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 'family medicine'. Sat, 03 Sep 2011 01:59:04 +0100 http://www.medworm.com/index.php?rid=5069477&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Finstitute-of-medicine-suggests-8-new-preventive-services-to-improve-womens-health%2F2011.07.26 Eight preventive health services for women should be added to the services that health plans will cover at no cost to patients under the Patient Protection and Affordable Care Act of 2010, according to a report by the Institute of Medicine. The recommendations encompass diseases and conditions that are more common or more serious in women than in men. They are based on existing guidelines and an assessment of the evidence on the effectiveness of different preventive services. They include: 1) screening for gestational diabetes in pregnant women between 24 and 28 weeks and at the first prenatal visit for women at high risk for diabetes, 2) adding high-risk human papillomavirus DNA testing in addition to conventional cytology testing in women with normal cytology results starting at age 30, ... Better Health blogs http://www.medworm.com/rss/comments.php?id=5069477 Tue, 26 Jul 2011 18:00:00 +0100 5069477 http://www.medworm.com/index.php?rid=5050775&cid=t_99405_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=5036234&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fbudget-cuts-and-their-potential-complications-for-family-medicine%2F2011.07.16 Every day in the news, you hear about the United States federal budget and the potential political complications if something is done or if nothing is done. And every day in the news you hear about possible cuts in Medicare. What you don’t know is that some cuts in Medicare can significantly impact the training of future Family Physicians. What do I mean by this? Well, did you know that residency programs are paid Medicare funds (called Graduate Medical Education funds) going to hospitals? Check out this great article about how residency programs are funded. So, let’s play this out with its potential complications for Family Medicine. If GME funds are cut as they are proposed, then many hospitals with only one residency program (usually a Family Medicine program), may be forced... Better Health blogs http://www.medworm.com/rss/comments.php?id=5036234 Sat, 16 Jul 2011 16:00:45 +0100 5036234 http://www.medworm.com/index.php?rid=4893470&cid=t_99405_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1649 My son Sam and I were driving along (well, he was driving) and discussing all of the things we’d like to do in life.  His interests are expansive, just like his dear old Papa, aka me.  We both recognize that life is not long enough to try all of the careers, degrees and experiences we would so love to enjoy.  ‘I think that’s what heaven is for, Sam.  Maybe we want to do those things because we’re supposed to do them in eternity!’ Sam, who sometimes toys with the idea of being a physician, pondered it all then said ‘No offense, but I don’t think we’ll need doctors.’ ‘That’s fine with me,’ I replied earnestly.  And I began to think about it. No more doctoring… A doctor I will no more be When I pass heaven&#821... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4893470 Fri, 03 Jun 2011 03:21:17 +0100 4893470 http://www.medworm.com/index.php?rid=4893456&cid=t_99405_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=4828883&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-family-medicine-needs-social-media%2F2011.05.16 I wasn’t able to attend the Annual Leadership Forum (ALF) and the National Conference of Special Constituencies (NCSC) meetings in person this year. This is an annual meeting in Kansas City put on by the American Academy of Family Physicians (AAFP). I know that it can be hard to believe that someone actually likes going to a meeting. However, for me, these meetings always re-energize me and connect me with people with a passion for Family Medicine. In 2010, there were only a few of us utilizing social media tools like twitter and facebook (including my blog posts from Thursday & Friday). However, just a year later, there seems to have been an explosion of people utilizing these platforms to a point yesterday when I saw a bunch of people signing up for the first time during the me... Better Health blogs http://www.medworm.com/rss/comments.php?id=4828883 Mon, 16 May 2011 18:00:18 +0100 4828883 http://www.medworm.com/index.php?rid=4789250&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-family-physician-may-become-extinct-is-that-a-bad-thing%2F2011.05.04 The New York Times recently published an article titled the Family Can’t Give Away Solo Practice wistfully noting that doctors like Dr. Ronald Sroka and “doctors like him are increasingly being replaced by teams of rotating doctors and nurses who do not know their patients nearly as well. A centuries-old intimacy between doctor and patient is being lost, and patients who visit the doctor are often kept guessing about who will appear in the white coat…larger practices tend to be less intimate” As a practicing family doctor of Gen X, I applaud Dr. Sroka for his many years of dedication and service.  How he can keep 4000 patients completely clear and straight in a paper-based medical system is frankly amazing.  Of course, there was a price.  His life was focused sol... Better Health blogs http://www.medworm.com/rss/comments.php?id=4789250 Wed, 04 May 2011 20:00:00 +0100 4789250 http://www.medworm.com/index.php?rid=4789251&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2F1.gravatar.com%2Favatar%2F1698659e0d52adbb43ab3ee84c47337c%3Fs%3D96%26amp%3Bd%3Didenticon%26amp%3Br%3DG 9:00 pm: Hello. It’s Mrs. Mumbledimumbler; I need the doctor to call me right away. My hip is driving me crazy. Please call me. I listen to the message three times so I can sort of make out the name. The problem is that even though I think I can understand it, I don’t recognize it at all. But I call her because she said she needed me to call her right away. Hello. I need you to call me in some tramadol right away. “What was your name again?” She repeats it clearly enough for me to confirm that I really don’t recognize it. “Have I ever seen you in the office?” No. Let me get this straight: it’s 9:00 at night and your hip is hurting, so you call a doctor who’s a complete stranger and insist that they call you in a powerful painkiller without ever having seen you, taken your... Better Health blogs http://www.medworm.com/rss/comments.php?id=4789251 Wed, 04 May 2011 18:00:05 +0100 4789251 http://www.medworm.com/index.php?rid=4753696&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fstatin-use-is-increasing-dramatically-are-americans-healthier-for-it%2F2011.04.25 Baseball fans have the Baseball Prospectus annual. Political junkies can get their fix from Nate Silver’s 538 blog. For those of us with geeky interest in health and medicine statistics, graphs, and charts, the Health, United States, 2010 report from the National Center for Health Statistics is that kind of treat. The 41 charts and graphs and 148 trend tables in the 2010 report (it’s dated 2010 but was released earlier this year) could keep me happily occupied for hours. One graph that really caught my eye shows the percentage of Americans that take a statin. Statins are prescribed mainly to lower “bad” LDL cholesterol, but they may have other benefits, too. The statins include atorvastatin (sold as Lipitor), rosuvastatin (sold as Crestor), and simvastatin (sold as Zocor but also a... Better Health blogs http://www.medworm.com/rss/comments.php?id=4753696 Mon, 25 Apr 2011 18:00:48 +0100 4753696 http://www.medworm.com/index.php?rid=4605827&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fasymptomatic-strep-throat-should-we-treat-it%2F2011.03.17 Occasionally, I see patients who have received throat swabs for strep that have come back positive… even if they have no signs or symptoms of pharyngitis. In this situation, there are 2 main actions a physician may take (I am biased towards one): 1) Prescribe antibiotics until throat cultures are normal 2) Do nothing Personally, if a patient is without throat symptoms and has no history of rheumatic fever or kidney damage, I would not have even bothered obtaining a strep test. What for??? (more…) *This blog post was originally published at Fauquier ENT Blog* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4605827 Thu, 17 Mar 2011 20:00:00 +0100 4605827 http://www.medworm.com/index.php?rid=4600536&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fobesity-beats-adiposity-for-cardiovascular-risk%2F2011.03.16 Obesity contributes to cardiovascular risk no matter where a person carries the weight, concluded researchers after looking at outcomes for nearly a quarter-million people worldwide. Body mass index, (BMI) waist circumference, and waist-to-hip ratio do not predict cardiovascular disease risk any better when physicians recorded systolic blood pressure, history of diabetes and cholesterol levels, researchers reported in The Lancet. The research group used individual records from 58 prospective studies with at least one year of follow up. In each study, participants were not selected on the basis of having previous vascular disease. Each study provided baseline for weight, height, and waist and hip circumference. Cause-specific mortality or vascular morbidity were recorded according to well d... Better Health blogs http://www.medworm.com/rss/comments.php?id=4600536 Wed, 16 Mar 2011 17:00:00 +0100 4600536 http://www.medworm.com/index.php?rid=4636509&cid=t_99405_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F03%2Fproviding-feedback-to-doctors-to-help.html What makes a good doctor good is the fact that he has good clinical judgment. This is a term which is hard to define, but basically a good doctor is one has seen and treated and learned from lots of patients, each of whom adds to his knowledgebase and clinical wisdom. As the saying goes, "Good judgment comes from experience. Experience comes from bad judgment."However, the mere passage of time does not provide good judgment . After all, 20 years of being a doctor could simply mean 20 years of doing the wrong thing ! It's important that doctors learn from their experience - and the only way they can do so is by tracking the outcomes of the patients they treat.Unfortunately, this rarely happens in real life ! Let's take 2 patients whom a family physician treats for abdominal pain. One gets b... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4636509 Wed, 16 Mar 2011 04:42:00 +0100 4636509 http://www.medworm.com/index.php?rid=4570546&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhat-to-do-about-fever%2F2011.03.10 Fever is often a part of life as a parent, particularly with young children in the winter time (read: six to 10 colds a year is the norm.) Although I sincerely don’t like it and do feel naturally uneasy when my boys have a fever, as a pediatrician I know to take fever as one of many symptoms they develop when responding to infection. I certainly use medications like Tylenol when my boys are feverish, refusing to eat, punked out, and exhausted. Thing is, it works! And often they respond beautifully, bouncing back, regaining energy, and improving their fluid intake and appetite. But I don’t treat every fever they have and I don’t recommend you run for the medicine cabinet when you feel that warm forehead. It’s not necessary to treat every fever. And it’s certainly not ideal to trea... Better Health blogs http://www.medworm.com/rss/comments.php?id=4570546 Thu, 10 Mar 2011 18:00:26 +0100 4570546 http://www.medworm.com/index.php?rid=4522106&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-thank-you-a-day%2F2011.02.25 This is a guest post by Dr. John Schumann. ********** I just read the book “365 Thank Yous” by John Kralik. I heard an interview with the author on NPR and it caught my attention. Kralik had been down on his luck in 2007: Divorced twice, overweight, with a struggling law firm that he’d started, he was also failing in a new romantic relationship. He was worried about losing his seven-year-old daughter, too, in a custody dispute. He made a momentous decision: Instead of feeling sorry for himself (easy to do given his predicaments), he decided to be grateful for what he had. To show it, he vowed to write a thank-you note every day for the next year. What do you think happened? His life changed for the better. His relationship improved. His clients started paying their bills... Better Health blogs http://www.medworm.com/rss/comments.php?id=4522106 Fri, 25 Feb 2011 18:00:00 +0100 4522106 http://www.medworm.com/index.php?rid=4517166&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-importance-of-diagnosing-birth-defects%2F2011.02.24 Birth defects, particularly those of the blood vessels, account for the majority of infant deaths, especially after the first week of life. Congenital heart disease (CHD) — meaning defects of the heart – is responsible for one-third of deaths between birth and the first year of life. Therefore, the diagnosis of CHD is critical in order to plan life-saving treatments, such as the proper place for the delivery, the type of delivery, and its timing. If it’s known in advance that an unborn baby has a heart problem and is delivered in a hospital that provides special care, its survival and future health will increase dramatically. Who’s at risk for having CHD and which expectant moms should have further evaluation? Families who have a history of CHD — especially ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4517166 Fri, 25 Feb 2011 00:00:49 +0100 4517166 http://www.medworm.com/index.php?rid=4512393&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fnew-doctor-considering-primary-care-show-me-the-money%2F2011.02.23 There are plenty of reasons why medical students aren’t choosing primary care as careers. Lack of role models. Perception of professional dissatisfaction. High burnout rate among generalist doctors. Long, uncontrollable hours. But what about salary? Until now, the wage disparity between primary care doctors and specialists has only been an assumed reason; the evidence was largely circumstantial. After all, the average medical school debt exceeds $160,000, so why not go into a specialty that pays several times more, with better hours? Thanks to Robert Centor, there’s a study published in Medscape that shows how money affects career choice among medical students. Here’s what they found: Sixty-six percent of students did not apply for a primary care residency. Of these, 30 percent woul... Better Health blogs http://www.medworm.com/rss/comments.php?id=4512393 Wed, 23 Feb 2011 18:00:09 +0100 4512393 http://www.medworm.com/index.php?rid=4507286&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fabout-white-coat-hypertension%2F2011.02.21 “But doc, my blood pressure is always normal at home.” I wish I had a dollar for every time I have heard that line and I know it is true. When some patients come to see me, their blood pressure is abnormally high (above 130/90). This is known as “white-coat hypertension.” Although it has been thought to be from anxiety about seeing the doctor, even long-established patients who have no conscious anxiety can exhibit elevated blood pressure in the office. Because blood pressure naturally fluctuates and the office visit is not a “normal” setting, it is important for patients who have high blood pressure (hypertension) to have their own blood pressure cuff at home. Now that devices are automated and easy to use, everyone with hypertension should be mo... Better Health blogs http://www.medworm.com/rss/comments.php?id=4507286 Mon, 21 Feb 2011 20:00:00 +0100 4507286 http://www.medworm.com/index.php?rid=4495205&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-pseudo-homeopathic-remedy%2F2011.02.18 Never in a million years would I have dreamed I would be able to say this, but I actually recommended a homeopathic remedy today. To briefly review, for anyone who may be under the mistaken impression that homeopathic remedies actually do anything – they don’t. Here’s why in a nutshell: Homeopathy is an unscientific and absurd pseudoscience, which persists today as an accepted form of complementary medicine, despite there never having been any reliable scientific evidence that it works. So what on earth possessed me to seriously recommend it? I’ll tell you. I saw a beautiful little four-month-old today whose mother thinks he might be teething. Everyone thinks their four-month-olds are teething because they start getting more drooly as their hand-mouth coordination improves, a... Better Health blogs http://www.medworm.com/rss/comments.php?id=4495205 Fri, 18 Feb 2011 16:00:01 +0100 4495205 http://www.medworm.com/index.php?rid=4489672&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fadult-vaccines-most-doctors-dont-stock-all-of-them%2F2011.02.17 Less than one in three primary care practices offer all 10 recommended adult vaccines, citing a variety of financial and logistical reasons. Researchers sponsored by the Centers for Disease Control and Prevention sampled 993 family physicians and 997 general internists. Of the respondents, 27 percent (31 percent of family practitioners and 20 percent of internists) stocked all 10. Results appear in the Feb. 17 issue of the journal Vaccine. The 10 vaccines were hepatitis A; hepatitis B; human papillomavirus vaccine (HPV); combined measles, mumps, and rubella (MMR); meningococcal conjugate vaccine (MCV4); pneumococcal polysaccharide (PPSV23); tetanus diphtheria (Td); combined tetanus, diphtheria, and pertussis (Tdap); varicella; and zoster. Of the responding practices, two percent plan... Better Health blogs http://www.medworm.com/rss/comments.php?id=4489672 Thu, 17 Feb 2011 19:00:00 +0100 4489672 http://www.medworm.com/index.php?rid=4482757&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fworking-mom-overweight-kid%2F2011.02.15 A study about working mothers is getting a lot of buzz. The official title of the paper is ”Maternal Employment, Work Schedules, and Childen’s Body Mass Index.” Most media summaries, however, are entitled something like this: “Mothers Who Work Have Fat Kids.” I’m not kidding. I hate seeing studies and media reports like this. Not because they’re not helpful or worthy of our time, but because they examine the effect of mothers working — not mothers and fathers working — on our childrens’ health. In addition, the media/blogosphere goes bananas. This is the stuff that sells — studies on working moms get our attention. They feed the so-called “mommy wars.” They suggest that with the rise of women in the work force over the last five decades, our... Better Health blogs http://www.medworm.com/rss/comments.php?id=4482757 Wed, 16 Feb 2011 02:00:45 +0100 4482757 http://www.medworm.com/index.php?rid=4450291&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fear-infections-to-treat-or-not-to-treat%2F2011.02.08 Ear infections used to be a devastating problem. In 1932, acute otitis media (AOM) and its suppurative complications accounted for 27 percent of all pediatric admissions to Bellevue Hospital. Since the introduction of antibiotics, it has become a much less serious problem. For decades it was taken for granted that all children with AOM should be given antibiotics, not only to treat the disease itself but to prevent complications like mastoiditis and meningitis. In the 1980s, that consensus began to change. We realized that as many as 80 percent of uncomplicated ear infections resolve without treatment in three days. Many infections are caused by viruses that don’t respond to antibiotics. Overuse of antibiotics leads to the emergence of resistant strains of bacteria. Antibiotics cause ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4450291 Tue, 08 Feb 2011 22:00:44 +0100 4450291 http://www.medworm.com/index.php?rid=4445800&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fsex-during-pregnancy-is-safe%2F2011.02.07 The Canadian Medical Association Journal (CMAJ) has published a new primer designed to help physicians when they counsel pregnant women. They note that sex during pregnancy is normal and is generally considered safe. The authors point out that there are very few proven contraindications and risks regarding intercourse in normal pregnancy. Pregnant women and their partners are often afraid to have sex. Men may think they are “invading” the home of the fetus and could actually harm the baby. In fact, the fetus is quite safe, ensconced in the uterus (womb) and the cervix (opening of the uterus) is closed in normal pregnancy. The penis has no contact with the fetus or the uterus during normal intercourse, no matter what the position. When is intercourse considered risky? Only f... Better Health blogs http://www.medworm.com/rss/comments.php?id=4445800 Tue, 08 Feb 2011 02:00:00 +0100 4445800 http://www.medworm.com/index.php?rid=4419137&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fbook-review-deadly-choices-how-the-anti-vaccine-movement-threatens-us-all%2F2011.01.31 A friend suggested she was tired of hearing about vaccines. Her comment and our subsequent conversation seemed to reflect an important shift in parent sentiment: The conversation about vaccines is beginning to get somewhere. While much of this was born of the mainstream media’s newfound realization that the vaccine-autism connection was cooked, some of this is due to the tireless work of those like the Children’s Hospital of Philedelphia’s Dr. Paul Offit who get the story right. As part of his passionate agenda to expose vaccine truths, he’s published “Deadly Choices: How the Anti-vaccine Movement Threatens Us All” (Basic Books, 2011). For those looking to understand the origins of anti-vaccine sentiment, read this book. What struck me is the deep history beh... Better Health blogs http://www.medworm.com/rss/comments.php?id=4419137 Mon, 31 Jan 2011 21:00:50 +0100 4419137 http://www.medworm.com/index.php?rid=4411527&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fstress-in-life-respond-differently-and-live-longer%2F2011.01.28 This study proved that one such intervention, cognitive behavioral therapy (CBT) for patients who suffered a first heart attack, lowered the risk of fatal and nonfatal recurrent cardiovascular disease events by 41 percent over eight years. Nonfatal heart attacks were almost cut in half. Excitement may be dampened by the fact that all-cause mortality did not statistically differ between the intervention and control groups, but did trend towards an improvement in the eight years of follow up. Definitely less suffering. Maybe less deaths. The authors state that psychosocial stressors have been shown to account for an astounding 30 percent of the attributable risk of having a heart attack. Chronic stressors include low socioeconomic status, low social support, marital problems, and work dist... Better Health blogs http://www.medworm.com/rss/comments.php?id=4411527 Fri, 28 Jan 2011 17:00:39 +0100 4411527 http://www.medworm.com/index.php?rid=4405778&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcranberry-juice-for-urinary-tract-infections-evidence-is-still-lacking%2F2011.01.26 It always somewhat surprises me how some interventions never seem to die. One therapy that refuses to be put to rest, or even to be clarified, is the use of cranberry juice for urinary tract infections (UTIs). PubMed references go back to 1962, and there are over 100 references. Firm conclusions are still lacking. There is a reasonable, but incomplete, basic science behind the use of the cranberry juice for UTIs. E. coli , the most common cause of UTIs, causes infection in the bladder by binding to the uroepithelial cells. To do this, they make  fimbriae,  proteinaceous fibers on the bacterial cell wall. Fimbriae are adhesins that attach to specific sugar based receptors on uroepithelial cells. Think Velcro. Being able to stick to cells is an important virulence factor for bacteri... Better Health blogs http://www.medworm.com/rss/comments.php?id=4405778 Wed, 26 Jan 2011 22:00:51 +0100 4405778 http://www.medworm.com/index.php?rid=4394444&cid=t_99405_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=4377570&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhos-more-pessimistic-about-healthcare-reform-physicians-or-patients%2F2011.01.20 While public opposition to healthcare reform has diminished since its passage, physician opinions are still negative, especially among specialists who see their value to the healthcare system decreasing as reform emphasizes primary care. A survey reports that 65 percent of nearly 3,000 physicians in all specialties said the quality of healthcare in the country will deteriorate in the next five years. Seventeen percent of respondents believe the quality of healthcare will stay the same and 18 percent believe it will improve. Meanwhile, 30 percent of healthcare consumers believe that the quality of healthcare will improve. Physicians cited as reasons for their pessimism personal political beliefs, anger at insurance companies and a lack of accurate planning in the reform act. Other reas... Better Health blogs http://www.medworm.com/rss/comments.php?id=4377570 Thu, 20 Jan 2011 18:00:00 +0100 4377570 http://www.medworm.com/index.php?rid=4352713&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-slippery-slope-of-anti-vaccine-complacency%2F2011.01.15 I got a package in the mail today: My very own (complimentary) copy of Paul Offit’s new book, “Deadly Choices; How the Anti-Vaccine Movement Threatens Us All.” Needless to say, I can’t wait to read it. Not coincidentally, Dr. Offit has been making the rounds of interviews in the wake of the book’s release. Although I haven’t heard any of them directly, I did see a reference to this NPR interview on the FaceBook page of an old friend, who quoted from it thusly: IRA FLATOW:  You write that some pediatricians will not see kids who are not vaccinated. Is that a good solution to the problem? DR. PAUL OFFIT: I don’t know what’s a good solution to that problem. And I feel tremendous sympathy for the clinician who’s in private practice. On the one hand, and my wife sort ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4352713 Sat, 15 Jan 2011 15:00:02 +0100 4352713 http://www.medworm.com/index.php?rid=4337940&cid=t_99405_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=4326903&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fgetting-kids-to-eat-low-sugar-cereals%2F2011.01.09 Just about everybody agrees that kids should eat breakfast every day. Breakfast improves their overall nutrition and their performance in school, among other things. But how helpful can breakfast really be if it consists of cereal deluged in sugar? “Not very” is the answer. Thankfully, a new study by Jennifer Harris and colleagues at Yale suggests that kids are perfectly willing to consume low-sugar cereals instead, particularly if they can add a pinch of table sugar or fresh fruit to the mix. To evaluate kids’ willingness to eat low-sugar cereals, Harris’ team randomized 91 kids between the ages of five and 12 to two groups. Kids in the first group were offered low-sugar cereals like Cheerios, Corn Flakes, and Rice Krispies, which contain one to four grams of sugar per servin... Better Health blogs http://www.medworm.com/rss/comments.php?id=4326903 Sun, 09 Jan 2011 14:00:41 +0100 4326903 http://www.medworm.com/index.php?rid=4322562&cid=t_99405_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2011%2F01%2Fdr-malpanis-opinion-on-why-indian.html There are major disadvantages to the cut system. For one, this system increases the cost to the patient. It also promotes malpractice, because family physicians often pressurise specialists to do surgery in order to maximise their revenue, which means that procedures are done, which are not always in the patient's best interests. Because this practice is hidden, it's never discussed openly, and this creates a lot of resentment amongst patients. The fact that doctors indulge in giving kickbacks is an open secret - and hiding this reality creates a lot of suspicion in the patient's mind. “This is one of the major reasons patients do not trust their doctors, and why the reputation of entire medical profession has taken such a beating in recent years,” says Dr. Malpani. (Source: The Patien... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4322562 Fri, 07 Jan 2011 12:39:00 +0100 4322562 http://www.medworm.com/index.php?rid=4318341&cid=t_99405_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1410 Theologically questionable; still pretty funny! Living and working in ‘Smite-ville.’ My partner, the sagacious Dr. Doug McGuff, has many words of wisdom.  I hope that he will one day collect them in a book, because generations of people will benefit. One of his pearls of wisdom is that, in emergency medicine (indeed, medicine in general), we live and work in ‘Smite-ville.’   That is, it always seems as if we care for patients who have been smitten by some terrible event, some awful disease.  His point was not that we are witnessing punishment, or even that the world is necessarily more horrible than we thought, but that we who work in emergency rooms and hospitals often see the worst of everything.  Emergency departments and hospitals are where horrors come to ... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4318341 Thu, 06 Jan 2011 15:08:51 +0100 4318341 http://www.medworm.com/index.php?rid=4304886&cid=t_99405_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1408 Animals are wonderful, but they just aren’t people! My Greenville News column from yesterday. (Incidentally, this column has the distinction of generating the most immediate hate-mail of anything I can recall writing in years!) We have five dogs and two cats. They are standard-issue canines and felines. We enjoy their company. We expect the dogs to kill rats, frighten snakes, chase coyotes, bark at strangers and generally to hold the porch in place against the random disappearance of gravity. The cats are for entertainment and otherwise useless. They leave hair-balls on narrow counters, shed and keep their kids awake by rubbing bristly kitty faces against them, all night long, in ecstacies of purring and love. So they are tolerable despite their cat proclivities. I’ve had many... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4304886 Mon, 03 Jan 2011 15:03:07 +0100 4304886 http://www.medworm.com/index.php?rid=4298624&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fso-many-patient-complaints-not-enough-time%2F2010.12.29 Primary care physicians often have to see patients with a litany of issues — often within a span of a 15-minute office visit. This places the doctor in the middle of a tension: Spend more time with the patient to address all of the concerns, but risk the wrath of patients scheduled afterwards, who are then forced to wait. And in some cases, it’s simply impossible to adequately address every patient question during a given visit. It’s a situation that internist Danielle Ofri wrote recently about in the New York Times. In her essay, she describes a patient, who she initially classified as the “worried well” type: … a thin, 50-year-old educated woman with a long litany of nonspecific, unrelated complaints and tight worry lines carved into her face. She unfolded a sheet of pape... Better Health blogs http://www.medworm.com/rss/comments.php?id=4298624 Wed, 29 Dec 2010 14:00:44 +0100 4298624 http://www.medworm.com/index.php?rid=4287412&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Freal-meaning-at-christmas%2F2010.12.24 Every day I go to work and spend time with suffering people. They come to me for help and for comfort. They open up to me with problems that they would not tell anyone else. They put trust in me — even if I am not able to fix their problems. I serve as a source of healing, but I also am a source of hope. Christmas is a moving season for many of the same reasons. No, I am not talking about the giving of gifts or the time spent with family. I am not talking about traditions, church services, or singing carols. I am not even talking about what many see as thereal meaning of Christmas: Mary, Joseph, shepherds, wise men, and baby Jesus. The Christmas story most of us see in pictures or read about in story books is a far cry from the Biblical account. The story we see and hear is... Better Health blogs http://www.medworm.com/rss/comments.php?id=4287412 Fri, 24 Dec 2010 22:00:14 +0100 4287412 http://www.medworm.com/index.php?rid=4281312&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhappiness-in-life-carrying-the-h-card%2F2010.12.22 The most moving speaker at the American Academy of Family Physicians (AAFP) convention I went to in Denver a few months ago was a doctor with Stage 4 cancer who had survived well past all expectations for his disease. While talking about achieving happiness through balance in life, he pulled out of his wallet a card made for him by his daughter, a preschool teacher. “This is the C card,” he told us. “It says: ‘I have cancer. I can do whatever I want.’” What a great idea, I thought. As much as it resonated with me, though, I couldn’t help but feel there was more to it than that. Recently I was comforting a dear friend who had lost her mother. Remembering this handout from the AAFP, I held her close and said: “You’re a mourner now. You can do whatever you want.” I might a... Better Health blogs http://www.medworm.com/rss/comments.php?id=4281312 Wed, 22 Dec 2010 21:00:13 +0100 4281312 http://www.medworm.com/index.php?rid=4272291&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fis-it-bad-patient-behavior-or-poor-doctor-patient-communication%2F2010.12.19 It seem like everyone these days is focused on changing some aspect of patient health behavior. You know — getting patients to get a mammogram or PSA test, exercise more, take medications as prescribed, or simply becoming more engaged in their healthcare. If only we could change unhealthy patient health behaviors, the world would be a better place.   I agree with the sentiment, but I think that patients and their health behavior often get a “bad rap” from healthcare professionals. I would even go so far as to say that much (not all) of what we attribute to poor patient behavior is more correctly attributable to ineffective doctor communications with patients. In my last post I talked about the link between strong physician advocacy, e.g., I recommend, and desirable health outcom... Better Health blogs http://www.medworm.com/rss/comments.php?id=4272291 Sun, 19 Dec 2010 14:00:18 +0100 4272291 http://www.medworm.com/index.php?rid=4265736&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fan-animated-look-at-the-future-of-healthcare%2F2010.12.17 Mrs. Happy and I just returned from Disney World for our Happy family vacation. (It was either that or a Parkinson’s Cruise.) While at Disney’s Epcot Center, Mama and Papa Happy discovered what the future of healthcare in America will look like, and it has nothing to do with insurance. You’ve all seen that giant Epcot ball. Inside that ball is a slow-moving ride that takes you through thousands of years of history. At the end you choose your own future. I present to you this video showing the future of healthcare in America, courtesy of the Epcot Spaceship Earth and Mama and Papa Happy: A couple words of mention. They still think there will be doctors in the future, unless their reference to doctors was reference to future nurse practitioners known as Dr. Nurse. That... Better Health blogs http://www.medworm.com/rss/comments.php?id=4265736 Fri, 17 Dec 2010 20:00:00 +0100 4265736 http://www.medworm.com/index.php?rid=4258863&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fskin-cancer-where-the-sun-don%25e2%2580%2599t-shine%2F2010.12.14 Not all skin cancers are from sun exposure. Viruses such as human papilloma virus (HPV), the virus that causes genital warts, also cause skin cancer. Skin cancer from HPV develops on genital skin in both men and women. It’s rarely talked about, but it’s important and can be deadly. Did you know that half of all deaths from skin cancer other than melanoma are from genital skin cancer? You probably also didn’t know that women are more likely to die from genital skin cancer as they are from skin cancer that developed from sun exposure (again, excluding melanoma). We dermatologists are inexhaustible when it comes to warning people about the dangers of sun exposure, but we should also be warning people about the dangers of genital warts. HPV protection, which includes HPV vaccines, ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4258863 Tue, 14 Dec 2010 23:00:03 +0100 4258863 http://www.medworm.com/index.php?rid=4258870&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmedical-marketing-more-money-wasted%2F2010.12.13 There was a series of ads on the radio awhile back that went something like this: When Mrs. Willis had a stroke, her husband never slept alone. Her daughter never had to go dress shopping for the prom by herself. And her son didn’t have to sit out the Mother-Son dance at his wedding. Why? Because she came to Hospital A…and she didn’t die! There’s another ad for one of the big downtown hospital’s cancer center (sorry, “advanced cancer center”): Every cancer, every stage. Your life depends on it! Let’s see: No one ever dies at Hospital A. And the big downtown cancer center can cure any cancer. That’s certainly what those ads would have you believe. Even the little local suburban hospitals have taken to advertising: Billboards around the neighborhoods, kiosks at the outlet m... Better Health blogs http://www.medworm.com/rss/comments.php?id=4258870 Mon, 13 Dec 2010 19:00:15 +0100 4258870 http://www.medworm.com/index.php?rid=4237893&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fnew-food-allergy-guidelines%2F2010.12.07 The National Institute of Allergy and Infectious Diseases (NIAID) issued comprehensive food allergy guidelines to help primary care physicians and subspecialists diagnose and manage patients. The guidelines were published online at the NIAID food allergy guidelines portal, which also has a frequently asked questions section. The agency will release a patient synopsis early next year. The guidelines establish consistent terminology and definitions, diagnostic criteria and patient management practices. Additional topics covered by the guidelines include the prevalence of food allergy and management of acute allergic reactions to food, including anaphylaxis. The report also identifies gaps about what is known about food allergy. NIAID Director Anthony S. Fauci, MACP, said, “Because thes... Better Health blogs http://www.medworm.com/rss/comments.php?id=4237893 Tue, 07 Dec 2010 21:00:00 +0100 4237893 http://www.medworm.com/index.php?rid=4225247&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Faddressing-healthcare-spending-%25e2%2580%259ccowardice%25e2%2580%259d-or-bravery%2F2010.12.03 In assessing the “best and worst” of the recommendations from the National Commission on Fiscal Responsibility, Washington Post blogger Ezra Klein accuses the Commission of “cowardice” in addressing healthcare spending: “The plan’s healthcare savings largely consist of hoping the cost controls . . . and various demonstration projects in the new healthcare law work and expanding their power and reach. . . In the event that more savings are needed, they throw out a grab bag of liberal and conservative policies . . . but don’t really put their weight behind any. . .[their] decision to hide from the big questions here is quite disappointing . . . ” Pretty harsh words, considering that in other respects Klein gives the Commission high marks. But I think there is a lot mo... Better Health blogs http://www.medworm.com/rss/comments.php?id=4225247 Fri, 03 Dec 2010 21:00:00 +0100 4225247 http://www.medworm.com/index.php?rid=4225250&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fhealthecommunications.files.wordpress.com%2F2010%2F12%2Fphysician-recommendation-styles.jpg “I recommend.” These are two word which, when spoken by a physician to a patient have tremendous power to change behavior. That assumes of course a trusting relationship between patient and physician (but that’s a topic for another day.)   Take the colonoscopy. The U.S. Preventive Services Task Force (USPSTF) recommends that adults aged ≥50 years get a colonoscopy every 10 years. In 2005, 50 percent of adults aged ≥50 years in the U.S. had been screened according to these recommendations. Not surprisingly, the rate of colonoscopy screening is much lower than that of other recommended adult preventive services. I was curious: Why?   Here are two interesting facts: 1. Studies show that patients cite “physician recommendation” as the most important motivator of colorectal sc... Better Health blogs http://www.medworm.com/rss/comments.php?id=4225250 Fri, 03 Dec 2010 15:00:35 +0100 4225250 http://www.medworm.com/index.php?rid=4225253&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fphysician-lifestyle-is-criteria-when-choosing-a-medical-specialty%2F2010.12.02 Medical students today consider lifestyle an essential criteria when choosing a specialty. It’s become a cliche that most are looking towards the ROAD (radiology, ophthalmology, anesthesiology and dermatology) to happiness. There’s been some recent media attention at how women are lured to specialties that offer a greater balance between their family lifestyle and professional demands. Claudia Golden, a Harvard economics professor, recently noted that, high-paying careers that offer more help in balancing work and family are the ones that end up luring the largest numbers of women. Surprisingly, colon and rectal surgery is one of these, because of rapid growth in routine colonoscopies that can be scheduled in advance, giving doctors control over their time. Goldin says 31% of colon and... Better Health blogs http://www.medworm.com/rss/comments.php?id=4225253 Thu, 02 Dec 2010 21:00:38 +0100 4225253 http://www.medworm.com/index.php?rid=4214129&cid=t_99405_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1373 Gifts for my colleagues, near and far This is my column in December’s EM News Merry Christmas! I like to think back on favorite Christmas gifts I have received down the years. I don’t think I can do any better than the children of mine who were born around Christmas. Three of the four came within one month of Christmas day. One came on December 23rd;. What wonderful presents! Going farther back, I recall sitting by the Christmas tree at my childhood home, or the homes of my grandparent’s. I found toy soldiers, toy horses, Matchbox cars, pocket-knives and many other little boy wonders. I remember the beautiful wooden stock and golden trigger of my first shotgun, and how it pulled me irresistably into a sense of impending manhood to know that my father and mother trusted m... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=4214129 Wed, 01 Dec 2010 03:37:03 +0100 4214129 http://www.medworm.com/index.php?rid=4214105&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fgerms-kids-and-school%2F2010.11.30 Everyone knows that when it comes to germs and kids, it can sometimes be difficult to limit the spread of infection — especially in a school or daycare setting. In this video, I talked with local TV news last week about germs and kids, and about preventing infections in college students during finals week:   If you find this video helpful, I invite you to check out my other videos at MikeSevilla.TV. Enjoy! *This blog post was originally published at Doctor Anonymous* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4214105 Wed, 01 Dec 2010 00:00:00 +0100 4214105 http://www.medworm.com/index.php?rid=4203157&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fprotecting-your-kids-brain%2F2010.11.26 Neuropsychologist Kim Gorgens spoke at the last TEDxDU about issues surrounding children’s safety and what parents can do to prevent concussions — and it’s probably not to wrap the little ones in bubble tape. Watch for yourself: (Hat Tip: Scope) *This blog post was originally published at Medgadget* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4203157 Fri, 26 Nov 2010 18:00:45 +0100 4203157 http://www.medworm.com/index.php?rid=4200562&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthanksgiving-and-your-priorities%2F2010.11.25 Here is my column in [the November 21st] Greenville News: This Thanksgiving we will have 32 guests at the table. Rather, at the tables we scatter about the dining room…and living room…and kitchen. At our house, food is practically a sacrament. And obviously Thanksgiving is the high holiday of American eating. So we will be honoring the tradition by feeding everyone as much as we can. Because the guests are all beloved to us, we will also have a variety of foods, in a variety of presentations. For instance, there will be fresh cranberries for organic purists, as well as a maroon gelatinous mass of cranberries for those who feel that cranberries indeed spring from aluminum. The turkeys will be divided perfectly among dark and light meat lovers. And for the carb-loving, there will be s... Better Health blogs http://www.medworm.com/rss/comments.php?id=4200562 Thu, 25 Nov 2010 13:00:38 +0100 4200562 http://www.medworm.com/index.php?rid=4197065&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-seduction-of-primary-care%2F2010.11.24 Hey there, big, smart, good-looking doctor… Are you tired of being snubbed at all the parties? Are you tired of those mean old specialists having all of the fun? I have something for you, something that will make you smile. Just come to me and see what I have for you. Embrace me and I will take away all of the bad things in your life. I am what you dream about. I am what you want.  I am yours if you want me… Seduce: verb [trans.] attract (someone) to a belief or into a course of action that is inadvisable or foolhardy : they should not be seduced into thinking that their success ruled out the possibility of a relapse. See note at “tempt.” (From the dictionary on my Mac, which I don’t know how to cite.) If you ever go to a professional meeting for doctors, make su... Better Health blogs http://www.medworm.com/rss/comments.php?id=4197065 Wed, 24 Nov 2010 13:00:39 +0100 4197065 http://www.medworm.com/index.php?rid=4183295&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fits-cold-and-flu-season-snls-hibernol%2F2010.11.19 Thanks to former student Allison Miller for reminding me about this clip from the Saturday Night Live (SNL) archives: *This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4183295 Fri, 19 Nov 2010 19:00:54 +0100 4183295 http://www.medworm.com/index.php?rid=4175695&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fprimary-care-poverty-and-mortality-in-england-and-america%2F2010.11.17 It is an article of faith that, in Barbara Starfield’s words, adults whose regular source of care is a primary care physician rather than a specialist have lower mortality, even after accounting for differences in income, and she draws upon studies at both the county and state levels to prove it. Now a new paper in JAMA about England’s Primary Care Trusts refocuses the discussion on poverty. While Starfield’s county-level studies are often cited as evidence that more primary care physicians and fewer specialists lead to lower mortality, they actually showed virtually no differences at all. And when repeated by Ricketts, the small differences noted were not consistent throughout various regions of the U.S. On the other hand, “counties with high income-inequality experienced much hig... Better Health blogs http://www.medworm.com/rss/comments.php?id=4175695 Wed, 17 Nov 2010 17:00:23 +0100 4175695 http://www.medworm.com/index.php?rid=4172060&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcaregivers%2F2010.11.16 It was a straightforward phone message (names changed): “Hey Dr. S., this is Bobbie Jones, April Dixon’s granddaughter. I was calling to inform you that April passed away today at City Hospital. They said she was bleeding in her stomach or something. I’m not quite what sure what happened, but she got real sick. But she’s gone, so, thanks so much. You’ve been a real neat doctor, and it’s been good working with you through the years taking care of my grandmother. Take care. Bye.” Bobbie Jones is a saint. Pure and simple. She took care of her 88-year-old grandmother with tender, loving care. I am certain if left to the vagaries of the “healthcare system” that her grandmother would have died at least three years ago, maybe earlier. Ms. Jone... Better Health blogs http://www.medworm.com/rss/comments.php?id=4172060 Tue, 16 Nov 2010 17:00:00 +0100 4172060 http://www.medworm.com/index.php?rid=4164521&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fnew-cigarette-labels-from-the-fda%2F2010.11.14 The FDA will soon require new cigarette package labeling to deter smoking. So in politically-correct governmental fashion, they are asking which labels you’d like to see. (You can pick your favorites here.) My personal favorite (so far) is the one shown to the left, but its impact factor pales in comparison to this example found in England. (That, my friends, is cancer!) Ironically, it appears the FDA isn’t too sure how forceful it should be in these warnings about the dangers of smoking. They offer a cornucopia of milquetoast labeling options, many of which contain cartoons. Might such unrealistic portrayals defy they hard-hitting message they want to project? Worse, at least one cartoon (seen here) even seems to promote cigarettes AND drug use together! In an even more astoni... Better Health blogs http://www.medworm.com/rss/comments.php?id=4164521 Sun, 14 Nov 2010 22:00:00 +0100 4164521 http://www.medworm.com/index.php?rid=4164524&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ftalk-to-patients-before-running-tests%2F2010.11.14 The Associated Press ran a provocatively-titled piece recently, “Family health history: ‘best kept secret’ in care”, which noted how a geneticist at the Cleveland Clinic discovered that asking about family members and their history of breast, colon, or prostate cancer was better than simply doing genetic blood testing. Surprising? Hardly. This is what all medical students are taught. Talk to the patient. Get a detailed history and physical. Lab work and imaging studies are merely tools that can help support or refute a diagnosis. They provide a piece of the puzzle, but always must be considered in the full context of a patient. They alone do not provide the truth. (more…) *This blog post was originally published at Saving Money and Surviving the H... Better Health blogs http://www.medworm.com/rss/comments.php?id=4164524 Sun, 14 Nov 2010 15:00:00 +0100 4164524 http://www.medworm.com/index.php?rid=4151789&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpatient-engagement-how-empathy-can-empower-your-patients%2F2010.11.10 In my recent post on KevinMD, “Deeply Connect and Engage Your Patients With Empathy,” I write about how empathy is essential to help empower our patients: “It is with empathy that we can engage and empower our patients.” Doctors and nurses are leaders in health care. Being a great leader means having a clear vision, mission or goal. It means being committed, and knowing how to listen and communicate, but it involves much more. It’s about having heart, empathy, and an uplifting spirit. I value and respect a well written post by Thomas Goetz, author of The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine recently published on KevinMD, “How can doctors successfully engage their patients?” Goetz writes about “Five things they should seek to... Better Health blogs http://www.medworm.com/rss/comments.php?id=4151789 Wed, 10 Nov 2010 14:00:50 +0100 4151789 http://www.medworm.com/index.php?rid=4151790&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fyour-insurance-plan-you-can-keep-it-if-you-want%25e2%2580%259d%2F2010.11.09 Forgive me for being a little late to the healthcare insurance reform discussion. I was busy, y’know, providing actual healthcare to sick people while that whole rigamarole was going on. But that one sentence, uttered over and over by everyone from the President on down, always stuck in my craw. At long last, I’m finally able to properly articulate my response. Trying to pass sweeping health insurance reform legislation while telling people that, of course, they “can keep their current plans if they want” is like legislating tough new laws against wifebeating and assuring women that, of course, they can stay with their husbands if they like. No one tries to force victims of domestic violence to leave their abusers, but they do try to help them understand that they h... Better Health blogs http://www.medworm.com/rss/comments.php?id=4151790 Tue, 09 Nov 2010 23:00:17 +0100 4151790 http://www.medworm.com/index.php?rid=4139235&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhow-your-health-insurance-can-save-your-life%2F2010.11.05 The Sacramento Bee recently ran the following opinion piece of mine below. A couple of additional comments not published follow. Enjoy.  ********* Viewpoints: Choice of health plan can be a lifesaver It’s that time of year when most of us pick a health insurance plan based simply on cost. It’s a belief that is often perpetuated by friends, family, and advice dispensed by many articles in magazines and newspapers. As a practicing primary care doctor, I can tell you that the advice is frankly wrong. Health insurance isn’t a commodity like auto insurance. It’s not just about the price. They aren’t all equally good at keeping you healthy and well. The recent annual report by the National Committee of Quality Assurance, which has been evaluating health plans for twenty years, contin... Better Health blogs http://www.medworm.com/rss/comments.php?id=4139235 Fri, 05 Nov 2010 18:00:00 +0100 4139235 http://www.medworm.com/index.php?rid=4125009&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-future-of-american-healthcare%2F2010.11.01 You want to see a doctor? You’re going to have to wait. And I don’t mean like an hour in the office. I mean like 53 days. It’s not some doomsday story from the future. It’s happening today here in Massachusetts. Massachusetts — the state whose 2006 law was the model for the federal healthcare reform law. Massachusetts — home to some of the world’s best medical centers and doctors. And, as the Boston Globe’s “White Coat Notes” blog reports, Massachusetts — home to doctor shortages and long waits to see a doctor: When primary care patients do secure an appointment for a non-urgent matter, they have to wait to get in the door, the survey found. The average delay is 29 days to see a family medicine doctor, down from 44 days last year, and 53 days ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4125009 Mon, 01 Nov 2010 14:00:44 +0100 4125009 http://www.medworm.com/index.php?rid=4118930&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fteen-pregnancy-decline-is-likely-as-low-as-it-will-go%2F2010.10.29 Teen pregnancy rates have declined, but likely bottomed out, according to a report by the Centers for Disease Control and Prevention (CDC). Teen births dropped by a third between 1990 to 2005, but rose again in 2006 and 2007. The latest figures for 2008 show a decline of 2.4 percent, to 41.5 pregnancies per 1,000 teenagers. Experts told My Health News Daily/MSNBC the dropping rates have bottomed out, and that new strategies are needed to deglamorize teen pregnancy. Teen birth rates were consistently highest in states across the South and Southwest, and lowest in the Northeast and upper Midwest. In 2008, state-specific teenage birth rates varied widely, from less than 25.0 per 1,000 15-19 year olds (Connecticut, Massachusetts, New Hampshire, and Vermont), to more than 60.0 per 1,000 (Arkans... Better Health blogs http://www.medworm.com/rss/comments.php?id=4118930 Fri, 29 Oct 2010 16:00:00 +0100 4118930 http://www.medworm.com/index.php?rid=4118934&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-big-picture-benefit-of-primary-care%2F2010.10.28 Her eyes were bloodshot. She responded to my casual greeting of “How are you?” with a sigh. “How am I? I’m alive, I can tell you that much for sure.” She went on to describe a situation with her adult son who’s in a bad marriage and has struggled with addiction. She sighed again: “I feel weak. I don’t know if I can deal with this one. I’ve had so many hard things in my life already. When will it stop?” “Many hard things” — yes, I agree with that assessment. She’s been my patient for more than a decade, and I’ve had a front row seat to her life. Her husband died a few years ago (while in his 40′s) of a longstanding chronic disease. Her daughter also has this disease, and has been slowly declining over time. I’ve watched her bear that burden,... Better Health blogs http://www.medworm.com/rss/comments.php?id=4118934 Thu, 28 Oct 2010 18:00:29 +0100 4118934 http://www.medworm.com/index.php?rid=4118937&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fprimary-care-doctors-how-valued-are-they%2F2010.10.27 Authors of a recent study from the Archives of Internal Medicine are unlikely to endear themselves to specialists. As reported by Reuters, and provocatively titled, Do specialist doctors make too much money?, the study gives a per-hour breakdown of how much doctors make. I think this is a good approach, since annual salary figures do not account for the number of hours doctors work — and in the case of primary care doctors, this includes uncompensated time doing paperwork and other bureaucratic chores. Here’s what they found: … the lowest wages — amounting to $60.48 an hour — [were] paid to primary care physicians. In other broad categories of practice, surgeons took home the highest average hourly wage of $92. Internal medicine and pediatric docs earned about $85 an hour, the re... Better Health blogs http://www.medworm.com/rss/comments.php?id=4118937 Wed, 27 Oct 2010 22:00:56 +0100 4118937 http://www.medworm.com/index.php?rid=4097935&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-family-doctors-footnotes%2F2010.10.23 Regular readers have heard me rant about the fragmentation of medical care in this country. Each body part not only has its own medical specialist, but in some cases its own allied health profession. Such is the case with the feet. Doctors of podiatric medicine have to complete a four-year course of study after college, followed by a three-year podiatry residency. At the end of all that, I grant, they are expert in the care and management of complex disorders and conditions of the foot, ankle, and lower leg. I refer to them regularly, especially for stubborn ingrown toenails. (I did indeed learn how to remove offending portions of nail bed, but over the years I’ve gotten away from it.) They fail, though, when they try to extend their reach beyond their grasp, which is the case of the pod... Better Health blogs http://www.medworm.com/rss/comments.php?id=4097935 Sat, 23 Oct 2010 19:00:54 +0100 4097935 http://www.medworm.com/index.php?rid=4086266&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fprenatal-vitamins-are-they-necessary-sufficient-safe%2F2010.10.20 What is in a prenatal vitamin? Why do most doctors recommend them? Is there any evidence taking them is worthwhile? I decided recently that I would read through the ingredients of these vitamins, often touted as “essential vitamins and nutrients, crucial for the healthy development of your baby.” Hmmm. Does that mean eating traces of polyvinyl alcohol every day is beneficial? The fine print ingredients of such brands as “One A Day”, “Centrum Materna”, “Rite Aid” and even the prescription only “Prenate Elite” are a confusing mess of milligrams, international units, RDA’s, and chemicals. As the makers of Centrum explain, “It is very challenging to formulate vitamins and minerals without the use of non-medicinal ingredients which serve to keep the product stable and to... Better Health blogs http://www.medworm.com/rss/comments.php?id=4086266 Wed, 20 Oct 2010 22:00:27 +0100 4086266 http://www.medworm.com/index.php?rid=4086268&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpreventive-healthmedicinecare-lets-give-it-a-name%2F2010.10.20 It’s a scene that plays out thousands of times every day in doctors’ offices across the country — the moment the doctor shifts from addressing the concerns that brought the patient into clinic to when he or she attempts to make sure everything else is going okay. Often this happens at the end of a sick visit, after working up an upper respiratory infection or back pain. Sometimes it happens after following up a chronic medical problem such as high blood pressure or arthritis, and occasionally it happens under ideal circumstances, during an annual physical or routine wellness visit. It doesn’t necessarily happen at the end of the visit. Often it sneaks it’s way into various points in the encounter — as when the doctor places his or her stethoscope over a patient’s che... Better Health blogs http://www.medworm.com/rss/comments.php?id=4086268 Wed, 20 Oct 2010 18:00:58 +0100 4086268 http://www.medworm.com/index.php?rid=4065366&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fvideo-we-are-family-physicians%2F2010.10.13 This video was [recently] shown at the 2010 American Academy of Family Physicians annual meeting in Denver. The theme is simple: “We are here. We are listening. We are healing. We are family physicians.” People ask me all the time “what do you do?” There’s no easy way to explain all the things that I do as a family physician. In addition, each family doc in each community is unique. That’s kind of part of the difficulty of answering the question. But I believe this video does a good job of trying to encapsulate who we are as family physicians: *This blog post was originally published at Doctor Anonymous* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4065366 Wed, 13 Oct 2010 19:00:00 +0100 4065366 http://www.medworm.com/index.php?rid=4065367&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-reality-of-participatory-primary-care%2F2010.10.13 No matter where one stands on appropriateness and advantages of each patient being involved in self-diagnosis and treatment of their own medical problems there are two inevitable conclusions: •    First of all, self diagnosis and treatment are as natural as breathing and as impossible to extinguish as thought itself. •    Secondly, given today’s healthcare system, there always will exist a dynamic tension between self-determination of the individual patient and the powerful healthcare system which often insists on patients falling back in line and complying with orders. Few would argue against the need for a powerful alliance that embraces the benefits brought to the table by both the practitioner and the patient. Simplistically, the physician would carry the role of healthcare... Better Health blogs http://www.medworm.com/rss/comments.php?id=4065367 Wed, 13 Oct 2010 14:00:06 +0100 4065367 http://www.medworm.com/index.php?rid=4065368&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpatients-as-partners%2F2010.10.13 The famous late 19th and early 20th century physician, Sir William Osler, said that “a physician who treats himself has a fool for a patient.” How would he have felt about patients diagnosing and treating themselves? Would he have written in support of the Journal of Participatory Medicine or against it? I also wonder how he would have practiced medicine in the “information age” when many of our patients present with a diagnosis already made, right or wrong. I recognize that bringing Dr. Osler into a discussion set in the information age is, perhaps, anachronistic. Yet I believe he still has something to teach the 21st century on the topic of patient participation. When he advised that “the first duty of the physician is to educate the masses not to take medicine,” ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4065368 Wed, 13 Oct 2010 12:00:24 +0100 4065368 http://www.medworm.com/index.php?rid=4053288&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fsnorin-in-the-usa%2F2010.10.10 Guest post by Dr. John Henning Schumann I’m not a drum banger for the latest “epidemics” to come to media attention, whether it’s H1N1, Vitamin D, or getting your kids CAT-scanned routinely. But there comes a time in every blogger’s life when he must comment on something that does bubble up into consciousness a tad, shall we say, often. I’m talking here about an epidemic that we are learning more about each passing day. Something that you or someone you know or sleep with may be diagnosed with, and ultimately treated for (an interesting national problem in its own right): Obstructive sleep apnea (OSA). What is it, you ask? A new national scourge? Stop the presses! Can I catch it? (more…) *This blog post was originally published at ACP Hospi... Better Health blogs http://www.medworm.com/rss/comments.php?id=4053288 Sun, 10 Oct 2010 17:00:00 +0100 4053288 http://www.medworm.com/index.php?rid=4045163&cid=t_99405_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F10%2Fis-real-life-doctor-better-than-online.html Traditionally, medical care was always provided face to face. If you had a medical problem, you went and saw your doctor for a consultation. He would take a history; examine you; and then decide on what treatment you needed.This was and is still a good model, because it allows doctors to provide the "human touch" , which is often a key ingredient in providing good medical care. However, as time evolved, doctors realised that not all their patients needed to come and see them for each and every problem.Many problems are self-limited and resolve on their own, so that they can be effectively managed by reassuring the patient; while others simply need a renewal of a prescription ( for example, for managing a stable patient with a chronic illness). This is why "telephone medicine" is an integra... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4045163 Fri, 08 Oct 2010 04:39:00 +0100 4045163 http://www.medworm.com/index.php?rid=4036644&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-patients-and-doctors-disagree%2F2010.10.06 A 69-year-old woman who swims in my master program came back to the pool after a total knee replacement. I asked her how she was doing. She said she is still in a lot of pain because of her physical therapy. She said that her physical therapist was disappointed that she still was still unable to achieve full flexion of 120 degrees. Why 120 degrees? Did you set that goal I asked her? ”No,” she said, “the therapist did.” She went on to tell how she already had more range of motion in her knee than she did before the surgery. My friend was quite satisfied with her progress and wanted to stop physical therapy. The pain from the PT was worse than anything she had experienced before the knee replacement. I knew she and her 80-year-old boy friend were going on a c... Better Health blogs http://www.medworm.com/rss/comments.php?id=4036644 Wed, 06 Oct 2010 22:00:00 +0100 4036644 http://www.medworm.com/index.php?rid=4036645&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Faafps-2011-family-physician-of-the-year%2F2010.10.06 This video was recorded at the American Academy of Family Physicians (AAFP) meeting in Denver last week. Hughes Melton, M.D., was awarded the “2011 Family Physician of the Year” award. The video below shares his story. I also encourage you to read more of his story from the news article on the AAFP website. I have always been inspired by hearing the stories of the “Family Physician of the Year.” One of my wild and crazy dreams is to achieve this award someday, but I know that I definitely have a long way to go. Congratulations, Dr. Melton! *This blog post was originally published at Doctor Anonymous* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4036645 Wed, 06 Oct 2010 19:00:00 +0100 4036645 http://www.medworm.com/index.php?rid=4036646&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fintegrating-wellness-into-a-primary-care-practice%2F2010.10.06 I often am asked how I incorporate wellness in our family medical practice, and I must admit that I’ve mixed feelings when it comes to the question because it implies that I’m not already trying to practice wellness simply by practicing medicine. I feel that the two are synonymous. To those who want to know more about wellness and primary care, here’s my approach: • I never try to sell anyone on a “wellness” program. • I follow specific guidelines on certain chronic illnesses, mostly adhering to evidence-based guidelines and not expert opinion or opinion by committee. • I offer the best advice I can to patients and try to guide them in the right direction when I feel they are taking pathways that worry me and that could be harmful (e.g. like using megavitamin an... Better Health blogs http://www.medworm.com/rss/comments.php?id=4036646 Wed, 06 Oct 2010 16:00:16 +0100 4036646 http://www.medworm.com/index.php?rid=4027160&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-struggle-to-retain-physicians%2F2010.10.03 Some states are finding it tough to retain physicians. Take Virginia for instance: A recent study found Virginia retains only 35 percent of its medical school graduates and ranks 31st among other states in retaining doctors. In 2008, Virginia spent more than $50 million from the general fund to support medical education and had nearly 600 new physicians graduate from Virginia’s four medical schools. Despite this, Virginia still struggles to retain medical graduates, with less than 25 percent of Virginia’s physicians graduating from medical schools in the Commonwealth. Some feel incentives might work: Dr. Greenawald says other states including North Carolina have incentives to keep medical students in state. He hopes Virginia considers following suit. Dr. Greenawald also said t... Better Health blogs http://www.medworm.com/rss/comments.php?id=4027160 Sun, 03 Oct 2010 14:00:00 +0100 4027160 http://www.medworm.com/index.php?rid=4018179&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-pain-cant-be-a-vital-sign%2F2010.09.29 There’s been a movement afoot for several years now to quantify pain as the so-called “Fifth Vital Sign.” It all started as a well-intentioned effort to raise the level of awareness of inadequate pain control in many patients, but has gotten way out of hand. The problem is that the word “sign” has a specific meaning in medicine that, by definition, cannot be applied to pain. When you hear us medicos talk about “signs and symptoms” of a disease, it turns out that they are not the same thing. “Symptoms” are things the patient experiences subjectively. “Signs” are things that can be observed objectively by another person. Headache is a symptom; cough is a sign. Itching is a symptom; scratch marks over a blistery linear rash are a sign. Vertigo, the hallucination of movem... Better Health blogs http://www.medworm.com/rss/comments.php?id=4018179 Wed, 29 Sep 2010 22:00:06 +0100 4018179 http://www.medworm.com/index.php?rid=4018181&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-medical-profession-is-it-devolving%2F2010.09.29 I had lunch with a group of physicians recently, and along for the ride was a college student thinking of applying to medical school. When talking about the future, I suggested that the work of a physician 30 years from now will be hardly recognizable to today’s physician. Everybody disagreed and the student was confused. There was a lot of denial and myopic rationalization. But I can’t blame them, really. Most of us see what’s immediately changing in our day-to-day work and the bigger picture gets lost. For most of us, the role of the physician is hard to see for anything other than it always has been. Most live and work as the self-determined independent care coordinator, reactively working to treat disease just as its been done for over a century. But change is happening arou... Better Health blogs http://www.medworm.com/rss/comments.php?id=4018181 Wed, 29 Sep 2010 17:00:11 +0100 4018181 http://www.medworm.com/index.php?rid=4001687&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmy-patient-the-health-nut%2F2010.09.25 A version of the following post, by Kimberly Manning, FACP, appeared on the blog “Life at Grady.” “My blood pressure is still borderline? Man!” “Yeah…and from looking through the chart, it was 150/96 on your admission. It’s pretty much been that since you’ve been here, give or take a few points. That’s a little more than borderline, actually.” I paused for a moment, realizing that I sounded a bit discouraging. “I don’t think this would be hard to get under control at all, sir. I mean…you’re such a motivated patient, you know?” I studied my patient carefully. He was in his late thirties, although he could totally pass for a twenty-something all day, every day. His skin looked like someone had grabbed ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4001687 Sat, 25 Sep 2010 17:00:00 +0100 4001687 http://www.medworm.com/index.php?rid=3998986&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fnutritional-supplements-do-they-really-help-prevent-disease%2F2010.09.24 (Guest post submitted by MD Anderson Cancer Center) Aisles in grocery stores and pharmacies are stacked with vitamins, minerals, herbs or other plants that you take in pill, capsule, tablet or liquid form. And, many of us buy these supplements and take them regularly, hoping to lower our chances of getting cancer and other diseases. But do supplements really work wonders? Should you take them to help prevent cancer? Our experts say beware. “Don’t be fooled by the label on the bottle,” says Sally Scroggs, health education manager at MD Anderson’s Cancer Prevention Center. “Researchers are still unsure about whether or not supplements actually prevent cancer.” Some studies have suggested that supplements may actually increase cancer risk by tilting the balance of nutrients in the... Better Health blogs http://www.medworm.com/rss/comments.php?id=3998986 Fri, 24 Sep 2010 20:00:57 +0100 3998986 http://www.medworm.com/index.php?rid=3998989&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-adults-get-chickenpox%2F2010.09.24 We think of chickenpox as a childhood disease, but there are adult cases and they tend to lead to more serious complications. Chickenpox is caused by the varicella virus and it is extremely contagious. Most people are exposed in childhood (or they receive the chicken pox vaccine), and so adults rarely contract it. It is especially dangerous for pregnant women because the fetus can become infected. The latency period from infection exposure to disease is 10 to 21 days. (more…) *This blog post was originally published at EverythingHealth* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3998989 Fri, 24 Sep 2010 14:00:00 +0100 3998989 http://www.medworm.com/index.php?rid=3993908&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fsickening-people%2F2010.09.22 The man who twirled with rose in teeth Has his tongue tied up in thorns His once expanded sense of time and Space all shot and torn See him wander hat in hand - “Look at me, I’m so forlorn - Ask anyone who can recall It’s horrible to be born! - Bruce Cockburn, from song “Shipwrecked at the Stable Door” I found the discussion around my recent post about treating colds very interesting. Sick people come to the office to find out how sick they are. Most people don’t want to be sick, and when they are sick they want doctors to make them better. Most people. Some people want to be sick, and some doctors want to make people sick. I am not talking about hypochondriacs — people who worry that they may have disease and become fixated on being sick. I am not talking about malingere... Better Health blogs http://www.medworm.com/rss/comments.php?id=3993908 Wed, 22 Sep 2010 14:00:34 +0100 3993908 http://www.medworm.com/index.php?rid=3993909&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhow-i-a-doctor-came-to-build-an-emr%2F2010.09.22 My desire for integrating the power of technology with primary care started nearly two decades ago. It was then, when working as a family physician in a busy medical practice, that I began experimenting with typing my notes and using computers in front of my patients. In 2001, I launched a new medical practice DocTalker, focusing on access of medical care to patients, and almost immediately I started searching in earnest for an EMR solution to fit my needs. However, I was not happy with the systems I looked into and tested and felt that they didn’t do what I needed them to.  Some of my discontent came from the way my medical practice consults with patients, which is primarily via telephones and emails and house calls (in addition to the common office visit). Because of our ability to of... Better Health blogs http://www.medworm.com/rss/comments.php?id=3993909 Wed, 22 Sep 2010 12:00:11 +0100 3993909 http://www.medworm.com/index.php?rid=3993911&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fall-about-hands-guidance-and-germs%2F2010.09.21 Some interesting items this week involving hands. The one which has gotten much news coverage is the issue of handwashing. Take a look at some of the headlines: High five! Handwashing on rise (Chicago Sun-Times) For Many, ‘Washroom’ Seems to Be Just a Name (The New York Times) 93% of women wash their hands vs. 77% of men (USA Today) All the above are reporting on the same study, but the difference in presentation is amazing to me. The study doesn’t involve handwashing in a hospital or doctor’s office setting. The JAMA article (2nd reference below) does, but this article focuses on whether public reporting of handwashing compliance is helpful or not. Do we inflate our numbers to make ourselves look better? (more…) *This blog post was originally published at ... Better Health blogs http://www.medworm.com/rss/comments.php?id=3993911 Tue, 21 Sep 2010 16:00:00 +0100 3993911 http://www.medworm.com/index.php?rid=3993914&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fprimary-care-has-it-been-oversold%2F2010.09.21 Citing a new study by the Dartmouth Atlas, the Wall Street Journal’s health blog provocatively asks: “Has the notion of ‘access’ to primary care been oversold?” The Dartmouth researchers found “that there is no simple relationship between the supply of physicians and access to primary care.” That is, they found that having a greater supply of primary care physicians in a community doesn’t mean that the community necessarily has better access to primary care. Some areas of the country with fewer primary care physicians per population do better on access than other areas with more primary care physicians. The researchers also report that the numbers of family physicians is more positively associated with better access than the numbers of internists... Better Health blogs http://www.medworm.com/rss/comments.php?id=3993914 Tue, 21 Sep 2010 10:00:00 +0100 3993914 http://www.medworm.com/index.php?rid=3987055&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fto-change-patient-behavior-change-how-you-talk-to-them%2F2010.09.20 According to Marshall Becker, PhD, MPH, a one-time professor of mine and prime mover behind the Health Belief Model (HBM), four things must be in place for health behavior change to occur. I am paraphrasing here:  A person has to know that they have a particular health condition. A person has to believe that having said health condition is bad. A person must perceive the benefits of behavior change to outweigh the difficulties of behavior change. There must be a “call to action” to spark the change. Absent any one of these steps and the likelihood that behavior change will occur is diminished. (more…) *This blog post was originally published at Mind The Gap* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3987055 Tue, 21 Sep 2010 02:19:26 +0100 3987055 http://www.medworm.com/index.php?rid=3980829&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmedical-errors-discuss-them-or-switch-doctors%2F2010.09.17 Patients won’t confront doctors if they think there’s been a mistake. They’ll just find a new doctor, even if there’d been no medical error. Researchers looked at adult visits to seven primary care practices in North Carolina during 2008. They asked patients about their perceptions of medical mistakes and how did it influence the choice to switch doctors. Of 1,697 patients, 265 (15.6 percent) reported a mistake had been made, 227 (13.4 percent) reported a wrong diagnosis, 212 (12.5 percent) reported a wrong treatment, and 239 (14.1 percent) reported changing doctors as a result. Results appeared in the Archives of Internal Medicine. But anecdotes cited by patients as mistakes were often normal diagnostic or therapeutic challenges. A typical scenario might be the pa... Better Health blogs http://www.medworm.com/rss/comments.php?id=3980829 Sat, 18 Sep 2010 04:32:24 +0100 3980829 http://www.medworm.com/index.php?rid=3980830&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2F3-things-that-make-a-better-doctor%2F2010.09.17 On Monday, NPR’s Scott Hensley posted: “Between the Internet and all the data insurance companies and the government collect on doctors, you’d think it would be a lot easier than it used to be to find a good one. But it’s not.” Sound familiar around here? See his thoughts: “3 Tips For Picking A Slightly Better Doctor.” (Thanks to friend Cindy Johnson for the tip.) *This blog post was originally published at e-Patients.net* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3980830 Fri, 17 Sep 2010 17:00:10 +0100 3980830 http://www.medworm.com/index.php?rid=3969068&cid=t_99405_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F09%2Fis-there-anything-wrong-with.html Cuts and kickbacks have become the norm in medical practise in India today. In public forums, most doctors frown on this practise as being unethical and unprofessional ( even though they continue giving cuts in their own practise). This is hypocritical and just adds more dishonour to the medical profession.Let's take a fresh look at the subject. The question we need to ask ourselves is - Is there anything wrong with doctors giving cuts ? Is this really such a bad thing ?Cuts and kickbacks are pretty much standard practise in many areas of life today, such as politics and commerce. Greasing palms is considered established practise if you want your file to move in the government office , and if it's okay to give bribes and kickbacks in other fields, what's wrong when doctors do the same ?Let... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=3969068 Wed, 15 Sep 2010 03:58:00 +0100 3969068 http://www.medworm.com/index.php?rid=3961813&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmammography-wars-an-important-discussion-to-keep-alive%2F2010.09.12 This is a thoughtful “sounding board” piece in the New England Journal of Medicine this week: Lessons from the Mammography Wars. It is so important to keep this discussion alive. The miscommunication that took place last November of what the U.S. Preventive Services Task Force tried to convey, and the complicity of some news organizations in adding to that confusion, provide lessons from which we simply must learn to do better. *This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3961813 Mon, 13 Sep 2010 03:26:23 +0100 3961813 http://www.medworm.com/index.php?rid=3959928&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Femergency-rooms-overused-for-routine-care%2F2010.09.11 The Patient Protection and Affordable Care Act (our government’s name for healthcare reform) may make our already crowded emergency rooms swarm with more patients. A new study from Health Affairs shows that more than a quarter of patients who currently visit emergency departments in the U.S. are there for routine care and not an emergency. New complaints like stomach pain, skin rashes, fever, chest pain, cough or for a flare up of a chronic condition should not be treated in emergency rooms. They are best worked up and treated by an internist or family physician, preferably one who knows the patient. So why are these patients waiting for hours and spending up to 10 times as much money for emergency department care? (more…) *This blog post was originally published at E... Better Health blogs http://www.medworm.com/rss/comments.php?id=3959928 Sat, 11 Sep 2010 15:00:00 +0100 3959928 http://www.medworm.com/index.php?rid=3954258&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmedicine-and-the-gender-barrier%2F2010.09.09 It’s only a matter of time before female physicians outnumber men, say medical school heads who are seeing more women in their programs. Although women have broken the gender barrier in medicine, they may want to keep going into nursing, because nurse practitioner salaries grew faster than primary care physicians’ pay – nearly 5 percent compared to nearly 3 percent. Physicians can take some comfort that their average pay is more — $191,000 compared to more than $85,000 — unless they’re women, who among all the life sciences average $13,000 less than their male counterparts in comparable positions and with similar experience. (WCSC TV, Fierce Practice Management, Academic Medicine) *This blog post was originally published at ACP Internist* (Sour... Better Health blogs http://www.medworm.com/rss/comments.php?id=3954258 Thu, 09 Sep 2010 22:00:00 +0100 3954258 http://www.medworm.com/index.php?rid=3954259&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpatients-starved-for-time-with-the-doctor%2F2010.09.09 If you’re into health care consumerism, you’ll enjoy my guest blog post at CDHC Solutions magazine. CDHC Solutions focuses on consumer-driven health plans. Consumer-driven plans are a form of “high deductible” health coverage that is more popular than ever. For whatever you want to say about these plans, one thing is clear: They don’t solve the fundamental problem of patients not having enough time with their doctors. Here’s a taste of what I wrote: Researchers have been trying to pinpoint the impact of this time starvation on the quality of medical care, and they’re finding disturbing results. A recent study in the Annals of Internal Medicine found that because of time pressures and related factors, doctors deliver “error-free” care as rarely as 22 percent of the ti... Better Health blogs http://www.medworm.com/rss/comments.php?id=3954259 Thu, 09 Sep 2010 19:00:36 +0100 3954259 http://www.medworm.com/index.php?rid=3946455&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoctors-wanted-for-hazardous-journey%2F2010.09.08 “MEN WANTED FOR HAZARDOUS JOURNEY. SMALL WAGES, BITTER COLD, LONG MONTHS OF COMPLETE DARKNESS, CONSTANT DANGER, SAFE RETURN DOUBTFUL. HONOR AND RECOGNITION IN CASE OF SUCCESS.” With this want ad, circa 1914, Sir Ernest Shackleton recruited 28 souls with an unimaginable challenge: To cross the unexplored Antarctica on dogsled. The polar explorer knew exactly what human characteristics he needed to pull off such a feat and understood that straight talk would resonate with a few select men. Shakleton and his crew boarded their ship, the “Endurance,” and sailed the world’s most dangerous oceans straight into harms way — still considered one of the world’s greatest survival stories. Amazingly, all men survived against unimaginable odds. Their story reminds us that we a... Better Health blogs http://www.medworm.com/rss/comments.php?id=3946455 Wed, 08 Sep 2010 12:00:38 +0100 3946455 http://www.medworm.com/index.php?rid=3942788&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2F5-reasons-why-people-dont-ask-their-doctor-questions%2F2010.09.07 A neighbor of mine was diagnosed with breast cancer about the same time my wife was being treated for lung cancer. I saw my neighbor the other day for the first time in several years. I asked her how she was doing. She said great. In turn I asked her how her PET/CT exam looked. PET/CT scans are often done to make sure that one’s cancer hasn’t spread. My wife gets one every year. My neighbor told me her doctor never told her she needed one, that mammograms would suffice. She went on to say a friend had also recently asked her if she had a PET/CT as well. “Maybe I should ask my doctor,” she told me. That was the same response she gave me the last time I raised the subject two years earlier: “I should ask my doctor.”   So Why Don’t People Ask More Questions?   My nei... Better Health blogs http://www.medworm.com/rss/comments.php?id=3942788 Wed, 08 Sep 2010 00:14:14 +0100 3942788 http://www.medworm.com/index.php?rid=3938328&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcanker-sores-who-gets-them-and-why%2F2010.09.06 Canker sores are painful, and mouth pain cannot be ignored. They’re difficult to prevent and you just have to cope with them until they go away. We have no idea what causes them. For a doctor, this is difficult to accept. What the heck are canker sores? The medical term is apthous ulcers and they’re round or oval painful ulcers that appear on the tongue, inner lips, inside of cheeks, or palate of the mouth. Up to 40 percent of people have experienced canker sores. So why have the remaining 60 percent never had them? We don’t know. (more…) *This blog post was originally published at EverythingHealth* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3938328 Mon, 06 Sep 2010 14:00:00 +0100 3938328 http://www.medworm.com/index.php?rid=3935798&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Frectal-cancer-becoming-more-common-in-younger-people%2F2010.09.05 Rates of rectal cancer in those younger than 40 have been increasing, the LA Times reported recently. Researchers studied data from the Surveillance, Epidemiology and End Results (SEER) Registry and looked at the change in rectal and colon cancer incidence in those under 40 from 1973 to 2005. Overall rates were low, but while colon cancer incidence remained constant, rectal cancer incidence increased by an average of 3.8 percent annually, the authors reported in the journal Cancer. The authors didn’t advocate routine screening in those under 40, but did recommend that physicians be more alert to the possibility of rectal cancer in those presenting with symptoms such as rectal bleeding, according to the Times. (LA Times) *This blog post was originally published at ACP Internist* ... Better Health blogs http://www.medworm.com/rss/comments.php?id=3935798 Sun, 05 Sep 2010 18:00:00 +0100 3935798 http://www.medworm.com/index.php?rid=3935799&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fgeneric-drugs-not-so-cheap%2F2010.09.05 I received the following e-mail from a patient (paraphrased): Dear Dr. Fisher, Thank you for trying to switch me from lisinopril to generic losartan (Cozaar) to help me with the irritating cough that has been nagging me since I was placed on lisinopril. I did not pick up my prescription, though. At nearly $200 for a three-month supply, I’ve decided to live with the cough, since the same amount of lisinopril costs me about $12. -Ms. Patient Interesting how the generic drug market for some drugs only marginally discounts prices. Since the companies that make generics did not have to absorb research and development costs, how do they justify the exorbitant prices? Simple: The middlemen still have to get theirs. -WesMusings of a cardiologist and cardiac electrophysiologist. *This... Better Health blogs http://www.medworm.com/rss/comments.php?id=3935799 Sun, 05 Sep 2010 16:00:00 +0100 3935799 http://www.medworm.com/index.php?rid=3935800&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fif-this-were-your-child-what-would-you-do%2F2010.09.05 Many times when faced with a clinical dilemma, a parent will turn to me and ask: “What would you do if this were your child?” When faced with this question, I never quite know what to say. And each time I feel a little on-the-spot. But why is that? Aren’t I comfortable recommending for someone else exactly what I would do for my own child? After all, what have I got to hide? Here’s the problem: The decisions we make as parents involve our values, tolerance of risk, level of concern and frustration, prior health experience, and religious belief — to name but a few. There’s no way to fully tease those things from the parent sitting across the room. (more…) *This blog post was originally published at 33 Charts* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3935800 Sun, 05 Sep 2010 12:00:30 +0100 3935800 http://www.medworm.com/index.php?rid=3934480&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoctor-patient-relationship-how-patients-can-help-enhance-communication%2F2010.09.04 From Kevin Pho’s medical blog, KevinMD, a post archived from 2004, Pho talks about the struggles of communication between doctor and patient during the 15-minute office visit. Pho sites a New York Times article that explains that more than two decades ago, research shows that patients were interrupted 18 seconds into explaining their problem (on average) and less than 2 percent got to finish their explanations. Pho sites that he sometimes falls into the “interruption trap,” saying: “I think this is a natural progression to our managed care environment. Physicians are compensated by quantity of patients seen, and are kept to a strict schedule -– in most cases every 15-minutes.” (more…) *This blog post was originally published at Health in 30* (Source: Better Healt... Better Health blogs http://www.medworm.com/rss/comments.php?id=3934480 Sat, 04 Sep 2010 12:00:37 +0100 3934480 http://www.medworm.com/index.php?rid=3933088&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdr-ozs-first-colonoscopy-finds-pre-cancerous-polyp-what-can-this-teach-us%2F2010.09.03 By Dr. Jon LaPook, CBS Doc Dot Com (CBS) Dr. Mehmet Oz just might be the last person on earth people would expect to get a colon polyp. He’s physically fit (he left me in the dust the last time we ran together), he eats a healthy diet, he doesn’t smoke, and he has no family history of colorectal cancer or colon polyps. But several weeks ago, when Mehmet had his first screening colonoscopy at age 50, I removed a small adenomatous polyp that had the potential to turn into cancer over time. Statistically, most small polyps like his don’t become cancer. But almost all colon cancers begin as benign polyps that gradually become malignant over about 10 to 15 years. Since there’s no way of knowing which polyps will turn bad, we take them all out. The good news is there&#8... Better Health blogs http://www.medworm.com/rss/comments.php?id=3933088 Fri, 03 Sep 2010 20:00:50 +0100 3933088 http://www.medworm.com/index.php?rid=3933091&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-right-to-mourn%2F2010.09.03 I seem to have had a run on bereavement recently, in that I’ve had several patients who have lost loved ones. Some have wound up in my office for unrelated complaints, only to have the grief spill out. I’ve become aware of the struggles of others via Facebook. I’ve found this handout (from Family Practice Management several years ago) to be very useful. I keep copies in my office and hand them out when needed, but it occurs to me that having another way to disseminate this helpful information would be a good idea. (more…) *This blog post was originally published at Musings of a Dinosaur* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3933091 Fri, 03 Sep 2010 12:00:14 +0100 3933091 http://www.medworm.com/index.php?rid=3929230&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpatients-are-splitting-pills-to-cut-healthcare-costs%2F2010.09.02 Patients are pill-splitting more to trim back healthcare costs, according to a poll by Consumer Reports. In the past year, 39 percent took some action to cut costs. The poll of more than 1,100 people found that 45 percent of people take at least one prescription drug and average four. But 27 percent said they didn’t always comply with a prescription, and 38 percent of those younger than 65 without drug coverage didn’t fill prescriptions at all. Just over half of patients felt that doctors didn’t consider their ability to pay when prescribing a drug, while nearly half blamed drugmaker’s influence for physicians’ prescribing habits. (HealthLeaders Media) *This blog post was originally published at ACP Internist* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3929230 Fri, 03 Sep 2010 01:00:00 +0100 3929230 http://www.medworm.com/index.php?rid=3929233&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fresponsible-vaccine-advocacy-how-to-make-a-difference%2F2010.09.02 I lost a patient this season, an infant, to whooping cough (pertussis). After falling ill, he lived for nearly a month in the intensive care unit on a ventilator, three weeks of which was spent on a heart/lung bypass machine (ECMO) due to the extent of the damage to his lungs. But all our efforts were in vain. The most aggressive and advanced care medicine has to offer couldn’t save his life. The only thing that could have saved him would have been to prevent him from contracting pertussis in the first place. He was unvaccinated, but that was because of his age. He was part of the population that is fully dependent on herd immunity for protection, and that is exquisitely prone to a life-threatening course once infected. This is a topic we’ve covered ad nauseum, and I’m not incli... Better Health blogs http://www.medworm.com/rss/comments.php?id=3929233 Thu, 02 Sep 2010 17:00:35 +0100 3929233 http://www.medworm.com/index.php?rid=3924906&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fvideo-one-primary-care-doctors-journey%2F2010.09.01 Doug Farrago is a family physician in Maine and the editor of the entertaining Placebo Journal. He uses his Placebo Journal media platform to show his audience what primary care is all about. In this video, “Doug Unplugged,” Dr. Farrago gives us a little taste of that journey. Hollywood, take notice. *This blog post was originally published at KevinMD.com* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3924906 Wed, 01 Sep 2010 14:00:07 +0100 3924906 http://www.medworm.com/index.php?rid=3924907&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpracticing-primary-care-a-lesson-in-treading-water%2F2010.09.01 As a primary care physician, I am becoming painfully aware of how hard it is to be good –- I mean really good — at what we do today. I would prefer to believe that it has always been so, yet I do not believe that our predecessors in the medical profession found it nearly as difficult to excel in their time as we do now. With all of the technological and medical advances, you might ask how I could believe this to be true. Too, you might consider it pessimistic or even crazy to suggest that physicians 20, 30, or 100 years ago found it easier to practice medicine well in their time. You could counter with numerous or obvious examples such as antibiotics, pharmaceuticals, robotic surgical procedures, or even our wondrous ability to peer inside the human body without cutting it open.�... Better Health blogs http://www.medworm.com/rss/comments.php?id=3924907 Wed, 01 Sep 2010 12:00:43 +0100 3924907 http://www.medworm.com/index.php?rid=3902899&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-gift-of-being-a-doctor-what-are-you-going-to-do-with-it%2F2010.08.25 I’m going to do something unusual: Reprint in its entirety a commentary from a fourth-year medical student, Jonathan. He posted it in response to comments from other readers to my blog about Dr. Berwick’s commencement address to his daughter’s medical school class. I tweeted about Jonathan’s post, calling it a needed voice of idealism at a cynical time. This is what Jonathan had to say to his physician colleagues: “To begin, I am a fourth-year medical student going into primary care and this directly applies to me. We have two options when reading [Dr. Berwick's] address. We can take, in my opinion, the weak road or the strong road. Our new generation, as well as the one that raised us, is one of apathy and selfishness. We are only concerned about how changes ... Better Health blogs http://www.medworm.com/rss/comments.php?id=3902899 Wed, 25 Aug 2010 18:00:00 +0100 3902899 http://www.medworm.com/index.php?rid=3902900&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-truly-useful-emr%2F2010.08.25 I love computers. Really, I do. Despite my oft-repeated claims about the shortcomings of electronic medical records in their current form, I do believe that information technology has the potential to be of great help to me and other physicians in providing quality care to Americans. Stop laughing. I really mean it. I do not believe, however, that IT best serves the medical needs of our patients when used to create non-interactive silos of information sequestered in the offices and clinics of individual doctors. Even hospitals and large integrated health systems information remains stuck within that system, providing limited utility when patients travel, or even go to a doctor not affiliated with the system. Although some (especially in government) seem to feel that expanding those kinds o... Better Health blogs http://www.medworm.com/rss/comments.php?id=3902900 Wed, 25 Aug 2010 16:00:29 +0100 3902900 http://www.medworm.com/index.php?rid=3902901&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fprimary-care-doctors-rewarded-for-time-with-patients%2F2010.08.25 Abraham Verghese is a professor of medicine at Stanford University and one of the most articulate physician-writers today. He recently wrote an op-ed highlighting primary care’s plight, and focuses on the scarcity of time: The science of medicine has never been more potent – incredible advances and great benefits realized in the treatment of individual diseases – yet the public perception of us physicians is often one of a harried individual more interested in the virtual construct of the patient in the computer than in the living, breathing patient seated on the exam table.Time is the scarcest commodity of all. Patients, particularly when it comes to their routine, day-to-day care, want a physician who has time to understand them as people first, and then as patients. It’s bee... Better Health blogs http://www.medworm.com/rss/comments.php?id=3902901 Wed, 25 Aug 2010 14:00:27 +0100 3902901 http://www.medworm.com/index.php?rid=3899392&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealth-tips-for-back-to-school%2F2010.08.24 I was lucky enough to be asked by one of the local TV stations to talk about some back-to-school issues when it comes to health. I don’t know about where you’re at, but most of the local schools around here started [yesterday, August 23rd]. Keeping up-to-date on immunizations is always important. Other important issues are getting kids back on their school sleep schedules and making sure the backpack isn’t overwhelmingly heavy. Check out the video below. Also check out the Back To School Video 2 and the Back To School Video 3 (Yup, that’s right — three segments in one day.) If you find those helpful, I encourage you to check out my You Tube page and click on “My TV Interviews” for more health segments from local TV news. Enjoy! *This bl... Better Health blogs http://www.medworm.com/rss/comments.php?id=3899392 Tue, 24 Aug 2010 20:00:00 +0100 3899392 http://www.medworm.com/index.php?rid=3891668&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmiscarriage-dont-wait-to-get-pregnant-again%2F2010.08.22 About 15 to 20 percent of women who know they are pregnant will have a miscarriage. The loss of a pregnancy before 20 weeks is considered a miscarriage. Many women suffer grief and shock after a miscarriage and fear there is something wrong with them or that they did something to cause it. But the reasons for miscarriage are usually not known. Women are often told to wait “a few months” to get pregnant again to let their bodies recover. A new study published in the British Medical Journal looked at over 30,000 women who had a miscarriage in their first recorded pregnancy and subsequently became pregnant again. They found that women who conceived again within six months were less likely to have another miscarriage or problem pregnancy. They were even less likely to have a... Better Health blogs http://www.medworm.com/rss/comments.php?id=3891668 Sun, 22 Aug 2010 18:00:00 +0100 3891668 http://www.medworm.com/index.php?rid=3889082&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-heart-health-risks-of-being-a-couch-potato%2F2010.08.20 We’ve all made the excuses: You can’t face the drive to the gym, you’re too tired at night, getting up in the morning is a chore, or it’s too hot or cold outside. So you cozy up on the couch in front of the television. If you’re a couch potato, you’re a gambler — with your life. Unfortunately you’ll need a big sofa because you’re not the only one whose heart isn’t in physical activity. About 60 percent of adults in the U.S. are not getting the exercise they need, according to a report from the U.S. Surgeon General. It’s time to get up and face — or better yet, dance to — the music! Here are a few facts that may get you moving for your heart’s sake. (more…) *This blog post was originally published at Health in 30* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3889082 Fri, 20 Aug 2010 15:00:55 +0100 3889082 http://www.medworm.com/index.php?rid=3880862&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcan-novel-approaches-fill-primary-care-needs%2F2010.08.18 New primary care arrangements show how primary care is evolving — or splitting apart, depending upon one’s perspective. Retainer fees let one practice handle more patients by phone or email. But, points out Richard Baron, FACP, affluent communities can take advantage of such arrangements, and not every community is. And Sam Fink, FACP, of southern California says tele-visits are no substitute for hands-on care. In another model, nurse-led facilities service the poor in north Philadelphia, and more states are expanding the power of the pen to cover shortages.  Another trend is the shared medical appointment. Led by physicians and conducted by “behaviorists,” the sessions cover a half-dozen or more patients at a time for both primary and specialty care. Even pharmaci... Better Health blogs http://www.medworm.com/rss/comments.php?id=3880862 Wed, 18 Aug 2010 14:00:00 +0100 3880862 http://www.medworm.com/index.php?rid=3880863&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmanaging-bias-in-healthcare%2F2010.08.18 This article was written more for family medicine physicians, but all of us can benefit from self-assessment of potential biases that might affect our judgment. It was also written with the potential bias towards the obese patient in mind, but the article could have been written with any “fill in the blank” bias as the topic. The article points out that bias among physicians tends to “be implicit rather than explicit because of social pressure for healthcare providers to show tolerance and cultural sensitivity.” (more…) *This blog post was originally published at Suture for a Living* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3880863 Wed, 18 Aug 2010 12:00:00 +0100 3880863 http://www.medworm.com/index.php?rid=3876652&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealthcare-advice-for-college-bound-kids%2F2010.08.17 Sending a child off to college? Call your lawyer first. From the Weekend Wall Street Journal: After a few clients ran into difficulty getting information about adult children who were ill, Sheila Benninger, an attorney in Chapel Hill, N.C., began recommending that clients’ children designate a health-care power of attorney after they turn 18 to identify who can speak for them if they can’t. She also includes a Health Insurance Portability and Accountability Act, or HIPAA, release form that allows patients to determine who can receive information about their medical care and whether information about treatment for substance abuse, mental health or sexually transmitted diseases can be disclosed. You don’t have to use a lawyer. Generic health-care power-of-attorney forms ca... Better Health blogs http://www.medworm.com/rss/comments.php?id=3876652 Tue, 17 Aug 2010 18:00:00 +0100 3876652 http://www.medworm.com/index.php?rid=3876654&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwater-safety-a-drowning-child-doesnt-scream%2F2010.08.17 This summer I learned a couple of very important lessons. Drowning kids don’t scream. Mothers have a sixth sense even when it’s not their own child. On a beautiful warm sunny day in San Diego, my family and our good friends were enjoying a well-deserved vacation. My five-year-old daughter was splashing around with her friends as their father and I observed them from the pool. Though he had to watch three kids, one was already on a swim team and the two younger children had followed their big sister in swim class. He also had some help. His wife was watching the kids from her chair.  The scene was certainly picturesque, serene, and unassuming. Children playing happily in the pool. Adults relaxing and talking. It was a great day to be away from home and work. Who would realize ... Better Health blogs http://www.medworm.com/rss/comments.php?id=3876654 Tue, 17 Aug 2010 14:00:00 +0100 3876654 http://www.medworm.com/index.php?rid=3872552&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpatients-are-avoiding-healthcare-because-of-costs%2F2010.08.16 One in five Americans didn’t seek medical care for a recent illness or injury, often because of the cost, according to a survey of adults polled by a healthcare consulting firm, and the number of people who saw a doctor fell as well. Four out of 10 adults said the cost was the main reason not to seek care, a trend that be driven by unemployment and health insurance costs, said a survey by the Deloitte Center for Health Solutions. They surveyed more than 4,000 adults. Also, 79 percent of respondents sought medical attention from a doctor or other health care professional in 2010, down from 85 percent in 2009. (more…) *This blog post was originally published at ACP Internist* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3872552 Mon, 16 Aug 2010 22:00:00 +0100 3872552 http://www.medworm.com/index.php?rid=3872556&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdo-foreign-medical-graduates-doctor-better%2F2010.08.16 Yes, according to a study in today’s Health Affairs. (The full text of the study is available only to subscribers, but Kaiser Health News Daily has a good summary of its findings and links to other news reports.) The study compares inpatient death rates and lengths of stay for patients with congestive heart failure or acute myocardial infarction when provided by U.S. citizens trained abroad, citizens trained in the United States, and non-citizens trained abroad. Treatment was provided by internists, family physicians, or cardiologists. The differences were striking, according to the authors: “Our analysis of 244,153 hospitalizations in Pennsylvania found that patients of doctors who graduated from international medical schools and were not U.S. citizens at the time they entered... Better Health blogs http://www.medworm.com/rss/comments.php?id=3872556 Mon, 16 Aug 2010 14:00:00 +0100 3872556 http://www.medworm.com/index.php?rid=3872557&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoctor-patient-relationship-humanized-by-touch%2F2010.08.16 I’ve written previously that many doctors are finding the physical exam obsolete, and are favoring more technologically-advanced, and expensive, tests. In fact, I alluded to traditional physical exam advocates as “arguing for staying with a horse and buggy when cars are rapidly becoming available.” In a recent piece from the New York Times, internist Danielle Ofri says we need to look past the lack of evidence supporting the physical exam. The benefits of touching the patient, and listening to his heart and lungs, cannot be quantitatively measured: Does the physical exam serve any other purpose? The doctor-patient relationship is fundamentally different from, say, the accountant-client relationship. The laying on of hands sets medical practitioners apart from their counterparts in th... Better Health blogs http://www.medworm.com/rss/comments.php?id=3872557 Mon, 16 Aug 2010 12:00:41 +0100 3872557 http://www.medworm.com/index.php?rid=3868735&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fstatic.slideshare.net%2Fswf%2Fssplayer2.swf%3Fid%3D4882813%26%23038%3Bdoc%3Dfutureofhealth-slideshareversion-100801104636-phpapp01 A report on the future of health was presented to the United Nations Children’s Fund (UNICEF) by PSFK, a trends research and innovation company. It features a wide range to topics including distant learning, diagnostics, gaming for health, offline web, DIY checkup, and many others: PSFK presents Future Of Health View more presentations from PSFK. (Hat Tip: iMedicalApps) *This blog post was originally published at ScienceRoll* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3868735 Sun, 15 Aug 2010 20:00:28 +0100 3868735 http://www.medworm.com/index.php?rid=3868737&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fovermedicated-teenagers%2F2010.08.15 It is summer camp season for kids and well-run camps require a medical history and record of prescription medications that the child is taking. One prestigious camp for teens (ages 11 to 19 — average camper is 16) in Southern California recently had 153 residential teenagers. These kids come from California and other states across the U.S. Fifty percent come from out of state and a number of campers each week are international. Okay, so far so good. Healthy teens getting together for a week of learning and fun. Here is the shocker! I was amazed to learn that almost 25 percent of these kids are on prescription medication. Can it be that we are overmedicating teens? (more…) *This blog post was originally published at EverythingHealth* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3868737 Sun, 15 Aug 2010 14:00:00 +0100 3868737 http://www.medworm.com/index.php?rid=3865266&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-story-of-online-care-without-opennotes%2F2010.08.13 Next in our series on my experience with OpenNotes, a project sponsored by the Robert Wood Johnson Foundation’s Pioneer Portfolio. This item has nothing to do with OpenNotes itself –- it’s what I’m seeing now that I’ve started accessing my doctor’s notes. In short, I see the clinical impact of not viewing my record as a shared working document. Here’s the story.  ______ In OpenNotes, patient participants can see the visit notes their primary physicians entered. Note “primary,” not specialists. I imagine they needed to keep the study design simple. So here I am in the study, going through life. Five weeks ago I wrote my first realization: After the visit I’d forgotten something, so I logged in. (more…) *This blog post was originally published at e-... Better Health blogs http://www.medworm.com/rss/comments.php?id=3865266 Fri, 13 Aug 2010 16:00:13 +0100 3865266 http://www.medworm.com/index.php?rid=3858153&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ffixing-up-primary-care-is-anyone-home%2F2010.08.11 By John Henning Schumann, M.D. The Patient Protection and Affordable Care Act (aka “Health Care Reform”) signed by President Obama in March will revolutionize primary care in the United States. By 2014 tens of millions of uninsured people will “enter” the system by being granted insurance, either through expansion of the Medicaid program or through mandated purchasing of insurance via state pools or the private market. This alone will have a profound impact, straining the capacity of our already frayed system. Therefore, embedded in the law are funds to encourage growth and improvement in primary care: Incentives to encourage graduates to enter primary care fields (family medicine, internal medicine, and pediatrics) and practice in underserved areas (through scholar... Better Health blogs http://www.medworm.com/rss/comments.php?id=3858153 Thu, 12 Aug 2010 01:00:00 +0100 3858153 http://www.medworm.com/index.php?rid=3858164&cid=t_99405_88_f&fid=39185&url=http%3A%2F%2Fedwinleap.com%2Fblog%2F%3Fp%3D1242 This is the text of what I said at the funeral of my partner, Howard Leslie, who was buried yesterday.  The world is less, and heaven is so much the better for his departure. It is my honor to speak a little humor into this very sad day.  Considering the situation, it’s a tough crowd!  You are all broken-hearted.  You are all so hurt by our loss.  Howard would want you to do one thing for him right now: He would want you to lighten up, and turn and thump the head of someone sitting next to you!  This is a Christian funeral, people! This is not a goodbye, but a bon voyage!  This is not an end, but a ’see ya later!’ What would that big goofball want me to say? First, he’d want to know if there was coffee here. Not the kind that has been brewing in the same pot for ... edwinleap.com blogs http://www.medworm.com/rss/comments.php?id=3858164 Wed, 11 Aug 2010 16:14:21 +0100 3858164 http://www.medworm.com/index.php?rid=3858158&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdefining-family-practice%2F2010.08.11 I like Dr. Rob, the one with the “distractible mind.” And although I thoroughly agree with the stance he takes in his recent post against cholesterol screening in kids, I must take issue with his opening statement: I have a unique vantage point when it comes to the issue universal cholesterol screening in children, when compared to most pediatricians. My unique view stems from the fact that I am also an internist who deals with those children after they grow up on KFC Double Downs. From Dictionary.com: “Unique: existing as the only one or as the sole example; single; solitary in type or characteristics.” Your med-peds training allows you to follow patients from birth to death (but no obstetrics or gynecology). You can care for all organ systems and all stages of di... Better Health blogs http://www.medworm.com/rss/comments.php?id=3858158 Wed, 11 Aug 2010 14:00:55 +0100 3858158 http://www.medworm.com/index.php?rid=3858159&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fleaving-the-organization-but-not-the-practice-of-medicine%2F2010.08.11 I confess ignorance. I know nothing about interviews with vampires. However, last week on my drive to a house call to see a sick patient, I experienced a sudden respect for author Anne Rice. I listened to a stranger completely off my radar screen being interviewed on NPR saying and making me feel the meaning of the phrase “Evil needs but one thing to grow. It is for good people to do nothing,” and reminding me that throughout history there have been numerous times where groups, organizations, and governments have acted even in ways that don’t represent our values or feel wrong minded or appear short sighted. This statement was her simple explanation for a recent blog posting announcing she was resigning from Christianity. She remained a believer in God and in Christ, but no long... Better Health blogs http://www.medworm.com/rss/comments.php?id=3858159 Wed, 11 Aug 2010 12:00:30 +0100 3858159 http://www.medworm.com/index.php?rid=3854520&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-divide-between-you-and-your-medical-records%2F2010.08.10 You have a right to your medical record. It’s true –- the record of every test and procedure you’ve had done, any films or studies, your doctors notes — it’s all yours if you ask for it. But it’s not that simple. If you’re sick, your “record” is likely in pieces in lots of different places. Some of it is in paper files and computers in the offices of each of your doctors, or in the clinics where you had a test or procedure. It’s in multiple computer systems in a hospital, or in a folder in a radiology department, a container in a pathology department, or the computer system of a pharmacy. Each of these places has their own policy or procedure if you want your record. There are forms you have to fill out, fees you have to pay, time you have to wait. So while you ... Better Health blogs http://www.medworm.com/rss/comments.php?id=3854520 Tue, 10 Aug 2010 21:00:42 +0100 3854520 http://www.medworm.com/index.php?rid=3854523&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fan-app-for-baby-related-emergencies%2F2010.08.10 RN Tara Summers was inspired to make an iPhone app after a frightening episode where she saw her infant child choking. Because she was a nurse, she sprang into action and gave the Heimlich maneuver, but worried about parents (or babysitters) without the same training. So, along with her emergency medicine physician husband, she created MedBasics — a readily-accessible information packet for the home about things to do in an emergency. Now they’re announcing an iPhone app called BabyMedBasics for emergencies when you’re not at home. More from MedBasics… iTunes link to the iOS app… *This blog post was originally published at Medgadget* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3854523 Tue, 10 Aug 2010 15:00:02 +0100 3854523 http://www.medworm.com/index.php?rid=3845098&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-big-pay-raise-for-internists%2F2010.08.09 Full-time internists average $191,864 in income, according to one recruiter’s annual salary survey. LocumTenens.com conducted its survey in the early spring of 2010 among locum tenens and permanently employed physicians. That’s up from $179,958 in 2009, the company reported. Specific breakdowns by gender, years in practice and owner/employee status are here. That’s a 6.6 percent pay raise. We’re going to do our own salary survey right here. Let us know if you saw such an increase in the past year. *This blog post was originally published at ACP Internist* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3845098 Mon, 09 Aug 2010 12:00:00 +0100 3845098 http://www.medworm.com/index.php?rid=3833425&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Flaxative-tantrums-in-kids%2F2010.08.07 This “Fletchers Castoria” ad from 1941 is priceless. And as someone who spends his days working with bound-up grumps like Mary, I was reassured to know that horrific constipation is not a me-generation problem born of chicken fingers and Goldfish. ”Laxative tantrums,” however, are new to me. I seem to have pretty good luck with Miralax and Kristalose in my office. Your mileage (or tantrums) may vary. *This blog post was originally published at 33 Charts* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3833425 Sat, 07 Aug 2010 15:00:38 +0100 3833425 http://www.medworm.com/index.php?rid=3833426&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-diagnosing-doctors-often-ignore-patients-social-factors%2F2010.08.07 A recent study from the Annals of Internal Medicine found that doctors often discounted a patient’s social situation when making a medical diagnosis. Lead researcher Saul Weiner “arranged to send actors playing patients into physicians’ offices and discovered that errors occurred in 78 percent of cases when socioeconomic concerns were a significant factor.” Evan Falchuk, commenting on the results, provides some context: It’s hard to expect even the most gifted clinician, trying to make it through yet another week of a hundred or more patient encounters, to get these difficult decisions right. Too much of the context of a patient’s care gets lost in the endless churn of patient visits that the health care system imposes on doctors.I suspect this is enormously frustrating for doc... Better Health blogs http://www.medworm.com/rss/comments.php?id=3833426 Sat, 07 Aug 2010 12:00:37 +0100 3833426 http://www.medworm.com/index.php?rid=3822918&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwe%25e2%2580%2599re-making-fewer-babies-what-to-expect%2F2010.08.04 Recently I ran into the office manager for one of Houston’s largest pediatric practices. New patient visits are way down and their doctors are looking for ways to keep business rolling. The same day I picked up this piece in the Wall Street Journal which shows declining admissions and doctor visits as a national trend. This is bad news and shows how our faltering economy is finally working its way more visibly into healthcare. And apparently we’re making fewer babies –- admissions to neonatal intensive care units are down. This is a problem. For large tertiary medical centers and hospitals specializing in maternal-child health, babies are the critical customers of a healthy operation. A few thoughts on what to look for (or dare I say, what to “expect”) with fewer ba... Better Health blogs http://www.medworm.com/rss/comments.php?id=3822918 Thu, 05 Aug 2010 01:11:40 +0100 3822918 http://www.medworm.com/index.php?rid=3822920&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhat-a-68-chevy-impala-can-tell-us-about-primary-care%2F2010.08.04 When I was a much younger man I had a 1968 Chevy Impala. I loved its V-8 engine and spaciousness, but I paid a steep price for it. It consumed gas like a drunk on a binge. It was prone to breakdowns, usually in the left lane of a busy highway. Even as it consumed my limited financial resources, I couldn’t count on it to reliably get me to where I wanted to be. Yet I held onto it. One day, though, its transmission gave out, and I finally had to resign myself to buying a new, more reliable, more modern, and efficient vehicle. Yet to this day, I miss my clunker. I am reminded of this when I think about the state of primary care today. Many of us are attached to a traditional primary care model that may no longer be economically viable — for physicians, for patients, and for purcha... Better Health blogs http://www.medworm.com/rss/comments.php?id=3822920 Wed, 04 Aug 2010 16:00:00 +0100 3822920 http://www.medworm.com/index.php?rid=3822921&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-patients-are-wary-of-the-primary-care-medical-home%2F2010.08.04 Say the words, “Patient-centered medical home,” and you’re bound to get a variety of opinions. On this blog alone, there are a variety of guest pieces critical of the effort, saying it does not increase patient satisfaction, nor does it save money. And that’s not good news for its advocates, who are pinning primary care’s last hopes on the model. Medical homes hit the mainstream media recently, with Pauline Chen focusing one of her recent, weekly New York Times columns to the issue. She discussed the results of a demonstration project, showing some positive results. (more…) *This blog post was originally published at KevinMD.com* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3822921 Wed, 04 Aug 2010 14:00:17 +0100 3822921 http://www.medworm.com/index.php?rid=3808667&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-doctors-feelings-about-caring-for-abnormal-kids%2F2010.08.01 I’ve been practicing for sixteen years now, doing both internal medicine and pediatrics. One of the joys of that is watching kids under my care grow up and not having to give up their care just because they get older. The spectrum is wide, with some kids growing up in “normal” families with “normal lives,” others in “abnormal” families, and yet others with inherently “abnormal” lives due to illness or disability. But the kids aren’t the only thing that has changed over the past sixteen years. Their doctor has changed as well. My comfort zones have widened, not getting rattled by “abnormal” as I once did. I used to feel uncomfortable with the mentally and emotionally disabled, now I am not. I used to feel sorry for parents with “abnormal” children. I used to feel... Better Health blogs http://www.medworm.com/rss/comments.php?id=3808667 Sun, 01 Aug 2010 14:00:16 +0100 3808667 http://www.medworm.com/index.php?rid=3798560&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fnew-pap-smear-guidelines-the-right-care-or-rationed-care%2F2010.07.28 The American College of Obstetricians and Gynecologists (ACOG) recently reiterated their position that Pap smears should be performed on healthy women starting at age 21. This is different from the past which recommended screening for cervical cancer at either three years after the time a woman became sexually active or age 21, whichever occurred first. How will the public respond to this change? Over the past year there have been plenty of announcements from the medical profession regarding to the appropriateness of PSA screening for prostate cancer and the timing of mammogram screening for breast cancer. Understandably, some people may view these changes in recommendations as the rationing of American healthcare. (more…) *This blog post was originally published at Saving Mo... Better Health blogs http://www.medworm.com/rss/comments.php?id=3798560 Wed, 28 Jul 2010 20:00:00 +0100 3798560 http://www.medworm.com/index.php?rid=3798562&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ftransitioning-primary-care-to-patient-centered-team-care%2F2010.07.28 While the “patient-centered medical home” may be a good idea, it needs a better name. It sounds like a hospice, reports surgeon and columnist Pauline Chen, M.D. She outlines the initial experiences of practices making the transition to the new practice model. One problem uncovered by pilot projects is that doctors in transition to the practice model have to spend inordinate amounts of time of things other than patients. And while the patients want and welcome the changes, they face a learning curve too, as they move from seeing just the doctor to working with a team of providers for their care.  Physicians suggested using resources from the Patient-Centered Primary Care Collaborative, a collaborative group set up to help offices make the transition. (New York Times) *T... Better Health blogs http://www.medworm.com/rss/comments.php?id=3798562 Wed, 28 Jul 2010 16:00:00 +0100 3798562 http://www.medworm.com/index.php?rid=3798564&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcareer-counselor-thoughts-on-becoming-a-doctor%2F2010.07.28 As a physician, I’ve had several people ask my “honest” opinion of their plans to become a doctor. I know what my response is to this question, but I wonder what others in my profession would answer. Would your response depend, in large part, on who’s doing the asking — could you answer your own child as you would someone you just met? Be careful, your answer to this question, if honestly given, might shine an unsettling light on your own feelings about your current career choice. Last week I spoke with a college junior working to fulfill her lifelong plans to become a physician. She told me about a recent conversation with her own doctor where she shared her plans to go to medical school and he’d tried to dissuade her. She couldn’t recall a single cogent reason given f... Better Health blogs http://www.medworm.com/rss/comments.php?id=3798564 Wed, 28 Jul 2010 12:00:26 +0100 3798564 http://www.medworm.com/index.php?rid=3794773&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmedical-devices-injure-70000-kids-each-year%2F2010.07.27 FDA researchers have published a study in Pediatrics that analyzed patient records from child and teen ER visits in 2004 and 2005. The investigators are reporting that 70,000 kids each year go to the ER because of issues caused by medical devices. About a quarter of the injuries were from contact lenses, while the other major contributors were needles, wheelchairs, braces, and obstetric exam tools. The study also looked at the devices most likely to cause hospitalization, and they were found to be mostly invasive devices like ostomy appliances and implanted defibrillators. (more…) *This blog post was originally published at Medgadget* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3794773 Tue, 27 Jul 2010 17:00:25 +0100 3794773 http://www.medworm.com/index.php?rid=3794775&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-insulting-term-physician-extender%2F2010.07.27 “Physician Extender.” It sounds like the name of a male enhancement product. It’s a term often used to describe a nurse practitioner or a physician’s assistant. I hate it. It’s insulting. A nurse practitioner is not an adjunct physician. They do not supplement the care of a physician. They provide essential advance-practice nursing services, services that include diagnosis and provision of medical care. While some of these services overlap those of medicine, nurse practitioners are not extensions of another profession, they provide care in their own right — as educated, licensed practitioners. Sometimes the only care provider for a community is a nurse practitioner. (more…) *This blog post was originally published at Emergiblog* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3794775 Tue, 27 Jul 2010 12:00:12 +0100 3794775 http://www.medworm.com/index.php?rid=3790705&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fteam-care-in-the-patient-centered-medical-home%2F2010.07.26 “Team care” has become a rallying cry for those who think the patient-centered medical home is bad for healthcare reform. Comments on a recent blog post in the New York Times provide a good example of this. When patients get sick, as the argument goes, they want to see their doctor — not some nurse or PA who they don’t know. I agree. There are a whole bunch of things wrong with all the current focus on team care in the patient-centered medical home. (more…) *This blog post was originally published at Mind The Gap* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3790705 Mon, 26 Jul 2010 14:00:24 +0100 3790705 http://www.medworm.com/index.php?rid=3786130&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhow-reliable-is-health-information-on-the-web%2F2010.07.24 Recently some Science-Based Medicine (SBM) colleagues (David Gorski, Kimball Atwood, Harriet Hall, Rachel Dunlop) and I gave two workshops on how to find reliable health information on the Web. As part of my research for this talk I came across this recent and interesting study that I would like to expand upon further: Quality and Content of Internet-Based Information for Ten Common Orthopaedic Sports Medicine Diagnoses. The fact that the article focuses on orthopedic diagnoses is probably not relevant to the point of the article itself, which was to assess the accuracy of health information on the Web. They looked at 10 orthopedic diagnoses and searched on them using Google and Yahoo, and then chose the top results. They ultimately evaluated 154 different sites with multiple reviewers fo... Better Health blogs http://www.medworm.com/rss/comments.php?id=3786130 Sat, 24 Jul 2010 22:00:13 +0100 3786130 http://www.medworm.com/index.php?rid=3776379&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fprimary-care-conference-moves-industry-support-off-site%2F2010.07.21 Harvard’s annual primary medicine conference, Pri-Med East 2010, will move the industry-supported portion of the program off-site, and marketing will be further restricted (advertisements had been allowed in bathrooms, for example.) A Harvard official said the new rules are meant to keep doctors from becoming or appearing as industry marketing agents. (The Boston Globe) *This blog post was originally published at ACP Internist* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3776379 Wed, 21 Jul 2010 21:00:00 +0100 3776379 http://www.medworm.com/index.php?rid=3776380&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdo-insurance-companies-help-kill-primary-care%2F2010.07.21 Most doctors have a love/hate (and mainly hate) relationship with health insurance companies. We struggle with their confusing and complex coding rules in an effort to be reimbursed for our care of patients. When patients leave the office, they may think that a bill is sent to their insurance company and payment follows. More often than not it rarely happens that way. I am staring at an explanation of benefits (EOB) from Blue Shield of California for a patient I saw for a physical exam and Pap test. This patient had recently been hospitalized with a life threatening throat infection and abscess and saw me for needed follow up. I spent about 45 minutes with the patient, reviewing the events leading to hospitalization, coordinating the medications, as well as addressing the routine screening... Better Health blogs http://www.medworm.com/rss/comments.php?id=3776380 Wed, 21 Jul 2010 19:00:00 +0100 3776380 http://www.medworm.com/index.php?rid=3776381&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-%25e2%2580%259ci-get-it%25e2%2580%259d-moment-in-direct-pay-primary-care%2F2010.07.21 After seven years, my wife has finally stopped asking me for “The Power of DocTalker” story of the day. Now when I start with the details of the latest case report justifying the model, she stops me with “I get it, I get it! Go write the case report up and post it on your website for others to ‘get it,’ too.” Case reports center on the mission of our medical practice, with points regarding care that include quality, accessibility, convenience, affordability, empowerment, trust, and price transparency. Because our patients pay us directly for the service and don’t necessarily expect any insurance “reimbursement,” we are a very unique practice. We adhere to the points in our mission and also outperform all our local competition — i.e. medical ... Better Health blogs http://www.medworm.com/rss/comments.php?id=3776381 Wed, 21 Jul 2010 14:00:32 +0100 3776381 http://www.medworm.com/index.php?rid=3776382&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-doctors-letter-to-patients-with-chronic-disease%2F2010.07.21 Dear Patients: You have it very hard — much harder than most people understand. Having sat for 16 years listening to the stories, seeing the tiredness in your eyes, hearing you try to describe the indescribable, I have come to understand that I, too, can’t understand what your lives are like. How do you answer the question, “How do you feel?” when you’ve forgotten what “normal” feels like? How do you deal with all of the people who think you are exaggerating your pain, your emotions, your fatigue? How do you decide when to believe them or when to trust your own body? How do you cope with living a life that won’t let you forget about your frailty, your limits, your mortality? I can’t imagine. But I do bring something to the table that you may not know. I do have ... Better Health blogs http://www.medworm.com/rss/comments.php?id=3776382 Wed, 21 Jul 2010 12:00:02 +0100 3776382 http://www.medworm.com/index.php?rid=3767077&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmeaningful-use-does-what-you-do-qualify%2F2010.07.19 One doesn’t usually look to the Federal Register to define meaning or purpose (philosophers, yes, but bureaucrats?), but the federal government has officially ruled on what constitutes “meaningful use” — for the purposes of distributing dollars to clinicians for electronic health records. The Wall Street Journal’s health blog has an excellent synopsis of the rule and the reaction from different interest groups and experts, and the New England Journal of Medicine has a very clear explanation and summary of its key elements by David Blumenthal, M.D., F.A.C.P., the federal government’s coordinator of health information technology. (more…) *This blog post was originally published at The ACP Advocate Blog by Bob Doherty* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3767077 Mon, 19 Jul 2010 16:00:00 +0100 3767077 http://www.medworm.com/index.php?rid=3764134&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ffilmaid-gives-hope-in-haiti%2F2010.07.18 FilmAid International provides the children of Haiti what many doctors can’t bring earthquake survivors — a moment to forget about the pain and suffering the last six months has brought. Dr. Jon LaPook reports. Click HERE to watch the CBS Evening News video. (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3764134 Mon, 19 Jul 2010 05:14:40 +0100 3764134 http://www.medworm.com/index.php?rid=3764138&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2F19th-century-cure-for-obesity%2F2010.07.18 I really want to know what the treatment is that this “regular practicing physician” sent to the patient to reduce the surplus flesh. “Eat as much and as often as you please” and “no bandaging nor tightlacing.” Bring it on! *This blog post was originally published at EverythingHealth* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3764138 Sun, 18 Jul 2010 12:00:00 +0100 3764138 http://www.medworm.com/index.php?rid=3753822&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fan-important-tip-for-men-who-use-viagra%2F2010.07.14 The medical journal Mayo Clinic Proceedings recently contained some clinical pearls that I wanted to pass on to my men readers who take medication for erectile dysfunction (ED). They reported on a healthy 67-year-old male who took two 25mg doses of Viagra (sildenafil) but still did not get erections. He was frustrated and inquired about other treatments for ED. The article reported that patients often take Viagra and other phosphodiesterase type 5 inhibitors (Cialis, Levitra) incorrectly. To be effective, Viagra must be taken on an empty stomach at least one hour before intercourse. Research has shown that approximately half of patients who don’t respond to Viagra will have success when they take it properly. The dose can go up to 100mg, but there is no need to increase the medi... Better Health blogs http://www.medworm.com/rss/comments.php?id=3753822 Wed, 14 Jul 2010 22:00:00 +0100 3753822 http://www.medworm.com/index.php?rid=3753824&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fno-medical-school-debt-more-primary-care-doctors%2F2010.07.14 There’s little question that medical school debt is rising rapidly, affecting the career choice of medical students. It’s one of the main reasons why the disparity between the number of specialists and primary care doctors is widening. There have been a variety of proposed solutions — most recent of which are medical schools completely subsidizing their tuition. I think that’s a good step forward, but so far has only been limited to a few schools nationwide. (more…) *This blog post was originally published at KevinMD.com* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3753824 Wed, 14 Jul 2010 18:00:45 +0100 3753824 http://www.medworm.com/index.php?rid=3750059&cid=t_99405_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fonline-medical-records-not-all-patients-want-all-that%2F2010.07.13 Anytime you come across a healthcare article that implies that every patient wants access to this or that – i.e. their medical record, patient-centered care, etc. – you can safely assume that the claim is wrong. Why? Patients are not a monolithic group –- they don’t all share the same motivations, preferences, beliefs or experiences when it comes to their health. But let’s face. If you are trying to push an agenda, just saying some people want this or that is not the same as implying that everyone wants it. Take the issue of patient access to physician notes in their medical record. Robert Wood Johnson (RWJ) recently announced their OpenNotes study. The OpenNotes project will evaluate the impact on both patients and physicians of sharing, through online medical record p... Better Health blogs http://www.medworm.com/rss/comments.php?id=3750059 Tue, 13 Jul 2010 18:00:51 +0100 3750059