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Could privacy laws and bureaucracy derail universal electronic health records?

Health IT is about to receive a $20 billion infusion from the Federal government.

Aside from the fact that the current generation of electronic records may not be ready for widespread use, there are questions as to whether privacy laws will impede the spread.

In general, doctors adopt the path of least resistance. Throwing in added steps, like filling out additional forms or requiring pre-authorization phone …

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Ted Kennedy’s brain tumor, and the medical care he receives

As we know, Massachusetts Senator Ted Kennedy has an advanced stage brain tumor, and was recently hospitalized for a seizure.

Seizures are a common side effect of malignant brain tumors, and often controlled with a variety of anti-seizure medications. There will be times where seizures can break through medication control, leading to the frightening episode that occurred on Inauguration Day.

Family physician Doug Farrago asks some …

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Did Obama provide any health care clues in his inaugural address?

There were little specifics, but he did give notice that he will use technology to “raise health care’s quality and lower its costs.”

Indeed, one of his first actions will be to infuse health technology with a significant influx of federal dollars. However, the wisdom of supporting a generation of fragmented digital systems that cannot communicate to one another remains to be seen.

MedPage Today was …

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Despite the best efforts of doctors, here’s how some trauma patients die

When are trauma injuries too severe to overcome?

When this drunk, unrestrained driver hits a tree during a car accident, the bleed into his abdomen is significant. The fact that it takes some time before he is found, causing the sub-zero temperatures to bring his body temperature down into the 80’s, makes his chances of survival slim.

Read how “frantic display of 21st century medical technology is unleashed,” …

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Temporary doctors, and the economic factors leading to their rise

There’s a increasing chance that the next time you undergo surgery, it will be by a locum tenens physician.

Because of rising overhead costs, combined with declining surgeon pay, more physicians are opting to become temporary doctors. They travel from hospital to hospital, and are paid a fixed rate, without worrying about office costs and struggling to stay open.

Numbers estimate that 1 in 20 general …

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Would you take a prescription drug for longer eyelashes?

A side effect of a glaucoma medication is being put to good use.

MedPage Today reports on Latisse, which is applied to the base of the upper eyelashes and promotes growth within eight to 16 weeks.

Side effects can include red, itchy eyes, as well as changes in the skin pigmentation around the application area.

The drug has to be continued daily, or else the eyelashes will …

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Designing a physician waiting room

A lot of thought goes into waiting room design.

Love seats or chairs with arms? How many of each? What kind of patient education materials should be offered? Should you install a flat-screen television showing medically relevant educational videos? And if you see children, how big should you make the play area?

A primary care doctor gives his opinion on each of these issues. …

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Did Ambien lead a man to freeze himself to death?

“How in the hell can a guy walk out in 20-below zero and not wake up?”

The answer may be Ambien (via Schwitzer), where there have been previous reports of patients sleep-walking or sleep-driving while on the medication.

The deadly episode wasn’t the first time for this particular patient, who previously “drove into the side of his own garage, knocked a neighbor’s hanging plant off the eave of …

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Tufts Medical Center versus Blue Cross Blue Shield, who blinked?

Boston’s Tufts Medical Center took on the state’s largest insurer in a battle over physician fees.

A resolution to the impasse was recently announced, but the details were not disclosed. According to newspaper reports, Tufts agreed to accept the insurer’s “Alternative Quality Contract,” where instead of being paid fee for service, a fixed amount was paid to doctors per patient. Doctors can earn more “by cutting …

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How should health care be reformed? The inauguration edition of Grand Rounds gives us answers

Medical bloggers give their suggestions to reform our health care system.

Val Jones hosts Grand Rounds over at MedPage Today, where she posts thoughts and ideas from those who see the problems with our dysfunctional system on a first-hand basis: the doctors, patients, nurses and other medical providers involved with the front lines of medicine.

Decision makers would be well-served to …

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Blame the RUC for the primary care crisis, or not

The maligned group that advises Medicare on physician payments has been frequently targeted by generalist doctors, as well as this blog.

Hold on, says the ACP’s Bob Doherty, who provides some arguments in their defense.

Indeed, the RUC did vote to marginally increase payments to evaluation and management codes, the ones frequently used by primary care doctors. Furthermore, Mr. Doherty brings up a good point, asking …

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Will medical tourism drive domestic doctors out of business?

Will American physicians go the way of the Big Three automakers?

Insurance companies are subtly pushing their members towards having their surgeries performed in countries like India or Thailand, in exchange for substantial cost savings at hospitals that are comparable in quality to those in the United States.

Also on another note, many hospitals are using so-called “nighthawk” radiologists from India to interpret many of their radiology studies, …

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What can doctors learn from Captain Chesley Sullenberger?

Medicine has borrowed before from the field of aviation safety.

The pre-surgical checklist, discussed last week, is one recent example.

Patient safety guru Bob Wachter discusses the procedures that went into training the US Airways crew in preparation for their harrowing landing in the Hudson River.

How many times do doctors receive similar training, especially as they manage dangerous situations on a daily basis?

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Is Steve Jobs dying? Two reasons that can explain his medical leave

Steve Jobs’ health has been much discussed, and of concern particularly to nervous Apple shareholders.

He recently took a 5-month leave of absence because his condition was “more complex” than originally thought.

Since that announcement, medical pundits have not been in short supply trying to explain what’s going on. Of the speculation that I’ve read thus far, here are two leading possibilities.

1) Cancer …

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CT scans in the ER, are emergency doctors ordering too many tests?

Internist Robert Centor provides some suggestions to fix health care.

On one point, he calls out emergency physicians, saying because of high exposure to malpractice claims, “technology trumps the history and physical examination.” Often times, “when in doubt, they image.”

This draws a sharp rebuke from Texas emergency physician GruntDoc, who points out that “ED care was 3.5% of the total healthcare budget. Squeeze …

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Second hand smoke and your kids

Provocative ad campaign from the UK’s Roy Castle Lung Cancer Foundation.

(via Ivor Kovic)

Why it’s so difficult to die in an American hospital

Dying has become a difficult and often excruciatingly slow process.

So says Minnesota internist Craig Bowron as he talks about treating some of the elderly patients on his hospital service (via Duncan Cross). Often times, these cases are among the most difficult, with family members contradicting previously discussed advance directives.

“There are no life-saving medications, only life-prolonging ones,” Dr. Bowron eloquently states, adding that “medical advances …

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Selling narcotics in the parking lot, a subtlety fail for this doctor

Brazen or desperate?

A family doctor was prescribing narcotics from his car, parked at various pharmacy parking lots.

Perhaps he was taking “customer service” to a new level.

(via GruntDoc)

Is conflict of interest influencing Uwe Reinhardt’s health care analysis?

Respected economist Uwe Reinhardt has been penning a series of NY Times blog entries explaining why American health care is so expensive.

In his latest entry, he takes on the physician payment system, writing that “studies have shown that physicians are not impervious to the financial incentives inherent in fee-for-service payments,” and that “physicians who have a direct financial interest in the use of imaging services, like …

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What do doctors look for when they examine the abdomen?

A primary care doctor guides us through the abdominal physical exam.

He deciphers the much-written notation of “Abd: Soft, NT, Normal BS, no HSM or masses*,” and explains what physicians look for when they poke, prod, percuss, and listen to when examining a patient’s belly.

You’d be surprised at some of the things we find simply by pressing on the abdomen.

* For those who need translation, …

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