Barack Obama is certain that electronic health records (EHRs) can improve the quality of care and the efficiency with which it is delivered. How certain? Certain enough to have bet billions on a program that pays providers to adopt and meaningfully use EHRs.Of course there are many ways to improve quality and efficiency. The Pennsylvania Health Care Cost Containment Council (PHC4) for example, publishes outcomes data for the states’ ...
November 2009
All Stories
The privacy and security risks of electronic health records
Originally published in HCPLive.comby Anthony NiehausAs part of the 2009 HITECH Act, a national health information technology infrastructure (NHITI) is required for access and use of electronic health records resulting in a more “effective marketplace, greater competition... [and] increased consumer choice (HITECH Act, Section 3001(b)).”
Such a system is not only necessary, but it is cardinal to improving delivery and reducing ...
Will the H1N1 flu virus mutate?
Originally published in MedPage Todayby Michael Smith, MedPage Today North American CorrespondentThe CDC is keeping a careful eye on a mutation in some strains of the pandemic H1N1 flu that Norwegian researchers isolated from three patients with severe disease.
The mutation has been seen "sporadically" in the U.S., according to Anne Schuchat, MD, director of the CDC's National Center for ...
Poll: Changing clinical study entry criteria to include terminal patients
When it comes to terminal disease, experimental therapies can be a patient's last hope.Should physicians try to bend the entry criteria of clinical studies to include these often desperate patients?A recent study from the University of Massachusetts medical school revealed that 90 percent of physicians would ignore the entry guidelines for a study if they felt that it would benefit the patient.The New York Times cited examples ranging from "altering ...
How to talk with your family about end of life care
Like last year, I'm participating in the Engage with Grace blog rally. I'll be signing off until Monday. Have a wonderful Thanksgiving holiday.Last Thanksgiving weekend, many of us bloggers participated in the first documented “blog rally” to promote Engage With Grace – a movement aimed at having all of us understand and communicate our end-of-life wishes.It was a great success, with over 100 bloggers in the ...
The joys of practicing rural emergency medicine
I practice in the rural, northwest corner of South Carolina, also known as “The Upstate.” It is a place of expansive lakes, white-water rivers and the mist covered foothills of the Blue Ridge Mountains. The area includes thousands of acres of Sumter National Forest. The natural beauty is breathtaking. Sumter National Forest and our various parks are laced with hiking trails, which are lined with unique plants and trees, some ...
Which drugs increase the risk of falling in the elderly?
Originally published in InsidermedicineThree distinct types of drugs that affect mental processes can increase the risk of falling when taken by adults over 60, according to research published in the latest edition of the Archives of Internal Medicine.id="play_continuous_flvs" classid="clsid:d27cdb6e-ae6d-11cf-96b8-444553540000" width="385" height="239" codebase="http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0">
Baby boomers don’t receive enough preventive health
Originally published in MedPage Todayby Kristina Fiore, MedPage Today Staff WriterOnly a quarter of baby boomers take advantage of preventive services such as flu vaccines and cancer screenings, a new report from the government and two powerful interest groups says. At the same time, states are falling behind goals to increase certain screenings and reduce unhealthy behaviors, according to the ...
What Lego would look like in a CT scan
Have you ever wanted your Lego bricks to undergo a CT scan?Well, wonder no more. Someone did it.
From the commentary: "This is a volume rendering based on the axial scan. Note that the density of the bricks is different for each ...
How the mammogram and Pap smear debates ignore the uninsured
by Jeoffry B.Gordon, MD, MPHThe recent recommendation of the US Preventive Services Task Force against routine screening mammograms for healthy, low risk women under the age of fifty has demonstrated our broad consensus about the value of breast cancer screening. The discussions about new guidance from the American Academy of Obstetrics and Gynecology on when to start and how often to do PAP smears illuminate the impact, effectiveness and support ...
Doctors can improve treating LDL cholesterol
Originally posted in Insidermedicine
Identification and treatment of individuals with high LDL or "bad" cholesterol has improved in recent years, but patients are still slipping through the cracks, according to a survey published in the Journal of the American Medical Association.id="play_continuous_flvs" classid="clsid:d27cdb6e-ae6d-11cf-96b8-444553540000" width="385" height="239" codebase="http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0">
The health reform politics of mammograms and breast cancer screening
Originally published in MedPage Todayby Emily P. Walker, MedPage Today Washington CorrespondentThe emotional debate over a federal panel's proposal to end routine mammograms for women in their 40s has reignited controversy over a contentious healthcare reform issue: comparative effectiveness research. Healthcare reform opponents say the new mammogram guidelines by the U.S. Preventive Services Task Force (USPSTF) make their point: If ...
A vocal minority of skeptical doctors are against the H1N1 flu vaccine
My position on the H1N1 flu vaccine is clear: everyone should get it.But not every physician shares that sentiment. The Washington Post reports that there are a minority who are unconvinced of the vaccine's safety and believe the H1N1 pandemic is over-hyped.Worse, they aren't vaccinating their patients. And when you're talking about pediatricians, that can mean trouble for their patients; children who are most susceptible to the ...
Informed consent is missing from Pap smears and cervical cancer screening
The American College of Obstetrics and Gynecology (ACOG) has just revised their guidelines for Pap smears under some pressure. This resulted from an Annals of Internal Medicine article which documented that only 16.4% of gynecologists followed the College’s prior guidelines. Most did more screenings than indicated, the worst record of the specialties tested. But the ACOG still recommends that nearly all women obtain regular screening at intervals of 1-3 years.The ...
The hard to reach on-call doctor, and how that affects patient care
Originally posted in HCPLive.comby Lisa Schulmeister, RN, MNIt's well known that many physicians are "on call" after hours and on weekends and holidays. "Call schedules" are commonplace in healthcare facilities and answering services. In an interesting study conducted at two Canadian hospitals over a two month period of time, Dr. Brian Wong found that 14% of all pages were sent ...
What is the death toll for the H1N1 flu pandemic?
Originally published in MedPage Todayby Michael Smith, MedPage Today North American CorrespondentIn the first six months of the H1N1 flu pandemic, 22 million Americans fell ill from the virus, the CDC now estimates. Of those, about 98,000 needed inpatient care, and 3,900 died, according to Anne Schuchat, MD, director of the CDC's National Center for Immunization and Respiratory Diseases.The estimates ...
Patients should be careful when doing online health information research
With the majority of American patients using the internet to research their health, it's essential that they be guided to reputable sources of information.Better Health's Val Jones, in a recent presentation at the e-Patient Connections 2009 Conference, starkly framed the problem in a creative limerick, presented Pecha Kucha-style.classid="clsid:d27cdb6e-ae6d-11cf-96b8-444553540000" width="425" height="344" codebase="http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0">
How does Zetia and niacin affect the carotid intima-media thickness (CIMT)?
Originally published in MedPage Todayby Peggy Peck, MedPage Today Executive EditorBy a margin of 0.014 mm in carotid intima-media thickness (CIMT), extended-release niacin (Niaspan) demonstrated superiority over ezetimibe (Zetia) as an add-on for high risk patients on long term statin therapy.
But is a difference of 0.014 mm clinically significant?The niacin versus ezetimibe findings come from the ARBITER 6-HALTS trial, ...
How training to become a doctor in France differs from the United States
Among the many differences between the U.S. and the French health-care systems is the approach to medical training. While U.S. medical school graduates in 2008 had an average debt of $154,000, French medical students receive their training virtually for free. For example, first-year medical students at the Faculte de Medecine Pierre et Marie Curie in Paris have only one mandatory cost for this year: an enrollment fee of $264.The amount ...
Using cell phone text messages to remind people to use sunscreen
Originally published in InsidermedicineDaily text messages sent to individuals' cells phones can help remind them to use sunscreen, according to research published in the latest issue of the Archives of Dermatology.id="play_continuous_flvs" classid="clsid:d27cdb6e-ae6d-11cf-96b8-444553540000" width="385" height="239" codebase="http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0">
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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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...
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The problem of insurance gaps in cancer patients
Why are cancer organizations waiting until it starts to rain before they suggest buying an umbrella? “Join my Medicare Advantage plan and...
Tech
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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...
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Google knows more about certain diseases than physicians ever will
Professor Gunter Dueck, is a calm and eloquent german mathematician who’s also the CTO of IBM Germany. He studied mathematics and philosophy...
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....
