May 2010

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Inhalant abuse remains prevalent in teens

in Conditions | 2 responses

by Todd NealeAlthough inhalant abuse has become less prevalent since the early 1990s in all age groups, it remains a source of injury and death, particularly among teenagers, researchers have found.From 1993 to 2008, intentional exposure to 3,410 different inhalants was reported to U.S. poison control centers, Toby Litovitz, MD, of the National Capital Poison Center in Washington, and colleagues reported in the May issue of Pediatrics.The highest rate of ...

Social networking impact on patients, doctors, and non-profits

by | in Social media | 4 responses

In its current listing of online social networks, Wikipedia presents 156 major, active websites. A neighboring link to view "now-defunct" sites accompanies the listing -- a subtle reminder of the Internet's competitive and volatile environment where promising endeavors rise and fall overnight.But although the popularity of a specific website may fade with time, the practice of online social networking is here to stay.In its simplest form, online social networking is ...

How Massachusetts can lead health IT modernization

by | in Tech | 10 responses

Although healthcare reform has its supporters and detractors, healthcare IT reform - the use of technology to improve the quality, safety and efficiency of healthcare throughout the country - has broad support from all stakeholders.The passage of last year’s $787 billion economic stimulus bill brought with it a healthcare IT modernization program that could inject about $30 billion into the economy. Since Massachusetts is a leader both in the use ...

Electronic medical records worsen patient communication

in Tech | 21 responses

Electronic medical records are becoming more prevalent in physician offices nationwide, but patient communication is being disrupted by the computer in the room.An excellent piece by the New York Times' Pauline Chen outlines the problem.Calling it an "unforeseen consequence" -- I quibble with whether this was truly unforeseen -- Dr. Chen notes that, although electronic medical records promise efficiency, in reality, they hamper communication:

But that afternoon as I settled ...

Family comes first for some who have finished residency

in Education | 24 responses

by Dr. Whoo, MDI have met several women who have completed residency and maybe even practiced beyond that, but decide to quit and stay at home with kids. I wonder - why would a woman who has gone through all of that training just quit? It would seem like the hard part is behind them and I am perplexed by their decision but, of course, I ...

How Massachusetts controls health costs should be closely watched

by | in Policy | 10 responses

A major criticism leveled at the health reform law is that it doesn’t do enough to control costs. Yet experience with a similar breed of health reform in Massachusetts indicates that the cost control issue will come to the fore sooner rather than later.Recent stories have reinforced my conviction about this:Massachusetts health plans have sued the state and stopped issuing new policies to small businesses and individuals after the ...

Maternal death rates improve but hurts fund raising

in Policy | one response

by Mike HimowitzWhen you’re advocating for a health cause, can good news be bad news?It’s entirely possible -- when science threatens fund-raising, and at the worst possible time.Consider a study of worldwide maternal death rates by a team from the University of Washington that appeared online recently in The Lancet.The group, led by Christopher Murray, of the school’s Institute for ...

Quality hospital care deserves to be celebrated

by | in Physician | no responses

Last week my wife and best friend, Elaine, had massive abdominal surgery. We fully expected her to be an inpatient for a week, but she was home in four and half days. To watch her recover was to see what happens when everything converges: the deep knowledge and skills of excellent, humane physicians; a capable, caring clinical staff; wonderful new technologies; and a lifetime of eating right, being fit and ...

The Vanishing Oath is a film patients must see

in Social media | 16 responses

I recently watched The Vanishing Oath, a physician-directed documentary detailing the challenges impeding doctors to best care for their patients. It follows the travels of Ryan Flesher, MD, an emergency physician who took time off and traveled the country talking to university economists, an Emergency Medicine trailblazer, a malpractice attorney, medical academics, a divinity professor, current physicians, former physicians about what ails our health system. Here's a video excerpt:width="400" height="327" ...

Comparative effectiveness studies may not be accepted by patients

in Policy | 13 responses

Comparative effectiveness is a buzzword that health reformers have been using to help curb soaring medical costs.And it makes sense. After all, why do we need to subject patients to tests and treatments that haven't been shown to work? Some degree of standardization of medical care is necessary.But what if patients don't listen?I have mentioned several times that there is a prevailing, and false, mentality among ...

Health reform may mean meaningful changes for physicians

in Policy | 7 responses

by Aldebra Schroll, MDJim called me late on a fall afternoon to report our mutual friend was in the local emergency room. “It looks like he had a stroke”. I immediately asked to speak to the ER doctor for the results of the CAT scan I knew would have been done. There were two metastatic tumors in the brain.It has been over two years since my friend died. He was ...

Problem list problems with electronic medical records

by | in Tech | 5 responses

In family medicine it has been common to keep a “Problem List” in patients’ paper charts. Usually placed on the left hand side, on top of the Medication List, it has given doctors like me an instant thumbnail sketch before considering the specifics of each patient’s visit for that day.A typical Problem List would include diagnoses like diabetes, hypertension, high cholesterol or rheumatoid arthritis. It would list prior surgeries, like ...

Malpractice fears influence cardiology decisions

in Physician | 5 responses

by Charles BankheadFor nearly a quarter of cardiologist respondents, malpractice concerns influenced their decisions to order tests or treatment for hypothetical cases included in a national survey.Almost 30% of cardiologists acknowledged ordering cardiac catheterization because colleagues did so in the same situation, according to an article published online in Circulation: Cardiovascular Quality Outcomes.Concerns about malpractice had a significant association with regional use of tests and treatment, Frances Lee Lucas, PhD, ...

Avoiding the ER and arranging a direct admit is not easy

in Physician | 16 responses

Are emergency departments solely responsible for the bulk of unnecessary tests?Most would like to believe so, but emergency physician Edwin Leap says that's not the case.He cites an instance involving a primary care doctor and hospitalist:

Local physician, who does not admit to the hospital, sees patient in the office. Patient has uncontrolled hypertension and is having some chest pain and shortness of breath. Local physician contacts hospitalist. ...

Defensive medicine worsens patient care and raises costs

by | in Physician | one response

Health care in the United States costs too much, and it doesn’t look like that’s going to change. Recent health care reform legislation doesn’t take any meaningful steps towards reducing or controlling costs. In fact, it explicitly forbids states from trying to curtail the costs of malpractice litigation in any way that would reduce lawyers’ fees.How does a fear of lawsuits increase costs? ...

Residency team changes can improve education and patient care

by | in Education | no responses

In the early 90s, I had the privilege of directing UCSF’s exceptional internal medicine residency program. It was a time of transition. A decade earlier, residency accreditation requirements (dictated by the Accreditation Council for Graduate Medical Education, ACGME) were fairly benign and largely ignored – marquee programs like ours were generally given carte blanche to organize our residents’ experience as we saw fit.When I took over our residency in 1992, ...

Money prevents patients from seeking timely heart care

in Physician | no responses

by Crystal PhendLack of insurance and financial concerns keep patients from treating a heart attack like the emergency it is, researchers affirmed.A delay in getting to the hospital for treatment of acute MI was 38% more likely among the uninsured and 21% more likely among insured patients with financial concerns, reported Paul S. Chan, MD, MSc, Mid America Heart Institute in Kansas City, Mo., and colleagues.More than two in every ...

How health care reform will affect mental health

in Policy | 4 responses

by Diana E. LeeThe cost of therapy and medication for underinsured people are common barriers keeping people from getting treatment for a mental health problem.Although there are community mental health centers that provide treatment for many people, their resources are stretched far too thin to help everyone who needs treatment on the level someone with a more serious issue may need. One of the most positive changes that will arise ...

Patient complaints may worsen defensive medicine

in Physician | 8 responses

Doctors often have a communication disconnect with their patients.A recent piece from the New York Times encapsulates the issue, citing a recent New England Journal of Medicine perspective.According to oncologist Ethan Basch, "Direct reports from patients are rarely used during drug approval or in clinical trials. If patients’ comments are sought at all, they are usually filtered through doctors and nurses, who write their own impressions of what ...

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