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 'internal medicine'. Sat, 03 Sep 2011 01:45:44 +0100 http://www.medworm.com/index.php?rid=5174617&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpatient-history-found-to-be-key-element-in-making-a-diagnosis%2F2011.08.28 Four out of five doctors agree that they don’t need scans to make the right diagnosis. It’s an old-fashioned concept frequently discussed among ACP members, but the history and physical combined with basic tests is way more important to diagnosis than ordering scans and advanced tests. A recent research letter in the Archives of Internal Medicine makes the case. In the letter, Israeli researchers described a prospective study of 442 consecutive patients admitted from the emergency department in 53 days. A senior resident examined all patients within 24 hours of admission (mean=14), including a history, physical, and review of ancillary test findings done at the emergency department, such as blood and urine tests, electrocardiography, and chest radiography. The resident also rev... Better Health blogs http://www.medworm.com/rss/comments.php?id=5174617 Sun, 28 Aug 2011 18:30:00 +0100 5174617 http://www.medworm.com/index.php?rid=5096205&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwill-patients-accept-the-patient-portal-as-the-next-big-thing%2F2011.08.04 There seems to be an inverse relationship between the amount of spin one hears about “the next big thing”…and reality.    First it was EMRs and virtual e-visits, then social media, and now patient portals seem poised to be next big thing.  The drumbeat of vendors and pundits is unmistakable….physicians that don’t adapt will be toast.   It can all sound pretty convincing until you ask to see the evidence.  What do patients think? Take the physician patient portal.   If you read between the lines, patient portals are frequently being positioned as the new “front door” to physician practices.   By signing on to a secure website patients will have real time access to the electronic health record and will be able to communicate with their physicians by e-mail.   Addit... Better Health blogs http://www.medworm.com/rss/comments.php?id=5096205 Thu, 04 Aug 2011 16:00:59 +0100 5096205 http://www.medworm.com/index.php?rid=5036231&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fstudy-investigates-relief-for-chronic-back-pain%2F2011.07.17 This study confirmed what I have known for a long time.  They looked at relaxation massage and structural massage, which focuses on correcting soft-tissue abnormalities.  At 10 weeks they found (more…) *This blog post was originally published at EverythingHealth* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=5036231 Sun, 17 Jul 2011 12:00:00 +0100 5036231 http://www.medworm.com/index.php?rid=5008197&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhat-to-do-if-your-doctors-appointment-isnt-soon-enough%2F2011.07.07 A friend of mine had a hard time getting in to see her doctor for an urgent visit last week. Reeling from an unexpected and sudden family upset, she was depressed and anxious, unable to sleep or function, and her therapist was advising an antidepressant.  She called her family doc, who works at a large hospital-based multispecialty group, and told the woman at the call center that she wanted to see the doctor on an urgent matter. She was given an appointment 6 weeks in the future. Summoning her courage, my friend told the woman her story – and that she was really worried about herself and did not think she could wait that long. “Sorry, that is the best I can do” was the reply. Increasingly upset, my friend told the woman that if she had to wait that long, she just might kill hersel... Better Health blogs http://www.medworm.com/rss/comments.php?id=5008197 Thu, 07 Jul 2011 17:00:32 +0100 5008197 http://www.medworm.com/index.php?rid=4921420&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fphysicians-must-do-their-part-to-reduce-unnecessary-hospital-expenses%2F2011.06.10 Hospital costs are out of control. We have an aging population living longer with more complicated presentation of disease. We have an insurance driven platform instead of a health driven accountability. The long term sustainability of that architecture is one of guaranteed insolvency. One way or another hospitals are going to find their lifeline cut off. Medicaid is bankrupt. Hospital profit margins from Medicare have been negative for almost a decade. In addition, the rapid rise in private insurance premiums and industry’s gradual but accelerating exit from the health insurance benefit market all tell me that hospitals must find a way to reduce the cost of providing care. There are many ways hospital costs can be reduced. Administrators are paid handsomely to make it happen. Either... Better Health blogs http://www.medworm.com/rss/comments.php?id=4921420 Fri, 10 Jun 2011 21:00:00 +0100 4921420 http://www.medworm.com/index.php?rid=4911479&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fstatins-reduce-heart-disease-risk-but-probably-not-because-they-lower-cholesterol%2F2011.06.08 When cyclists find out that I am a heart doctor, they most frequently ask about cholesterol numbers. “…My cholesterol is this…What do you think?” “…My doctor wants me to take a statin…But I read that these drugs might lower my functional threshold power 2.014 watts/40km.” All this focus on numbers saddens me. Remember, I am a forest guy, not a tree guy. What’s more, as a doctor that revels in the adrenaline rush of ablating rogue circuits with technology that would impress even a twenty-something, I find questions about biochemistry dreary–like eating quinoa. I wish folks would ask me about how to terminate AF with a catheter, or how an (evidenced-based) ICD saved a mom’s life, or perhaps even this: “Do you do heart surgery?” But more often than not people want t... Better Health blogs http://www.medworm.com/rss/comments.php?id=4911479 Wed, 08 Jun 2011 21:00:58 +0100 4911479 http://www.medworm.com/index.php?rid=4893454&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fscary-images-on-cigarette-packages-do-make-people-think-about-quitting%2F2011.06.02 The World Health Organization (WHO) says graphic health warnings on tobacco packages are a powerful “best buy” in decreasing tobacco use and its many health consequences. The Centers for Disease Control and Prevention outlined the research in the MMWR. The World Health Organization (WHO) created a treaty for tobacco product labels that many countries have ratified. Among other requirements, these warnings are expected to appear on at least 30%, and ideally 50% or more, of the package’s principal display areas, and preferably use pictures. To assess how cigarette package labels impact quitting smoking, researchers used data from the Global Adult Tobacco Survey (GATS) in 14 countries from 2008 to 2010 that had ratified WHO’s tobacco control treaty. Current smokers of ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4893454 Thu, 02 Jun 2011 19:00:00 +0100 4893454 http://www.medworm.com/index.php?rid=4893456&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoes-your-doctor-have-time-to-think-about-you%2F2011.06.02 At the New York Times’ City Room Blog, Joel Cohen writes: my wife and I are convinced that all medical students should have to pass Overbooking 101 before they can become doctors.Again and again, we arrive at a doctor’s aptly named waiting room on or before the scheduled time, only to learn that three or four others sitting there have been given the same appointment. He says doctors need to understand the impact of this on their patients.  I agree, but not just because it’s annoying. A typical doctor sees thirty patients a day.  Some see even more. Reflect on that math.  If your doctor sees 30 patients a day, that’s 150 a week, 600 a month, maybe 7,000 a year. It means that if it’s been even two months since you last saw your doctor, he has probably seen more than a thousand p... Better Health blogs http://www.medworm.com/rss/comments.php?id=4893456 Thu, 02 Jun 2011 15:00:57 +0100 4893456 http://www.medworm.com/index.php?rid=4852862&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-new-way-to-find-a-vein-vein-lights-for-iv-access%2F2011.05.22 Here’s how we used to find a difficult vein.  If a floor nurse could not get an IV in, they asked one of their colleagues to try.  If their colleague could not find the impossible-to-locate vein, they contacted an ICU nurse.  If the ICU nurse couldn’t get one, sometimes an ER nurse or a flight nurse would try.  If they still couldn’t get an IV, then I would be paged to ask if they could get an order for an anesthesiologist to try.  And if the anesthesiologist couldn’t figure out how to find a difficult vein, we got a PICC line with the PICC nurse or with the radiologist or I placed a central line if the patient could not wait for a PICC line. That’s how we used to find a difficult IV. How do we find one now?  If you’re on the floor, you use one of ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4852862 Sun, 22 May 2011 17:00:00 +0100 4852862 http://www.medworm.com/index.php?rid=4841475&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhow-to-hide-an-insulin-pump-under-a-wedding-dress%2F2011.05.19 Yesterday I wrote about my wedding, focusing on the parts that meant the most to me:  the man I love, our families and friends, the church service, saying “I do,” and dancing ourselves silly at the reception. But diabetes was a part of my wedding day.  We did our best to keep it quiet and unnoticed, though, using several tricky methods.  I’m like a diabetes wedding magician … sort of. First things first:  the dress.  Wearing an insulin pump is the easiest and least intrusive way for me to take my insulin, and I wasn’t about to go off the pump just for the sake of fashion.  My solution?  Design a pocket to hold my insulin pump, hidden in my wedding dress.  I spoke with the seamstress at Ye Olde Bridal Shoppe and she and I designed something that left th... Better Health blogs http://www.medworm.com/rss/comments.php?id=4841475 Thu, 19 May 2011 19:00:02 +0100 4841475 http://www.medworm.com/index.php?rid=4803138&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhat-are-the-most-popular-and-most-expensive-drugs-in-america%2F2011.05.09 The top 10 prescribed drugs in the U.S. for 2010 in order of prescriptions written are: Hydrocodone (combined with acetaminophen) — 131.2 million prescriptions Generic Zocor (simvastatin), a cholesterol-lowering statin drug — 94.1 million prescriptions Lisinopril (brand names include Prinivil and Zestril), a blood pressure drug — 87.4 million prescriptions Generic Synthroid (levothyroxine sodium), synthetic thyroid hormone — 70.5 million prescriptions Generic Norvasc (amlodipine besylate), an angina/blood pressure drug — 57.2 million prescriptions Generic Prilosec (omeprazole), an antacid drug — 53.4 million prescriptions (does not include over-the-counter sales) Azithromycin (brand names include Z-Pak and Zithromax), an antibiotic — 52.6 million ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4803138 Mon, 09 May 2011 21:00:00 +0100 4803138 http://www.medworm.com/index.php?rid=4797771&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmore-medical-waste-does-a-6000-flashlight-improve-patient-outcomes%2F2011.05.07 So I’m rounding in the ICU the other day when I came upon this new hospital medical device.  It’s called a pupillometer.  What does this pupillometer do?  It  measures subtle changes in the light reflex of the pupil to help take the physical exam to the next level of precision. Or eliminate it, depending on how you look at it.  What used to be a basic physical exam skill is now being replaced by a $6000 piece of medical technology that can distinguish tiny changes in pupil size. Now the real questions remain.  Has this pupillometer device gone through the rigors of randomized trials in the ICU to define whether a  $6000 flashlight changes outcomes or mortality?   And if not, how do we allow medications to require such testing but not the technology that often changes n... Better Health blogs http://www.medworm.com/rss/comments.php?id=4797771 Sun, 08 May 2011 00:00:00 +0100 4797771 http://www.medworm.com/index.php?rid=4789251&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2F1.gravatar.com%2Favatar%2F1698659e0d52adbb43ab3ee84c47337c%3Fs%3D96%26amp%3Bd%3Didenticon%26amp%3Br%3DG 9:00 pm: Hello. It’s Mrs. Mumbledimumbler; I need the doctor to call me right away. My hip is driving me crazy. Please call me. I listen to the message three times so I can sort of make out the name. The problem is that even though I think I can understand it, I don’t recognize it at all. But I call her because she said she needed me to call her right away. Hello. I need you to call me in some tramadol right away. “What was your name again?” She repeats it clearly enough for me to confirm that I really don’t recognize it. “Have I ever seen you in the office?” No. Let me get this straight: it’s 9:00 at night and your hip is hurting, so you call a doctor who’s a complete stranger and insist that they call you in a powerful painkiller without ever having seen you, taken your... Better Health blogs http://www.medworm.com/rss/comments.php?id=4789251 Wed, 04 May 2011 18:00:05 +0100 4789251 http://www.medworm.com/index.php?rid=4775389&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fswearing-in-moderation-may-ease-pain%2F2011.05.02 Swearing really can relieve pain, but only if one doesn’t do it daily. Researchers at Keele University in England have considered this topic before, and most recently, they studied whether people who swear more often in everyday life get as much pain relief from cursing as those who swear less frequently. Researchers recruited 71 participants who completed a questionnaire that assessed how often they swore. Pain tolerance was assessed by how long participants could keep their unclenched hand in icy water (5° C, capped at 5 minutes) while repeating a chosen word. The word was either a swear word (self-selected from a list of five words the person might use after hitting their thumb with a hammer) or a control word (one of five they might use to describe a table). Interestingly, one p... Better Health blogs http://www.medworm.com/rss/comments.php?id=4775389 Mon, 02 May 2011 19:00:00 +0100 4775389 http://www.medworm.com/index.php?rid=4775393&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fnew-alzheimer%25e2%2580%2599s-guidelines-emphasize-early-detection-frighten-some%2F2011.05.02 For the first time in 30 years, an expert panel has updated guidelines for the diagnosis of Alzheimer’s disease. The long overdue facelift should favorably impact care for millions and accelerate badly needed research on the disease. The guidelines were produced by representatives from the National Institute on Aging and the Alzheimer’s Association. They portray Alzheimer’s for the first time as a three-stage disease. In addition to ‘Stage 3,’—the full-blown clinical syndrome that had been described in earlier versions of the guidelines—the new guidelines describe an earlier ‘Stage 2,’ of mild cognitive impairment due to Alzheimer’s, and a ‘Stage 1, or preclinical’ phase of the disease. The latter can only be detected with biochemical marker tests and brain scans.Th... Better Health blogs http://www.medworm.com/rss/comments.php?id=4775393 Mon, 02 May 2011 11:00:06 +0100 4775393 http://www.medworm.com/index.php?rid=4767997&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdeath-threats-for-hospital-pecking-order-violations%2F2011.04.29 The consultants didn’t always need to know what was happening on the floor. But sometimes keeping things away from them became downright clandestine. I was a senior registrar at Kalafong (hell). An old friend of mine had just taken up a post as consultant in the department of Internal Medicine. One day he approached me. “Bongi, what are the chances you can do the occasional open lung biopsy for me?” Now there was no thoracic department in Kalafong so it seemed to me to be a reasonable request. In fact I was quite excited. It would give me a chance to do a few thoracotomies, something us general surgeons don’t do all that regularly. “Sure! Anytime. Just let me know and I’ll book them on my list.” “Uhmmm, there is just one small problem,&#822... Better Health blogs http://www.medworm.com/rss/comments.php?id=4767997 Fri, 29 Apr 2011 20:00:00 +0100 4767997 http://www.medworm.com/index.php?rid=4758754&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-husbands-gain-weight-and-physicians-wimp-out%2F2011.04.27 A friend of mine is in great physical shape but her husband (we’ll call him “Mr. B”)  has gained 40 pounds since they were married five years ago. He also has familial hypercholesterolemia, and several of his relatives have had heart attacks at young ages. Mrs. B is distraught – she is worried about her husband’s health, and has tried to gently nudge him towards healthier eating habits and regular exercise (as well as taking a statin for his cholesterol). Unfortunately, the nudges were received as nagging, and a wedge has formed between them in their relationship. Last week my friend planned a trip to a primary care physician in the hopes that he would educate Mr. B about the dangers of being overweight and not treating his high cholesterol. “Surely Mr.... Better Health blogs http://www.medworm.com/rss/comments.php?id=4758754 Wed, 27 Apr 2011 16:00:19 +0100 4758754 http://www.medworm.com/index.php?rid=4753696&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fstatin-use-is-increasing-dramatically-are-americans-healthier-for-it%2F2011.04.25 Baseball fans have the Baseball Prospectus annual. Political junkies can get their fix from Nate Silver’s 538 blog. For those of us with geeky interest in health and medicine statistics, graphs, and charts, the Health, United States, 2010 report from the National Center for Health Statistics is that kind of treat. The 41 charts and graphs and 148 trend tables in the 2010 report (it’s dated 2010 but was released earlier this year) could keep me happily occupied for hours. One graph that really caught my eye shows the percentage of Americans that take a statin. Statins are prescribed mainly to lower “bad” LDL cholesterol, but they may have other benefits, too. The statins include atorvastatin (sold as Lipitor), rosuvastatin (sold as Crestor), and simvastatin (sold as Zocor but also a... Better Health blogs http://www.medworm.com/rss/comments.php?id=4753696 Mon, 25 Apr 2011 18:00:48 +0100 4753696 http://www.medworm.com/index.php?rid=4723801&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Funcover-your-heart-disease-risk-with-a-wrist-band-device%2F2011.04.18 A study published in journal Chest has shown that novel intra-sleep pulse oxymetry can be an effective modality in identifying cardiovascular disease risk in patients. In the study, a modified version of Weinmann‘s SOMNOcheck micro oximeter was used to observe pulse wave attenuation, heart rate acceleration, pulse propagation times, as well as respiration-related pulse oscillations and oxygen desaturation episodes. All the collected data was analyzed by an algorithm, and the prognostic results were checked against European Society of Hypertension/European Society of Cardiology (ESH/ESC) risk factor matrix. Some details from the study abstract: (more…) *This blog post was originally published at Medgadget* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4723801 Mon, 18 Apr 2011 15:00:51 +0100 4723801 http://www.medworm.com/index.php?rid=4719897&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fphysicians-will-be-sued-if-they-dont-tell-people-theyre-fat-and-also-if-they-do-tell-them%2F2011.04.15 The leader of the anti-obesity lawsuit movement is threatening physicians-in-training with lawsuits if they don’t warn obese patients about their excessive weight. George Washington University law professor John Banzhaf III, who has led efforts to sue fast-food chains for contributing to America’s extra weight, is scheduled to speak tomorrow morning at the annual convention for the American Medical Student Association. Source: washingtontimes.com/business/20050317-102021-7358r.htm A lawyer warns of obesity suits. He is telling medical students that they need to warn their patients of the risks of their obesity. Not long ago we spoke of a doctor being sued for the way he told a patient she was obese. Is the bottom line no matter what you do, as a doctor you will be sued? (more…) ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4719897 Fri, 15 Apr 2011 23:00:55 +0100 4719897 http://www.medworm.com/index.php?rid=4714741&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhow-a-patient-who-asks-for-salt-for-his-eggs-could-cost-a-hospital-2-5-million%2F2011.04.14 This was a classic moment of comical clarity that only comes along once a week.  As you may or may not know, starting in 2013, The Medicare National Bank has promised to take back 1% of all  of a hospital’s total Medicare revenue (to increase in future years) if the hospital has a higher 30 day readmission rate for  congestive heart failure, acute myocardial infarction or pneumonia than an as yet undefined acceptable 30 day rate of readmission. What does this mean?  It means if the government decides that 20% is an acceptable rate for congestive heart failure 30 day readmission, and the hospital has a readmission rate of 25%, the hospital will be told to return 1% of all Medicare revenue for the year, not just their heart failure revenue. Let’s use some hypothetical numbers... Better Health blogs http://www.medworm.com/rss/comments.php?id=4714741 Thu, 14 Apr 2011 21:00:00 +0100 4714741 http://www.medworm.com/index.php?rid=4714746&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdo-it-yourself-health-care-a-new-form-of-outsourcing%2F2011.04.14 The outsourcing of work by businesses to the cheapest available workers has received a lot of attention in recent years.  It has largely escaped notice, however, that the new labor force isn’t necessarily located in Southeast Asia, but is often found here at home and is virtually free.  It is us, using our laptops and smart phones to perform more and more functions once carried out by knowledgeable salespeople and service reps. This was particularly salient to me this week: I spent an hour online browsing, comparing prices, reading customer reviews and filling out the required billing and shipping information to get a great deal on a new lamp.  An airline would charge me 99 cents to talk to a person but provides information for free online.  Calls to Amtrak to make train reservations... Better Health blogs http://www.medworm.com/rss/comments.php?id=4714746 Thu, 14 Apr 2011 12:00:54 +0100 4714746 http://www.medworm.com/index.php?rid=4709203&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fphysicians-wary-of-healthcare-reform-models-intended-to-save-primary-care%2F2011.04.13 When I talk to internal medicine audiences around the country about the latest health policy flavor of the day – accountable care organizations (ACOs) – a typical reaction is skepticism trending toward cynicism. Many don’t quite get what ACOs are all about and certainly don’t want to be lectured about how they need to re-invent their practices. And they don’t buy the idea that ACOs will somehow save internal medicine primary care. The same can be said, perhaps to a lesser extent, about their reactions to PCMHs (Patient-Centered Medical Homes), P4P ( pay-for-performance), HIT (health information technology), MU (meaningful use), and the whole alphabet soup of other reforms being proposed to reform health care delivery and payment systems. And who can blame them? Older inte... Better Health blogs http://www.medworm.com/rss/comments.php?id=4709203 Wed, 13 Apr 2011 23:00:00 +0100 4709203 http://www.medworm.com/index.php?rid=4709206&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fibms-new-solution-for-drug-resistant-bacteria-nanotechnology%2F2011.04.13 IBM and the Institute of Bioengineering and Nanotechnology in Shanghai have designed a new type of polymer that can detect and destroy antibiotic-resistant bacteria such as MRSA. The polymer nanostructures also prevent bacteria from developing drug resistance. Moreover, because of the mechanism by which the nanostructures work, they don’t affect circulating blood cells, and, unlike most traditional antimicrobial agents, the nanostructures are biodegradable, naturally eliminated from the body rather than remaining behind and accumulating in tissues. From the Nature Chemistry abstract by Nederberg, et al.: (more…) *This blog post was originally published at Medgadget* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4709206 Wed, 13 Apr 2011 15:00:58 +0100 4709206 http://www.medworm.com/index.php?rid=4684316&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fis-church-attendance-a-risk-factor-for-obesity%2F2011.04.07 For competitive cyclists, Sunday morning usually signifies a time for combining spirituality with calorie-burning. Whether we are immersed in the total focus of a hotly-contested bike race or meditating our way through a seemingly endless training ride, it’s a given that most cyclists use Sundays to churn out the kilo-joules. This kind of Sunday-behavior differs significantly from many regular (normal) people, who like to sleep late, get up slowly, dress themselves nicely and amble off to church. It goes without saying that this kind of spiritual exercise doesn’t burn many calories. And it is also well known that worship and consuming high-calorie comfort food frequently go hand in hand. In the hard-to-believe-that-people-study-this kind-of-thing category, comes a report that frequent ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4684316 Thu, 07 Apr 2011 14:00:08 +0100 4684316 http://www.medworm.com/index.php?rid=4676783&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmedical-apps-allow-doctors-to-monitor-icu-patients-remotely%2F2011.04.05 We have reported in the past on AirStrip, a smartphone and iPad app that allows a mobile doctor to monitor the vital signs of patients in an obstetric ward or an ICU. The reverse, where a fixed doctor monitors multiple remote patients is now entering the mainstream and already making a difference in many patients’ lives. In a compelling anecdote recently reported in Computerworld, a man experienced cardiac arrest while shopping and was taken to a nearby community hospital. An intensivist, monitoring from an eICU miles away, was immediately consulted. The remote doctor guided the treating physicians as they initiated unfamiliar hypothermia therapy to preserve the brain, and continued to follow the patient remotely throughout his 10 day ICU stay.  Happily, the patient had a good outcome a... Better Health blogs http://www.medworm.com/rss/comments.php?id=4676783 Tue, 05 Apr 2011 11:00:36 +0100 4676783 http://www.medworm.com/index.php?rid=4670109&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoes-your-doctor-trust-you%2F2011.04.02 Members of the  American public are frequently surveyed about their trust in various professionals.  Doctors and nurses usually wind up near the top of the list, especially when compared to lawyers, hairdressers and politicians.  Trust in professionals is important to us: they possess expertise we lack but need, to solve problems ranging from the serious (illness) to the relatively trivial (appearance). How much professionals trust us seems irrelevant: our reciprocity is expressed in the form of payment for services rendered or promised, our recommendations to friends and families and repeat appearances. So I was surprised to read an article in the Annals of Family Medicine describing a new scale to measure doctors’ trust in their patients.  This scale, based on input from focus grou... Better Health blogs http://www.medworm.com/rss/comments.php?id=4670109 Sat, 02 Apr 2011 18:00:08 +0100 4670109 http://www.medworm.com/index.php?rid=4600538&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcolon-cancer-screening-guideline-truths-and-myths%2F2011.03.16 Colon cancer screening has a particular personal interest for me — one of my colleagues in residency training had her father die of colon cancer when she was a teenager. No one should lose a loved one to a disease that, when caught early, is often treatable. But for both men and women, colon cancer is the third most common cancer behind lung cancer and prostate cancer in men, and behind lung cancer and breast cancer in women, it’s the second most lethal. The problem is that patients are often confused about which test is the right one. Is it simply a stool test? Flexible sigmoidoscopy? Colonoscopy? Virtual colonoscopy? Isn’t there just a blood test that can be done? (No.) In simple terms, this is what you need to know: All men and women age 50 and older should be scr... Better Health blogs http://www.medworm.com/rss/comments.php?id=4600538 Wed, 16 Mar 2011 13:00:00 +0100 4600538 http://www.medworm.com/index.php?rid=4544967&cid=t_90241_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=4527733&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fweight-loss-counseling-is-race-a-factor%2F2011.02.27 Most people know that the U.S. is struggling to contain a surging epidemic of obesity, and that the problem is most acute among African-Americans. Whereas about 27 percent of all adult Americans are obese (defined as having a body mass index of 30 or more), fully 37 percent of African-American adults are obese, and that number jumps to an appalling 42 percent among African-American women. Over the years, public health officials have provided evidence that socioeconomic and cultural factors drive this racial disparity. Now, a new study suggests there is another reason as well: Obese African-Americans receive less obesity-related counseling than their white counterparts, and it matters not whether the physicians they see are African-American or white. To reach these conclusions, Sara Ble... Better Health blogs http://www.medworm.com/rss/comments.php?id=4527733 Sun, 27 Feb 2011 21:00:02 +0100 4527733 http://www.medworm.com/index.php?rid=4522106&cid=t_90241_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=4512393&cid=t_90241_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=4501584&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fnarrative-medicine-healing-through-storytelling%2F2011.02.21 More in the evolving meme of narrative medicine: Researchers at the University of Massachusetts Medical School (my alma mater) have found that for a select population of individuals, listening to personal narratives helps control blood pressure. While the power of stories is old news, the connection to clinical outcomes is what’s newsworthy here. Read Dr. Pauline Chen’s nice piece in the New York Times. The implications for ongoing work in this area are mind boggling. The Annals of Internal Medicine study authors sum it up nicely: Emerging evidence suggests that storytelling, or narrative communication, may offer a unique opportunity to promote evidence-based choices in a culturally appropriate context.  Stories can help listeners make meaning of their lives, and listeners may be in... Better Health blogs http://www.medworm.com/rss/comments.php?id=4501584 Mon, 21 Feb 2011 16:00:32 +0100 4501584 http://www.medworm.com/index.php?rid=4411527&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fstress-in-life-respond-differently-and-live-longer%2F2011.01.28 This study proved that one such intervention, cognitive behavioral therapy (CBT) for patients who suffered a first heart attack, lowered the risk of fatal and nonfatal recurrent cardiovascular disease events by 41 percent over eight years. Nonfatal heart attacks were almost cut in half. Excitement may be dampened by the fact that all-cause mortality did not statistically differ between the intervention and control groups, but did trend towards an improvement in the eight years of follow up. Definitely less suffering. Maybe less deaths. The authors state that psychosocial stressors have been shown to account for an astounding 30 percent of the attributable risk of having a heart attack. Chronic stressors include low socioeconomic status, low social support, marital problems, and work dist... Better Health blogs http://www.medworm.com/rss/comments.php?id=4411527 Fri, 28 Jan 2011 17:00:39 +0100 4411527 http://www.medworm.com/index.php?rid=4405778&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcranberry-juice-for-urinary-tract-infections-evidence-is-still-lacking%2F2011.01.26 It always somewhat surprises me how some interventions never seem to die. One therapy that refuses to be put to rest, or even to be clarified, is the use of cranberry juice for urinary tract infections (UTIs). PubMed references go back to 1962, and there are over 100 references. Firm conclusions are still lacking. There is a reasonable, but incomplete, basic science behind the use of the cranberry juice for UTIs. E. coli , the most common cause of UTIs, causes infection in the bladder by binding to the uroepithelial cells. To do this, they make  fimbriae,  proteinaceous fibers on the bacterial cell wall. Fimbriae are adhesins that attach to specific sugar based receptors on uroepithelial cells. Think Velcro. Being able to stick to cells is an important virulence factor for bacteri... Better Health blogs http://www.medworm.com/rss/comments.php?id=4405778 Wed, 26 Jan 2011 22:00:51 +0100 4405778 http://www.medworm.com/index.php?rid=4394444&cid=t_90241_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=4377789&cid=t_90241_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2FaVe4cHW2HSM%2F In a move that some may consider long overdue, more than a dozen of the most prestigious medical journals will consider requiring doctors who submit studies to disclose any payments received from hedge funds and other large investors. The proposal is expected to be discussed at the next annual meeting of The International Committee of Medical Journal Editors, which is scheduled for June, according to a spokeswoman for the New England Journal of Medicine. The possibility follows ongoing concerns about conflicts of interest between researchers and the pharmaceutical industry and the extent to which undisclosed financial relationships may unduly influence medical research and, from there, medical practice. But the issue is also encompassing financial ties to large investors, given the growing... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=4377789 Thu, 20 Jan 2011 15:21:05 +0100 4377789 http://www.medworm.com/index.php?rid=4349515&cid=t_90241_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=4337937&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2F%25e2%2580%259cjust-in-case%25e2%2580%259d-heart-tests-can-they-do-more-harm-than-good%2F2011.01.12 Here’s an important equation that all of us — doctors include — should know about healthcare, but don’t: More ≠ Better “More does not equal better” applies to diagnostic procedures, screening tests meant to identify problems before they appear, medications, dietary supplements, and just about every aspect of medicine. That scenario is spelled out in alarming detail in the Archives of Internal Medicine. Clinicians at the Cleveland Clinic describe the case of a 52-year-old woman who went to her community hospital because she had been having chest pain for two days. She wasn’t having symptoms of a heart attack, such as shortness of breath, unexplained nausea, or a cold sweat, and her electrocardiogram and other tests were fine. The woman’s doctors concluded that her ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4337937 Wed, 12 Jan 2011 16:00:10 +0100 4337937 http://www.medworm.com/index.php?rid=4314005&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fon-the-value-of-open-mindedness%2F2011.01.05 Three recent sto­ries lead me to my open­ing topic for the year: The value of open-mindedness. This char­ac­ter­is­tic — a state of recep­tive­ness to new ideas — affects how we per­ceive and process infor­ma­tion. It’s a qual­ity I look for in my doc­tors, and which I admire espe­cially in older people. Piece #1 — On the brain’s matu­rity, flex­i­bil­ity and “cog­ni­tive fitness” For the first piece, I’ll note a Dec 31 op-ed piece that appeared in the New York Times: This Year, Change Your Mind, by Dr. Oliver Sacks, the neu­rol­o­gist and author. In this thought­ful essay, he con­sid­ers the adult brain’s “mys­te­ri­ous and extra­or­di­nary” power to adapt and grow: “I have seen hun­dreds of patients with var­i­ous deficits &#8212... Better Health blogs http://www.medworm.com/rss/comments.php?id=4314005 Wed, 05 Jan 2011 22:00:57 +0100 4314005 http://www.medworm.com/index.php?rid=4304875&cid=t_90241_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=4302123&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fechinacea-for-colds-does-it-really-work%2F2010.12.31 This study is unlikely to change minds about whether to take this remedy. Have you tried echinacea as a cold remedy? Has it worked? How do research findings, pro and con, affect your opinion of so-called alternative medicines? Many of the echinacea studies, especially early on, were sponsored by companies making or selling the product. This study was supported by a grant from the National Center for Complementary and Alternative Medicine, which is part of the National Institutes of Health. - Peter Wehrwein, Editor, Harvard Health Letter *This blog post was originally published at Harvard Health Blog* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4302123 Fri, 31 Dec 2010 20:00:12 +0100 4302123 http://www.medworm.com/index.php?rid=4298624&cid=t_90241_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=4294629&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-business-of-anticoagulation%2F2010.12.28 This is a guest post by Dr. Juliet Mavromatis: ********** The emergence of a new generation of anticoagulants, including the direct thrombin inhibitor, dabigatran and the factor Xa inhibitor, rivaroxaban, has the potential to significantly change the business of thinning blood in the United States. For years warfarin has been the main therapeutic option for patients with health conditions such as atrial fibrillation, venous thrombosis, artificial heart valves and pulmonary embolus, which are associated with excess clotting risk that may cause adverse outcomes, including stroke and death. However, warfarin therapy is fraught with risk and liability. The drug interacts with food and many drugs and requires careful monitoring of the prothrombin time (PT) and international normalized ratio (IN... Better Health blogs http://www.medworm.com/rss/comments.php?id=4294629 Tue, 28 Dec 2010 15:00:00 +0100 4294629 http://www.medworm.com/index.php?rid=4287415&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpainkiller-safety%2F2010.12.24 Perhaps as many as one in every five American adults will get a prescription for a painkiller this year, and many more will buy over-the-counter medicines without a prescription. These drugs can do wonders — getting rid of pain can seem like a miracle — but sometimes there’s a high price to be paid. Remember the heavily marketed COX-2 inhibitors? Rofecoxib, sold as Vioxx, and valdecoxib, sold as Bextra, were taken off the market in 2004 and 2005, respectively, after studies linked them to an increased risk of heart attack and stroke. The nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin, ibuprofen (sold as Advil and Motrin), and naproxen (sold as Aleve) seem like safe bets. But taken over long periods, they have potentially dangerous gastrointestinal side effect... Better Health blogs http://www.medworm.com/rss/comments.php?id=4287415 Fri, 24 Dec 2010 16:00:34 +0100 4287415 http://www.medworm.com/index.php?rid=4281314&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fabout-weightlifting-and-breast-cancer%2F2010.12.22 Last August, Kathryn Schmitz, PhD, MPH and colleagues published the results of their study Weightlifting in Women with Breast-Cancer–Related Lymphedema (BCRL) in the New England Journal of Medicine. They have now published a similar study in the Archives of Internal Medicine (see full reference below). While the NEJM article focused on breast cancer survivors with lymphedema, the Archives article focuses on breast cancer survivors without lymphedema. The new study adds weight for the need to change historic dogma which cautions breast cancer patients to avoid weight training after a mastectomy and or axillary dissection. (more…) *This blog post was originally published at Suture for a Living* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4281314 Wed, 22 Dec 2010 17:00:00 +0100 4281314 http://www.medworm.com/index.php?rid=4275325&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Freassuring-patients-about-ct-scans-and-radiation-risks%2F2010.12.20 Emergency patients with acute abdominal pain feel more confident about medical diagnoses when a doctor has ordered a computed tomography (CT) scan, and nearly three-quarters of patients underestimate the radiation risk posed by this test, reports the Annals of Emergency Medicine. “Patients with abdominal pain are four times more confident in an exam that includes imaging than in an exam that has no testing,” said the paper’s lead author. “Most of the patients in our study had little understanding of the amount of radiation delivered by one CT scan, never mind several over the course of a lifetime. Many of the patients did not recall earlier CT scans, even though they were listed in electronic medical records.” Researchers surveyed 1,168 patients with non-traum... Better Health blogs http://www.medworm.com/rss/comments.php?id=4275325 Mon, 20 Dec 2010 22:00:00 +0100 4275325 http://www.medworm.com/index.php?rid=4272291&cid=t_90241_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=4258863&cid=t_90241_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=4233229&cid=t_90241_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2010%2F12%2F06%2Fsex-important-to-older-men-stop-the-presses%2F Here’s a news flash for you — people like sex. Even older people. Wow, what an astounding insight into human behavior. I think some people have this conception that older people are somehow, like, not normal. Like they don’t have all the same needs, wants and desires as a younger person does. Like aging itself is some sort of disorder or disease that needs separate studying and understanding. I’ll let you in on a little secret — most older folks don’t feel their age. Most middle-age folks don’t feel their age. Once you hit 25 or so, many people (most?) seem “stuck in time” in terms of their own self-image and what they imagine others see them as. Most people simply don’t seem to feel their chronological age. So your grandparents ... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=4233229 Tue, 07 Dec 2010 00:31:18 +0100 4233229 http://www.medworm.com/index.php?rid=4230199&cid=t_90241_112_f&fid=34971&url=http%3A%2F%2Fdoctorandpatient.blogspot.com%2F2010%2F12%2Fmedical-errors-discuss-them-or-switch.html Patients won’t confront doctors if they think there’s been a mistake. They’ll just find a new doctor, even if there’d been no medical error. Researchers looked at adult visits to seven primary care practices in North Carolina during 2008. They asked patients about their perceptions of medical mistakes and how did it influence the choice to switch doctors. Of 1,697 patients, 265 (15.6 percent) reported a mistake had been made, 227 (13.4 percent) reported a wrong diagnosis, 212 (12.5 percent) reported a wrong treatment, and 239 (14.1 percent) reported changing doctors as a result. Results appeared in the Archives of Internal Medicine. But anecdotes cited by patients as mistakes were often normal diagnostic or therapeutic challenges. A typical scenario might be the patient reported sy... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4230199 Sun, 05 Dec 2010 18:44:00 +0100 4230199 http://www.medworm.com/index.php?rid=4214108&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Funderstanding-treatment-the-communication-disconnect-between-doctors-and-patients%2F2010.11.30 Over the long week­end I caught up on some read­ing. One arti­cle* stands out. It’s on informed con­sent, and the stun­ning dis­con­nect between physi­cians’ and patients’ under­stand­ing of a procedure’s value. The study, pub­lished in the Sept 7th Annals of Inter­nal Med­i­cine, used sur­vey meth­ods to eval­u­ate 153 car­di­ol­ogy patients’ under­stand­ing of the poten­tial ben­e­fit of per­cu­ta­neous coro­nary inter­ven­tion (PCI or angio­plasty). The inves­ti­ga­tors, at Baystate Med­ical Cen­ter in Mass­a­chu­setts, com­pared patients’ responses to those of car­di­ol­o­gists who obtained con­sent and who per­formed the pro­ce­dure. As out­lined in the article’s intro­duc­tion, PCI reduces heart attacks in patients wi... Better Health blogs http://www.medworm.com/rss/comments.php?id=4214108 Tue, 30 Nov 2010 17:00:42 +0100 4214108 http://www.medworm.com/index.php?rid=4205932&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcan-patients-choose-a-good-doctor-online%2F2010.11.27 The following op-ed was published on October 27th, 2010 in USA Today: When I ask new patients how they found me, frequently they say on the Internet through search engines such as Google. Out of curiosity, I recently Googled myself. Numerous ads appeared, promising readers a “detailed background report” or a “profile” of me. Among the search results was information about my practice, whether I was board certified, had any lawsuits against me, and reviews from online doctor rating sites. Thankfully, most were favorable, but some were not. Can patients reliably choose a good doctor online? People already choose restaurants, movies, and their college professors based on what they read on the Internet, so it’s inevitable that many will research their doctors on the Web as well. But t... Better Health blogs http://www.medworm.com/rss/comments.php?id=4205932 Sat, 27 Nov 2010 21:00:36 +0100 4205932 http://www.medworm.com/index.php?rid=4200565&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-taste-of-canadian-healthcare-on-chicago%25e2%2580%2599s-south-side%2F2010.11.24 This past September, a group of medical residents at my institution began seeing primary care patients at a free clinic down the street from our tertiary academic medical center (“hospital clinic”). Far from my expectations, the care we are able to provide at our free clinic is in many ways better than our hospital clinic. Somewhat paradoxically, the experience has given me a taste of what the practice of medicine is like in single-payer healthcare systems like Canada’s. When I volunteered to start seeing patients at a nearby free clinic, I had little idea what I was signing up for. The term “free clinic” conjured up memories as a medical student in East Baltimore tending to patients at a local homeless shelter with severe frostbite or at a student-run clinic rummaging through th... Better Health blogs http://www.medworm.com/rss/comments.php?id=4200565 Wed, 24 Nov 2010 19:00:41 +0100 4200565 http://www.medworm.com/index.php?rid=4159241&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmore-doctors-are-refusing-industry-perks-and-gifts%2F2010.11.12 Physicians and particularly primary care doctors are reporting fewer industry ties than five years ago, according to a survey. While 94% of doctors reported some type of perk from a drug or device maker in 2004, 83.8% did in 2009, researchers reported in the Nov. 8 Archives of Internal Medicine. Researchers surveyed a stratified random sample of 2,938 primary care physicians (internal medicine, family practice, and pediatrics) and specialists (cardiology, general surgery, psychiatry and anesthesiology) with a 64.4% response rate. (more…) *This blog post was originally published at ACP Internist* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=4159241 Fri, 12 Nov 2010 15:00:00 +0100 4159241 http://www.medworm.com/index.php?rid=4151789&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpatient-engagement-how-empathy-can-empower-your-patients%2F2010.11.10 In my recent post on KevinMD, “Deeply Connect and Engage Your Patients With Empathy,” I write about how empathy is essential to help empower our patients: “It is with empathy that we can engage and empower our patients.” Doctors and nurses are leaders in health care. Being a great leader means having a clear vision, mission or goal. It means being committed, and knowing how to listen and communicate, but it involves much more. It’s about having heart, empathy, and an uplifting spirit. I value and respect a well written post by Thomas Goetz, author of The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine recently published on KevinMD, “How can doctors successfully engage their patients?” Goetz writes about “Five things they should seek to... Better Health blogs http://www.medworm.com/rss/comments.php?id=4151789 Wed, 10 Nov 2010 14:00:50 +0100 4151789 http://www.medworm.com/index.php?rid=4139236&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhigh-cholesterol-and-red-yeast-rice-supplements%2F2010.11.05 People are always on the search for “natural” ways to stay healthy and reduce cholesterol. Chinese red yeast rice supplements have been touted as a natural, safer way to lower cholesterol compared to statin medications. The yeast that grows on a particular type of rice contains a family of substances called monocolins, which lower cholesterol by inhibiting cholesterol production in the liver in the same manner as prescription statin drugs. Some studies have shown as much as a 15 percent drop in cholesterol. All of this sounds good until you dig a little deeper. Supplements are not regulated by the Food and Drug Administration (FDA), and a new study in the Archives of Internal Medicine showed that different brands of red yeast rice supplements have dramatic variation in le... Better Health blogs http://www.medworm.com/rss/comments.php?id=4139236 Fri, 05 Nov 2010 16:00:00 +0100 4139236 http://www.medworm.com/index.php?rid=4125283&cid=t_90241_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2Fz4r5rINz09I%2F Much attention has been paid to conflicts of interest relating to the pharmaceutical industry, but where do medical journals fit in this equation? A new study notes that journals also have vested interests that warrant disclosure. Specifically, industry-supported clinical trials can boost a journal’s so-called impact factor by generating greater distribution of reprints that increase citation rates and, of course, revenue. The trials are often supported by drugmakers, which purchase reprints. What is an impact factor? The researchers defined it this way: a measure of a journal’s importance based on how often its articles are cited. This is not just about prestige, of course, but the potential for greater circulation (there is a formula contained in the study, which was publishe... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=4125283 Mon, 01 Nov 2010 12:41:53 +0100 4125283 http://www.medworm.com/index.php?rid=4125010&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fprogressive-healthcare-rationing-what-will-it-look-like%2F2010.11.01 In prior posts, DrRich introduced his readers to Ezekiel Emanuel, M.D., Ph.D., brother of Rahm, eminent medical ethicist, and one of the White House’s chief advisers on healthcare policy. Dr. Emanuel was one of the authors of that recent paper in the Annals of Internal Medicine which admonished American physicians that resistance is futile. He has also famously called upon American physicians to abandon the obsolete medical ethics expressed in the Hippocratic Oath. The reason the ideas (and pronouncements) of Dr. Emanuel are important is that he presumably will be a major “decider” in determining who will serve on the GOD panels, and how those panels will operate to advance his (and Mr. Obama’s) program of healthcare reform. So, before we leave Dr. Emanuel to his important duties, ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4125010 Mon, 01 Nov 2010 12:00:10 +0100 4125010 http://www.medworm.com/index.php?rid=4118934&cid=t_90241_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_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fprimary-care-doctors-how-valued-are-they%2F2010.10.27 Authors of a recent study from the Archives of Internal Medicine are unlikely to endear themselves to specialists. As reported by Reuters, and provocatively titled, Do specialist doctors make too much money?, the study gives a per-hour breakdown of how much doctors make. I think this is a good approach, since annual salary figures do not account for the number of hours doctors work — and in the case of primary care doctors, this includes uncompensated time doing paperwork and other bureaucratic chores. Here’s what they found: … the lowest wages — amounting to $60.48 an hour — [were] paid to primary care physicians. In other broad categories of practice, surgeons took home the highest average hourly wage of $92. Internal medicine and pediatric docs earned about $85 an hour, the re... Better Health blogs http://www.medworm.com/rss/comments.php?id=4118937 Wed, 27 Oct 2010 22:00:56 +0100 4118937 http://www.medworm.com/index.php?rid=4097935&cid=t_90241_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=4086267&cid=t_90241_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=4065366&cid=t_90241_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_90241_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_90241_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=4036644&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-patients-and-doctors-disagree%2F2010.10.06 A 69-year-old woman who swims in my master program came back to the pool after a total knee replacement. I asked her how she was doing. She said she is still in a lot of pain because of her physical therapy. She said that her physical therapist was disappointed that she still was still unable to achieve full flexion of 120 degrees. Why 120 degrees? Did you set that goal I asked her? ”No,” she said, “the therapist did.” She went on to tell how she already had more range of motion in her knee than she did before the surgery. My friend was quite satisfied with her progress and wanted to stop physical therapy. The pain from the PT was worse than anything she had experienced before the knee replacement. I knew she and her 80-year-old boy friend were going on a c... Better Health blogs http://www.medworm.com/rss/comments.php?id=4036644 Wed, 06 Oct 2010 22:00:00 +0100 4036644 http://www.medworm.com/index.php?rid=4036646&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fintegrating-wellness-into-a-primary-care-practice%2F2010.10.06 I often am asked how I incorporate wellness in our family medical practice, and I must admit that I’ve mixed feelings when it comes to the question because it implies that I’m not already trying to practice wellness simply by practicing medicine. I feel that the two are synonymous. To those who want to know more about wellness and primary care, here’s my approach: • I never try to sell anyone on a “wellness” program. • I follow specific guidelines on certain chronic illnesses, mostly adhering to evidence-based guidelines and not expert opinion or opinion by committee. • I offer the best advice I can to patients and try to guide them in the right direction when I feel they are taking pathways that worry me and that could be harmful (e.g. like using megavitamin an... Better Health blogs http://www.medworm.com/rss/comments.php?id=4036646 Wed, 06 Oct 2010 16:00:16 +0100 4036646 http://www.medworm.com/index.php?rid=4027160&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-struggle-to-retain-physicians%2F2010.10.03 Some states are finding it tough to retain physicians. Take Virginia for instance: A recent study found Virginia retains only 35 percent of its medical school graduates and ranks 31st among other states in retaining doctors. In 2008, Virginia spent more than $50 million from the general fund to support medical education and had nearly 600 new physicians graduate from Virginia’s four medical schools. Despite this, Virginia still struggles to retain medical graduates, with less than 25 percent of Virginia’s physicians graduating from medical schools in the Commonwealth. Some feel incentives might work: Dr. Greenawald says other states including North Carolina have incentives to keep medical students in state. He hopes Virginia considers following suit. Dr. Greenawald also said t... Better Health blogs http://www.medworm.com/rss/comments.php?id=4027160 Sun, 03 Oct 2010 14:00:00 +0100 4027160 http://www.medworm.com/index.php?rid=4018179&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-pain-cant-be-a-vital-sign%2F2010.09.29 There’s been a movement afoot for several years now to quantify pain as the so-called “Fifth Vital Sign.” It all started as a well-intentioned effort to raise the level of awareness of inadequate pain control in many patients, but has gotten way out of hand. The problem is that the word “sign” has a specific meaning in medicine that, by definition, cannot be applied to pain. When you hear us medicos talk about “signs and symptoms” of a disease, it turns out that they are not the same thing. “Symptoms” are things the patient experiences subjectively. “Signs” are things that can be observed objectively by another person. Headache is a symptom; cough is a sign. Itching is a symptom; scratch marks over a blistery linear rash are a sign. Vertigo, the hallucination of movem... Better Health blogs http://www.medworm.com/rss/comments.php?id=4018179 Wed, 29 Sep 2010 22:00:06 +0100 4018179 http://www.medworm.com/index.php?rid=3998986&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fnutritional-supplements-do-they-really-help-prevent-disease%2F2010.09.24 (Guest post submitted by MD Anderson Cancer Center) Aisles in grocery stores and pharmacies are stacked with vitamins, minerals, herbs or other plants that you take in pill, capsule, tablet or liquid form. And, many of us buy these supplements and take them regularly, hoping to lower our chances of getting cancer and other diseases. But do supplements really work wonders? Should you take them to help prevent cancer? Our experts say beware. “Don’t be fooled by the label on the bottle,” says Sally Scroggs, health education manager at MD Anderson’s Cancer Prevention Center. “Researchers are still unsure about whether or not supplements actually prevent cancer.” Some studies have suggested that supplements may actually increase cancer risk by tilting the balance of nutrients in the... Better Health blogs http://www.medworm.com/rss/comments.php?id=3998986 Fri, 24 Sep 2010 20:00:57 +0100 3998986 http://www.medworm.com/index.php?rid=3998989&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-adults-get-chickenpox%2F2010.09.24 We think of chickenpox as a childhood disease, but there are adult cases and they tend to lead to more serious complications. Chickenpox is caused by the varicella virus and it is extremely contagious. Most people are exposed in childhood (or they receive the chicken pox vaccine), and so adults rarely contract it. It is especially dangerous for pregnant women because the fetus can become infected. The latency period from infection exposure to disease is 10 to 21 days. (more…) *This blog post was originally published at EverythingHealth* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3998989 Fri, 24 Sep 2010 14:00:00 +0100 3998989 http://www.medworm.com/index.php?rid=3998992&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-report-from-the-blackberry-clinical-collaboration-summit%2F2010.09.23 Last week, Research In Motion (RIM), the makers of BlackBerry smartphones, held a clinical collaboration summit in Boston to discuss their vision of the future of mobile device integration into healthcare IT. Several vendors and app makers attended and shared how they are implementing mobile devices into workflows with RIM claiming their superiority in security and data protection through data wiping, access control, and audit trail. One claim that several speakers made was that hours per week could be saved by making clinical and logistical data available on smartphones and that studies have shown clinical information presented on a small screen can be used for mobile situation diagnostic ability, notably for ECG and OB data through companies like AirStrip. A few studies have backed parts... Better Health blogs http://www.medworm.com/rss/comments.php?id=3998992 Thu, 23 Sep 2010 22:00:01 +0100 3998992 http://www.medworm.com/index.php?rid=3993908&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fsickening-people%2F2010.09.22 The man who twirled with rose in teeth Has his tongue tied up in thorns His once expanded sense of time and Space all shot and torn See him wander hat in hand - “Look at me, I’m so forlorn - Ask anyone who can recall It’s horrible to be born! - Bruce Cockburn, from song “Shipwrecked at the Stable Door” I found the discussion around my recent post about treating colds very interesting. Sick people come to the office to find out how sick they are. Most people don’t want to be sick, and when they are sick they want doctors to make them better. Most people. Some people want to be sick, and some doctors want to make people sick. I am not talking about hypochondriacs — people who worry that they may have disease and become fixated on being sick. I am not talking about malingere... Better Health blogs http://www.medworm.com/rss/comments.php?id=3993908 Wed, 22 Sep 2010 14:00:34 +0100 3993908 http://www.medworm.com/index.php?rid=3993911&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fall-about-hands-guidance-and-germs%2F2010.09.21 Some interesting items this week involving hands. The one which has gotten much news coverage is the issue of handwashing. Take a look at some of the headlines: High five! Handwashing on rise (Chicago Sun-Times) For Many, ‘Washroom’ Seems to Be Just a Name (The New York Times) 93% of women wash their hands vs. 77% of men (USA Today) All the above are reporting on the same study, but the difference in presentation is amazing to me. The study doesn’t involve handwashing in a hospital or doctor’s office setting. The JAMA article (2nd reference below) does, but this article focuses on whether public reporting of handwashing compliance is helpful or not. Do we inflate our numbers to make ourselves look better? (more…) *This blog post was originally published at ... Better Health blogs http://www.medworm.com/rss/comments.php?id=3993911 Tue, 21 Sep 2010 16:00:00 +0100 3993911 http://www.medworm.com/index.php?rid=3993914&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fprimary-care-has-it-been-oversold%2F2010.09.21 Citing a new study by the Dartmouth Atlas, the Wall Street Journal’s health blog provocatively asks: “Has the notion of ‘access’ to primary care been oversold?” The Dartmouth researchers found “that there is no simple relationship between the supply of physicians and access to primary care.” That is, they found that having a greater supply of primary care physicians in a community doesn’t mean that the community necessarily has better access to primary care. Some areas of the country with fewer primary care physicians per population do better on access than other areas with more primary care physicians. The researchers also report that the numbers of family physicians is more positively associated with better access than the numbers of internists... Better Health blogs http://www.medworm.com/rss/comments.php?id=3993914 Tue, 21 Sep 2010 10:00:00 +0100 3993914 http://www.medworm.com/index.php?rid=3980829&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmedical-errors-discuss-them-or-switch-doctors%2F2010.09.17 Patients won’t confront doctors if they think there’s been a mistake. They’ll just find a new doctor, even if there’d been no medical error. Researchers looked at adult visits to seven primary care practices in North Carolina during 2008. They asked patients about their perceptions of medical mistakes and how did it influence the choice to switch doctors. Of 1,697 patients, 265 (15.6 percent) reported a mistake had been made, 227 (13.4 percent) reported a wrong diagnosis, 212 (12.5 percent) reported a wrong treatment, and 239 (14.1 percent) reported changing doctors as a result. Results appeared in the Archives of Internal Medicine. But anecdotes cited by patients as mistakes were often normal diagnostic or therapeutic challenges. A typical scenario might be the pa... Better Health blogs http://www.medworm.com/rss/comments.php?id=3980829 Sat, 18 Sep 2010 04:32:24 +0100 3980829 http://www.medworm.com/index.php?rid=3980830&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2F3-things-that-make-a-better-doctor%2F2010.09.17 On Monday, NPR’s Scott Hensley posted: “Between the Internet and all the data insurance companies and the government collect on doctors, you’d think it would be a lot easier than it used to be to find a good one. But it’s not.” Sound familiar around here? See his thoughts: “3 Tips For Picking A Slightly Better Doctor.” (Thanks to friend Cindy Johnson for the tip.) *This blog post was originally published at e-Patients.net* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3980830 Fri, 17 Sep 2010 17:00:10 +0100 3980830 http://www.medworm.com/index.php?rid=3965409&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Feating-a-food-based-approach%2F2010.09.14 The science of nutrition is changing and not in the way you might expect. After years of “reductionist” thinking — where food has been viewed as the sum of its parts -– a call to treat food as food has been sounded. No more poring over nutrition labels to calculate grams of fat or chasing down the latest go-to chemical –- be it vitamin E, fish oil or omega-3. Instead we are being asked to call a potato a potato and a piece of steak — well, a piece of steak. If you haven’t heard about this sea change yet, you are not alone. The food science industry that markets “food products” for our consumption has done a good job giving their laboratory creations a semblance of health with phrases like “low fat” and “high in vitamin C.” For our part, the medical community i... Better Health blogs http://www.medworm.com/rss/comments.php?id=3965409 Tue, 14 Sep 2010 12:00:27 +0100 3965409 http://www.medworm.com/index.php?rid=3961815&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Flocally-grown-medical-students-more-likely-to-stick-around%2F2010.09.12 Nearly a third of medical graduates at the University of North Dakota continue in primary care, down from nearly half just two years ago. This is the university that leads the nation for the percentage of students (about 20 percent) choosing family medicine. North Dakota overall will be short about 160 physicians by 2025, and the need is now affecting urban areas as well as rural ones, said Joshua Wynne, FACP, dean of the university’s School of Medicine and Health Sciences. Keeping medical students interested in practicing primary care in rural America depends upon whom medical schools choose to admit. For example, one-fourth of the University of North Dakota’s student population hails from small towns, and 80 percent are in-state. More and more medical schools are looking at ... Better Health blogs http://www.medworm.com/rss/comments.php?id=3961815 Sun, 12 Sep 2010 15:00:00 +0100 3961815 http://www.medworm.com/index.php?rid=3954258&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmedicine-and-the-gender-barrier%2F2010.09.09 It’s only a matter of time before female physicians outnumber men, say medical school heads who are seeing more women in their programs. Although women have broken the gender barrier in medicine, they may want to keep going into nursing, because nurse practitioner salaries grew faster than primary care physicians’ pay – nearly 5 percent compared to nearly 3 percent. Physicians can take some comfort that their average pay is more — $191,000 compared to more than $85,000 — unless they’re women, who among all the life sciences average $13,000 less than their male counterparts in comparable positions and with similar experience. (WCSC TV, Fierce Practice Management, Academic Medicine) *This blog post was originally published at ACP Internist* (Sour... Better Health blogs http://www.medworm.com/rss/comments.php?id=3954258 Thu, 09 Sep 2010 22:00:00 +0100 3954258 http://www.medworm.com/index.php?rid=3954259&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpatients-starved-for-time-with-the-doctor%2F2010.09.09 If you’re into health care consumerism, you’ll enjoy my guest blog post at CDHC Solutions magazine. CDHC Solutions focuses on consumer-driven health plans. Consumer-driven plans are a form of “high deductible” health coverage that is more popular than ever. For whatever you want to say about these plans, one thing is clear: They don’t solve the fundamental problem of patients not having enough time with their doctors. Here’s a taste of what I wrote: Researchers have been trying to pinpoint the impact of this time starvation on the quality of medical care, and they’re finding disturbing results. A recent study in the Annals of Internal Medicine found that because of time pressures and related factors, doctors deliver “error-free” care as rarely as 22 percent of the ti... Better Health blogs http://www.medworm.com/rss/comments.php?id=3954259 Thu, 09 Sep 2010 19:00:36 +0100 3954259 http://www.medworm.com/index.php?rid=3942788&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2F5-reasons-why-people-dont-ask-their-doctor-questions%2F2010.09.07 A neighbor of mine was diagnosed with breast cancer about the same time my wife was being treated for lung cancer. I saw my neighbor the other day for the first time in several years. I asked her how she was doing. She said great. In turn I asked her how her PET/CT exam looked. PET/CT scans are often done to make sure that one’s cancer hasn’t spread. My wife gets one every year. My neighbor told me her doctor never told her she needed one, that mammograms would suffice. She went on to say a friend had also recently asked her if she had a PET/CT as well. “Maybe I should ask my doctor,” she told me. That was the same response she gave me the last time I raised the subject two years earlier: “I should ask my doctor.”   So Why Don’t People Ask More Questions?   My nei... Better Health blogs http://www.medworm.com/rss/comments.php?id=3942788 Wed, 08 Sep 2010 00:14:14 +0100 3942788 http://www.medworm.com/index.php?rid=3938327&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fphysician-burnout-doctors-and-patients-deserve-better%2F2010.09.06 A new patient recently said he was referred to me after his last doctor had left medicine. His old doctor always looked unhappy and burned out, he noted. Burnout affects more than half of doctors, according to researchers at the University of Rochester School of Medicine. Beyond mere job dissatisfaction, these doctors are emotionally exhausted to the point where they lose focus. They tend to be more depressed — perhaps one reason why doctors have a higher suicide rate than the general population. While burnout can happen in any profession, the performance of stressed-out doctors can hurt someone else: Patients. (more…) *This blog post was originally published at KevinMD.com* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3938327 Mon, 06 Sep 2010 18:00:14 +0100 3938327 http://www.medworm.com/index.php?rid=3938328&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcanker-sores-who-gets-them-and-why%2F2010.09.06 Canker sores are painful, and mouth pain cannot be ignored. They’re difficult to prevent and you just have to cope with them until they go away. We have no idea what causes them. For a doctor, this is difficult to accept. What the heck are canker sores? The medical term is apthous ulcers and they’re round or oval painful ulcers that appear on the tongue, inner lips, inside of cheeks, or palate of the mouth. Up to 40 percent of people have experienced canker sores. So why have the remaining 60 percent never had them? We don’t know. (more…) *This blog post was originally published at EverythingHealth* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3938328 Mon, 06 Sep 2010 14:00:00 +0100 3938328 http://www.medworm.com/index.php?rid=3935798&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Frectal-cancer-becoming-more-common-in-younger-people%2F2010.09.05 Rates of rectal cancer in those younger than 40 have been increasing, the LA Times reported recently. Researchers studied data from the Surveillance, Epidemiology and End Results (SEER) Registry and looked at the change in rectal and colon cancer incidence in those under 40 from 1973 to 2005. Overall rates were low, but while colon cancer incidence remained constant, rectal cancer incidence increased by an average of 3.8 percent annually, the authors reported in the journal Cancer. The authors didn’t advocate routine screening in those under 40, but did recommend that physicians be more alert to the possibility of rectal cancer in those presenting with symptoms such as rectal bleeding, according to the Times. (LA Times) *This blog post was originally published at ACP Internist* ... Better Health blogs http://www.medworm.com/rss/comments.php?id=3935798 Sun, 05 Sep 2010 18:00:00 +0100 3935798 http://www.medworm.com/index.php?rid=3935799&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fgeneric-drugs-not-so-cheap%2F2010.09.05 I received the following e-mail from a patient (paraphrased): Dear Dr. Fisher, Thank you for trying to switch me from lisinopril to generic losartan (Cozaar) to help me with the irritating cough that has been nagging me since I was placed on lisinopril. I did not pick up my prescription, though. At nearly $200 for a three-month supply, I’ve decided to live with the cough, since the same amount of lisinopril costs me about $12. -Ms. Patient Interesting how the generic drug market for some drugs only marginally discounts prices. Since the companies that make generics did not have to absorb research and development costs, how do they justify the exorbitant prices? Simple: The middlemen still have to get theirs. -WesMusings of a cardiologist and cardiac electrophysiologist. *This... Better Health blogs http://www.medworm.com/rss/comments.php?id=3935799 Sun, 05 Sep 2010 16:00:00 +0100 3935799 http://www.medworm.com/index.php?rid=3924902&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoctor-patient-communication-much-room-for-improvement%2F2010.09.01 In a surprising report from the Archives of Internal Medicine, we learn that most hospitalized patients (82 percent) could not accurately name the physician responsible for their care and almost half of the patients did not even know their diagnosis or why they were admitted. If that isn’t enough, when the researchers queried the physicians, 67 percent thought the patients knew their name and 77 percent of doctors thought the patients “understood their diagnoses at least somewhat well.” I would call that a pretty significant communication gap. Ninety percent of the patients said they received a new medication and didn’t know the side effects. Although 98 percent of physicians thought they discussed their patients’ fears and anxieties with them, only 54 perc... Better Health blogs http://www.medworm.com/rss/comments.php?id=3924902 Thu, 02 Sep 2010 01:00:00 +0100 3924902 http://www.medworm.com/index.php?rid=3902900&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-truly-useful-emr%2F2010.08.25 I love computers. Really, I do. Despite my oft-repeated claims about the shortcomings of electronic medical records in their current form, I do believe that information technology has the potential to be of great help to me and other physicians in providing quality care to Americans. Stop laughing. I really mean it. I do not believe, however, that IT best serves the medical needs of our patients when used to create non-interactive silos of information sequestered in the offices and clinics of individual doctors. Even hospitals and large integrated health systems information remains stuck within that system, providing limited utility when patients travel, or even go to a doctor not affiliated with the system. Although some (especially in government) seem to feel that expanding those kinds o... Better Health blogs http://www.medworm.com/rss/comments.php?id=3902900 Wed, 25 Aug 2010 16:00:29 +0100 3902900 http://www.medworm.com/index.php?rid=3902901&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fprimary-care-doctors-rewarded-for-time-with-patients%2F2010.08.25 Abraham Verghese is a professor of medicine at Stanford University and one of the most articulate physician-writers today. He recently wrote an op-ed highlighting primary care’s plight, and focuses on the scarcity of time: The science of medicine has never been more potent – incredible advances and great benefits realized in the treatment of individual diseases – yet the public perception of us physicians is often one of a harried individual more interested in the virtual construct of the patient in the computer than in the living, breathing patient seated on the exam table.Time is the scarcest commodity of all. Patients, particularly when it comes to their routine, day-to-day care, want a physician who has time to understand them as people first, and then as patients. It’s bee... Better Health blogs http://www.medworm.com/rss/comments.php?id=3902901 Wed, 25 Aug 2010 14:00:27 +0100 3902901 http://www.medworm.com/index.php?rid=3880860&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fcovertrationingblog.com%2Fpodpress_trac%2Ffeed%2F883%2F0%2FsucksbeingPCP.mp3 DrRich entered medical school 40 years ago with every intention of becoming a general medical practitioner, and indeed he became one. But after only a year in practice as a generalist, he found himself so frustrated with the frivolous limitations and the superfluous obligations that even then were being externally imposed on these supposedly revered professionals, that DrRich altered course and spent several years retraining to become a cardiac electrophysiologist. (Electrophysiology is a field of endeavor so arcane as to be mystifying even to other cardiologists. DrRich hoped that the officious regulators and stone-witted insurance clerks would be so confused –- and possibly intimidated –- by the mysterious doings of electrophysiologists that they would leave him alone. Happily, this ... Better Health blogs http://www.medworm.com/rss/comments.php?id=3880860 Wed, 18 Aug 2010 18:00:32 +0100 3880860 http://www.medworm.com/index.php?rid=3880861&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcommunication-gap-widens-between-doctors-and-patients%2F2010.08.18 In a surprising report from the Archives of Internal Medicine, we learn that most hospitalized patients (82 percent) could not accurately name the physician responsible for their care and almost half of the patients did not even know their diagnosis or why they were admitted. If that isn’t enough, when the researchers queried the physicians, 67 percent thought the patients knew their name and 77 percent of doctors thought the patients “understood their diagnoses at least somewhat well.” I would call that a pretty significant communication gap. Ninety percent of the patients said they received a new medication and didn’t know the side effects. Although 98 percent of physicians thought they discussed their patient’s fears and anxieties with them, only 54 per... Better Health blogs http://www.medworm.com/rss/comments.php?id=3880861 Wed, 18 Aug 2010 16:00:00 +0100 3880861 http://www.medworm.com/index.php?rid=3880862&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcan-novel-approaches-fill-primary-care-needs%2F2010.08.18 New primary care arrangements show how primary care is evolving — or splitting apart, depending upon one’s perspective. Retainer fees let one practice handle more patients by phone or email. But, points out Richard Baron, FACP, affluent communities can take advantage of such arrangements, and not every community is. And Sam Fink, FACP, of southern California says tele-visits are no substitute for hands-on care. In another model, nurse-led facilities service the poor in north Philadelphia, and more states are expanding the power of the pen to cover shortages.  Another trend is the shared medical appointment. Led by physicians and conducted by “behaviorists,” the sessions cover a half-dozen or more patients at a time for both primary and specialty care. Even pharmaci... Better Health blogs http://www.medworm.com/rss/comments.php?id=3880862 Wed, 18 Aug 2010 14:00:00 +0100 3880862 http://www.medworm.com/index.php?rid=3880863&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmanaging-bias-in-healthcare%2F2010.08.18 This article was written more for family medicine physicians, but all of us can benefit from self-assessment of potential biases that might affect our judgment. It was also written with the potential bias towards the obese patient in mind, but the article could have been written with any “fill in the blank” bias as the topic. The article points out that bias among physicians tends to “be implicit rather than explicit because of social pressure for healthcare providers to show tolerance and cultural sensitivity.” (more…) *This blog post was originally published at Suture for a Living* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3880863 Wed, 18 Aug 2010 12:00:00 +0100 3880863 http://www.medworm.com/index.php?rid=3872557&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdoctor-patient-relationship-humanized-by-touch%2F2010.08.16 I’ve written previously that many doctors are finding the physical exam obsolete, and are favoring more technologically-advanced, and expensive, tests. In fact, I alluded to traditional physical exam advocates as “arguing for staying with a horse and buggy when cars are rapidly becoming available.” In a recent piece from the New York Times, internist Danielle Ofri says we need to look past the lack of evidence supporting the physical exam. The benefits of touching the patient, and listening to his heart and lungs, cannot be quantitatively measured: Does the physical exam serve any other purpose? The doctor-patient relationship is fundamentally different from, say, the accountant-client relationship. The laying on of hands sets medical practitioners apart from their counterparts in th... Better Health blogs http://www.medworm.com/rss/comments.php?id=3872557 Mon, 16 Aug 2010 12:00:41 +0100 3872557 http://www.medworm.com/index.php?rid=3865266&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-story-of-online-care-without-opennotes%2F2010.08.13 Next in our series on my experience with OpenNotes, a project sponsored by the Robert Wood Johnson Foundation’s Pioneer Portfolio. This item has nothing to do with OpenNotes itself –- it’s what I’m seeing now that I’ve started accessing my doctor’s notes. In short, I see the clinical impact of not viewing my record as a shared working document. Here’s the story.  ______ In OpenNotes, patient participants can see the visit notes their primary physicians entered. Note “primary,” not specialists. I imagine they needed to keep the study design simple. So here I am in the study, going through life. Five weeks ago I wrote my first realization: After the visit I’d forgotten something, so I logged in. (more…) *This blog post was originally published at e-... Better Health blogs http://www.medworm.com/rss/comments.php?id=3865266 Fri, 13 Aug 2010 16:00:13 +0100 3865266 http://www.medworm.com/index.php?rid=3858156&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fyoung-doctors-who-lie%2F2010.08.11 This is something: A study published in the July 20, 2010 Annals of Internal Medicine finds that 5 percent of residency applications contain plagiarized content. The study from Boston’s Brigham & Woman’s Hospital is based on the personal statements of nearly 5,000 residency applicants that were matched against a database of published content. The authors comment that the study is limited, among other things, by the fact that it was done in just one institution. It makes me wonder if the number is artificially high or potentially too low. So why would medical students lie? (more…) *This blog post was originally published at 33 Charts* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3858156 Wed, 11 Aug 2010 18:00:14 +0100 3858156 http://www.medworm.com/index.php?rid=3858158&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdefining-family-practice%2F2010.08.11 I like Dr. Rob, the one with the “distractible mind.” And although I thoroughly agree with the stance he takes in his recent post against cholesterol screening in kids, I must take issue with his opening statement: I have a unique vantage point when it comes to the issue universal cholesterol screening in children, when compared to most pediatricians. My unique view stems from the fact that I am also an internist who deals with those children after they grow up on KFC Double Downs. From Dictionary.com: “Unique: existing as the only one or as the sole example; single; solitary in type or characteristics.” Your med-peds training allows you to follow patients from birth to death (but no obstetrics or gynecology). You can care for all organ systems and all stages of di... Better Health blogs http://www.medworm.com/rss/comments.php?id=3858158 Wed, 11 Aug 2010 14:00:55 +0100 3858158 http://www.medworm.com/index.php?rid=3854520&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-divide-between-you-and-your-medical-records%2F2010.08.10 You have a right to your medical record. It’s true –- the record of every test and procedure you’ve had done, any films or studies, your doctors notes — it’s all yours if you ask for it. But it’s not that simple. If you’re sick, your “record” is likely in pieces in lots of different places. Some of it is in paper files and computers in the offices of each of your doctors, or in the clinics where you had a test or procedure. It’s in multiple computer systems in a hospital, or in a folder in a radiology department, a container in a pathology department, or the computer system of a pharmacy. Each of these places has their own policy or procedure if you want your record. There are forms you have to fill out, fees you have to pay, time you have to wait. So while you ... Better Health blogs http://www.medworm.com/rss/comments.php?id=3854520 Tue, 10 Aug 2010 21:00:42 +0100 3854520 http://www.medworm.com/index.php?rid=3845098&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-big-pay-raise-for-internists%2F2010.08.09 Full-time internists average $191,864 in income, according to one recruiter’s annual salary survey. LocumTenens.com conducted its survey in the early spring of 2010 among locum tenens and permanently employed physicians. That’s up from $179,958 in 2009, the company reported. Specific breakdowns by gender, years in practice and owner/employee status are here. That’s a 6.6 percent pay raise. We’re going to do our own salary survey right here. Let us know if you saw such an increase in the past year. *This blog post was originally published at ACP Internist* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3845098 Mon, 09 Aug 2010 12:00:00 +0100 3845098 http://www.medworm.com/index.php?rid=3833426&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-diagnosing-doctors-often-ignore-patients-social-factors%2F2010.08.07 A recent study from the Annals of Internal Medicine found that doctors often discounted a patient’s social situation when making a medical diagnosis. Lead researcher Saul Weiner “arranged to send actors playing patients into physicians’ offices and discovered that errors occurred in 78 percent of cases when socioeconomic concerns were a significant factor.” Evan Falchuk, commenting on the results, provides some context: It’s hard to expect even the most gifted clinician, trying to make it through yet another week of a hundred or more patient encounters, to get these difficult decisions right. Too much of the context of a patient’s care gets lost in the endless churn of patient visits that the health care system imposes on doctors.I suspect this is enormously frustrating for doc... Better Health blogs http://www.medworm.com/rss/comments.php?id=3833426 Sat, 07 Aug 2010 12:00:37 +0100 3833426 http://www.medworm.com/index.php?rid=3831357&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fanatomy-101-are-you-up-to-snuff%2F2010.08.06 It’s time we get away from all of the serious nonsense and back to something I am far more comfortable with: Taking otherwise-useful information and twisting it into utter nonsense. Yes, it’s time to journey back to the wonderful world of the physical exam. My ongoing mission is to explore the human body from my unique (albeit moderately unstable) perspective. For an overview of my previous posts on the physical exam see this post which features Dick Chaney on a Segway (reason enough to click on the link). Please visit a psychiatry blog to aid in recovery once you have done so. My most recent post in this fine series covered the topic of psychics and about the examination of the hand. It was mainly about psychics examining the hand, but I did slip in a little doctor stuff to keep the ... Better Health blogs http://www.medworm.com/rss/comments.php?id=3831357 Fri, 06 Aug 2010 12:00:05 +0100 3831357 http://www.medworm.com/index.php?rid=3822921&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-patients-are-wary-of-the-primary-care-medical-home%2F2010.08.04 Say the words, “Patient-centered medical home,” and you’re bound to get a variety of opinions. On this blog alone, there are a variety of guest pieces critical of the effort, saying it does not increase patient satisfaction, nor does it save money. And that’s not good news for its advocates, who are pinning primary care’s last hopes on the model. Medical homes hit the mainstream media recently, with Pauline Chen focusing one of her recent, weekly New York Times columns to the issue. She discussed the results of a demonstration project, showing some positive results. (more…) *This blog post was originally published at KevinMD.com* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3822921 Wed, 04 Aug 2010 14:00:17 +0100 3822921 http://www.medworm.com/index.php?rid=3816758&cid=t_90241_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2FmShjsSO3yyM%2F A new study finds that clinical trials funded by the pharmaceutical industry are more likely to report a positive outcome, but less likely to be published shortly after completion than trials funded by other sources, such as the federal government, non-profit groups or academia. Unlike previous studies on this topic, the researchers say their study broadens the debate because they made a point of examining 546 trials that were registered on ClinicalTrials.gov and involved five widely used classes of meds for treating depression, high cholesterol, high blood pressure, heartburn and schizophrenia. All of the trials occurred between 2000 and 2006. The study, which was published in The Annals of Internal Medicine, found 346 trials, or 63 percent, were primarily funded by industry, 74 or 14 per... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=3816758 Tue, 03 Aug 2010 14:50:41 +0100 3816758 http://www.medworm.com/index.php?rid=3816331&cid=t_90241_83_f&fid=34856&url=http%3A%2F%2Finsidesurgery.com%2F2010%2F08%2Freport-shows-industrysponsored-medical-research-finds-surprise-positive-benefits%2F Dr. Kenneth Mandl and colleagues at Childrens Hospital in Boston have published a report in Annals of Internal Medicine showing that the overwhelming majority of industry-sponsored medical research finds results that would financially benefit the sponsoring industry. (Source: Inside Surgery) Inside Surgery blogs http://www.medworm.com/rss/comments.php?id=3816331 Tue, 03 Aug 2010 13:38:35 +0100 3816331 http://www.medworm.com/index.php?rid=3812978&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhow-error-free-is-your-doctors-care%2F2010.08.02 According to the Annals of Internal Medicine, doctors make the wrong medical decisions surprisingly often. Using a “mystery patient” technique –- in which actors pretended to be patients –- researchers found that doctors made errors in complicated cases in 60 percent to 90 percent of cases. Sixty to ninety percent. In uncomplicated cases, they made errors in nearly 30 percent of cases. As one study participant put it, “I was shocked.” The study took place over three years, and included more than 100 doctors in six Chicago-area hospitals. The doctors had agreed to participate in a study on medical decision making, but had no idea that they might see a patient who was actually an actor. The actors recorded their conversations with the doctors. (more…) *This bl... Better Health blogs http://www.medworm.com/rss/comments.php?id=3812978 Mon, 02 Aug 2010 16:00:06 +0100 3812978 http://www.medworm.com/index.php?rid=3808667&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fa-doctors-feelings-about-caring-for-abnormal-kids%2F2010.08.01 I’ve been practicing for sixteen years now, doing both internal medicine and pediatrics. One of the joys of that is watching kids under my care grow up and not having to give up their care just because they get older. The spectrum is wide, with some kids growing up in “normal” families with “normal lives,” others in “abnormal” families, and yet others with inherently “abnormal” lives due to illness or disability. But the kids aren’t the only thing that has changed over the past sixteen years. Their doctor has changed as well. My comfort zones have widened, not getting rattled by “abnormal” as I once did. I used to feel uncomfortable with the mentally and emotionally disabled, now I am not. I used to feel sorry for parents with “abnormal” children. I used to feel... Better Health blogs http://www.medworm.com/rss/comments.php?id=3808667 Sun, 01 Aug 2010 14:00:16 +0100 3808667 http://www.medworm.com/index.php?rid=3798562&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ftransitioning-primary-care-to-patient-centered-team-care%2F2010.07.28 While the “patient-centered medical home” may be a good idea, it needs a better name. It sounds like a hospice, reports surgeon and columnist Pauline Chen, M.D. She outlines the initial experiences of practices making the transition to the new practice model. One problem uncovered by pilot projects is that doctors in transition to the practice model have to spend inordinate amounts of time of things other than patients. And while the patients want and welcome the changes, they face a learning curve too, as they move from seeing just the doctor to working with a team of providers for their care.  Physicians suggested using resources from the Patient-Centered Primary Care Collaborative, a collaborative group set up to help offices make the transition. (New York Times) *T... Better Health blogs http://www.medworm.com/rss/comments.php?id=3798562 Wed, 28 Jul 2010 16:00:00 +0100 3798562 http://www.medworm.com/index.php?rid=3798564&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fcareer-counselor-thoughts-on-becoming-a-doctor%2F2010.07.28 As a physician, I’ve had several people ask my “honest” opinion of their plans to become a doctor. I know what my response is to this question, but I wonder what others in my profession would answer. Would your response depend, in large part, on who’s doing the asking — could you answer your own child as you would someone you just met? Be careful, your answer to this question, if honestly given, might shine an unsettling light on your own feelings about your current career choice. Last week I spoke with a college junior working to fulfill her lifelong plans to become a physician. She told me about a recent conversation with her own doctor where she shared her plans to go to medical school and he’d tried to dissuade her. She couldn’t recall a single cogent reason given f... Better Health blogs http://www.medworm.com/rss/comments.php?id=3798564 Wed, 28 Jul 2010 12:00:26 +0100 3798564 http://www.medworm.com/index.php?rid=3794775&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-insulting-term-physician-extender%2F2010.07.27 “Physician Extender.” It sounds like the name of a male enhancement product. It’s a term often used to describe a nurse practitioner or a physician’s assistant. I hate it. It’s insulting. A nurse practitioner is not an adjunct physician. They do not supplement the care of a physician. They provide essential advance-practice nursing services, services that include diagnosis and provision of medical care. While some of these services overlap those of medicine, nurse practitioners are not extensions of another profession, they provide care in their own right — as educated, licensed practitioners. Sometimes the only care provider for a community is a nurse practitioner. (more…) *This blog post was originally published at Emergiblog* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3794775 Tue, 27 Jul 2010 12:00:12 +0100 3794775 http://www.medworm.com/index.php?rid=3790705&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fteam-care-in-the-patient-centered-medical-home%2F2010.07.26 “Team care” has become a rallying cry for those who think the patient-centered medical home is bad for healthcare reform. Comments on a recent blog post in the New York Times provide a good example of this. When patients get sick, as the argument goes, they want to see their doctor — not some nurse or PA who they don’t know. I agree. There are a whole bunch of things wrong with all the current focus on team care in the patient-centered medical home. (more…) *This blog post was originally published at Mind The Gap* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3790705 Mon, 26 Jul 2010 14:00:24 +0100 3790705 http://www.medworm.com/index.php?rid=3776379&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fprimary-care-conference-moves-industry-support-off-site%2F2010.07.21 Harvard’s annual primary medicine conference, Pri-Med East 2010, will move the industry-supported portion of the program off-site, and marketing will be further restricted (advertisements had been allowed in bathrooms, for example.) A Harvard official said the new rules are meant to keep doctors from becoming or appearing as industry marketing agents. (The Boston Globe) *This blog post was originally published at ACP Internist* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3776379 Wed, 21 Jul 2010 21:00:00 +0100 3776379 http://www.medworm.com/index.php?rid=3764138&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2F19th-century-cure-for-obesity%2F2010.07.18 I really want to know what the treatment is that this “regular practicing physician” sent to the patient to reduce the surplus flesh. “Eat as much and as often as you please” and “no bandaging nor tightlacing.” Bring it on! *This blog post was originally published at EverythingHealth* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3764138 Sun, 18 Jul 2010 12:00:00 +0100 3764138 http://www.medworm.com/index.php?rid=3753822&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fan-important-tip-for-men-who-use-viagra%2F2010.07.14 The medical journal Mayo Clinic Proceedings recently contained some clinical pearls that I wanted to pass on to my men readers who take medication for erectile dysfunction (ED). They reported on a healthy 67-year-old male who took two 25mg doses of Viagra (sildenafil) but still did not get erections. He was frustrated and inquired about other treatments for ED. The article reported that patients often take Viagra and other phosphodiesterase type 5 inhibitors (Cialis, Levitra) incorrectly. To be effective, Viagra must be taken on an empty stomach at least one hour before intercourse. Research has shown that approximately half of patients who don’t respond to Viagra will have success when they take it properly. The dose can go up to 100mg, but there is no need to increase the medi... Better Health blogs http://www.medworm.com/rss/comments.php?id=3753822 Wed, 14 Jul 2010 22:00:00 +0100 3753822 http://www.medworm.com/index.php?rid=3753824&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fno-medical-school-debt-more-primary-care-doctors%2F2010.07.14 There’s little question that medical school debt is rising rapidly, affecting the career choice of medical students. It’s one of the main reasons why the disparity between the number of specialists and primary care doctors is widening. There have been a variety of proposed solutions — most recent of which are medical schools completely subsidizing their tuition. I think that’s a good step forward, but so far has only been limited to a few schools nationwide. (more…) *This blog post was originally published at KevinMD.com* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3753824 Wed, 14 Jul 2010 18:00:45 +0100 3753824 http://www.medworm.com/index.php?rid=3750059&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fonline-medical-records-not-all-patients-want-all-that%2F2010.07.13 Anytime you come across a healthcare article that implies that every patient wants access to this or that – i.e. their medical record, patient-centered care, etc. – you can safely assume that the claim is wrong. Why? Patients are not a monolithic group –- they don’t all share the same motivations, preferences, beliefs or experiences when it comes to their health. But let’s face. If you are trying to push an agenda, just saying some people want this or that is not the same as implying that everyone wants it. Take the issue of patient access to physician notes in their medical record. Robert Wood Johnson (RWJ) recently announced their OpenNotes study. The OpenNotes project will evaluate the impact on both patients and physicians of sharing, through online medical record p... Better Health blogs http://www.medworm.com/rss/comments.php?id=3750059 Tue, 13 Jul 2010 18:00:51 +0100 3750059 http://www.medworm.com/index.php?rid=3740595&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fno-forgetting-to-take-your-meds%2F2010.07.09 Normally, the patient calls the pharmacy for a prescription. Now, the prescription is doing that by itself. GlowCaps, a prescription bottle cap made by Vitality, has assumed control for medication compliance. The bottle cap fits prescription bottles, but has uses cellphone technology to tap into wireless networks. Once connected, the pill bottle does everything imaginable to remind patients to take their pills. There’s lights — plenty of them. The bottle cap really does glow and make noise to remind patients. Plug-in units wirelessly connected to the bottle cap can be placed anywhere there’s a wall socket. Oh, and it will call you, too, if you forget. The company calls this “Reminders Ramp from Subtle to Insistent.” (Add “relentless” to that.) Ulti... Better Health blogs http://www.medworm.com/rss/comments.php?id=3740595 Sat, 10 Jul 2010 03:47:23 +0100 3740595 http://www.medworm.com/index.php?rid=3740598&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fon-hold-with-the-doctors-office-is-pop-music-doc-music%2F2010.07.09 So I’m calling a referring physician’s office the other day when their telephone answering message puts me on hold. And wouldn’t you know it — Kelly Clarkson was blasting in my ears. When the doc came on the phone, I asked him if he was a Kelly Clarkson fan. He had no idea what I was talking about. But it got me thinking. So I asked him how their office chose their telephone answering message. He said he didn’t know. He figured the music was being fed from a local radio station. You may not realize it, but having a well-thought-out telephone answering message can be a vitally important part of a doctor’s business. It’s the first contact patients and colleagues have with an office. It sets the first impression. I’m sure there are consult... Better Health blogs http://www.medworm.com/rss/comments.php?id=3740598 Fri, 09 Jul 2010 13:00:00 +0100 3740598 http://www.medworm.com/index.php?rid=3733084&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fget-a-discount-if-your-doctor-is-running-late%2F2010.07.07 Should doctors face consequences if they run late? From The New York Times’ health blog, Well, comes a story where a medical group promises “same-day appointments and longer, more personalized visits that start on time.” Sounds good, right? But it comes with a caveat, namely, a $199 annual membership fee. A tremendous amount of primary care can be bought with that amount of money, and if patients were willing to pay that, service will most definitely improve. (more…) *This blog post was originally published at KevinMD.com* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3733084 Wed, 07 Jul 2010 23:00:19 +0100 3733084 http://www.medworm.com/index.php?rid=3733085&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fwww.vimeo.com%2Fmoogaloop.swf%3Fclip_id%3D10444174%26amp%3Bserver%3Dwww.vimeo.com%26amp%3Bfullscreen%3D1%26amp%3Bshow_title%3D1%26amp%3Bshow_byline%3D0%26amp%3Bshow_portrait%3D0%26amp%3Bcolor%3D01AAEA ePatient Dave, who shared his story (video below) with my students in the “Internet in Medicine” course this semester, is about to publish his own book: “Laugh, Sing, and Eat Like a Pig: How an Empowered Patient Beat Stage IV Cancer.” Now three of his friends have written essays about this important issue: We who’ve worked on it hope it will provoke thought about how healthcare is changing because of what e-patients can contribute, empowered as individuals and enabled by the Internet. To start that process, we’re publishing the introduction. Three friends and mentors generously offered introductory essays. These essays they have little to do with my story, and everything to do with how e-patients can help heal healthcare: Part 1, by Dr. Danny Sands: Putting Informatio... Better Health blogs http://www.medworm.com/rss/comments.php?id=3733085 Wed, 07 Jul 2010 19:00:37 +0100 3733085 http://www.medworm.com/index.php?rid=3733087&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdespite-medicare-primary-care-doctors-were-paid-more-in-2009%2F2010.07.07 The Senate has further tweaked its doc fix legislation to restore the extension to six months (from June 1 through Nov. 30) and the pay raise to 2.2 percent, reports a Senate Finance Committee Republican advisor. In Northern Michigan, the doc fix can’t come soon enough, as yet more physicians contemplate not accepting any more Medicare patients. The legislation continues to see revisions in the Senate, following the U.S. House refusal to consider the doc fix as a stand-alone bill. (TwitDoc, WWTV/WWUP-TV News) But primary care physicians saw a 2.8 percent median compensation increase in 2009, according to a Medical Group Management Association survey. MGMA attributed the rise to employers’ and payers’ increased commitment to primary care, but noted threats to Medicare payments s... Better Health blogs http://www.medworm.com/rss/comments.php?id=3733087 Wed, 07 Jul 2010 14:00:00 +0100 3733087 http://www.medworm.com/index.php?rid=3729876&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fnew-study-shingles-vaccine-is-safe-and-effective%2F2010.07.06 Shingles (herpes zoster) is no fun. It usually begins with a couple of days of pain, then a painful rash breaks out and lasts a couple of weeks. The rash consists of blisters that eventually break open, crust over, and consolidate into an ugly plaque. It is localized to one side of the body and to a stripe of skin corresponding to the dermatomal distribution of a sensory nerve. Very rarely a shingles infection can lead to pneumonia, hearing problems, blindness, brain inflammation (encephalitis) or death. More commonly, patients develop postherpetic neuralgia (PHN) in the area where the rash was. The overall incidence of PHN is 20%; after the age of 60 this rises to 40%, and after age 70 it rises to 50%. It can be excruciatingly painful, resistant to treatment, and can last for years or eve... Better Health blogs http://www.medworm.com/rss/comments.php?id=3729876 Tue, 06 Jul 2010 19:00:19 +0100 3729876 http://www.medworm.com/index.php?rid=3723304&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2F6-tips-to-a-simpler-lifestyle%2F2010.07.03 I like to pass on good tips, and these ways to simplify your life make a lot of sense. The constant stress we feel because life is so complicated isn’t good for our health. Here are six tips to have a simpler lifestyle: 1. De-Clutter Your Home Look around. If you have piles of paper, too many “things” and nic-nacs laying around, it’s hard to think clearly and function. An open, clear space allows our minds to feel open and more peaceful. Tackle one room at a time. Be ruthless and donate or toss everything that isn’t useful, beautiful, or has special memories. 2. Limit Family Activities Try to force family members to choose only those activities that are most important. Many of us are over-scheduled and have no time to “just see where the day will t... Better Health blogs http://www.medworm.com/rss/comments.php?id=3723304 Sat, 03 Jul 2010 22:00:00 +0100 3723304 http://www.medworm.com/index.php?rid=3723306&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fweight-loss-the-horserace-between-low-carb-and-low-fat%2F2010.07.03 Journalist Andrew Holtz, one of our expert reviewers on HealthNewsReview.org, has some fun with a horserace-style look at low-carb versus low-fat diet research on his MDiTV.com site: *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=3723306 Sat, 03 Jul 2010 14:00:18 +0100 3723306 http://www.medworm.com/index.php?rid=3721767&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpreventive-health-in-hd-a-video-just-for-men%2F2010.07.02 Check out this darkly humorous advertising campaign from the U.S. Department of Health and Human Services. How do you convince men to go to the doctor and get the preventive healthcare that’s known to save lives?  You make it all about television. Men + HD TV = “Yes.” This video is funny on so many levels. *This blog post was originally published at The Happy Hospitalist* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3721767 Fri, 02 Jul 2010 12:00:00 +0100 3721767 http://www.medworm.com/index.php?rid=3714185&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fnational-headache-awareness-week-two-helpful-videos%2F2010.06.30 June 6-12 was National Headache Awareness Week. If you would like more information, check out the website for the National Headache Foundation. Below are two TV interviews that took place this week on local morning TV news shows talking about headaches: If you find these helpful, I encourage you to check out my other TV interviews at MikeSevilla.TV. *This blog post was originally published at Doctor Anonymous* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3714185 Wed, 30 Jun 2010 18:00:00 +0100 3714185 http://www.medworm.com/index.php?rid=3714444&cid=t_90241_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2FJSU5gTPTZaE%2F Earlier this week, the Archives of Internal Medicine published a few articles and editorials about statins, although one, in particular, generated some heat - a review of the controversial Jupiter study from 2008. The study, which focused on AstraZeneca’s Crestor cholesterol pill, measured levels of a protein called CRP that can indicate arteries are inflamed and point toward heart disease. The results prompted debate over the extent to which CRP should be used as a guideline for treating cholsterol and the wisdom in prescribing Crestor and other statins to people with low cholesterol. This week’s revisitation (see here) stirred anew the controversy, but also focused on allegations of poor methodology, bias and conflicts of interest (see here). However, as was noted yesterday, two ... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=3714444 Wed, 30 Jun 2010 13:42:30 +0100 3714444 http://www.medworm.com/index.php?rid=3714188&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fsocial-mission-a-primary-care-score-for-medical-schools%2F2010.06.30 Medical schools are traditionally ranked on criteria like research funding and technological innovation. These rankings are highly significant. A place on the U.S. News‘ annual “Best Medical School” list  is a coveted spot indeed. So that’s why there was some media attention paid to a recent study from the Annals of Internal Medicine, which ranked medical schools according to their “social mission” — a phrase that defines a school’s commitment to primary care, underserved populations and workforce diversity. Using this new criterion, some of the traditionally high ranking schools fell significantly. (more…) *This blog post was originally published at KevinMD.com* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3714188 Wed, 30 Jun 2010 12:00:17 +0100 3714188 http://www.medworm.com/index.php?rid=3706674&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhoop-de-do-to-the-medicare-physician-pay-cut-problem%2F2010.06.28 After months of dithering, delaying, denying, and defaulting on a decision, Congress ended up…doing as little as possible to address the Medicare physician pay cut problem. Thursday night the House of Representatives acceded to the Senate’s bill to provide physicians with a 2.2 percent update retroactive to June 1. This respite, though, lasts only through the end of November, when physicians and patients will again face another double-digit cut. And if the past is prologue, a lame-duck Congress then will wait until the very last minute to enact another short-term patch, or worse yet, allow the cut to go into effect on December 1 and then pass some kind of retroactive adjustment. You know that the situation has gotten ridiculously bad when the President says this about the bill he ... Better Health blogs http://www.medworm.com/rss/comments.php?id=3706674 Mon, 28 Jun 2010 18:00:00 +0100 3706674 http://www.medworm.com/index.php?rid=3706675&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fsgr-tired-of-congress-hitting-the-6-month-snooze-button%2F2010.06.28 I have not a single thing I want to write about today. I am weary of the obvious topic: the “passage” of the 6-month extension on the SGR, but do feel I need to comment. I am tired of this. I am tired of being jerked around by congress. I am tired of congress hitting the 6-month snooze button and somehow feeling that they are doing something good. This is procrastination, not a solution. Reassurances that something will be done are starting to be irrelevant. The problem is becoming the frustration, anger, and exhaustion that congress is thrusting upon doctors and patients, not the pay cut itself. The idea of no longer having to deal with the passive-aggressive tactics of congress is becoming increasingly appealing –- and if it’s this way for me, I’m sure it’s the s... Better Health blogs http://www.medworm.com/rss/comments.php?id=3706675 Mon, 28 Jun 2010 16:00:17 +0100 3706675 http://www.medworm.com/index.php?rid=3699496&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdiarrhea-clinic-for-international-travelers%2F2010.06.25 I’m not sure what country this photo was snapped in, but the clinic owners were smart enough to help international travelers seek care for traveler’s diarrhea. There’s no beating around the bush on this one. If you’re in this waiting room staring at strangers, they’re all going to know why you’re there. Diarrhea Clinic — that’s simple brilliance. That doctor needs to be hired by the ACP and SHM and ABIM to help us answer questions like ”What is an internist?” and “What is a hospitalist?” For these doctors, everyone knows exactly what he does — no questions necessary. *This blog post was originally published at The Happy Hospitalist* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3699496 Fri, 25 Jun 2010 16:00:00 +0100 3699496 http://www.medworm.com/index.php?rid=3699497&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmicrobiology-and-the-cooties-epidemic%2F2010.06.25 Remember “cooties” in grade school? You know, the germs or disease that girls gave boys or boys gave girls in grade school if they touched? Well, it seems they’re becoming an epidemic. Thank goodness someone checked for “cooties” on the Stanley Cup: The NHL champion Blackhawks’ beloved trophy stopped by the Chicago Tribune newsroom, and so we took the opportunity to do something the Cup’s keeper said had never been done: We swabbed it for germs. We sent the samples to the Chicago lab EMSL Analytical, which found very little general bacteria and no signs of staph, salmonella or E. coli. “It’s surprisingly clean,” lab manager Nancy McDonald said. Just 400 counts of general bacteria were found, she said. By comparison, a desk in an o... Better Health blogs http://www.medworm.com/rss/comments.php?id=3699497 Fri, 25 Jun 2010 14:00:00 +0100 3699497 http://www.medworm.com/index.php?rid=3695570&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fscience-and-the-pain-scale%2F2010.06.24 Every day in the emergency department I am confronted by pain. In fact, the treatment of pain is one of the most important skills emergency physicians, indeed all physicians, possess. For instance, I recently cared for a child with sickle cell disease who was having a pain crisis which involved severe leg pain. His life is one of frequent, intense pain. I gently, and repeatedly, treated his pain with morphine until he had relief. I see hip fractures; all broken bones hurt. I am thrilled to alleviate that discomfort.  Pain is one of the things I can fix, if only temporarily. It makes me happy to see the relaxed face of a man or woman with a kidney stone or migraine, who suddenly smiles and says “thanks!” But pain is also the source of so much subterfuge. Emergency depart... Better Health blogs http://www.medworm.com/rss/comments.php?id=3695570 Thu, 24 Jun 2010 16:00:26 +0100 3695570 http://www.medworm.com/index.php?rid=3690836&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealthcare-finance-and-poverty-fault-lines-intersected%2F2010.06.23 Solutions to problems are generally sought from within the problems themselves. Two recent examples are healthcare and finance. In both cases, the solutions are believed to be better-structured and regulated systems. In blogs, articles and speeches, I have stressed that — while there are myriad ways that healthcare can be improved — the real solutions to high healthcare spending lie outside of healthcare. Poverty and its associated manifestations are at the core of the healthcare spending crisis. The high costs of caring for the poor will continue to overwhelm the system, no matter how it’s structured and improved. Rather than looking for solutions through changes in process and regulation, the major solutions to healthcare’s excessive spending reside in areas such as ... Better Health blogs http://www.medworm.com/rss/comments.php?id=3690836 Thu, 24 Jun 2010 00:45:35 +0100 3690836 http://www.medworm.com/index.php?rid=3690837&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fphysician-burnout-when-being-a-doctor-makes-you-sick%2F2010.06.23 Do doctors take care of themselves? Sometimes patients may better follow the advice of physicians who aren’t obese and don’t smoke. That was a question asked in a post last year, entitled “When fat doctors talk to obese patients.” According to studies, as reported in the Wall Street Journal, it’s a mixed bag: Physicians as a group are leaner, fitter and live longer than average Americans. Male physicians keep their cholesterol and blood pressure lower. Women doctors are more likely to use hormone-replacement therapy than their patients. Doctors are also less likely to have their own primary care physician—and more apt to abuse prescription drugs. Clearly there’s room for improvement. (more…) *This blog post was originally published at KevinMD.com* ... Better Health blogs http://www.medworm.com/rss/comments.php?id=3690837 Wed, 23 Jun 2010 20:00:31 +0100 3690837 http://www.medworm.com/index.php?rid=3690838&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmedical-schools-why-do-some-do-primary-care-better%2F2010.06.23 A new study published in the Annals of Internal Medicine, ACP’s flagship journal, finds that medical schools vary greatly in producing more primary care physicians and getting them into underserved communities. - “Public schools graduate higher proportions of primary care physicians” than private schools. - “The 3 historically black colleges and universities with medical schools (Morehouse College, Meharry Medical College, and Howard University) score at the top” in training primary care physicians who then go on to practice in underserved communities. (Click here for an interview with two recent graduates of historically black colleges and with Wayne Riley, MD, FACP, who is the president and CEO of Meharry Medical College in Nashville, Tennessee and a regent ... Better Health blogs http://www.medworm.com/rss/comments.php?id=3690838 Wed, 23 Jun 2010 18:00:00 +0100 3690838 http://www.medworm.com/index.php?rid=3690839&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fkeeping-the-primary-in-care%2F2010.06.23 He came in for his regular blood pressure and cholesterol check. On the review of systems sheet he circled “depression.” “I see you circled depression,” I said after dealing with his routine problems. “What’s up?” “I don’t think I am actually clinically depressed, but I’ve just been finding it harder to get going recently,” he responded. “I can force myself to do things, but I’ve never have had to force myself.” “I noticed that you retired recently. Do you think that has something to do with your depression?” I asked. “I’m not really sure. I don’t feel like it makes me depressed. I was definitely happy to stop going to work.” I have taken care of him for many years, and k... Better Health blogs http://www.medworm.com/rss/comments.php?id=3690839 Wed, 23 Jun 2010 16:00:00 +0100 3690839 http://www.medworm.com/index.php?rid=3687102&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpay-patients-to-take-their-medicine%2F2010.06.22 The New York Times reported recently on efforts by providers and payers to increase patient medication adherence through the use financial incentives paid to patients. The article cited the use of small financial payments (<$100), awarded via lotteries, to patients that take Warfarin –- an anti-blood clotting medication. There is certainly nothing wrong with financial incentives. Incentives have been proven successful in changing selected provider (quality and safety improvement) and patient behavior (stop smoking, weight loss and taking health risk surveys). But paying patients to take their medication is different. Actually, the evidence suggests that it is a just plain stupid idea for a whole lot of reasons. (more…) *This blog post was originally published at Mind The... Better Health blogs http://www.medworm.com/rss/comments.php?id=3687102 Tue, 22 Jun 2010 14:00:17 +0100 3687102 http://www.medworm.com/index.php?rid=3683622&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhealthcare-reform-digging-out-of-the-sgr-hole%2F2010.06.21 Friday, the Senate — in a rare stroke of bipartisanship — voted by unanimous consent to reverse the 21 percent SGR cut and provide positive updates of 2.2 percent through November 2010. The legislation is fully paid for by offsets in other spending programs. Unfortunately, though, the cut remains in effect and claims are being processed at reduced rates, because the House of Representatives has recessed for the weekend and won’t be back until Tuesday. At that time, I expect that the House will pass the Senate’s six-month reprieve and Medicare will make doctors “whole” for the period of time that the cut was in effect. Not that any of this is a cause for celebration. In the meantime, claims still are being paid at reduced rates, creating havoc for physicians... Better Health blogs http://www.medworm.com/rss/comments.php?id=3683622 Mon, 21 Jun 2010 12:00:00 +0100 3683622 http://www.medworm.com/index.php?rid=3679755&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fhow-to-be-happy%2F2010.06.20 The bilious oil hemorrhaging from the bowels of the Earth, coupled with the usual stressors of life, makes me feel sad and pessimistic of late. And while I’m still pretty sure that ignorance, intolerance, and our polluting routines will be our ruin, I also search for ways to retain optimism and hope. Amid the constant erosion there are basic roots that hold life together. If you share the belief that life is fundamentally absurd, then life is truly what you make it. Are there small steps proven to make us happier? Psychology often concerns itself with helping ailing people get back to a neutral ground, but the field of positive psychology aims to do more. University of Pennsylvania psychologist Dr. Martin Seligman, positive psychology’s most renowned proponent, once said: “I realized... Better Health blogs http://www.medworm.com/rss/comments.php?id=3679755 Mon, 21 Jun 2010 02:36:21 +0100 3679755 http://www.medworm.com/index.php?rid=3678529&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fsports-on-doctor-time%2F2010.06.19 We all know about “doctor time.” No matter how hard I try, the clock seems to out sprint me. Morning rounds in the hospital go longer than expected, a colleague stops you with a question, a son forgot his lunch, or something else. The list is long. In fact, as a very well-educated patient, it seems that the doctors I choose for myself and family are even later than I. It seems that most good doctors have long waits. A coincidence? However accepted ”doctor time” is in the office or hospital, it doesn’t work the same in the bike racing world. In the land of genetically endowed androids, the clock waits for no one in particular. It turns out that our pizza-sponsored team has a few doctors who run on “doctor time” in real life. (more…) ... Better Health blogs http://www.medworm.com/rss/comments.php?id=3678529 Sat, 19 Jun 2010 14:00:00 +0100 3678529 http://www.medworm.com/index.php?rid=3671697&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-improved-patient-care-isnt-in-the-chart%2F2010.06.16 Why do we physicians chart the way we do? Hopefully, we do it perfectly well and have no concerns at all. But where I practice emergency medicine, we are approaching maximum inefficiency in charting. It all became much clearer when we started using our new EMR system. Let me make it clear, I’m not against EMR. In fact, typing and templates work better for me than dictating. My dictations were usually a mine field of blanks and misunderstood words. Furthermore, if I wanted to use it, we have a new voice recognition dictation system in addition to our templated chart. Though admittedly, the voice recognition program clearly hates some of my partners, as evidenced by the way they grasp the screen and yell at it (‘Chest Pain, not west rain!’) and by its inexplicable use of profanity in ... Better Health blogs http://www.medworm.com/rss/comments.php?id=3671697 Wed, 16 Jun 2010 22:00:10 +0100 3671697 http://www.medworm.com/index.php?rid=3671698&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-primary-care-doctors-leave%2F2010.06.16 There’s little question that the workplace environment for doctors is deteriorating. Especially in primary care, where physicians are arguably needed the most. That’s why is so disheartening to read this Newsweek essay from pediatrician Karen Li, explaining why she left the field. Much of her piece can be attributed to the bad old days of managed care, where doctors were frustrated by the bureaucratic impediments placed before them. (more…) *This blog post was originally published at KevinMD.com* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3671698 Wed, 16 Jun 2010 20:00:15 +0100 3671698 http://www.medworm.com/index.php?rid=3671699&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Ftoo-much-testing-and-treatment-try-superb-primary-care%2F2010.06.16 The Associated Press has been running a fantastic series of must reads with the latest article highlighting the consequence of too many imaging studies, like X-rays and CT scans, which are the biggest contributor to an individual’s total radiation exposure in a lifetime. Americans get more imaging radiation exposure and testing than people from other industrialized countries. Reasons for doing too many tests include malpractice fear, patient demands for imaging, the difficulty in obtaining imaging results from other doctors or hospitals, as well as advanced technologies, like coronary angioplasty, which have increased radiation but avoid a far more invasive surgery like heart bypass. (more…) *This blog post was originally published at Saving Money and Surviving the Heal... Better Health blogs http://www.medworm.com/rss/comments.php?id=3671699 Wed, 16 Jun 2010 18:00:00 +0100 3671699 http://www.medworm.com/index.php?rid=3671700&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2F8-things-you-shouldnt-keep-from-your-doctor%2F2010.06.16 It’s important to have an open relationship with your primary care physician because the more he or she knows about your health and lifestyle, the better able he or she is to diagnose illnesses as they come up. You wouldn’t take your car to a mechanic and not tell him that the brake is sticking, and a human organism is thousands of times more complicated than a car. But patients are shy. They’re embarrassed. They don’t want you to think badly about them, so they often leave out important information that’s critical for the physician to know. (more…) *This blog post was originally published at EverythingHealth* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3671700 Wed, 16 Jun 2010 16:00:00 +0100 3671700 http://www.medworm.com/index.php?rid=3665969&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhy-you-should-still-see-your-doctor-when-youre-not-sick%2F2010.06.16 Experts say over 100,000 lives a year could be saved in the United States if patients focused more on preventive medicine. What is preventive medicine? What can you do in your everyday life that may make a long-term difference? On this Patient Power program, you will hear from two board certified internists from the UW Medicine Neighborhood Clinics in Western Washington. They will discuss how having an ongoing relationship with a primary care physician who you check in with regularly –- even when you’re well –- gives you the best chance at staying healthy. (more…) (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3665969 Wed, 16 Jun 2010 14:00:13 +0100 3665969 http://www.medworm.com/index.php?rid=3662672&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fless-is-more-in-medicine-why-patients-arent-buying-it%2F2010.06.14 In a recent article, the editors of the Archives of Internal Medicine make the case that too much unneeded care is being delivered in physician’s offices these days. According to the authors, “patient expectations” are a leading cause of this costly problem. Their solution? Get physicians to share with patients the “evidence” for why their requests are crazy, wrong, ill-informed or just plain stupid. But getting patients to buy into the “less is more” argument is a daunting task as most physicians already know. The problem is complicated by the fact that patients have a lot good reasons for not buying it. (more…) *This blog post was originally published at Mind The Gap* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3662672 Mon, 14 Jun 2010 20:00:18 +0100 3662672 http://www.medworm.com/index.php?rid=3662674&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Funnecessary-tests-and-treatments-responsible-reporting-can-help%2F2010.06.14 Just when I’ve lost hope that mainstream media will stop perpetuating the myth the more medicine equals better care, the Associated Press came up with this excellent piece. The article states, rightly, that “anywhere from one-fifth to nearly one-third of the tests and treatments we get are estimated to be unnecessary,” and that, “it may lead to dangerous side effects.” Regular readers of this blog should be familiar with those concepts. I wrote recently that patients often reject evidence-based medicine. One reason is that there aren’t enough clinical guidelines available for patients to make an informed decision. (more…) *This blog post was originally published at KevinMD.com* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3662674 Mon, 14 Jun 2010 16:00:37 +0100 3662674 http://www.medworm.com/index.php?rid=3655587&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Funderwear-20-the-militarys-vital-monitoring-briefs%2F2010.06.11 You just can’t make this stuff up: The underwear project, spearheaded by the nanoengineering professor, was funded by the U.S. military and its effectiveness will likely be tested on the battlefield. “This specific project involves monitoring the injury of soldiers during battlefield surgery,” Wang told Reuters. “The goal is to develop minimally invasive sensors that can locate, in the field, and identify the type of injury.” Ultimately, the waistband sensors will be able to direct the release of drugs to treat the wounded soldier. I wonder what other creative uses our men in uniform will find for this? I can hear it now: “It’s not the size of the device, honey, it’s the metronome that’s in it!” (Heh.) -WesMusings of a cardiologis... Better Health blogs http://www.medworm.com/rss/comments.php?id=3655587 Fri, 11 Jun 2010 21:00:00 +0100 3655587 http://www.medworm.com/index.php?rid=3652408&cid=t_90241_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmedical-devices-spell-stromuhr-win-the-spelling-championship%2F2010.06.10 They seem to like medical devices in the high stakes world of spelling championships. Anamika Veeramani, from Cleveland, Ohio, won the Scripps National Spelling Bee this weekend by spelling “stromuhr,” a rheometer designed to measure the amount and speed of blood flow through an artery. Don’t feel bad — we’d never heard of it before either, and we’re supposed to be experts in this stuff. Education never ends… Merriam-Webster: Stromuhr London Science Museum: Ludwig-type stromuhr, London, England, 1920-1940 Press release: National Spelling Bee: A Spawning Ground for Future Physicians and Obscure Diseases *This blog post was originally published at Medgadget* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3652408 Thu, 10 Jun 2010 18:00:01 +0100 3652408