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 Priscilla Chan may become the country’s most influential doctor
Who has the potential to be the most influential physician of our generation? It's Priscilla Chan, who not only recently graduated from...
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Confused about prostate cancer screening? Make a shared decision
In a widely anticipated move, the USPSTF officially recommended against prostate cancer screening in healthy men. Case closed, right? Hardly. The prostate...
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When it comes to doctors and social media, hospitals fail miserably
When it comes to medicine and social media, much of the attention is negative. Doctors losing their hospital privileges because of Facebook....
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Warren Buffett’s prostate cancer choices aren’t right for every man
A version of this column was published on April 24, 2012 in USA Today. There has been a recent uptick of elderly men...
Physician
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Why test recalls should not be considered cheating
I was appalled recently by the coverage of radiology “test recalls” by CNN, amplified by Dr. Gary Becker of the American Board...
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Why physicians are susceptible to hardball tactics
I was invited to a medical staff leadership conference sponsored by our hospital. A company specializing in training physician leaders ran the...
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How we deliver bad news is critical to how families deal with grief
As a cardiac electrophysiologist, I have had to discuss bad news with patients and families more times than I would like during...
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His father’s suffering had already been too great
He looked dead. The paramedics brought him down the hall toward one of my critical care beds, and for a moment I...
Patient
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How death can be a beautiful experience
I was honored to be part of a beautiful experience in late January of 2011. It was the death of my mother-in-law...
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What meaningful encouragement can be given to someone who is dying?
Theirs is a lonely journey; to be moving towards the separation and end of all things known and loved. Being with a...
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Health care journalists have tendencies similar to those of doctors
As a patient who was asked to speak at the Association of Health Care Journalists 2012 conference, I felt a bit covert....
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Adaptation can be painful, but it can also be a gift
Nothing will force you to live life on your own terms faster than almost losing it. In 2008, I was on fire....
Policy
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What should America’s health care vision be?
America has this paradox of excellent biomedical science, innovative drug manufacturers and entrepreneurial device developers along with outstanding providers but at the...
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Hospitals around the world aim to remain relevant to patients
"It was the best of times, it was the worst of times ..." So begins a story called A Tale of Two...
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Repairing the tear in health care’s safety net with social media
The nation’s “safety net” hospitals are designed to ensure that uninsured, lower income and indigent populations receive adequate medical care – a...
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Look to technology to reduce health costs
Technology to lower costs rather than accelerate them. Smart phones to increase physician and other providers’ productivity. Fewer primary care physicians but...
Tech
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When patient care becomes secondary to filling out the medical record
The policeman was two cars in front of me. I meandered down the road cautiously adjusting my speed a few ticks above...
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Doctors, use Google to get more patients in less than 7 minutes
Every month, hundreds of thousands of people look for a doctor on Google. As an amazing practitioner, your site deserves to be...
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The user interface for EHRs should be uniform
The first thing I noticed when I walked into the physician’s office were the tall cabinets filled with manila folders, tabbed with...
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EMR liability needs to go further than just the physician
This example of a disaster waiting to happen, in the form of an error-promoting CPOE, is a poster example of why the...
Social Media
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We need to see the potential harm of social media
Prior to 1794, farms across the world could only pick cotton as fast as humanly possible. In the late 18th century, Eli Whitney...
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Why social media may not be worth it for doctors
Social media in healthcare is all the rage these days. You can’t visit even one physician-oriented website without someone breathlessly advising you...
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Transparency defines social media success for doctors
Want to understand social media? Physicians wanting to learn about social media must learn transparency. We must learn transparency on a personal...
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How Twitter was used in a potential mass casualty scenario
It was my first ER shift in charge of the resuscitation area. Needless to say, my adrenaline and nerves were firing like...
