments.php?id=4322508 Fri, 07 Jan 2011 18:00:43 +0100 4322508 http://www.medworm.com/index.php?rid=4322568&cid=t_99909_113_f&fid=34634&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FEmrAndHipaa%2F%7E3%2Fn_aBTJhXj8w%2F A source just told me that an insurance company that does only professional liability insurance for doctors is providing a 5% discount to all doctors who implement EHR and use it in a meaningful manner. This is really interesting news for me since I’ve seen a number of really interesting debates about whether use of an EHR would actually raise liability insurance for doctors or lower it. This is the first confirmed company I’ve found that has actually acted on a doctors use of an EMR in their liability insurance premiums (of course, maybe there are more I don’t know about). Of course, there are a lot of details missing in the statement posted above. For example, how does the liability insurance company plan to measure if the doctor is using an EMR in a “meaningful m... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=4322568 Fri, 07 Jan 2011 16:27:57 +0100 4322568 http://www.medworm.com/index.php?rid=4318331&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcomparative-effectiveness-research-more-can-be-less%2F2011.01.06 Discussion About Comparative Effectiveness Research When the public turns its attention to medical effectiveness research, a discussion often follows about how this research might restrict access to new medical innovations. But this focus obscures the vital role that effectiveness research will play in evaluating current medical and surgical care. I am now slogging through chemotherapy for stomach cancer, probably the result of high doses of radiation for Hodgkin lymphoma in the early 1970s, which was the standard treatment until long-term side effects (heart problems, additional cancers) emerged in the late 80s. So I am especially attuned to the need for research that tracks the short and long-term effectiveness — and dangers — of treatments.  Choosing a surgeon this Septembe... Better Health blogs http://www.medworm.com/rss/comments.php?id=4318331 Thu, 06 Jan 2011 22:00:53 +0100 4318331 http://www.medworm.com/index.php?rid=4314005&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fon-the-value-of-open-mindedness%2F2011.01.05 Three recent sto­ries lead me to my open­ing topic for the year: The value of open-mindedness. This char­ac­ter­is­tic — a state of recep­tive­ness to new ideas — affects how we per­ceive and process infor­ma­tion. It’s a qual­ity I look for in my doc­tors, and which I admire espe­cially in older people. Piece #1 — On the brain’s matu­rity, flex­i­bil­ity and “cog­ni­tive fitness” For the first piece, I’ll note a Dec 31 op-ed piece that appeared in the New York Times: This Year, Change Your Mind, by Dr. Oliver Sacks, the neu­rol­o­gist and author. In this thought­ful essay, he con­sid­ers the adult brain’s “mys­te­ri­ous and extra­or­di­nary” power to adapt and grow: “I have seen hun­dreds of patients with var­i­ous deficits &#8212... Better Health blogs http://www.medworm.com/rss/comments.php?id=4314005 Wed, 05 Jan 2011 22:00:57 +0100 4314005 http://www.medworm.com/index.php?rid=4314008&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fliposuction-related-death-and-finding-a-safe-doctor%2F2011.01.05 From the Chicago Tribune: A 35-year-old woman who wanted to resculpt herself for the new year with liposuction and a buttocks enhancement is dead from apparent complications of plastic surgery, her husband and lawyer said Thursday. Miami customer service representative Lidvian Zelaya died Monday, hours after the operation began at Strax Rejuvenation and Aesthetics Institute, a busy cosmetic surgery practice in Lauderhill. Zelaya went to Strax to have fat suctioned from her back and belly, and to have the material injected into her backside, family representatives said. She chose Strax because she got a good deal. Aronfeld said the operation was to be done by Dr. Roger L. Gordon. He was disciplined by the state in connection with two plastic surgery deaths in 2004. This is getting ridiculou... Better Health blogs http://www.medworm.com/rss/comments.php?id=4314008 Wed, 05 Jan 2011 16:00:26 +0100 4314008 http://www.medworm.com/index.php?rid=4302122&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2F10-new-years-resolutions-for-doctors-and-patients%2F2010.12.31 #1 Doctor: Resolve to let patients speak without interruption and describe their symptoms. Patient: Resolve to focus on the problem I am seeing the doctor about and not come with a list of 10 complaints for a 15-minute office visit. #2 Doctor: Resolve to keep a pleasant tone of voice when answering night and weekend phone calls from the answering service, patients, or nurses. Patient: Resolve to get my prescriptions filled during office hours, not forget my medications while traveling, and to use night and weekend phone calls for emergencies only. #3 Doctor: Resolve to exercise a minimum of four times a week for better health. Patient: Ditto. #4 Doctor: Resolve to train my staff and model excellent customer service for patients. Patient: Resolve to understand that getting an instant refer... Better Health blogs http://www.medworm.com/rss/comments.php?id=4302122 Fri, 31 Dec 2010 22:00:00 +0100 4302122 http://www.medworm.com/index.php?rid=4302161&cid=t_99909_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F12%2F31%2Fworkarounds-that-work-russell-bishops-wise-advice-for-2011%2F Here’s an appropriate post for New Year’s Eve! How to organize your life! So that everything that happens in 2011 will fit into a nice, neat category. Sort of. My only resolution this year is to become more organized in the way I work and live so that work and life are less on my mind during the times that I’m supposed to be chilling with the kids or hanging with friends. I hereby declare that I am guilty of the perspective of just getting through something to get to the other side, where things will be peaceful. I’m constantly wishing for a date in the nearby future, where the specific problems and complications of today won’t be there. But that attitude robs me of so many teaching moments of today. Thus, next year, I am going to try my best to be as organiz... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=4302161 Fri, 31 Dec 2010 21:00:37 +0100 4302161 http://www.medworm.com/index.php?rid=4298620&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fabout-patient-autonomy%2F2010.12.29 Recently, I was involved in a discussion on an email list serve and decided to takes some of my comments on patient autonomy and blog about them. This arose following a debate about whether the term “patient” engendered a sense of passivity and, therefore, whether the term should be dropped in favor of something else, like “client” or something similar. Having participated in the preparation and dissemination of the white paper on e-patients, I don’t see the need for “factions” or disagreements in the service of advancing Participatory Medicine. As Alan Greene aptly stated: “This is a big tent, with room for all.” I want all of my patients to be as autonomous as possible. In my view, their autonomy is independent of the doctor-patient r... Better Health blogs http://www.medworm.com/rss/comments.php?id=4298620 Wed, 29 Dec 2010 22:00:00 +0100 4298620 http://www.medworm.com/index.php?rid=4298621&cid=t_99909_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fweight-loss-the-most-common-new-years-resolution%2F2010.12.29 Probably the most common New Year’s resolution I hear year after year is the one to lose weight. I mean, hey — even I tell myself that I’ll feel better when I’m able to drop some pounds. But how is that done? I get asked all the time what is the best diet out there and what piece of exercise equipment should be purchases to get the job done. And, oh yeah — how soon can I see results? Losing weight is not easy (duh) — a doctor doesn’t need to tell you that. But in this video, I talked with our local TV station about some practical “dos and don’ts” when it comes to trying to lose some weight as your New Year’s resolution. As a rule, I tell people to start off your plan slowly when it comes to eating better and incorporating s... Better Health blogs http://www.medworm.com/rss/comments.php?id=4298621 Wed, 29 Dec 2010 20:00:00 +0100 4298621