The magic number is 39 weeks.
MedPage Today reports on a NEJM study that looked at women who underwent a repeat Caesarean delivery. It found that infants who delivered early, defined as less than 39 weeks, had a markedly increased risk of adverse outcomes, which included "adverse respiratory outcomes, need for mechanical ventilation, newborn sepsis, hypoglycemia, admission to the neonatal ICU, and hospitalization for five days ...
January 2009
All Stories
President Bush, lauded by The New York Times? On health care?
Read it to believe it.
The editorial staff (via Catron) throws the outgoing president a bone, praising him for increasing American support for the global fight against AIDS, pushing through Medicare's drug prescription plan, granting Massachusetts a Medicaid waiver to help with their health reform plan, and doubling federal financing for community health centers.
Sure, much of the praise was tempered by their left-leaning bias, but ...
Recruiting a surgeon to a rural area, it takes more than money
Surgeons are often lured to practice in rural areas for large initial sums of money.
A typical package can be as high as a $350,000 salary, guaranteed for 3 years, along with a large signing bonus.
But long term, the prospects aren't as rosy says Jeffrey Parks. First off, rural surgeons may perform procedures that they may not be trained in, such "setting minor fractures, hysterectomies, ...
Poll: Which events of 2008 most affected and will continue to affect practicing physicians?
Which events of 2008 most affected and will continue to affect practicing physicians?
Here are my top 3.
First, is Medicare's institution of "never" events, where payment is denied for certain medical errors. In addition to uncontroversial events like operating on the wrong patient, Medicare has also included conditions where total prevention is impossible, including patient falls and hospital acquired infections. By doing so, hospitals ...
How Obama’s health reform will hurt Canada
Providing universal care will stretch our already thin primary care resources beyond capacity.
So where will the new doctors come from, given the influx of 50 million or so newly insured patients? Look no further than our neighbors up north.
Analysts are predicting a surge in primary care demand that is "likely to trigger a drain on Canada's already meager supply of physicians."
Consider Massachusetts, who ...
How doctors can stay on time when seeing patients
I see close to 30 patients a day and generally stay on time.
So yes, it's possible. With customer service being an important component of patient satisfaction, it pays to stay on time. That's literally true, as you can also see more patients in a day when you're punctual.
Most patients do not like spending the day at a physician's office, and are pleasantly surprised when ...
Ban smoking and watch the rate of heart attacks drop
Consider the town of Pueblo, Colorado.
Since banning smoking in public places three years ago, hospital admissions for myocardial infarctions had declined 41% from pre-ban levels.
MedPage Today points to the numbers from the CDC's Morbidity and Mortality Weekly Report, and also finds that neighboring counties, which did not implement the smoking ban, did not see the benefit of reduced heart attack admissions.
The ...
How to intubate yourself
Don't try this at home.
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(via The Happy Hospitalist and Bad Medicine, Good Solutions)
What if restaurants were paid like doctors?
Imagine if food was a universal right in America, and citizens can forward the bill to the national government.
Wendy Lynch does so, and hypothetically describes a system which assigns an "RVU" value to weigh the cost of different meals. Examples include "basic oatmeal and fruit served at a diner in Omaha is assigned a RVU of 1 . . . for consumers needing special meals, a ...
Treating chronic pain with narcotics and avoiding the risk of addiction
Management of chronic pain and anxiety is a significant challenge in primary care.
Rob Lamberts provides an excellent overview of how he manages pain requiring narcotic medications, and touches on other controlled substances like benzodiazepines.
Physician prescribing patterns can be quite variable, ranging from those who won't prescribe controlled substances under any circumstances, to others who take a "candy-man" approach, giving short-term narcotics liberally.
I agree with ...
Sanjay Gupta for Surgeon General, is he qualified?
Is this a case of style over substance?
Val Jones, who has interviewed three recent Surgeon Generals, calls it a "shock," and says, "I don't think he has the gravitas or appropriate experience for the role of Surgeon General of the United States."
She cites a source that is concerned about his lack of experience, and notes that it may cause tension within the Pentagon. "It ...
Why health IT and electronic medical records are so misguided
Is it the technology or the people behind the computers?
This piece from Health Care Renewal suggests it's the latter, or the so-called sociotechnical issues. In other words, the problem is not with the technology itself, but "inadequate planning, insufficient testing or training, failing to include front-line clinicians in the planning process, failure to consider best practices for HIT operationalization, failure to ...
Tufts Medical Center plays the Partners HealthCare card and drops Blue Cross Blue Shield
The stakes cannot be higher for Boston's Tufts Medical Center.
Over the past few weeks, we've been reading how rival Partners HealthCare, comprised of powerhouse hospitals Massachusetts General and Brigham and Women's Hospitals, have bullied health insurers into disproportionally higher payments.
I have argued it is because patients demand their services.
Now, Tufts Medical Center is attempting to play the same game, announcing they are ...
Prescribing insulin for diabetes, do endocrinologists have a financial incentive to do so?
Recent guidelines ignore newer oral diabetes agents like Avandia and Januvia.
Matthew Mintz criticizes this move, saying that this will lower the threshold for diabetes to begin insulin therapy.
He wonders if the endocrinologists, who authored the guidelines, have a financial motive to do so. Due to time constraints, primary care physicians do not have the inclination to manage insulin regimens, which can ...
Apple’s Steve Jobs, and how his hormonal imbalance and pancreas is making him sick
Endocrinologists are puzzled over the Apple chief executive's medical condition.
Steve Jobs disclosed a cryptic letter today detailing his health condition. It reads, "As many of you know, I have been losing weight throughout 2008. The reason has been a mystery to me and my doctors. A few weeks ago, I decided that getting to the root cause of this and reversing it needed to become my ...
Are all for-profit health care companies evil?
For-profit health care organizations are vilified in the media and those wanting to reform health care
But are the attacks justified or not? Val Jones points to several instances were non-profit academic institutions engaged in less than ethical behavior, while pointing out examples of for-profit companies who "who cultivate a culture of environmental responsibility and charity."
Judgments should not be made on
How to convince doctors to accept health reform
Stuff their mouths with gold.
Or so says Britain's health minister when asked how he got doctors to buy into the UK's National Health Service.
One way to overcome dissent is to buy off the opposition, and this is what Jacob Hacker is alluding to in his piece promoting an influx of dollars to push health reform forward (via Maggie Mahar) at all costs. He ...
Doctors are finding leprosy in the heartland
A man presents with a fever of 109 degrees, swollen lymph nodes, and hepatosplenomegaly.
MedPage Today reports that many doctors are unaccustomed to diagnosing and treating leprosy.
Approximately 150 cases are diagnosed annually, mainly in port cities. As immigrants are moving middle America, where the jobs are, medical providers are finding more cases.
The big clue is "a reduction or absence of sensation around the ...
Why doctors need to embrace retail clinics
A nice op-ed in Forbes.com outlines some basic strategies to revamp our generalist system.
Two suggestions, increasing payment and addressing defensive medicine, are not new and I certainly agree they need to be part of the answer. They have been discussed comprehensively in my past posts.
One idea, allying with retail clinics, is something that many physician groups foolishly oppose. But as the opinion piece ...
Do electronic medical records really reduce malpractice risk?
News released last week suggests this is may be the case.
The study, published in the Archives of Internal Medicine, trumpeted that of the doctors who used electronic medical systems, "6.1 percent had a record of paid malpractice claims compared with 10.8 percent of physicians who did not use an EHR."
In lieu of the lack of any improved patient outcome data associated with EHRs, proponents are ...
Kevin Pho, MD
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Why more primary care doctors are referring patients to specialists
According to a recent study from the Archives of Internal Medicine, primary care physicians are referring more patients to specialists than ever...
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Should Google censor anti-vaccine claims?
One of the reasons there is such a movement against vaccines is the democratization of information, perpetuated by search engines like Google....
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Radiologists who cheat on their board exams: Who’s to blame?
In a widely circulated CNN article, many radiologists have been found to cheat on their board exams: "Doctors around the country taking an...
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Doctors: Don’t be ashamed about going bankrupt
Are doctors really going broke? According to this piece from CNN Money, some are: "Doctors list shrinking insurance reimbursements, changing regulations, rising...
Physician
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Patients will understand an honest mistake if the doctor tells the truth
It was 1976 and I was a junior resident in urology at Baylor College of Medicine in Houston, Texas. I was assigned...
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Diagnosing an illness is an art
Diagnosis is the foundation on which all care and treatments rest. If the diagnosis is wrong, most probably so is the treatment. ...
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Physicians have a natural role as advocates
As physicians, we are often called upon to be advocates for our patients. Sometimes they have no other person to turn to....
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Our society expends huge sums on futile care
Mike was a runner, outdoors-man, and fitness nut. This was not so much as for health reasons as for "feeling good", but...
Patient
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How will the Baby Boomers age and die?
I love listening to life stories. As a hospice chaplain, I loved sitting with our patients and their loved ones engaging in...
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Patient engagement is the holy grail of health care
For health care professionals, patient engagement is the holy grail of health care. It is the key to patient adherence – a...
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Why do doctors delay hospice referrals?
This is a response to Deb Discenza's article requesting a one page informational sheet informing a patient about hospice or palliative care. This would...
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How touch can calm patients
So, Megen at Not Nurse Ratched wrote post recently about therapeutic presence. The following passage really caught my attention: "Question is: are...
Policy
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Improve patient safety to improve healthcare quality
It has taken 13 years for us to revisit the issues in To Err Is Human, the 1999 landmark government report that...
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A lack of incentive for medical schools to train primary care doctors
A social media movement is happening before our eyes with action starting to take shape. The #occupyhealthcare movement has begun within to...
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What should be the stated aim of health care in America?
The triple aim of health care, as defined by the Center for Medicare and Medicaid Services (CMS) is: improving the experience of care, bettering...
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How Moneyball applies to healthcare
The storyline is familiar. An organization is challenged to achieve better results without spending more money. An executive is committed to obtaining...
Tech
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New classes of devices to diet and exercise
For many celebrities, their livelihoods depend on their physical appearance and they rely on armies of personal assistants, schedulers, stylists, trainers and...
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Repetition is the curse of the doctor-patient engagement
How many times as a doctor do you ask the same questions over and over again as part of the routine process...
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Why the prognosis of patients is difficult
Many clinical decisions in older persons are dependent on life expectancy. For example, as life expectancy declines, cancer screening is likely to...
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Innovative technologies can markedly enhance safety
“To Err Is Human” is the title of the now famous book from the Institute of Medicine on patient safety published about...
Social Media
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The Internet is where patients go for pre-visit consultations
As a physician, technology cannot replace you, but it can make you more efficient and effective. This was the message from Richard...
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5 ways doctors can benefit from professional connections
Looking ahead to the next several months, I’ve found myself frequently wondering how many physicians will make this their year to take...
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Twitter Is my third office location
The physician’s decision to first dive into social media can be stress-inducing. Issues of time management, maintaining professionalism, and determining a return...
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The impact of social media on a physician assistant
The impact of social media on medicine could arguably be compared to the impact of the industrial revolution on the human condition....
