Media deprivation: Do you think it exists? Although laughable at first glance I know I’m not the only parent who wonders if limiting screen time could change my child’s opportunity. Those of us who fiercely control screen/device time may have momentary lapses where we wonder if we’re doing things right. Even though I’m convinced there isn’t a study telling us that typically-developing children need media/apps/screen time to learn how to ...

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The recent independence referendum in Scotland got me thinking. I must admit I was glued to the news over the last few days of campaigning. For those of you not following closely, it seemed as if the "no" camp had a comfortable lead right up until the last week when the opinion polls suddenly showed the "yes" camp pulling ahead. This rattled the establishment. The prospect of my country of ...

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About a year ago, I shared details of my own out of pocket medical expenses and concluded that we have to have to be more transparent with our patients (and potential patients) about the costs they will face for our services. The urgency of price transparency as a business imperative and a professional responsibility has only increased since then. Consider that we are now a year in to the implementation of the ...

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As we head into health insurance enrollment season, which opens in November, consumers/patients will face yet another challenge in selecting the best health plan. Sorting through policies was tough already, but now insurers are making it even harder by changing the way they will cover generic drugs. It used to be that opting for generics was a snap. Health plans usually offered three or four tiers of drugs -- one for ...

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I saw another exciting news story on a mobile health intervention the other day.  I honestly don’t remember the company or product, but what stuck with me was the declaration of success based on 10 patients using the product for three months.  Success was touted in terms of cost reduction and resource utilization reduction in a before/after analysis.  This inspired me to collect some thoughts on some of the challenges ...

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He had called the other day to update me up on his condition.  He did not sound upset, but resolute.  "They offered me peritoneal dialysis," he said, "but I decided against it and figured I'd just let nature take its course.  The hospice people are so wonderful -- I've got things all set here at home, but I have two questions.  What should I do about my warfarin?  You know, ...

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Top stories in health and medicine, October 9, 2014From MedPage Today:

  1. Obese Kids Face Greater Risk for Heart Disease. The adverse long-term influence of obesity and elevated blood pressure on left ventricular remodeling begins in childhood, according to findings from the world's longest running biracial heart study.
  2. IBM's Watson Comes to the Bedside. If a physician or a patient could ...

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A friend of mine plays a mean game of poker.  She comes out ahead in Atlantic City, finishing near the top in hold ’em tournaments.  She is a poker savant. Not long ago I asked her secret to playing the game so well. “I learned to play cards when I was being trained to treat cancer.” “Oh,” I said, “the discipline, memorization, patience and statistics?” “No, that is when I learned not to ...

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I direct a nutrition clinic in a large center for children with special needs. My kids can have everything from mild learning disabilities to genetic disorders that affect growth and development to profound intellectual and physical impairments that cause them to be unable to walk, speak or even scratch their heads. My most seriously involved kids are completely dependent for all their care. Children who are somewhere in between -- for example, children who ...

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Recently, my 16-month-old grandson was at a backyard barbecue with his parents. He had been eating some potato chips when he suddenly stopped breathing and turned blue. Having had CPR training, my son started rescue breathing and suspecting aspiration, performed toddler airway clearance maneuvers. No obstruction was found. The child slowly awakened but was very drowsy. Because of the concern for aspiration, an ambulance was called and the child was taken to ...

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“I’ve been with my doctor for years and years,” an elderly man, voice hoarse but lilting with fondness for his caregiver, told a nurse in the primary care clinic where I was waiting to see a doctor. “He’s fantastic.” I was coming to the clinic for a follow-up appointment about an injury for which I’d been seen a few months prior, but neither the initial appointment nor this follow-up were with ...

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Not long ago, the Joint Commission established that patients with pneumonia should receive antibiotics within four hours of diagnosis. Timely diagnosis and treatment can be the difference between life and death in patients with this illness. In fact, some people believe this kind of quality measure should play a large role in how we pay for medical care. After all, doctors should not be paid solely on the basis of ...

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There is much to deplore in our medical system.  Atrocities abound in the dark recesses of hospital wards, the overpacked waiting rooms of outpatient offices, and the algorithmic hum of insurance claim denials.  Yet time and again, the most vile of of insults are hurled at one setting in particular.  I'm talking of the place cursed by emergency room physicians when admitting yet another poor soul with a sacral ulcer, ...

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Top stories in health and medicine, October 8, 2014From MedPage Today:

  1. PTSD Common After TIA. Nearly one-third of transient ischemic attack (TIA) patients developed post-traumatic stress disorder (PTSD) afterward.
  2. Task Force: People at Risk for T2D Need Screening. Adults at risk for type 2 diabetes should undergo screening for elevated blood glucose and be treated with lifestyle interventions if hyperglycemia ...

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Baseball fans like me take great joy in studying the way general managers assemble their rosters. The variations are fascinating. Some teams focus on pitching strength. Others go for speed or power-hitting. Each approach carries distinct advantages and disadvantages on the field. That same level of variation and strategic decision-making applies to health plans, as well. With the health care marketplaces reopening for enrollment on Nov. 15, anyone evaluating their coverage options should take ...

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She grasps her chest dramatically and falls to the floor. Her eyes flutter as she tries to hold them closed. Her one arm across her chest the other flailed in theatrical fashion to her side. She’s dead. Her heart is broken. The other jumps from the bed, and after landing, reports her leg is broken. She hops about the room, unable to use the leg and there are no crutches ...

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The public perception of oncologists: Is it really true?I had taken care of her for years. We had faced a new diagnosis, the toxicities of adjuvant treatment, the promises of having no evidence of disease (NED as my friend, Molly, refers to it), only to have it shattered with the first recurrence. Over the next three years, she had undergone treatment -- chemotherapy, a trial of endocrine therapy, ...

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To the inevitable backdrop of John Philip Souza marches and presidential photo-ops, big soda has announced that it will do some vague kind of something about the excesses they contribute to our intake of calories and sugars over something like ten years. (Unless, of course, they don't.) Cue the 21-gun salute! Release the confetti! Folks, that this is heralded as "huge" news -- and by our former head of state, no ...

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Who is blocking EMR interoperability? You are. The Senate Appropriations Committee has defined a new transgression perpetrated in the committee’s expert opinion by vendors of certified EHRs, as well as “eligible hospitals or providers.” Since the committee has no data or evidence of any kind that this transgression is actually occurring, it requires the Office of the National Coordinator for Health Information Technology (ONC) to embark on a ...

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We recently had a readmission -- a straightforward case, really.  Mr. Jones, a 64-year-old homeless veteran, intermittently took his diabetes medications and would often run out.  He had recently been discharged from our hospital (a VA hospital) after admission for hyperglycemia.  The discharging team had been meticulous in their care.  At the time of discharge, they had simplified his medication regimen, called him at his shelter to check in a few ...

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