by Melissa Velez-AvrachAbout eight years ago, I was in an accident that left me with chronic lower back pain and muscle spasms.Then, about a year and half ago, I was in a car accident. Bad combo for the pain. I've been to chiropractors, orthopedic spine specialists, had MRIs, the works and am following my doctor's recommendations, doing yoga, deep breathing and physical therapy when needed. It has all helped me ...
July 2010
All Stories
Why technology and the Internet may not be good for patients
Paro the robot baby harp seal was the final straw.I had vowed to myself not to think about or write about “the internet makes you smarter, the internet makes you dumber” argument. Even when some of my favorite authors (Steven B. Johnson, Clay Shirky, Nicholas Carr, and Jonah Lehrer) weighed in, I thought it best not to participate.And then I read about Paro, either “a disturbing turn in our treatment ...
Would eliminating medical school debt produce more primary care doctors?
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 ...
Is health care experience mandatory for a pharmaceutical CEO?
A persistent theme for Health Care Renewal has been how concentration and abuse of power in health care trap patients and heath care professionals in a maze of bureaucracy, perverse incentives, deception, and conflicts of interest.To anyone who has to make the transition from person to patient, some of these problems become immediately obvious.Consider, for example, this account of "going into a hospital for a minor procedure":
The very idea of ...
Top health care blog posts, June 2010
Here are the top posts from the past month, based on the number of times they were viewed.1. Doctors make far less money than most people think2. Tips for students who want to shadow doctors3. ABIM responds to doctors sharing board certification questions4. 6 reasons why people commit suicide5. Why pediatricians and other primary care doctors leave medicine6. Listening to nurses is key to ...
How H1N1 influenza is similar to the influenza A virus
by Todd NealeThe pandemic H1N1 influenza virus is similar to seasonal influenza A viruses in terms of viral shedding, symptoms, and household transmission, researchers in Hong Kong found.The researchers prospectively followed 99 patients testing positive in rapid diagnostic tests for influenza A virus and found 45 had the H1N1 pandemic virus and 54 were infected with a seasonal influenza A virus, H3N2, but the two strains did not differ significantly, ...
iPhone, Android or Blackberry? The right smartphone for doctors
Lately, I’ve often been asked the question, “What type of smartphone should I get?” by my medical peers. I’ve been asked this by physicians, residents, medical students, and others. Many of my friends are entering residency and plan on upgrading to a smart phone, while others already entrenched in residency have phone contracts finishing up.The answer to this question is not easy. Rather, as Facebook nomenclature would demand, “it’s complicated”. ...
Be skeptical of natural and herbal supplements
by Danielle Ofri, MD, PhDA good chunk of every medical visit is spent writing prescriptions.Before we had an electronic medical record, this was often an arduous task, leading to serious writer’s cramp. Now the computer makes it easier on the doctor, but it doesn’t seem to have much effect on the patient.A recent article in the Journal of General Internal Medicine highlighted what most doctors have suspected all along, that ...
Linezolid resistant Staphylococcus aureus (LRSA) emerging
by Kristina FioreThe first known outbreak of linezolid and methicillin-resistant Staphylococcus aureus (LRSA) occurred during a 13-week period in 2008 in a hospital in Madrid, researchers say.The LRSA outbreak, involving 12 patients in the hospital's intensive care unit (ICU), was also the first with cfr gene-mediated linezolid resistance and was associated with nosocomial transmission and prior administration of linezolid, Miguel Sanchez Garcia, MD, PhD, of Hospital Clinico San Carlos in ...
Practical barriers for comparative effectiveness studies
Writing in the New England Journal of Medicine three authors share their experience in running a head-to-head trial of Avastin (bevacizumab) versus Lucentis (ranibizumab) for wet age-related macular degeneration (AMD).They describe the barriers they faced and suggest that the barriers will need to be removed for comparative effectiveness research to succeed. They make good points and may well be correct in their policy recommendations.However the case of Avastin and ...
How to treat slouching in children
“I’m worried about my daughter’s posture. What can I do about it other than constantly nagging her to stand up straight?”You’re probably talking about “kyphosis,” which is the rounded-shoulders, hunched forward kind of posture common in children and many adults. It’s often called “postural kyphosis” because it can be corrected if the child tries to stand straight up. Rarely, there’s a genuine spinal deformity, called Scheuermann’s Kyphosis or Scheuermann’s Disease, ...
How to implement CPOE successfully at your hospital
One in every 10 patients admitted to six Massachusetts community hospitals suffered serious and avoidable medication mistakes. This has created a new urgency for all hospitals in the state to install computerized physician order entry (CPOE).At BIDMC, we implemented CPOE in 2001 and have not had a handwritten order in most areas, except for the 2 days of our network outage in 2002. Implementing CPOE is challenging and requires ...
Short stature increases heart disease risk
by Todd NealePeople of short stature appear to have a heightened risk of adverse cardiovascular outcomes compared with their taller counterparts, according to a new meta-analysis.Among 22 studies analyzed, the shortest people had a 1.46-fold greater risk of coronary heart disease or death, Tuula Paajanen, MD, of the University of Tampere in Finland, and colleagues reported online in the European Heart Journal.A critical height cutoff point for increased risk could ...
World Cup soccer lessons that doctors can use
Not being much of a soccer aficionado, I have nevertheless been captivated by some of the games in the 2010 World Cup Soccer. Probably has something to do with my being South African!While I hear many Americans bemoan the slow pace of the televised game ("boring!"), the low scores ("where's the action?") and the vuvuzelas ("irritating!"), I have been struck by lessons these matches have offered up for entrepreneurial physician ...
Direct to consumer drug advertising is money wasted
How effective is direct to consumer drug advertising?Some think that drug ads should be banned altogether, saying that it encourages patients to ask their doctors for expensive, brand name prescription drugs.It turns out, their fears may be overblown.NPR's Shots blogs about a recent study looking at the effectiveness of these ads. The numbers, for the pharmaceutical companies anyways, are not encouraging:
Overall, about 8 percent of the people who were ...
Mark Midei and the failure of peer review
A couple of months ago, a Baltimore reporter called to get my take on a scandal at St. Joseph’s Hospital in Towson, an upscale suburb.A rainmaker cardiologist there, Dr. Mark Midei, had been accused of placing more than 500 stents in patients who didn’t need them, justifying the procedures by purposely misreading cath films. In several of the cases, Midei allegedly read a 90 percent coronary stenosis when the actual ...
Answers to patient questions may not always be simple
I used to get frustrated when patients, typically at the very end of a long visit for some other serious problem, would utter one-liners like “What can I take for headaches?” “How do I know if I have cancer?” or “Why can’t I lose weight?”Now I have a one-liner, of sorts, myself in response to those types of questions. I usually lean back slightly, widen my eyes, nod and say:“Now, ...
Become a locums doctor and think like a professional athlete
by 911Doc, MDWhen our colleagues want to criticize our approach to medicine in the wild, wild west, they call us "cowboys."So be it. And guess what? You too can take to the road with your skills and wits only and be paid what you are worth.Locums companies are now offering me almost twice what I make working for my group to travel, be put up in a nice hotel, and ...
Ambulatory surgical centers may have higher infection rates
by Todd NealeFailure to follow recommendations to control nosocomial infections appears to be common in ambulatory surgical centers -- even during formal inspections, researchers found.Of 68 centers in three states participating in a pilot inspection program, about two-thirds (67.6%) had a lapse in at least one of five infection control categories, according to Melissa Schaefer, MD, of the CDC's Division of Healthcare Quality Promotion in Atlanta, and colleagues.The most common ...
The grief men face when their wives undergo mastectomies
I have given anesthesia for a lot of breast surgery. I don't think I'll ever get used to the fog of pain and sorrow surrounding a double mastectomy.All surgery is invasive in some way. Amputations, in particular, have a horror all their own; the idea that destroying someone - cutting off a body part, violating a coherent whole - should be necessary in order to save a life is almost ...
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....
