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 'general medicine'. Sat, 03 Sep 2011 02:17:34 +0100 http://www.medworm.com/index.php?rid=5181923&cid=t_104770_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2011%2F08%2F30%2Fsocial-media-and-surgery%2F Buffer Surgeons not being the most social animals among doctors, I was surprised to see 7 editorials about surgery and social media. These seven editorials highlighted the use of social media and different settings for surgeons, from medical school all the way up to the American College of Surgeons. The most factual contribution was about the implications of social media such as twitter, blogging and facebook on the next generation of physicians. In this editorial a recent study was cited. They found a difference in the use of social media between residents and medical students. 13% of residents and 64% of medical students at the University of Florida, Gainesville had Facebook profiles. Suggesting a 6 fold increase in the number of social media users in the next generation of physicians. I... Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=5181923 Tue, 30 Aug 2011 06:13:02 +0100 5181923 http://www.medworm.com/index.php?rid=5159228&cid=t_104770_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2011%2F08%2F22%2Fvirtual-environments-for-health%2F Buffer Another useful health application developed with game engines. Relax in a beautiful virtual world when you can’t go there. The real environment is to be preferred but not everyone is able to go there. Interesting research, not only a good idea but also proven effective after the research, hopefully. Reporter Daniel Cressey takes a trip to the University of Birmingham for a walk through a virtual world. By recreating the positive effects of spending time in natural environments, Bob Stone and his team hope to help those who can’t get out and about by bringing these environments to them. Buffer   No related posts. (Source: Dr Shock MD PhD) Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=5159228 Mon, 22 Aug 2011 12:17:40 +0100 5159228 http://www.medworm.com/index.php?rid=5077692&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fphysician-shows-gratitude-for-his-often-unappreciated-colleagues%2F2011.07.28 Today I would like to say thanks to a group of colleagues that too often go un-thanked. These would be my hospital-based internal medicine friends: hospitalists are what they are called. This idea came to me after reading Dr Robert Centor’s post on KevinMD. In his usual concise manner, he laments the lack of respect that many sub-specialists show hospitalists. I feel differently about my hard-working colleagues. As a sub, sub-specialist who works primarily in the hospital, I would like to say how grateful I am to have knowledgeable, hospital-based internists available. I believe, and write frequently about the importance of seeing the forest through the trees. A good doctor must see the big picture: a little atrial fib, for instance, isn’t a major problem if you can’t move, eat or ha... Better Health blogs http://www.medworm.com/rss/comments.php?id=5077692 Thu, 28 Jul 2011 14:00:54 +0100 5077692 http://www.medworm.com/index.php?rid=5062305&cid=t_104770_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2011%2F07%2F25%2Fsocial-media-use-by-us-hospitals%2F Buffer From a structured review of websites of 1800 US hospitals focusing on their Facebook, Twitter and Youtube accounts: 21% used social media More likely to be large, urban hospitals run by nonprofit, nongovernment organisations More likely to participate in graduate medical education Used social media to target a general audience (97%) Provide content about the entire organization (93%) Announce news and events (91%) Further public relations (89%) Promote health (90%). In short, used social media for unidirectional communication. Thaker SI, Nowacki AS, Mehta NB, & Edwards AR (2011). How U.S. hospitals use social media. Annals of internal medicine, 154 (10), 707-8 PMID: 21576547 Buffer   No related posts. (Source: Dr Shock MD PhD) Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=5062305 Mon, 25 Jul 2011 05:48:25 +0100 5062305 http://www.medworm.com/index.php?rid=5050748&cid=t_104770_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2011%2F07%2F21%2Fa-day-in-the-or%2F Buffer This time-lapse video was made for a video contest for residents. It’s a look inside a busy time in the OR, showing all the people involved during different procedures. Fine example of why hygiene is such an important topic in hospitals. More videos in this contest here Buffer   No related posts. (Source: Dr Shock MD PhD) Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=5050748 Thu, 21 Jul 2011 06:34:52 +0100 5050748 http://www.medworm.com/index.php?rid=5050749&cid=t_104770_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2011%2F07%2F20%2Fmd-celebrities-in-the-media%2F Buffer In this video a certain Dr Oz gets dissed, if that’s the right word. For all god reasons you can read them at ZDoggMD. A phenomenon not very popular were I live, fortunately. What do you think? Buffer   No related posts. (Source: Dr Shock MD PhD) Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=5050749 Wed, 20 Jul 2011 06:00:14 +0100 5050749 http://www.medworm.com/index.php?rid=5028491&cid=t_104770_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2011%2F07%2F11%2Funderutilized-resource-in-healthcare-the-patient%2F Buffer When Dave deBronkart learned he had a rare and terminal cancer, he turned to a group of fellow patients online — and found a medical treatment that even his own doctors didn’t know. It saved his life. Now he calls on all patients to talk with one another, know their own health data, and make health care better one e-Patient at a time. Dave deBronkart: Meet e-Patient Dave Buffer   No related posts. (Source: Dr Shock MD PhD) Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=5028491 Mon, 11 Jul 2011 05:43:23 +0100 5028491 http://www.medworm.com/index.php?rid=5008326&cid=t_104770_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2011%2F07%2F08%2Fwhy-do-the-same-drugs-look-different%2F Conclusions are very interesting and readable. Buffer   No related posts. (Source: Dr Shock MD PhD) Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=5008326 Fri, 08 Jul 2011 06:03:57 +0100 5008326 http://www.medworm.com/index.php?rid=5008329&cid=t_104770_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2011%2F07%2F05%2Fthe-sense-and-non-sense-of-vitamine-d-suppletion%2F Buffer David Agus shows how when proscribing treatment, doctors and government guidelines need to view the body as a network and not a series of isolated nodes. Liked this video also because it used Vitamine D as an example for hio point. Look at networks in the human body instead of nodes. Buffer   No related posts. (Source: Dr Shock MD PhD) Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=5008329 Tue, 05 Jul 2011 06:02:26 +0100 5008329 http://www.medworm.com/index.php?rid=4734229&cid=t_104770_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2011%2F04%2F19%2Fwho-should-select-the-music-during-medical-procedures%2F According to recent research it’s not the patient who should select it. Possibly because the patient will be afraid choosing a kind of music not agreeable to the physician. Overall, listening to music during cardiac catheterization significantly reduces anxiety as measured before and after the procedure with the State-Trait Anxiety Inventory (STAI). Moreover, all patients who listened to music had a trend to lower values of systolic and diastolic blood pressure and heart rate than control-group with no music. Women had higher anxiety scores before the procedure, the post operative score were similar in men and women. Women had a stronger anxiety reduction than men due to the music. All patients with music during the procedure showed a positive reaction to the music played and they di... Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=4734229 Tue, 19 Apr 2011 05:32:49 +0100 4734229 http://www.medworm.com/index.php?rid=4642692&cid=t_104770_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2011%2F03%2F28%2Fphysician-son-to-his-mother%2F A hospital is always a dangerous place to be. Mostly because you came because something is wrong with you. In the discussions I have with my mother about working in a hospital I always warn her to stay out as long as possible. In The Netherlands with a good functioning primary care help and social security this is a lot easier than in other countries. Another topic of debate is who to ask for taking care of you in a University Hospital. I always let her promise not to ask for the professor. Ask for the resident instead, I’ll tell her. The head of the department hasn’t seen patients probably for a long time and his head is busy with other things than patient care such as financial and staff problems. A resident is curious, eager to learn and caring and will do his best, the supe... Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=4642692 Mon, 28 Mar 2011 05:16:05 +0100 4642692 http://www.medworm.com/index.php?rid=4626873&cid=t_104770_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2011%2F03%2F23%2Fgrand-rounds-volume-7-number-26-the-emotional-edition%2F This brand new Grand Round is up at Better Health When I host Grand Rounds I like to organize the posts into emotion categories – kind of the way that movies are categorized into “drama, action, comedy, etc.” This achieves two goals: first, readers have the option of starting with their favorite emotion – maybe you need a “pick me up” or maybe you’re looking for something to get your blood pumping? Second, I get a general feeling for how my fellow bloggers are feeling these days. Judging from the volume of posts in each category, it seems that the majority of you are either surprised or outraged!   No related posts. (Source: Dr Shock MD PhD) Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=4626873 Wed, 23 Mar 2011 06:52:54 +0100 4626873 http://www.medworm.com/index.php?rid=4622370&cid=t_104770_122_f&fid=35055&url=http%3A%2F%2Fsarasotaneurology.com%2F2011%2F03%2F23%2Fall-massage-therapy-is-not-created-equal-in-pain-treatment%2F What do you think of when you think of neck or back massage therapy? Most people think of the type of massage you would receive if you went to the spa for the day.  That type of massage therapy is known as a Swedish Massage. Swedish Massage is only one of over 40 types of massage that a person can receive. When you say you went to see your doctor today, what do you think of?  If I went to see my family doctor, my image would be different than if I said I went to see my Cardiovascular surgeon.  They are both doctors, but the exams and procedures that they perform are vastly different. The field of massage is similar in its sub-specialization within the scope of massage therapy. Swedish Massage is great for relaxation and stress reduction, but if your back just went into spasm and is  lo... Sarasota Neurology blogs http://www.medworm.com/rss/comments.php?id=4622370 Wed, 23 Mar 2011 05:00:03 +0100 4622370 http://www.medworm.com/index.php?rid=4600536&cid=t_104770_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=4570595&cid=t_104770_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2011%2F03%2F10%2Fprinting-a-human-kidney%2F Amazing Surgeon Anthony Atala demonstrates an early-stage experiment that could someday solve the organ-donor problem: a 3D printer that uses living cells to output a transplantable kidney. Using similar technology, Dr. Atala’s young patient Luke Massella received an engineered bladder 10 years ago; we meet him onstage.   No related posts. (Source: Dr Shock MD PhD) Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=4570595 Thu, 10 Mar 2011 06:23:51 +0100 4570595 http://www.medworm.com/index.php?rid=4549751&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdefining-online-physician-conduct%2F2011.03.04 This week a reporter cornered me on the issue of professional behavior in the social space. How is it defined? I didn’t have an answer. But it’s something that I think about. Perhaps there isn’t much to think about. As a “representative” of my hospital and a physician to the children in my community, how I behave in public isn’t any different than a decade ago. Social media is just another public space. Sometimes it’s easy to forget that we’re in public. When I’m wrapped up in a Twitter thread it’s easy to forget that the world is watching. But the solution is simple: Always remember that the world is watching. On Twitter I think and behave as I do in public: Very much myself but considerate of those around me. I always think about how I might be perceived.... Better Health blogs http://www.medworm.com/rss/comments.php?id=4549751 Fri, 04 Mar 2011 20:00:27 +0100 4549751 http://www.medworm.com/index.php?rid=4545020&cid=t_104770_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2011%2F03%2F04%2Fgoogle-body-3d-model%2F Discovered an astonishing piece of help for med students: Google Body, a detailed 3D model of the human body. You can have a detailed look at the vascular system and heart, bones and the brain. You can add labels and zoom in, rotate the model. Learn the cranial nerves or brain structures with the help of labels on and of. You will need a Web browser that supports WebGL, such as Google Chrome, Mozilla Firefox 4 Beta. You can peel back anatomical layers, zoom in, click to identify anatomy, or search for muscles, organs, bones and more. You can also share the exact scene you are viewing by copying and pasting the URL.   No related posts. (Source: Dr Shock MD PhD) Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=4545020 Fri, 04 Mar 2011 06:40:37 +0100 4545020 http://www.medworm.com/index.php?rid=4544967&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fhealthecommunications.files.wordpress.com%2F2011%2F02%2Ffalls.jpg We hear about stories like this all time: An elderly person falls and breaks something — a hip, a wrist, or an arm. Soon what once was a healthy, independent senior begins an inexorable downhill slide. Such is the case of my 89-year-old mother who recently fell and broke her wrist. Turns out that 30 percent of people age 65 and older fall each year. Predictably, seniors with the following risk factors are more prone to falls: Using sedatives Cognitive impairment Problems walking Urinary tract infection Eye problems Balance issues Similarly, when a person does fall, a cascading series of predictable clinical events occurs. It even has a name: “Post-fall syndrome.” This syndrome is characterized by things like fear of falling again, increased immobility, loss of muscle and contr... Better Health blogs http://www.medworm.com/rss/comments.php?id=4544967 Thu, 03 Mar 2011 22:00:05 +0100 4544967 http://www.medworm.com/index.php?rid=4532268&cid=t_104770_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2011%2F03%2F01%2Fa-video-educating-parents-about-vaccinations%2F In The Netherlands vaccination programs are widely accepted, antivaccine movement to my knowledge doesn’t exist. In the US that’s a different story. Luckily we’ve the talented Dr. ZDogg, an internal medicine hospitalist; Dr Harry, a pediatrician; Doc Quixote, a general surgeon; and Dr. Diego, a radiologist. They not only write exceptional good and funny blog posts at ZDoggMD, they can actually also sing and perform. Watch this video and enjoy Get your shots on! Our parody of the Travie McCoy and Bruno Mars song Billionaire. Lyrics and more at http://ZDoggMD.com. Written and performed by Dr. Harry and ZDoggMD. Recording and video editing by ZDoggMD. Image editing by Dr. Diego. We would also like to thank Dr. Andrew Wakefield, whose child-endangering fraud unfortunately mad... Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=4532268 Tue, 01 Mar 2011 06:51:13 +0100 4532268 http://www.medworm.com/index.php?rid=4532209&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-third-place-in-healthcare-what-we-can-learn-from-starbucks%2F2011.02.28 Media reports on misdiagnosis continue to mount. A recent study on patients with Alzheimer’s found that half had been misdiagnosed. Half. Another headline blared “4 out of 10 patients being misdiagnosed.” The article encouraged patients to “see another doctor” if they are worried about their diagnosis. You know what it makes me think about? Starbucks. Why? Because the way Starbucks revolutionized coffee drinking shows a way forward for healthcare. Starbucks realized that since our lives focus on two places — home and work — most of us don’t have a “third place” to go. A place where we can be free of everyday distractions and take care of ourselves. Starbucks set out to create that “third place” by making its shops comfortable, inviting places. It works... Better Health blogs http://www.medworm.com/rss/comments.php?id=4532209 Mon, 28 Feb 2011 23:00:22 +0100 4532209 http://www.medworm.com/index.php?rid=4532210&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ffree-drug-samples-or-hospital-hotels-the-greater-evil%2F2011.02.28 Many folks criticize pharmaceutical companies for providing physicians’ offices with free drug samples. They claim that this giveaway harms consumers because drug companies must raise their prices to cover the costs of these freebies. Of course, this is undeniable. Any business expense, such as payroll or advertising, has to be covered and is expectedly borne by the consumer. If a company chooses not to advertise, outsources manufacturing to a country with cheaper labor, offers limited benefits to its employees, then they can sell their product at a low price. In this hypothetical example, anemic sales may doom the company quickly. Naturally, free samples are not really free. The rest of us pay for them. While this is true, I don’t think it is evil. Unlike the U.S. government, at least... Better Health blogs http://www.medworm.com/rss/comments.php?id=4532210 Mon, 28 Feb 2011 20:00:00 +0100 4532210 http://www.medworm.com/index.php?rid=4532211&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdr-watson-and-the-7-human-qualities-of-an-ideal-physician%2F2011.02.28 After the computer known as Watson easily dispatched of the best two human Jeopardy! contestants in history, IBM announced that one of the first applications of their artificial intelligence technology would be in the medical field. We should soon expect virtual physician assistants in the exam room. At least one of my friends even speculated that the days of human doctors are numbered. Is it possible that machines will replace humans in the doctor-patient relationship? I doubt it. According to a study done by the Mayo Clinic in 2006, the most important characteristics patients feel a good doctor must possess are entirely human. According to the study, the ideal physician is confident, empathetic, humane, personal, forthright, respectful, and thorough. Watson may have proved his cognitive ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4532211 Mon, 28 Feb 2011 18:00:27 +0100 4532211 http://www.medworm.com/index.php?rid=4532212&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-headlines-bash-doctors%2F2011.02.28 While I know it grabs the eye, it really didn’t matter what the article was about. The headline says it all: Doctors are the problem, not the system, right? -WesMusings of a cardiologist and cardiac electrophysiologist. *This blog post was originally published at Dr. Wes* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4532212 Mon, 28 Feb 2011 16:00:00 +0100 4532212 http://www.medworm.com/index.php?rid=4527734&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fquestioning-mobile-health%2F2011.02.27 This is something. Jay Parkinson on the Future Well blog has suggested that health apps are overrated. Then on Twitter came a remark that the post represented “fightin’ words.” While I think the tweet was in jest, I’m sure there are some who will take offense to the less-than-flattering remarks about our coveted health apps. We love the concept of health apps for what they represent more than for what they really offer us. We want to feel that we’ve got it all in the palm of our hand. After all, technology might do for us what we won’t do for ourselves. Like Jay I’m underwhelmed, but I don’t think that’ll always be the case. The post’s criticism should start a conversation about what’s real in mobile health and what isn’t. Even the fantasy of Health 2.... Better Health blogs http://www.medworm.com/rss/comments.php?id=4527734 Sun, 27 Feb 2011 18:00:47 +0100 4527734 http://www.medworm.com/index.php?rid=4525031&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoes-cell-phone-use-stimulate-brain-activity%2F2011.02.26 We all know that using a cell phone can stimulate the brain to work a bit harder. “Mr. Skerrett? This is Dr. LeWine’s office. Do you have a minute to talk about your test results?” or “Dad, a bunch of kids are going to Casey’s house after the dance. Can I go?” But a new study published in JAMA is making me wonder what the energy emitted by the phone itself — not just the information it delivers — is doing to my brain. Here’s the study in a nutshell. Dr. Nora Volkow and her colleagues recruited 47 volunteers to have their brain activity measured twice by a PET scanner. Both times the volunteer had a cell phone strapped to each ear. During one measurement, both phones were turned off. During the other, one phone was turned on but muted so the volunteer didn’t know... Better Health blogs http://www.medworm.com/rss/comments.php?id=4525031 Sat, 26 Feb 2011 22:00:29 +0100 4525031 http://www.medworm.com/index.php?rid=4522106&cid=t_104770_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=4512391&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fconsumer-driven-healthcare-why-it-will-fail%2F2011.02.23 With the creation of consumer-driven health plans and health insurance policies with high deductibles linked to a savings option, more financial responsibility shouldered by patients and employees and less by employers was completely inevitable. The American public likes to have everything, whether consumer electronics or other services, as cheap as possible. With escalating healthcare expenses rising far more rapidly than wages or inflation, it’s not surprising employers needed a way to manage this increasingly-costly business expense. In the past, companies faced a similar dilemma. It wasn’t about medical costs, but managing increasingly expensive retirement and pension plan obligations. Years ago, companies moved from these defined benefit plans to defined contribution plan... Better Health blogs http://www.medworm.com/rss/comments.php?id=4512391 Wed, 23 Feb 2011 22:00:00 +0100 4512391 http://www.medworm.com/index.php?rid=4512393&cid=t_104770_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=4512394&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoctors-are-sponges%2F2011.02.23 I am a doctor. Go ahead, call me what you may. Group me into a neatly, prejudged category: “All you doctors.” Just don’t label me a sponge. That’s right. Recently in the Wall Street Journal, Mr. Andy Kessler, famous author and former hedge fund manager smart enough to turn $100 million into $1 billion, grouped doctors into a sub-category of the service economy which he labeled as “sponges.” We could have done worse: His other categories included “sloppers” (DMV workers), “slimers” (financial planners), and “thieves” (cable companies). It seems that doctors — along with cosmetologists, lawyers, and real estate brokers — offend him because of the tests and licenses that we deem necessary: Sponges are those who earned t... Better Health blogs http://www.medworm.com/rss/comments.php?id=4512394 Wed, 23 Feb 2011 16:00:37 +0100 4512394 http://www.medworm.com/index.php?rid=4512441&cid=t_104770_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2011%2F02%2F23%2Fthe-placebo-effect%2F Everything you wanted to know about the placebos. Thanks Life in the Fast Lane   No related posts. (Source: Dr Shock MD PhD) Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=4512441 Wed, 23 Feb 2011 09:52:20 +0100 4512441 http://www.medworm.com/index.php?rid=4489672&cid=t_104770_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=4477824&cid=t_104770_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2011%2F02%2F15%2Fits-time-to-redesign-medical-data%2F Your medical chart: it’s hard to access, impossible to read — and full of information that could make you healthier if you just knew how to use it. At TEDMED, Thomas Goetz looks at medical data, making a bold call to redesign it and get more insight from it. It starts off with an interesting experiment in dentistry. Fear doesn’t work in communicating messages about health.   No related posts. (Source: Dr Shock MD PhD) Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=4477824 Tue, 15 Feb 2011 09:04:31 +0100 4477824 http://www.medworm.com/index.php?rid=4472949&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-nursing-shortage-a-big-disconnect%2F2011.02.13 With the aging of America, it’s well known that there will be a shortage of registered nurses and nursing assistants to take care of the population. It’s predicted that the shortage of nurses in California will climb to 80,000 by 2015. California has just 653 registered nurses employed per 100,000 people. One of the problems is a lack of qualified faculty to teach at nursing schools. California was forced to turn away 23,000 qualified applicants from nursing programs during 2008-2009. And this week Humboldt State University announced plans to discontinue the school’s nursing program because of financial concerns and inability to retain nursing faculty. Shortage of nurses and closing nursing programs — now there’s a big disconnect. *This blog post was ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4472949 Sun, 13 Feb 2011 19:00:00 +0100 4472949 http://www.medworm.com/index.php?rid=4464493&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthree-rs-of-health-and-wellness%2F2011.02.11 I’d like to talk about how rodents, relationships, and riding relate to overall health and wellness. This idea comes from a nicely-written New York Times piece entitled, “Does Loneliness Reduce the Benefits of Exercise?” Here, Gretchen Reynolds reviews a few intriguing studies about how relationships may affect exercise, stress hormone levels, and intelligence. The combo caught my eye. Anyone who pays attention to wellness knows that exercise produces more flexible arteries, more durable hearts, and leaner body shapes. These benefits are obvious, and honestly, sometimes a bit tiresome to write about. To me, a far more interesting — and lesser known — benefit of regular exercise is that it might make us smarter. Here’s where the rodents come into the story. As ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4464493 Fri, 11 Feb 2011 22:00:40 +0100 4464493 http://www.medworm.com/index.php?rid=4460012&cid=t_104770_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2011%2F02%2F10%2Fphysicians-on-twitter%2F In the latest issue of the JAMA the results of a survey is published. The authors did a search on physicians using twitter. They extracted the public profile pages of the physicians using twitter with 500 or more followers between May 1 and May 31, 2010. They analyzed the tweets of these professionals. Of the 5156 tweets analyzed, 49% (2543) were health or medical related, 21% (1082) were personal communications, 14% (703) were retweets, and 58% (2965) contained links. Seventy-three tweets (1%) recommended a medical product or proprietary service, 634 (12%) were self-promotional, and 31 (1%) were related to medical education. But what is somewhat worrying were their findings of potential patient privacy violations and conflicts of interest. Thirty-eight tweets (0.7%) represented potential ... Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=4460012 Thu, 10 Feb 2011 11:50:06 +0100 4460012 http://www.medworm.com/index.php?rid=4445804&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-problem-with-casual-medical-advice%2F2011.02.07 It’s happening more frequently: Requests for medical advice by email. The more I do, the more people I meet. The network grows and friends of friends learn about what I do. So junior has a little pain and shows at the local ER where the requisite CT shows a little thickening of the ileum. Someone suggests that the family drop me a line. Here’s the problem: There’s more to this than digital correspondence will allow. While the statistical reality of this child’s situation is that this finding represents a little edema from a virus, the differential is precarious: Crohn’s disease, lymphoma, tuberculous ileitis, eosinophilic enteropathy. A case of this type requires the thorough exploration of a child’s story and a compulsive exam that takes into consideration the problems in the... Better Health blogs http://www.medworm.com/rss/comments.php?id=4445804 Mon, 07 Feb 2011 14:00:30 +0100 4445804 http://www.medworm.com/index.php?rid=4438885&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-female-physicians-make-less-money%2F2011.02.05 Female doctors make less than male physicians. That conclusion gained major media traction recently. A recent post on KevinMD.com by medical student Emily Lu had some great conversation discussing reasons why women make less money in medicine. To recap, the study from Health Affairs concluded that, newly-trained physicians who are women are being paid significantly lower salaries than their male counterparts according to a new study. The authors identify an unexplained gender gap in starting salaries for physicians that has been growing steadily since 1999, increasing from a difference of $3,600 in 1999 to $16,819 in 2008. This gap exists even after accounting for gender differences in determinants of salary including medical specialty, hours worked, and practice type, say the authors. Eve... Better Health blogs http://www.medworm.com/rss/comments.php?id=4438885 Sat, 05 Feb 2011 20:00:52 +0100 4438885 http://www.medworm.com/index.php?rid=4438886&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fis-the-er-really-the-best-place-to-get-primary-care-quicker%2F2011.02.05 In 1986, when Congress passed the Emergency Medical Treatment and Active Labor Act (EMTALA), hospitals and ambulance services were mandated by law to stabilize anyone needing emergency healthcare services regardless of citizenship, legal status, and/or insurance status. This was instituted at the time to prevent the prevalent practice of “dumping” — refusing to treat patients because of insufficient insurance or transferring or discharging patients on the basis of anticipating high diagnosis and treatment costs. While the implications of this law are indeed very noble in providing undifferentiated care to all patients based solely on healthcare needs and not financial status, it has unfortunately led to many patients presenting to the emergency department (ED) for primary care is... Better Health blogs http://www.medworm.com/rss/comments.php?id=4438886 Sat, 05 Feb 2011 17:00:34 +0100 4438886 http://www.medworm.com/index.php?rid=4424234&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoctors-and-aging-5-things-to-help-good-doctors-stay-good-longer%2F2011.02.01 I asked my age-matched colleague the other day: “Do you think we’ll know when it happens to us?” He responded: “I know. I worry about that, too…a lot. I’m getting out before it happens to me.” We were talking about our fears of being labeled as an “old” doctor.  Not just old in years — our children and bifocals remind of us of that — but old in our mindset. We fear becoming one of the dinosaur doctors who get known for their excessive attachment to old dogma, premature dismissiveness of novel new approaches, fear of social media, and of course the tell-tail (pathognomonic) sign of agedness, ranting mindlessly in front of Fox news about healthcare reform in the doctor’s lounge. This transition can happen fast. One moment a doctor might be in their s... Better Health blogs http://www.medworm.com/rss/comments.php?id=4424234 Tue, 01 Feb 2011 20:00:27 +0100 4424234 http://www.medworm.com/index.php?rid=4424236&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-eroding-doctor-label%2F2011.02.01 It came as a Twitter “follow” from @coldfeet65, a self-proclaimed “Nurse Practitioner Hospitalist.” I had never heard this term before. Does it mean a nurse practitioner who cares for hospitalists? Or is it a hospitalist who is a nurse practitioner? Or maybe it’s a nurse practitioner who helps hospitalists? (Honestly, I think I know which one she means, but you get my point.) Perhaps this is a prescient glimpse to healthcare of the future, where our more typical nurse and doctor labels are supplanted by more and more monikers that serve to confuse, rather than clarify, each of our roles in healthcare delivery. As specialists in cardiology, we’ve seen a similar trend with cardiology hospitalists. But we should be clear what this means to the patients and ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4424236 Tue, 01 Feb 2011 16:00:00 +0100 4424236 http://www.medworm.com/index.php?rid=4424286&cid=t_104770_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2011%2F02%2F01%2Fmanaging-the-demands-of-professional-life%2F This is the title of an article recently published and written by a psychiatrist and a cardiac surgeon. It’s about an important question not only for physicians but also for other professionals. I found their answer recognizable for most of their concepts. In short, it’s about five concepts that can be helpful in the work of busy professionals. Mindfulness, to my opinion one of the least recognizable concepts to be advised to busy professionals. Professionals are usually busy trying to achieve goals in the near future. They take little time to think and enjoy the present. The article goes into detail about some of the exercises you can do for mindfulness. Examples of these exercises can easily be found on the Internet. Intentionality. This is about “having a choice&#8221... Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=4424286 Tue, 01 Feb 2011 06:50:20 +0100 4424286 http://www.medworm.com/index.php?rid=4419137&cid=t_104770_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=4414521&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-money-isnt-everything-to-doctors%2F2011.01.29 I recently pointed to a BMJ study concluding that pay for performance doesn’t seem to motivate doctors. It has been picking up steam in major media with TIME, for instance, saying: “Money isn’t everything, even to doctors.” So much is riding on the concept of pay for performance, that it’s hard to fathom what other options there are should it fail. And there’s mounting evidence that it will. Dr. Aaron Carroll, a pediatrician at the University of Indiana, and regular contributor to KevinMD.com, ponders the options. First he comments on why the performance incentives in the NHS failed: Perhaps the doctors were already improving without the program. If that’s the case, though, then you don’t need economic incentives. It’s possible the incentives were too low. But I don’t... Better Health blogs http://www.medworm.com/rss/comments.php?id=4414521 Sat, 29 Jan 2011 17:00:01 +0100 4414521 http://www.medworm.com/index.php?rid=4405835&cid=t_104770_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2011%2F01%2F27%2Fvisualizing-the-medical-data-explosion%2F Today medical scans produce thousands of images and terabytes of data for a single patient in mere seconds, but how do doctors parse this information and determine what’s useful? At TEDxGöteborg, scientific visualization expert Anders Ynnerman shows us sophisticated new tools — like virtual autopsies — for analyzing this myriad data, and a glimpse at some sci-fi-sounding medical technologies in development. This talk contains some graphic medical imagery. Why you should tell your kids to play video games. How graphic cards can be helpful with virtual autopsies in forensic medicine.   No related posts. (Source: Dr Shock MD PhD) Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=4405835 Thu, 27 Jan 2011 07:18:25 +0100 4405835 http://www.medworm.com/index.php?rid=4399525&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-older-doctors-continue-to-treat-patients%2F2011.01.25 Did you know that one-third of the country’s physicians are over the age of 65? That’s right, there’s a good chance that your doctor is on Medicare. That’s a concern, because physicians aren’t immune to the ails of aging, and are just as prone as patients to succumb to the effects of Parkinson’s or various types of dementias. Not comforting if you’re about to undergo an operation, for instance. And absolutely frightening when you consider baby boomers and newly-insured patients will flood our health system in the coming years. An eye-opening piece from the New York Times highlights the trend. It’s up to doctors and medical societies to report doctors who aren’t able to proficiently perform, but few do. According to the data, the rate of disciplinary action for physician... Better Health blogs http://www.medworm.com/rss/comments.php?id=4399525 Tue, 25 Jan 2011 22:00:06 +0100 4399525 http://www.medworm.com/index.php?rid=4394442&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fclinical-guidelines-who-writes-them-anyway%2F2011.01.25 While DrRich is a conservative American, and has made plain the difficulties he has with the Progressive program in general and with Progressive healthcare reform in particular, at times he is forced to admit that, on occasion, the Progressive way of looking at the world has certain merits. And as DrRich contemplates a question that has been bothering him lately, a question that no doubt plagues many American physicians who (unlike DrRich) are still toiling away in the trenches, he finds that this is one such occasion. That question is: Just who are the people writing all those clinical guidelines — the  “guidelines” physicians are now expected to follow in every particular in every case, on pain of massive fines, loss of career, and/or incarceration? DrRich is quick to say that... Better Health blogs http://www.medworm.com/rss/comments.php?id=4394442 Tue, 25 Jan 2011 14:00:26 +0100 4394442 http://www.medworm.com/index.php?rid=4394444&cid=t_104770_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=4394445&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhat-is-a-%25e2%2580%259ccomplete%25e2%2580%259d-physical%2F2011.01.24 A reader requests: Can you do a post on what procedures constitute a thorough physical, in your opinion? I haven’t had one in several years and thinking of making an appointment now. The last doctor I went to didn’t even listen to my heart or go though the motions with feeling my belly and that stuff. And of the last three doctors I went to, I realized they didn’t bring up my immunization records. Is this usually left for the patients to bring up on their own? Good question. What exactly is a physical? Does it include blood work? What about an EKG? And a cardiac stress test? Is an “executive physical” an orgy of “more is better,” previously paid lavishly, really better than a “camp physical?” Here’s the thing: There is no such thing as a “complete physical exami... Better Health blogs http://www.medworm.com/rss/comments.php?id=4394445 Mon, 24 Jan 2011 18:00:47 +0100 4394445 http://www.medworm.com/index.php?rid=4394446&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmedical-ethics-why-they-should-matter-to-patients%2F2011.01.24 Medical ethics has properly gained a foothold in the public square. There is a national conversation about euthanasia, stem cell research, fertilization and embryo implantation techniques, end-of-life care, prenatal diagnosis of serious diseases, defining death to facilitate organ donation, cloning and financial conflicts of interest. Nearly every day, we read (or click) on a headline highlighting one of these or similar ethical controversies. These great issues hover over us. We physicians face ethical dilemmas every day in the mundane world of our medical practices. They won’t appear in your newspapers or pop up on your smartphones, but they are real and they are important. Here is a sampling from the everyday ethical smorgasbord that your doctor faces. How would you act under the fol... Better Health blogs http://www.medworm.com/rss/comments.php?id=4394446 Mon, 24 Jan 2011 16:00:00 +0100 4394446 http://www.medworm.com/index.php?rid=4377570&cid=t_104770_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=4360977&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpoint-and-click-medicine-the-emr-game%2F2011.01.18 Whistleblower readers know of my criticisms of the electronic medical record (EMR) juggernaut that is oozing over the medical landscape. Ultimately, this technology will make medical care better and easier to practice. All systems will be integrated, so that a physician will have instant access to his patients’ medical data from other physicians’ offices, emergency rooms and hospitals. In addition, data input in the physician’s office will use reliable voice activated technology, so that some antiquated physician behaviors, such as eye contact, can still occur. Clearly, EMR is in transition. I place it on the 40 yard line, a long way from a touch down or field goal position. A colleague related a distressing meeting he had at the community hospital he works at. This hospital, like ne... Better Health blogs http://www.medworm.com/rss/comments.php?id=4360977 Tue, 18 Jan 2011 20:00:00 +0100 4360977 http://www.medworm.com/index.php?rid=4355716&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdo-patients-have-clinical-judgment%2F2011.01.16 I used to think they didn’t, but they do. Clinical judgment is the application of individual experience to the variables of a patient’s medical presentation. It’s the hard-worn skill of knowing what to do and how far to go in a particular situation. It’s having the confidence to do nothing. Clinical judgment is learned from seeing lots of sick people. Good clinical judgment is when the gifted capacity of reasoning intersects with experience. Some doctors have better judgment than others. Aristotle called this phronesis – or practical judgment. Patients have practical judgment. We often can tell when something’s amiss with our own body. Things feel different or look different. Taking action on these observations is how we exercise judgment as patients. Parents of chi... Better Health blogs http://www.medworm.com/rss/comments.php?id=4355716 Sun, 16 Jan 2011 23:00:49 +0100 4355716 http://www.medworm.com/index.php?rid=4355717&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmedical-errors-should-doctors-always-fess-up%2F2011.01.16 From the Medscape Medical Ethics article entitled “‘Some Worms Are Best Left In The Can’: Should You Hide Medical Errors?“: Consequences aside, from a strictly ethical perspective, if a patient doesn’t realize that his physician made a mistake, should the physician fess up? Before you jump to conclusions (as I did), look at the article’s three parts. It’s about a survey. The title is on the inflammatory side; the article is a window into physicians’ views. The introduction continues: Evidence of the complex prisms through which physicians view these issues was apparent in the replies to four questions asked in Medscape’s exclusive ethics survey. More than 10,000 physicians responded to the survey in 2010. Subheads: – Mistakes that don’t harm p... Better Health blogs http://www.medworm.com/rss/comments.php?id=4355717 Sun, 16 Jan 2011 20:00:12 +0100 4355717 http://www.medworm.com/index.php?rid=4349514&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-the-term-patient-is-so-important-in-healthcare%2F2011.01.14 An online friend, col­league, and out­spoken patient advocate, Trisha Torrey, has an ongoing e-vote about whether people prefer to be called a “patient,” a “con­sumer,” a “cus­tomer,” or some other noun to describe a person who receives healthcare. My vote is: PATIENT. Here’s why: Providing medical care is or should be unlike other com­mercial trans­ac­tions. The doctor, or other person who gives medical treatment, has a special pro­fes­sional and moral oblig­ation to help the person who’s receiving his or her treatment. This respon­si­bility — to heal, hon­estly and to the best of one’s ability — over­rides any other com­mit­ments, or con­flicts, between the two. The term “patient” con­stantly reminds the doctor of the spe­cialness of... Better Health blogs http://www.medworm.com/rss/comments.php?id=4349514 Fri, 14 Jan 2011 21:00:02 +0100 4349514 http://www.medworm.com/index.php?rid=4349515&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Freferral-communication-what-happens-to-handoffs-between-primary-care-physicians-and-specialists%2F2011.01.14 Far more primary care doctors report detailed referrals than do specialists report receiving them. The same applies in reverse. Specialists report returning quality consultations, while primary care physicians report receiving them far less often. Researchers reported in Archives of Internal Medicine that perceptions of communication regarding referrals and consultations differed widely. While 69.3 percent of primary care physicians reported “always” or “most of the time” sending a patient’s history and the reason for the consultation to specialists, only 34.8 percent of specialists said they “always” or “most of the time” received the information. And, while 80.6 percent of specialists said they “always” or “most o... Better Health blogs http://www.medworm.com/rss/comments.php?id=4349515 Fri, 14 Jan 2011 18:00:00 +0100 4349515 http://www.medworm.com/index.php?rid=4337934&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-doctors-and-patients-speak-different-languages%2F2011.01.12 I can’t say that I enjoy the patient encounter as much when it involves a translator. There’s just something about communicating through a third party that changes the experience. But there are some things you can do as a provider to bridge the language gap: Look. Even thought the translator is doing the talking, look at the patient just as if you are asking the question yourself. There’s a tendency to let the translator act as a surrogate with respect to eye contact and visual feedback. Smile. A smile doesn’t need translation. It conveys very clearly that have a sincere interest in making a connection. Touch. I never leave the exam room without some type of sincere physical contact. A firm handshake or a hand on the shoulder go a long way in closing the language barrier. Sa... Better Health blogs http://www.medworm.com/rss/comments.php?id=4337934 Wed, 12 Jan 2011 22:00:29 +0100 4337934 http://www.medworm.com/index.php?rid=4309608&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpersonalized-medicine-a-2011-resolution-for-you%2F2011.01.04 You are an individual right? To your mom and dad you are/were like no other. Hopefully your family and friends continue to see you as one-of-a-kind. Had you considered your doctor should see you that way too? Not as yet another one with diabetes, or heart disease, or cancer, but as a singular human being with biology that may be different from even the next person through the door with the same diagnosis. This is the age of “personalized medicine” and it will accelerate in 2011. It is our responsibility as patients to ensure the power of this concept is leveraged for us each time we interact with the healthcare system. This is especially true as we manage a serious chronic condition or a cancer. Now, in research and in clinical practice there are refined tests to determine what our spe... Better Health blogs http://www.medworm.com/rss/comments.php?id=4309608 Tue, 04 Jan 2011 19:00:47 +0100 4309608 http://www.medworm.com/index.php?rid=4309611&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Falzheimers-disease-to-test-or-not-to-test%2F2011.01.03 The medical profession’s ability to diagnose far exceeds its ability to effectively treat the conditions discovered. Consider arthritis, Parkinson’s disease, irritable bowel syndrome, strokes, emphysema, and many cancers. When a physician orders a diagnostic test, ideally it should be to answer a specific question, rather than a buckshot approach. A chest X-ray is not ordered because a patient has a cough. It should be done because the test has a reasonable chance of yielding information that would change the physician’s advice. If the doctor was going to prescribe an antibiotic anyway, then why order the chest X-ray? Physicians and patients should ask before a test is performed if the information is likely to change the medical management. In other words, is a test being ordered bec... Better Health blogs http://www.medworm.com/rss/comments.php?id=4309611 Mon, 03 Jan 2011 22:00:00 +0100 4309611 http://www.medworm.com/index.php?rid=4304875&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ffalse-positives-in-medical-tests-how-they-can-kill-patients%2F2011.01.03 I’ve written in the past that more medicine and tests do not necessarily reflect better care. There is no test that is 100 percent specific or sensitive. That means tests may be positive, when, in fact, there is no disease (“false positive”), or tests may be negative in the presence of disease (“false negative”). It’s the latter that often gets the most media attention, often trumpeted as missed diagnoses. But false positives can be just as dangerous. Consider this frightening case report from the Archives of Internal Medicine: A 52-year-old woman presented to a community hospital with atypical chest pain. Her low-density lipoprotein cholesterol and high-sensitivity C-reactive protein levels were not elevated. She underwent cardiac computed tomography angiography, which showed... Better Health blogs http://www.medworm.com/rss/comments.php?id=4304875 Mon, 03 Jan 2011 18:00:49 +0100 4304875 http://www.medworm.com/index.php?rid=4304877&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-best-book-on-health-care-reform%2F2011.01.03 The best book on health care reform — or surviving it — is the “The Innovator’s Prescription: A Disruptive Solution for Health Care.” The decade worth of research spent understanding, studying, and ultimately offering solutions to make the health care system more accessible, higher quality, and affordable is clear. Unlike other books, the authors, respected Harvard Business School (HBS) professor Clayton Christensen, Jerome Grossman, a doctor who also was the Director of Health Care Delivery Policy Program at Harvard Kennedy School, and Jason Hwang, another doctor and graduate of the MBA program at HBS, avoid the traps the plague most other solutions by taking a completely different perspective by looking at other industries where products and services offere... Better Health blogs http://www.medworm.com/rss/comments.php?id=4304877 Mon, 03 Jan 2011 14:00:00 +0100 4304877 http://www.medworm.com/index.php?rid=4302122&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2F10-new-years-resolutions-for-doctors-and-patients%2F2010.12.31 #1 Doctor: Resolve to let patients speak without interruption and describe their symptoms. Patient: Resolve to focus on the problem I am seeing the doctor about and not come with a list of 10 complaints for a 15-minute office visit. #2 Doctor: Resolve to keep a pleasant tone of voice when answering night and weekend phone calls from the answering service, patients, or nurses. Patient: Resolve to get my prescriptions filled during office hours, not forget my medications while traveling, and to use night and weekend phone calls for emergencies only. #3 Doctor: Resolve to exercise a minimum of four times a week for better health. Patient: Ditto. #4 Doctor: Resolve to train my staff and model excellent customer service for patients. Patient: Resolve to understand that getting an instant refer... Better Health blogs http://www.medworm.com/rss/comments.php?id=4302122 Fri, 31 Dec 2010 22:00:00 +0100 4302122 http://www.medworm.com/index.php?rid=4298620&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fabout-patient-autonomy%2F2010.12.29 Recently, I was involved in a discussion on an email list serve and decided to takes some of my comments on patient autonomy and blog about them. This arose following a debate about whether the term “patient” engendered a sense of passivity and, therefore, whether the term should be dropped in favor of something else, like “client” or something similar. Having participated in the preparation and dissemination of the white paper on e-patients, I don’t see the need for “factions” or disagreements in the service of advancing Participatory Medicine. As Alan Greene aptly stated: “This is a big tent, with room for all.” I want all of my patients to be as autonomous as possible. In my view, their autonomy is independent of the doctor-patient r... Better Health blogs http://www.medworm.com/rss/comments.php?id=4298620 Wed, 29 Dec 2010 22:00:00 +0100 4298620 http://www.medworm.com/index.php?rid=4298624&cid=t_104770_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_104770_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=4287416&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-twelve-days-of-healthcare-reform%2F2010.12.24 Today’s blog will be my last for 2010, as I will be taking a break to spend the Christmas and New Year’s holidays with family and friends. In keeping with a tradition I started two years ago, I again have taken the liberty of mangling a beloved holiday song, story, or rhyme to give a humorous (I hope!) perspective on current politics. In December, 2008, I adapted “Twas the Night Before Christmas” to convey President-elect Obama as being a not-so-jolly old elf besieged by lobbyists demanding stimulus gifts. Last year, I depicted the GOP as the Grinch trying to stop “ObamaCare” from coming. Today, I’ve re-written the “Twelve Days of Christmas” carol so that it is the government bestowing “gifts” (based on actual provisions of the Affordable Care Act) that the new Co... Better Health blogs http://www.medworm.com/rss/comments.php?id=4287416 Fri, 24 Dec 2010 14:00:00 +0100 4287416 http://www.medworm.com/index.php?rid=4285200&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-makeover-for-lab-reports%2F2010.12.23 Although medical professionals get used to it, the way laboratory data is presented in reports can be quite confusing to the patient. Typically, it is a few columns of black text with poor organization and little guidance to help the patient discern any meaning. The folks at Wired agreed, and they brought together some Dartmouth physicians and a group of designers to bring a new look to these drab reports. We got to see their refreshing results at TEDMED, but now these prototype reports have been published online: Link: The Blood Test Gets a Makeover… *This blog post was originally published at Medgadget* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4285200 Thu, 23 Dec 2010 18:00:02 +0100 4285200 http://www.medworm.com/index.php?rid=4281312&cid=t_104770_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=4272371&cid=t_104770_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2010%2F12%2F20%2Fhow-to-develop-the-ability-to-think-strategically%2F What is strategical thinking? A key leadership requirement. Strategic thinking is an individual thinking activity that benefits organizations. Its purpose is to discover competitive strategies to position the organization significantly differently from the present. Experiences contributing to the development of strategic thinking in order of importance according to a survey in individuals who attended ten educational events sponsored by the American College of healthcare Executives (ACHE) in various U.S. cities. Participating in organizational strategic planning was the most important experience contributing to the development of strategic thinking. Starting a major organizational project. This experience involves a complex project that lasts one year or more and affords the executive s... Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=4272371 Mon, 20 Dec 2010 06:42:34 +0100 4272371 http://www.medworm.com/index.php?rid=4272291&cid=t_104770_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=4265737&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmediation-for-medical-malpractice-why-doctors-should-embrace-it%2F2010.12.17 Mediation has been cited as a way to lower the cost of litigation and compensate injured patients without going through the ordeal of a trial. In a post from the WSJ Health Blog, the problem is that few doctors are participating. That’s a problem. A study from a law journal looked at 31 cases that went to mediation and found that, of those cases, 16 were settled at mediation, 5 settled afterward and 10 weren’t settled. While defense attorneys were less likely to agree to mediation than plaintiff attorneys, lawyers who did participate reported satisfaction with the process, as did “plaintiffs, hospital representatives and insurers,” the study finds. The authors write that in no cases did physicians participate in the mediation. Many times, patients resort to suing their physicians ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4265737 Fri, 17 Dec 2010 18:00:16 +0100 4265737 http://www.medworm.com/index.php?rid=4258863&cid=t_104770_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=4258868&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fblood-print-am-i-the-doctor-bleeding%2F2010.12.14 I’m diligently writing a detailed note in the patient’s chart as he speaks of his multiple concerns — severe depression, headaches, and dizziness. I’m not making good eye contact. Often this is effective because I can resist the allure of passively following his narrative to its own diagnostic suspicions. Instead I can record his intuitive guesses without persuasion, formulating my own independent ideas even as I value his. Except that as I write in his chart I notice streaks of red blood appearing among the black script. Am I hallucinating? Am I capable of making paper bleed? Am I, the doctor, bleeding? With closer inspection I notice three small cuts on my chapped knuckles and fingers, products of the incessant and obsessive handwashing compelled by modern medicine. We are ob... Better Health blogs http://www.medworm.com/rss/comments.php?id=4258868 Tue, 14 Dec 2010 13:00:50 +0100 4258868 http://www.medworm.com/index.php?rid=4258869&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-illusion-of-healthcare-reform%2F2010.12.13 The greatest minds are assembled to discern the answer in healthcare reform. Powerful interest groups are aligned to design solutions to protect their turf. Rubrics, formulas, slogans and taglines get designed, spun, pitched and thrown out. The burden of finding alignment, an answer, a plan that suits everyone seems insurmountable — unless we don’t. The idea of a fit for all is an illusion. Justice and equity are seen differently. We imagine some public consensus at our own peril. But honesty has been in short supply. To paraphrase Oprah: What do we know for sure? Some people want a relationship with a trusted doctor who knows them well. They want to pick the doctor, the neighborhood and the hospital they attend. Others want immediate access and have little trust or interest in a p... Better Health blogs http://www.medworm.com/rss/comments.php?id=4258869 Mon, 13 Dec 2010 21:00:00 +0100 4258869 http://www.medworm.com/index.php?rid=4258870&cid=t_104770_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=4251109&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fchristmas-gifts-for-my-medical-colleagues%2F2010.12.11 This is my column in December’s Emergency Medicine News: 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 grandparents. 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 me enough to give such a gift. I have been thrilled to ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4251109 Sat, 11 Dec 2010 16:00:03 +0100 4251109 http://www.medworm.com/index.php?rid=4249056&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fnewt-gingrichs-take-on-facebook-saving-a-womans-life%2F2010.12.10 I’ve seen at least half a dozen links to the op-ed coauthored by Newt Gingrich and neurosurgeon Kamal Thapar about how the doctor used information on Facebook to save a woman’s life. (It was published by AOL News. Really.) In brief, a woman who had been to see a number of different health care providers without getting a clear diagnosis showed up in an emergency room, went into a coma and nearly died. She was saved by a doctor’s review of the detailed notes she kept about her symptoms, etc., which she posted on Facebook. The story is vague on the details, but apparently her son facilitated getting the doc access to her Facebook page, and the details posted there allowed him to diagnose and treat her condition. She recovered fully. Newt and Dr. Thapar wax rhapsodic about... Better Health blogs http://www.medworm.com/rss/comments.php?id=4249056 Fri, 10 Dec 2010 23:00:54 +0100 4249056 http://www.medworm.com/index.php?rid=4249059&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-virtue-of-unnecessary-care%2F2010.12.10 I case you didn’t hear the news, the American healthcare system is in financial crisis. One of the biggest culprits indicted in this crises is “unnecessary care,” with estimates ranging from $500 to $650 billion (total spending estimate is $2.6 trillion) going toward things labeled “unnecessary.” Personally I think this is an underestimate, as it doesn’t take into account the some big-ticket items: Brand name drugs given when generics would do. Antibiotics given for viral infections (and the additional cost due to reactions and resistance). Unproven costly care considered “standard of care” (PSA testing, robotic surgery, coronary stents). The unnecessarily high price of drugs. One of the main reasons I am an advocate of EMR is to measure and analyze care, eliminating tha... Better Health blogs http://www.medworm.com/rss/comments.php?id=4249059 Fri, 10 Dec 2010 17:00:19 +0100 4249059 http://www.medworm.com/index.php?rid=4245304&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fnot-just-any-joe-smith%2F2010.12.09 DrRich is delighted to note that a very good and longtime friend and former colleague has been named as one of the HealthLeaders 20 for 2010 — that is, as one of 20 people, chosen by HealthLeaders Media, who are changing healthcare for the better. DrRich has known this man for nearly two decades, and from the very beginning he has insisted his real name is Joe Smith. So let’s go with that. Joe’s recognition by HealthLeaders is very well deserved. Joe is chief medical and science officer of the West Wireless Health Institute in San Diego, a non-profit institution whose mission is to bring wireless technologies to the patient, technologies to diagnose, monitor and treat health conditions in the patient’s own home. Joe is uniquely qualified for this role, having earned a PhD in me... Better Health blogs http://www.medworm.com/rss/comments.php?id=4245304 Thu, 09 Dec 2010 16:00:32 +0100 4245304 http://www.medworm.com/index.php?rid=4241724&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fsocial-media-for-doctors-the-pros-and-cons%2F2010.12.08 The pros and cons of social media for physicians are nicely reviewed by a number of prominent medbloggers (including yours truly) by Bonnie Ellerin in her recent white paper (pdf). An excerpt: There is a profound change sweeping the world of medicine. Technology is the driver, but it has nothing to do with a new drug, device or procedure. Rather it is about the change in physician behavior and mindset that technology — the Internet more specifically — has unleashed. Today, physicians of all ages and specialties are online, whether via laptop, desktop, or mobile. With physicians’ acceptance of technology has come a new type of openness among a small but growing number. In the past, the only doctors who were likely to air views publicly were medical journalists. But, today, there are p... Better Health blogs http://www.medworm.com/rss/comments.php?id=4241724 Wed, 08 Dec 2010 14:00:00 +0100 4241724 http://www.medworm.com/index.php?rid=4237897&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-best-social-tool-for-doctors-and-patients%2F2010.12.07 We all want technology to improve communication between doctors and patients. We fantasize that social tools will open doors and bridge the expanding divide between doctors and patients. I’m wondering if it’s a case of unicorns and rainbows: Fancy new tools to do the old thing in a less-effective way. I’m guessing that if Facebook was the old platform for doctor-patient dialog and the telephone was invented this year, everyone would be clamoring to use the phone (“Dude, this is amazing…you can hear them talk.”) I like the telephone. Written copy misses intonation, timing, pitch, and all the other rich elements of human speech. Subtle changes in a parent’s voice tell me if I’ve made my point and exactly how I need to proceed [with caring for their child]. Unspoken wo... Better Health blogs http://www.medworm.com/rss/comments.php?id=4237897 Tue, 07 Dec 2010 13:00:50 +0100 4237897 http://www.medworm.com/index.php?rid=4233182&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhow-preauthorization-impacts-care%2F2010.12.06 The American Medical Association (AMA) had a press release [recently] announcing findings from their survey on the impact of insurance company preauthorization policies. Surprisingly, they discovered that these policies use physician time and delay treatment. It’s funny, because preauthorization policies were designed to save money. And I imagine they do, for the insurer, but they cost money for everyone else. (more…) *This blog post was originally published at Shrink Rap* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4233182 Mon, 06 Dec 2010 23:00:00 +0100 4233182 http://www.medworm.com/index.php?rid=4233186&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fgetting-quality-and-profit-out-of-medicine%2F2010.12.06 Looking for a great story about the state of hospital care in America? Look no further. The Health Care Blog has a great article by hospitalist Dr. Robert Wachter that sums it up nicely. It’s about money. Thats how hospitals get paid. That’s how everyone gets paid. It will always be about money. We don’t pay doctors, nurses, or administrators with smiley faces and candy canes. We pay them with cold hard cash. For example: One of the physicians, an invasive cardiologist, stopped me in my tracks. “Actually, our hospital already provides a tremendous amount of support and feedback,” he said. “When I perform a catheterization or angioplasty, a hospital staff member watches the entire procedure, she sometimes suggests mid-course corrections, and as soon as I’m do... Better Health blogs http://www.medworm.com/rss/comments.php?id=4233186 Mon, 06 Dec 2010 15:00:00 +0100 4233186 http://www.medworm.com/index.php?rid=4230192&cid=t_104770_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2010%2F12%2F05%2Fhealth-in-200-countries-over-200-years-in-4-minutes%2F Hans Rosling’s famous lectures combine enormous quantities of public data with a sport’s commentator’s style to reveal the story of the world’s past, present and future development. Now he explores stats in a way he has never done before – using augmented reality animation. In this spectacular section of ‘The Joy of Stats’ he tells the story of the world in 200 countries over 200 years using 120,000 numbers – in just four minutes. Plotting life expectancy against income for every country since 1810, Hans shows how the world we live in is radically different from the world most of us imagine. Thanks Highlight Health   Related posts:Walking 3 times 50 minutes a week keeps the doctor a way Drug Companies shift their Activities to... Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=4230192 Sun, 05 Dec 2010 19:57:25 +0100 4230192 http://www.medworm.com/index.php?rid=4230160&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2F5-reasons-why-patients-dont-mention-symptoms-to-their-doctors%2F2010.12.04 To com­plain or “be good” is an appar­ent dilemma for some patients with seri­ous illness. Yes­ter­day I received an email from a close friend with advanced breast can­cer. She’s got a lot of symp­toms: Her fatigue is so over­whelm­ing she can’t do more than one activ­ity each day. Yes­ter­day, for exam­ple, she stayed home all day and did noth­ing because she was sup­posed to watch a hockey game in the evening with her teenage son and other fam­ily mem­bers. Her voice is weak, so much it’s hard to talk on the phone. She has dif­fi­culty writ­ing, in the man­ual sense — mean­ing she can’t quite use her right arm and hand properly. “It’s some­thing I would never men­tion to the doc­tor because it is very sub­tle,” she wrote. “But it has no... Better Health blogs http://www.medworm.com/rss/comments.php?id=4230160 Sat, 04 Dec 2010 21:00:07 +0100 4230160 http://www.medworm.com/index.php?rid=4225247&cid=t_104770_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_104770_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=4214106&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealthcare-transparency-patient-experts-at-medical-conventions%2F2010.11.30 We are invading their home turf. Increasingly, in among the thousands of doctors, scientists, and medical industry marketers at the largest medical conventions you are finding real patients who have the conditions discussed in the scientific sessions and exhibit halls. Patients like me want to be where the news breaks. We want to ask questions and — thanks to the Internet — we have a direct line to thousands of other patients waiting to know what new developments mean for them. I vividly remember attending an FDA drug hearing a few years ago and how there were stock analysts sitting in the audience, BlackBerries poised for the “thumbs up” or “thumbs down” on whether a proposed new drug would be recommended for approval. (At that session it was thumbs dow... Better Health blogs http://www.medworm.com/rss/comments.php?id=4214106 Tue, 30 Nov 2010 22:00:47 +0100 4214106 http://www.medworm.com/index.php?rid=4214204&cid=t_104770_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2010%2F11%2F30%2Frapid-tranquillisation%2F Rapid tranquillisation is sometimes used with disturbed violent patients in adult in-psychiatric settings and emergency departments. It’s only a small part of the algorithm for the short term management of these patients. Other aspects are prediction, prevention, other interventions than medication and a post incident review. There’s a guideline from the UK’s National Institute for Health and Clinical Excellence (NICE). This guideline makes a distinction between psycotic and non psychotic context. With psychotic context the combination of lorazepam and haloperidol is advised and olanzapine i.m. is also advised with moderate disturbance. The evidence for the latter is mainly from industry sponsored studies and drug industry authored papers. As with most industry sponsored ... Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=4214204 Tue, 30 Nov 2010 07:30:59 +0100 4214204 http://www.medworm.com/index.php?rid=4214112&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwikileaks-what-it-means-for-healthcare-privacy%2F2010.11.29 From the official White House statement yesterday regarding WikiLeaks disclosure of diplomatic cables: “By releasing stolen and classified documents, WikiLeaks has put at risk not only the cause of human rights, but also the lives and work of the individuals. We condemn in strongest terms, the unauthorized disclosure of classified documents and sensitive national security information.” No matter what people think of WikiLeaks disclosure of approximately 250,000 classified diplomatic cables to the Internet yesterday with the help of the New York Times, The Guardian, Der Spiegel, and Le Monde, the implications to electronic healthcare information security are significant. Day in and day out, I type huge volumes of information on my patients on a computer and my fellow physicians ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4214112 Mon, 29 Nov 2010 19:00:00 +0100 4214112 http://www.medworm.com/index.php?rid=4205937&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fare-airport-security-pat-downs-unhealthy%2F2010.11.26 Potential health effects of airport security are being questioned for their possible health consequences, from spreading germs to radiation exposure to the stress that being searched induces. With cheaper flights available this year and the need for security in air travel, the Transportation Security Administration (TSA) is justifying its full body scans and its pat-downs that rise up travelers’ legs — all the way up. The scanners use microwaves, leading some to question whether people may be receiving too much radiation. It’s also a concern to activists who may have already undergone a lot of radiation for existing condition, or who have other conditions for which TSA agents may not be trained. (Read one seasoned traveler’s personal experience here.) The TSA report... Better Health blogs http://www.medworm.com/rss/comments.php?id=4205937 Fri, 26 Nov 2010 22:00:00 +0100 4205937 http://www.medworm.com/index.php?rid=4200560&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthanksgiving-a-heart-attack-for-dessert%2F2010.11.25 It seems the Washington Post, cloaked under an anonymous author, wants to use scare tactics to keep most of us from enjoying Thanksgiving with their ominously titled article, “And for dessert, a heart attack?” They spew all kinds of garbage with very little data about how eating a high-fat diet might give you a heart attack. If you want to know more, consider this article* from some pretty smart folks at Harvard. Then eat, drink, and be merry without guilt (courtesy of Dr. Wes). Happy Thanksgiving! - WesMusings of a cardiologist and cardiac electrophysiologist. *REFERENCE: Renata, M. and Mozaffarian, D. “Saturated Fat and Cardiometabolic Risk Factors, Coronary Heart Disease, Stroke, and Diabetes: a Fresh Look at the Evidence.” Lipids, 31 Mar 2010. [Photo credit: La... Better Health blogs http://www.medworm.com/rss/comments.php?id=4200560 Thu, 25 Nov 2010 18:00:00 +0100 4200560 http://www.medworm.com/index.php?rid=4200562&cid=t_104770_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=4197064&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-patient-the-most-important-member-of-the-healthcare-team%2F2010.11.24 Do you feel patients are the most important part of the medical (healthcare) team? In a recent post on Health in 30, “When Doctors and Nurses Work Together,” I wrote about the team-based approach for caring and treating patients, and it addressed the relationship between nurses, doctors, patients and the importance of a multidisciplinary, team-based approach to patient care. The healthcare team is comprised of a diverse group of specialized professionals, and the most important part of the medical team is the patient. Subsequent to publishing this post, I received an email from an author and patient advocate stating that patients are not the most important member of the medical team. I value and respect this comment, however I politely and passionately disagree. As a registered nurse a... Better Health blogs http://www.medworm.com/rss/comments.php?id=4197064 Wed, 24 Nov 2010 15:00:41 +0100 4197064 http://www.medworm.com/index.php?rid=4197065&cid=t_104770_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=4197071&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-nnt-quick-summaries-of-evidence-based-medicine%2F2010.11.23 I think I blogged this before, but didn’t describe it much. Allow me to rectify that mistake. The NNT.com (“Number Needed To Treat”) is an ever-expanding website which boils down high-quality reviews of medications and interventions and presents its recommendations in a much more approachable green-yellow-red “warning triangle” format rather than some ratio. While I won’t use this as a single source to change my practice, I’m going to have to do some more research on some of the [questionables] of our age (i.e. Octreotide for variceal bleeding, PPI infusions for upper GI bleeding, etc.) — just two of the studies that fly in the face of current practice. An aside: While inhaled corticosteroids for asthma aren’t beneficial in the review, what it doesn�... Better Health blogs http://www.medworm.com/rss/comments.php?id=4197071 Tue, 23 Nov 2010 13:00:56 +0100 4197071 http://www.medworm.com/index.php?rid=4190148&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fworkers-compensation-a-model-for-the-future-of-american-healthcare%2F2010.11.22 There’s a country with an unusual healthcare system. In it, you often spend about as much time with your lawyer as you do your doctor. There are special courts set up to decide what kinds of treatment you are allowed to have. And doctors have to be careful that they don’t say or do the wrong thing, or else they risk being blackballed by insurance companies. The country:  The United States of America. You may not realize it, but if you hurt your back at work you end up in a different healthcare system than if you hurt your back at home. Sure, you may end up with similar doctors or hospitals, but your experience of healthcare will be completely different. Here’s why. If you get hurt at work, you’re covered by the “workers compensation” system. That system has its roots over ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4190148 Tue, 23 Nov 2010 02:00:49 +0100 4190148 http://www.medworm.com/index.php?rid=4190150&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-rationing-of-healthcare%2F2010.11.22 Do you recall the severe rationing of food and water the Chilean miners had to endure to survive? The rationing was done to stretch their limited resources. I would argue the state of Arizona’s new policy to not cover organ transplants for patients on Arizona Health Care Cost Containment System (AHCCCS) or their version of Medicaid is a similar form of rationing. AHCCCS, as many Medicaid programs, is underfunded. They are trying to operate on a limited budget. Something has to give. Sadly in this case, many (NPR reports 98) had already been granted approval for organ transplants which they may not receive. Francisco Felix, 32, who due to hepatitis-C needs a liver transplant, is reported to have made it to the operating room, prepped and ready for his life-saving liver transplant when d... Better Health blogs http://www.medworm.com/rss/comments.php?id=4190150 Mon, 22 Nov 2010 21:00:00 +0100 4190150 http://www.medworm.com/index.php?rid=4190152&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhat-kind-of-physicians-does-the-government-want-to-see%2F2010.11.22 Here’s my [recent] commentary at KevinMD.  Let me know what you think. What kind of physicians DO we want for the future? I was talking with a pre-med student recently. He had completed his very first medical school interview and was, understandably, excited. But he told me the interviewer had asked him what he thought would be the outcome of the current healthcare reform measures. I laughed to myself. After 17 years in practice, even I don’t know the outcome, though I have my suspicions. It seemed a loaded, almost unfair question. After miring students in biology, physics, chemistry and every known application-padding activity, after expecting volunteerism and activism, I’m not sure why they would expect this young man to have any earthly idea about the reform measures from hi... Better Health blogs http://www.medworm.com/rss/comments.php?id=4190152 Mon, 22 Nov 2010 17:00:20 +0100 4190152 http://www.medworm.com/index.php?rid=4186904&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-clinical-case-game-for-your-iphone-or-ipad%2F2010.11.20 A new iPhone/iPad game called “Prognosis: Your Diagnosis” looks like a decent attempt at making clinical case studies into a fun activity. Though it’s not clear how accurate and educational the game really is, the interface and goofy screenshots can certainly provide the foundation on which to deliver great content. iTunes: Prognosis: Your Diagnosis… Hat tip: ScienceRoll *This blog post was originally published at Medgadget* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4186904 Sat, 20 Nov 2010 21:00:52 +0100 4186904 http://www.medworm.com/index.php?rid=4186906&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Finfection-control-and-the-doctor-patient-relationship%2F2010.11.20 Hospitals have recently been stepping up their infection control procedures, in the wake of news about iatrogenic infections afflicting patients when they are admitted. Doctors are increasingly wearing a variety of protective garb — gowns, gloves, and masks — while seeing patients. In an interesting New York Times column, Pauline Chen wonders how this affects the doctor-patient relationship. She cites a study from the Annals of Family Medicine, which concluded that, fear of contagion among physicians, studies have shown, can compromise the quality of care delivered. When compared with patients not in isolation, those individuals on contact precautions have fewer interactions with clinicians, more delays in care, decreased satisfaction and greater incidences of depression and anxiety. T... Better Health blogs http://www.medworm.com/rss/comments.php?id=4186906 Sat, 20 Nov 2010 15:00:09 +0100 4186906 http://www.medworm.com/index.php?rid=4183295&cid=t_104770_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=4175692&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-doctors-make-mistakes-about-humanness-and-perfection%2F2010.11.17 The best part of doctoring is its humanness. Machines can’t do it — not even Apple products. But that’s the worst part, too. Since humans practice medicine, there will be “medical errors.” And when doctors err, people — not spreadsheets or profits — are hurt. That’s the rub. Like any endeavor, the greater the reward the greater the risk.  Those cards were put on the table in medical school. “Don’t want mistakes? Don’t do anything. Don’t make any decisions. Don’t do any procedures. Then, there will be no errors,”  the grey-haired, Swiss-born cardiac surgeon counseled me many years ago after an imperfect ablation. The headline was about a doctor’s error. It was a doozy. But for me, the story belies t... Better Health blogs http://www.medworm.com/rss/comments.php?id=4175692 Wed, 17 Nov 2010 23:00:00 +0100 4175692 http://www.medworm.com/index.php?rid=4175693&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Funintended-consequences-of-cheaper-generic-drugs%2F2010.11.17 There’s an article in the New England Journal of Medicine entitled the “Unintended Consequences of Four-Dollar Generic Drugs.“ Ever one to hone in on unintended consequences of all stripes, I quickly clicked through. Oh, dear! What bad could possibly come of making drugs significantly more affordable? Were more people demanding prescriptions for drugs they didn’t really need now that they were so cheap? (Dream on. I’m still twisting arms to get my high-risk cardiac patients to take their generic statins.) Were pharmacies going out of business, no longer to make ends meet without massive markups on brand name drugs, contributing to skyrocketing unemployment and otherwise adding to the country’s general economic malaise? Were cardiologists’ incomes plummeting because of saggin... Better Health blogs http://www.medworm.com/rss/comments.php?id=4175693 Wed, 17 Nov 2010 21:00:35 +0100 4175693 http://www.medworm.com/index.php?rid=4175695&cid=t_104770_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=4175697&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fgive-a-microloan-get-healthier%2F2010.11.17 Research has shown that giving to others can lead to a healthier, happier, and longer life. Generous behavior reduces depression and risk of suicide in adolescents.  Volunteerism on the part of older adults significantly reduces mortality. Giving to others enables people to forgive themselves for mistakes — a key element in well-being. One way to have a lot of fun on the Internet and get a health boost while doing so is to log on to a cool site called Kiva. For as little as $25.00, ordinary people like you and me can be part of the worldwide microloan (or microcredit) community. Kiva’s mission is to connect people through lending for the sake of alleviating poverty. (more…) *This blog post was originally published at EverythingHealth* (Source: Better Health... Better Health blogs http://www.medworm.com/rss/comments.php?id=4175697 Wed, 17 Nov 2010 13:00:00 +0100 4175697 http://www.medworm.com/index.php?rid=4172057&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-a-patient-contacts-a-doctor-on-twitter%2F2010.11.16 When perusing my Twitter feed [one] morning, I stumbled onto this post directed to me: Patients reaching me in public social spaces is becoming a regular thing. I’ve discussed this in the past, but I think it bears repeating. So here’s what I did: I understood the mom’s needs. Patients resort to “nontraditional” means of communication when the traditional channels fail to meet their needs. Recognize that these patients (or parents in my case) are simply advocating for themselves. My specialty struggles with a shortage of physicians, so we’re dependent upon phone triage to sort out the really sick from the less-than-sick. It’s an imperfect system and consequently parents find themselves having to speak up when the gravity of their child’s condition hasn’t be... Better Health blogs http://www.medworm.com/rss/comments.php?id=4172057 Tue, 16 Nov 2010 23:00:23 +0100 4172057 http://www.medworm.com/index.php?rid=4172060&cid=t_104770_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=4167959&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-government-healthcare-is-your-best-bet%2F2010.11.15 A friend who works with the unemployed called me up the other day huffing with indignation. The local charity clinic, apparently overwhelmed, had changed its policies so that her unemployed uninsured would no longer be able to seek care there. “Someone has to do something!” Um, what exactly would that be? I’d love to help, but I have bills to pay (as do charity clinics) so I can hardly provide medical care without seeking payment. I understand her desperation (and that of the people she so valiantly helps) but who, exactly, is supposed to do what, precisely? Things are going to get worse before they get better, I fear. The unemployment issue goes way beyond a devastating economic downturn. It’s a reflection of the most basic economic principle of supply and demand. Wages are the �... Better Health blogs http://www.medworm.com/rss/comments.php?id=4167959 Mon, 15 Nov 2010 17:00:30 +0100 4167959 http://www.medworm.com/index.php?rid=4164521&cid=t_104770_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=4164523&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-tribute-to-hospital-volunteers%2F2010.11.14 Here is a talk I gave last week to our hospital auxiliary association, mostly made up of retired volunteers. They give us so much, and this is my tribute to them. Capacity, utility and volunteers Thank you for letting me speak to you tonight. It is an honor. I have today been at two different ends of the medical world . Today at lunch, I spoke to a Christian Medical Student’s association at USC in Columbia, SC. And now, I am honored to speak to you, who do so much to keep the hospital functioning by your gift of volunteerism. Tonight I want to talk about capacity and functionality. About utility and usefulness. In preparing to do so, I began to think about how I became the way I am, and my mind wandered to ancestry. I suppose that ancestry has much to do with who we are, though I doubt... Better Health blogs http://www.medworm.com/rss/comments.php?id=4164523 Sun, 14 Nov 2010 18:00:37 +0100 4164523 http://www.medworm.com/index.php?rid=4164524&cid=t_104770_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=4159240&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-two-biscotti-physician%2F2010.11.12 [Recently] I ate at one of my favorite Italian restaurants. I had eaten there many times before, but the experience this time was different. After ordering, I received a vacuous bread basket with precisely two pieces of bread. At the end of my meal I was offered two biscotti — and no more. Only the manager could offer an explanation: As a means of containing costs, the decision had been made to capitate bread and biscotti distribution. I was disappointed. I had been eating here for years. When Colic Solved was released, my publication party was held here. After all those anniversaries, New Year’s celebrations, and birthdays, I’m shortchanged on cookies? It’s remarkable how a great experience can be shadowed by something so small. Then I got to thinking: Perhaps I’m a tw... Better Health blogs http://www.medworm.com/rss/comments.php?id=4159240 Fri, 12 Nov 2010 17:00:23 +0100 4159240 http://www.medworm.com/index.php?rid=4159247&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fgather-professional-opinions-from-your-medcrowd%2F2010.11.11 medCrowd is the 52nd in my list of biomedical community sites and maybe the first one using crowdsourcing. From medCrowd: Perhaps, you have a patient with a rare condition and you don’t know the best treatment. Or you are treating a patient and you have heard there have been recent developments in the field, but you are not sure how these actually affect your patient’s day-to-day management. The problem is finding the best solution for your patient. What you need is help finding it. medCrowd enables you to find the best solution for your patient by collecting your peers’ professional opinions, simply and in one place. This is called crowdsourcing. *This blog post was originally published at ScienceRoll* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4159247 Thu, 11 Nov 2010 15:00:42 +0100 4159247 http://www.medworm.com/index.php?rid=4155235&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fbuzcooper.files.wordpress.com%2F2010%2F11%2Fgrand-junction-comparison.png In a high-profile paper in the September issue of Health Affairs, Thorson and coworkers showed that the care at St. Mary’s Hospital in Grand Junction, CO was superior to that of 20 other unnamed hospitals. Grand Junction is, of course the smal town in SW Colorado that became famous when President Obama visited there during the health care reform debates during the summer of 2009, and here’s what he said: “Hello, Grand Junction! It’s great to be back in Southwest Colorado. Here in Grand Junction, you know that lowering costs is possible if you put in place smarter incentives; if you think about how to treat people, not just illnesses. That’s what the medical community in this city did; now you are getting better results while wasting less money.” So, Grand Junction, a town of 58... Better Health blogs http://www.medworm.com/rss/comments.php?id=4155235 Wed, 10 Nov 2010 22:00:35 +0100 4155235 http://www.medworm.com/index.php?rid=4151790&cid=t_104770_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=4151794&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fsocial-media-managers-can-they-get-more-doctors-to-go-online%2F2010.11.09 A social media manager is becoming an imperative position for hospitals. Medical institutions are waking up to the fact that they need to engage their patients and physicians online. Nowhere is there more fertile growth than in the various social media platforms that are prevalent today — like Facebook, Twitter, and YouTube. American Medical News recently profiled the phenomenon, highlighting the position of social media manager, which some institutions pay between $60,000 and $80,000 per year. As it stands, many hospitals are tiptoeing into the world of social networks, guided by the able hands of select online mavens like Mayo Clinic’s Lee Aase and Swedish Medical Center’s Dana Lewis. However, convincing executives of the return on investment remains a challenge. (more…) ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4151794 Tue, 09 Nov 2010 15:00:25 +0100 4151794 http://www.medworm.com/index.php?rid=4151795&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-doctors-raise-their-voices-and-throw-their-weight%2F2010.11.09 When we physicians don’t get our way, or don’t get the response we desire, we can be intimidating. I have seen this play out many different ways. I have been treated rudely by other physicians. I was once threatened by a very prominent one, who told me (in response to the fact that I dared question his tone): “Be careful son, you’re digging yourself a deep hole.” I don’t know what kind of hole, or where it would have taken me, but he was certain I was digging it. Oddly enough, I rather like digging holes. (Very zen.) Physicians yell at one another, or curse. Physicians stomp around and slam down charts. I don’t like it at all. I think it suggests immaturity. I always tell students and residents that in the ER, especially, the physician is “Captain of the Sh... Better Health blogs http://www.medworm.com/rss/comments.php?id=4151795 Tue, 09 Nov 2010 13:00:42 +0100 4151795 http://www.medworm.com/index.php?rid=4151796&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-end-of-private-practice%2F2010.11.08 I didn’t need the Wall Street Journal to tell that the days of “private practice” are numbered. According to recent numbers, fewer and fewer medical practices are under the ownership of physicians. Even in my corner of the economically secure State of Texas, small practices are folding faster than beach chairs at high tide. I was driven out of private practice in 2004 by rising malpractice premiums and plummeting reimbursement. In Texas at the time the trial attorneys ran the place and medmal insurance carriers simply couldn’t keep up with the greed. Medical practices are just too expensive to run and the services that physicians provide are dangerously undervalued. You do the math. Sure it’s a complicated issue. But the end result is institutionally-employed doctors with inst... Better Health blogs http://www.medworm.com/rss/comments.php?id=4151796 Mon, 08 Nov 2010 23:00:01 +0100 4151796 http://www.medworm.com/index.php?rid=4142748&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealthcare-reform-texas-style%2F2010.11.07 Via the Texas Tribune: Some Republican lawmakers — still reveling in Tuesday’s statewide election sweep — are proposing an unprecedented solution to the state’s estimated $25 billion budget shortfall: dropping out of the federal Medicaid program. Hmmm. Welcome to entitlement reality, Texas-style. Currently 20 billion a year and going to go up with expanded eligibility, the article does say the Feds pay 60 percent, but doesn’t say: 1) It’s temporary, then the Federal contribution goes down or away, and 2) The Federal component doesn’t come from magical money fairies — it’s money taken from taxpayers then funneled back into a particular program. Medicaid is not loved or respected in medicine. Decreasing reimbursements coupled to increasing requirements mean it’s at a... Better Health blogs http://www.medworm.com/rss/comments.php?id=4142748 Sun, 07 Nov 2010 20:00:29 +0100 4142748 http://www.medworm.com/index.php?rid=4142750&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2F5-tips-for-diagnosing-yourself-online%2F2010.11.07 “What’s the highest peak in North America, Mt. McKinley or Denali?” This is a great question the Web can answer for you. “What’s that lump on my neck?”  This is another great question — but not one you should rely on the Web to solve. Best Doctors recently conducted a Twitter-based poll to find out what channels of information people use to get healthcare advice.  It turns out, 54 percent of respondents use the Web as their primary source of information. Is this kind of do-it-yourself medicine a good idea? I’m a firm believer that you should do everything you can to make sure you’re getting the right care when you’re sick. But before you start your do-it-yourself journey, here are five things to keep in mind: 1. To get the right answer, you need to a... Better Health blogs http://www.medworm.com/rss/comments.php?id=4142750 Sun, 07 Nov 2010 14:00:20 +0100 4142750 http://www.medworm.com/index.php?rid=4139296&cid=t_104770_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2010%2F11%2F05%2Fdo-we-need-health-geojunction%2F HEALTH GeoJunction is a web application that supports researchers in the task of quickly finding scientific publications that are relevant geographically and temporally as well as thematically. It uses location, time and tags for these searches. You can give it a try at Health Geojunction, but I couldn’t make it work, can you. Just wondering if any health care worker was looking for these features in searches? Do we need visually supported quick finding of scientific research publications that are relevant not only to a particular topic, but also to particular places and times? Apparently there’s also a International Journal of Health Geographics Related posts:Finding Credible Health Information Online: MedLibs Round 1.8 Health Talk Online Read Medblogs instead of News M... Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=4139296 Fri, 05 Nov 2010 07:23:04 +0100 4139296 http://www.medworm.com/index.php?rid=4125009&cid=t_104770_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=4121850&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fscienceroll.files.wordpress.com%2F2010%2F10%2Fcdc-toolkit.jpg The Centers for Disease Control and Prevention (CDC) has published the newest “Health Communicator’s Social Media Toolkit.” From the CDC: A guide to using social media to improve reach of health messages, increase access to your content, further participation with audiences, and advance transparency to improve health communication efforts. The guide is truly fantastic, detailed, and comprehensive. *This blog post was originally published at ScienceRoll* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4121850 Sun, 31 Oct 2010 19:00:11 +0100 4121850 http://www.medworm.com/index.php?rid=4121926&cid=t_104770_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2010%2F10%2F31%2Funderstanding-the-heart-hazards-of-marathon-running%2F ‘p Have been there, marathons is not for sissies, so take care and do enough training, be prepared but most of all listen to your body during training. Nevertheless keep in mind that exercise and running are good for your physical and mental health. Pushing yourself through a marathon isn’t good for your heart, but that doesn’t mean you shouldn’t run Related posts:The Fresh Air Fund NYC Marathon 2010 What do drug addiction and running have in common? Free Running (Source: Dr Shock MD PhD) Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=4121926 Sun, 31 Oct 2010 17:44:22 +0100 4121926 http://www.medworm.com/index.php?rid=4118933&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fphysician-referrals-be-daring-and-ask-for-a-special-order%2F2010.10.28 As a specialist, one of the saddest truisms about practicing medicine in the private world has always been how little one’s clinical skills determines referrals. Unfortunately, as our present healthcare climate pushes “providers” to consolidate along the lines of major hospital networks this injustice will only worsen. A decade or so ago when I started private practice it was obvious that referrals came to me because of my association with an established group. This association was essential, as one could have been the next Michael Jordan of electrophysiology, but referrals would still have gone along historic lines, to the favored group. It would have taken a Herculean effort, over years, to encroach upon such long-established referral patterns, etched over the bonds of ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4118933 Thu, 28 Oct 2010 20:00:00 +0100 4118933 http://www.medworm.com/index.php?rid=4118934&cid=t_104770_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_104770_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=4105668&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-lies-of-medical-science-whats-an-e-patient-to-do%2F2010.10.25 There’s an extraordinary new article in The Atlantic entitled “Lies, Damned Lies, and Medical Science.” It echos an excellent article in our Journal of Participatory Medicine (JoPM) a year ago by Richard W. Smith, 25-year editor of the British Medical Journal, entitled ”In Search Of an Optimal Peer Review System.” JoPM, Oct 21, 2009: “….most of what appears in peer-reviewed journals is scientifically weak.” The Atlantic, Oct. 16, 2010: “Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong.” JoPM 2009: “Yet peer review remains sacred, worshiped by scientists and central to the processes of science — awarding grants, publishing, and dishing out prizes.” The Atlantic 2010: “So why are doctors — to... Better Health blogs http://www.medworm.com/rss/comments.php?id=4105668 Mon, 25 Oct 2010 16:00:09 +0100 4105668 http://www.medworm.com/index.php?rid=4105669&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-new-healthcare-law-so-sad-its-funny%2F2010.10.25 Thanks to Scott Hensley over at Shots, NPR’s Health Blog, for highlighting this sad but funny video on where we’re going with healthcare. Scary what happens when theory meets reality: -WesMusings of a cardiologist and cardiac electrophysiologist. *This blog post was originally published at Dr. Wes* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4105669 Mon, 25 Oct 2010 13:00:00 +0100 4105669 http://www.medworm.com/index.php?rid=4098076&cid=t_104770_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2010%2F10%2F24%2Fspider-laporoscopic-surgical-instrument%2F The TransEnterix SPIDER Surgical System is a laporoscopic surgical instrument that allows for easy tool-swapping without withdrawing the device from the patient. Thanks BoingBoing Related posts:Spider named after Neil Young Surgical Residents more health complaints than other employees Potential surgical targets for deep brain stimulation in treatment-resistant depression (Source: Dr Shock MD PhD) Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=4098076 Sun, 24 Oct 2010 13:18:39 +0100 4098076 http://www.medworm.com/index.php?rid=4098077&cid=t_104770_109_f&fid=38950&url=http%3A%2F%2Fwww.shockmd.com%2F2010%2F10%2F24%2Fthe-safe-sex-song-in-hip-hop%2F Followed the advice of The Geek, The Hedonist, The Absurdist & The Would-Be Visionary to visit ZDoggMD and Dr. Harry. Amongst other nice videos found this excellent video, talented guys in more than one way. Related posts:5 Tips for Safe Medical Web Surfing Another Autumn Song from YouTube Play A Nerdy Rap Song (Source: Dr Shock MD PhD) Dr Shock MD PhD blogs http://www.medworm.com/rss/comments.php?id=4098077 Sun, 24 Oct 2010 10:23:29 +0100 4098077 http://www.medworm.com/index.php?rid=4097934&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhospitalist-food-service-too%2F2010.10.23 What is a hospitalist and what kind of care does a hospitalist provide? It’s funny to read what people are writing these days about my professional role in patient care. It now appears hospitalists don’t manage medical issues anymore, but rather go through seven years of medical training to discuss the efficiency of the cafeteria food with their patients. I read one article where the reader (obviously not a hospitalist) suggests that a hospitalist is a medical doctor who can do all the things normal doctors can, but instead of seeing patients all day, he makes rounds through the hospital, talking to patients to find out what can make their hospital stay better. And what kind of issues does the hospitalist deal with on their rounds? Why, the efficiency of the cafeteria food, of ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4097934 Sat, 23 Oct 2010 22:00:00 +0100 4097934 http://www.medworm.com/index.php?rid=4097935&cid=t_104770_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=4097936&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoctors-hospitals-and-the-yankees%2F2010.10.23 Joe Boyd hated the Yankees. “Those damn Yankees. Why can’t we beat ‘em?” Then he got the opportunity to save his beloved Washington Senators by making a deal with the devil — giving up his soul in exchange for being transformed into “Shoeless Joe” to propel his team to win the World Series. Interesting. I think a lot of doctors are making their deal with the devil. They are looking for a small gain in comparison to a long-term of misery. True — Joe Boyd made out in the end, but that will only happen if someone from Hollywood writes our script. Here’s the problem: At the core of our problems with healthcare is the total lack of cohesive communication. Doctors have no idea what other doctors have done with a patient. Tests get ordered, medications get changed, proc... Better Health blogs http://www.medworm.com/rss/comments.php?id=4097936 Sat, 23 Oct 2010 16:00:04 +0100 4097936 http://www.medworm.com/index.php?rid=4097940&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwaiting-for-the-doctor-can-be-a-blessing%2F2010.10.22 I have an easy solution to a vexing problem in today’s healthcare crisis. A problem so widespread that it’s worth hundreds of words in the Wall Street Journal: Long wait times at the doctor’s office. But first, before I give my simple, pragmatic, master-of-the-obvious solution, let me say something truthful: I try. I try really hard — to run on time, that is. I’ve been there myself — a patient in a gown, in a cold room with only big pharma-sponsored propaganda on the walls to stare at. At the risk of a sounding like a…blogger, let it be said that practicing quality medicine in the current luxury of technology is much more complicated than it used to be. Such complexity devours our most precious treasure: Time with the patient. (more…) *Th... Better Health blogs http://www.medworm.com/rss/comments.php?id=4097940 Fri, 22 Oct 2010 18:00:00 +0100 4097940 http://www.medworm.com/index.php?rid=4086267&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-comparing-the-performance-of-doctors-is-trouble%2F2010.10.20 Who do you think is likely to be a better doctor: A board certified graduate of one of the top medical schools in America, or a non-certified doctor trained in a foreign country? If your answer is “I have absolutely no idea,” then you’re probably spending a lot of time looking at the “report cards” that pass for measures of health care quality. And you’re probably confused. Researchers in Pittsburgh studied 124 process-based quality measures in 30 clinical areas. These process measures are the state-of-the-art ways in which government and private insurers are checking up on the quality of medical care. They include things like making sure patients with heart problems are prescribed aspirin, and that women get Pap smears. The researchers compared these measures against other,... Better Health blogs http://www.medworm.com/rss/comments.php?id=4086267 Wed, 20 Oct 2010 20:00:37 +0100 4086267 http://www.medworm.com/index.php?rid=4086268&cid=t_104770_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=4086269&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmedical-ethics-and-the-amish-bus-driver-rule%2F2010.10.20 Rachel Maddow, in a discussion related to the provision of abortion services, once proposed that we (society) should invoke the Amish Bus Driver Rule (ABDR) whenever medical professionals invoke their personal convictions in refusing to provide legal medical services. The ABDR goes like this: If you’re Amish, and therefore have religious convictions against internal combustion engines, then you have disqualified yourself for employment as a bus driver. (Presumably Ms. Maddow would not apply the ABDR to everyone, since it would disqualify, for instance, Al Gore from utilizing horseless carriages and other fossil-fueled contrivances.) The ABDR would do far more than merely render it okay for doctors to perform abortions and other ethically controversial (but legal) medical services. The... Better Health blogs http://www.medworm.com/rss/comments.php?id=4086269 Wed, 20 Oct 2010 16:00:58 +0100 4086269 http://www.medworm.com/index.php?rid=4082092&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpatient-customer-service-is-good-care%2F2010.10.18 Gosh, a whole lot of huffing over a little word! “Customer.” Okay, now grab a paper bag and breathe slowly and steadily into it. I know it’s hard to hear that word. I am sorry to have caused such trouble. Some folks misunderstood my last post, thinking that I thought patients should only be considered customers, or that they should be referred to as customers. I never said that, nor did I imply it. I simply said that patients are customers. They are. Medical care is not free, and it is being paid for by the patient (directly or indirectly). Medicine is a business that has been so mismanaged that we are now in a crisis over its financial side. The trouble is the cost of care. Cost implies money is used, and trading money for services or goods is what business is about. We�... Better Health blogs http://www.medworm.com/rss/comments.php?id=4082092 Mon, 18 Oct 2010 22:00:20 +0100 4082092 http://www.medworm.com/index.php?rid=4082093&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Facos-the-gathering-storm%2F2010.10.18 Those of you who’ve read this blog for any length of time know that I have been a pretty strong advocate for healthcare reform. This has been primarily motivated by my passion for universal coverage, but also with my frustration with the cost of the current healthcare system, the generally crummy outcomes, and the overall level of fragmentation in the whole affair. Even today, I had to repeat blood tests on a cancer patient who came to the ER. He had had blood tests at the cancer center ACROSS THE STREET before presenting, but, so sorry, our computers don’t talk to theirs and it’s after 5pm now, so forget about getting those results.  So it’s with a mixture of enthusiasm and dread that I consider the coming onslaught of accountable care organizations (ACOs). What ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4082093 Mon, 18 Oct 2010 19:00:00 +0100 4082093 http://www.medworm.com/index.php?rid=4077247&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fprofessional-boundaries-is-it-okay-for-a-friend-to-treat-a-friend%2F2010.10.17 I just finished reading Dr. Gary Small’s book, The Naked Lady Who Stood On Her Head. In the final chapter of the book, Dr. Small talks about his mentor, friend, and father figure who’s mentioned throughout the book. The mentor approaches him on the golf course, where they meet to talk, and says he needs psychotherapy and Small is the man to do it. The author is surprised, hesitant, and a bit uncomfortable with the demand (it comes as more than a request.) His wife likens it to the need for a plumber or a dentist, and Dr. Small takes on the task. The mentor calls all the shots: Where the meetings will be, what pastry they will eat, the form of his payment. The author initially misses the diagnosis and uses this as an example of how one can be blinded. So is it okay for a friend... Better Health blogs http://www.medworm.com/rss/comments.php?id=4077247 Sun, 17 Oct 2010 18:00:00 +0100 4077247 http://www.medworm.com/index.php?rid=4074062&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fun-insurance-reform%2F2010.10.15 Who doesn’t need insurance reform? Why, the insurers like Aetna, Cigna, and BCS Insurance, that’s who! From Emergency Physicians Monthly: By threatening to raise health care premiums by 200 percent or threatening to drop coverage altogether, the companies got the Department of Health and Human Services to cave. Now the companies have our government’s blessing to continue offering “insurance” to their employees that is capped at a few thousand dollars per year instead of the $750,000 required in the health care law. Perhaps GruntDoc said it best: “I am not an Obamacare fan, and would like it repealed, with smaller, more focused Bipartisan fixes, but if the government is going to pass something then roll over this easily to special interests… it’s already worse th... Better Health blogs http://www.medworm.com/rss/comments.php?id=4074062 Fri, 15 Oct 2010 19:00:00 +0100 4074062 http://www.medworm.com/index.php?rid=4074064&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ftweetchats-are-they-good-for-doctors%2F2010.10.15 [Recently] some of us participated in the flagship physician Tweetchat (MDChat). Or better, I tried to participate between finishing up some calls and choking down a bean burrito. When the idea was initially proposed to me I committed only to supporting its initiation with the occasional role of host. I’m simply overcommitted, but wanted to support Phil Baumann and those who were willing to try to break new ground. So I lurked, chewed, and pondered. Doctors or not, everyone knows I’ve been a pretty lukewarm proponent of the tweetchat. I think they’re noisy, difficult to follow, and too abbreviated for constructive dialog. As early adopters I think we tend to put the novelty of the medium above its practicality. With that said, chats can be fun. It’s a situation where I feel co... Better Health blogs http://www.medworm.com/rss/comments.php?id=4074064 Fri, 15 Oct 2010 12:00:10 +0100 4074064 http://www.medworm.com/index.php?rid=4065366&cid=t_104770_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_104770_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_104770_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=4060587&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhat-is-a-patient-a-doctors-perspective%2F2010.10.12 What is a patient? What do they do? What’s their role in the doctor’s office?  Are they chassis on a conveyor belt? Are they puzzles for doctors to solve? Are they diseases? Are they demographics? Are they a repository for applied science? Or are they consumers? Are they paying customers? Are they the ones in charge? Are they employing physicians for their own needs? It depends. It depends on the situation. It depends on perspective. Some physicians are very offended when the “consumer” and “customer”  labels are applied to patients. They see this as the industrialization of healthcare. We are no longer professionals, we are made into “providers” — sort of smart vending-machine made out of flesh. Patients, on the other hand, get offended when doctors forget who... Better Health blogs http://www.medworm.com/rss/comments.php?id=4060587 Tue, 12 Oct 2010 22:00:31 +0100 4060587 http://www.medworm.com/index.php?rid=4060589&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ftoo-much-data-can-it-overwhelm-doctors-and-harm-patients%2F2010.10.12 One of the supposed strengths of electronic medical records is better tracking of test data. In theory, when using more sophisticated digital systems, doctors can better follow the mountains of test results that they encounter daily. But a recent study, as written in the WSJ Health Blog, says otherwise. Apparently, a study performed in 2007 found: VA doctors failed to acknowledge receipt of 368 electronically transmitted alerts about abnormal imaging tests, or one third of the total, during the study period. In 4% of the cases, imaging-test results hadn’t been followed up on four weeks after the test was done. Another study, published in March in the American Journal of Medicine, showed only 10.2% of abnormal lab test results were unacknowledged, but timely follow-up was lacking in 6.8% ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4060589 Tue, 12 Oct 2010 17:00:11 +0100 4060589 http://www.medworm.com/index.php?rid=4060591&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdisease-detected-in-exhaled-breath%2F2010.10.12 A new sensor developed at Stony Brook University may become a clinically useful tool for detecting disease biomarkers in breath. The nanoprobe-based technology is currently able to detect acetone, but should be modifiable to spot other compounds. From the study abstract: This paper describes a sensor nanotechnology suitable for non-invasive monitoring of a signaling gas, such as acetone, in exhaled breath. This is a nanomedicine tool comprised of a selective acetone nanoprobe working on the principle of ferroelectric poling sensing, and a microelectronics circuit for comparing the actual sensor signal to a predetermined threshold value, displaying the result using LED signals. This on/off type non-invasive diagnostics platform technology is based on nanotechnology, gives a fast response, i... Better Health blogs http://www.medworm.com/rss/comments.php?id=4060591 Tue, 12 Oct 2010 12:00:13 +0100 4060591 http://www.medworm.com/index.php?rid=4060593&cid=t_104770_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fu-s-healthcare-spending-why-so-much%2F2010.10.11 Aaron Carroll over at The Incidental Economist has been running an excellent series on healthcare spending in the U.S. and how much more we spend than the rest of the world on a per capita basis, as a percentage of GDP, and by category. It’s an excellent series and I wholly recommend it. Summary graph: Hint: the U.S. is the lavender-ish line on top. As he says, is there anything about this graph that isn’t concerning? (more…) *This blog post was originally published at Movin' Meat* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4060593 Mon, 11 Oct 2010 20:00:00 +0100 4060593