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Why the medical home may not save primary care money

Health Policy

June 29, 2010

When the Disease Management Care Blog saw the flurry of news reports about the Patient Centered Medical Home (PCMH) “saving money,” it couldn’t wait for the full print version of Health Affairs to arrive at the DMCB World Headquarters.

The DMCB had previously reviewed Group Health’s negative “no statistically significant…. cost differences” one year study and was looking forward to seeing researchers Robert Reid et al’s reportedly positive two …

Abuse of prescription drugs starts in high school

MedPage Today

Medications

June 29, 2010

by Todd Neale

One high school student in five has taken a prescription drug without a doctor’s order, according to a nationwide survey.

Abuse of a prescription drug was most common among white students (23%), followed by Hispanics (17.2%) and blacks (11.8%), according to Danice Eaton, PhD, of the CDC’s Division of Adolescent and School Health in Atlanta, and colleagues.

Improper use increased steadily from ninth grade (15.1%) to 12th grade (25.8%). Girls …

How EMR and EHR systems can kill patients

Margalit Gur-Arie

Health Technology

June 29, 2010

Back in the times when EHRs were just EMRs, they had a very simple and humble mission.

The software was supposed to help providers of health care services better manage their business. EMRs were supposed to help physicians adhere to CMS documentation rules, automate patient flow management and get rid of all the mountains of paper floating around a typical medical office or hospital. It was assumed that EMR software will …

Prevent bullying by accepting healthy aggression

Claudia M. Gold, MD

Conditions and Diseases

June 28, 2010

“Momma, have you ever felt like there’s a puzzle and there’s a piece missing and you find the piece and it fits? When I’m with the Maasai all the pieces fit.”

This is a quote from my friend Roland, a seven year old boy, on a trip to Tanzania with his mother. He was on a safari and, using a stick, he was learning how the Maasai use spears to protect …

When patients don’t take their prescription drugs

Kenneth Lin, MD

Medications

June 28, 2010

One of my favorite patients in residency was a lady in her seventies who had longstanding high blood pressure, high cholesterol, and diabetes.

Each time she visited the office, I would recommend that we start multiple medications to control these conditions, and every time she would politely decline. Her previous physicians had left frustrated notes in her chart littered with terms such as “non-compliant,” “against medical advice” and expressing wonderment why …

The public wants resident physicians to work less

Emily P. Walker

Medical Education

June 28, 2010

by Emily P. Walker

A majority of the American public doesn’t approve of doctors working 24 hours straight and supports tougher work hour regulation for resident physicians, according to a new public opinion survey.

The survey, published in the online journal BMC Medicine, is the first to assess the public’s perceptions about the controversial issue of medical residents’ work hours.

The survey found that 90% of Americans believe the maximum shift duration should …

A cardiologist discusses screening for vascular disease

Eric Van De Graaff, MD

Conditions and Diseases

June 28, 2010

Just last week I saw a full-page ad in the newspaper for a series of medical screening tests — EKG, echocardiogram, aortic ultrasound, and the like (all interpreted by “certified doctors”) — that a person could arrange for oneself or a loved one.

We newspaper readers were told we could arrange to have these tests performed without a doctor’s order as …

Why Obamacare scares this cardiologist

Richard Reece, MD

Health Policy

June 27, 2010

I recently visited my cardiologist. It was a routine follow up after a heart attack a year ago. I enjoy our relationship. As a token of my regard, I came bearing a gift. It was a copy of my book Obama, Doctors, and Health Reform.

I knew he had qualms about Obamacare. He expressed doubts about the health reform bill’s merits. The bill will roll out over the next ten years. …

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Why Obamacare scares this cardiologist

American cigarettes contain more carcinogens

MedPage Today

Medications

June 27, 2010

by Todd Neale

Levels of tobacco-related nitrosamines — known carcinogens produced when curing tobacco — are higher in popular brands of American cigarettes compared with those from other countries, potentially leading to more cases of lung cancer, researchers found.

The study of 126 smokers in four countries found that exposure to one carcinogen — 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) — was highest among those from the U.S. compared with smokers from England, Canada, and Australia, …

Reducing salt is a good idea but won’t save your life

Shantanu Nundy, MD

Patient

June 26, 2010

In case you missed it, salt is the new fat.

It seems that everybody from the FDA to Steven Colbert of the Colbert Report has set their sights on limiting our consumption of salt. In the past week, I’ve seen dozens of articles from the blogosphere to the front page of USA Today and a recent edition of Time on reducing our alarming levels of salt consumption.

Many of us are aware …

Supplemental oxygen during cardiac arrest resuscitation

MedPage Today

Conditions and Diseases

June 26, 2010

by Michael Smith

Administering high concentrations of supplemental oxygen during resuscitation after cardiac arrest is associated with increased inhospital mortality, researchers said.

So-called blood hyperoxia resulting from being given pure oxygen after cardiac arrest was associated with an 80% increase in the risk of death, compared with patients whose blood gases were normal on admission to the intensive care unit (ICU), according to Stephen Trzeciak, MD, of Cooper University Hospital in Camden, …

Lifestyle tips for aging family members

Therese B. Bevers, MD

Patient

June 26, 2010

Thanks to modern medicine, more people are living longer, but a longer life isn’t always a healthier one. According to the American Cancer Society, about 77 percent of people diagnosed with cancer are 55 or older.

Living a healthy lifestyle is important to reducing cancer risks. But as we age, it’s sometimes easy to forget the importance of exercise, proper nutrition and stress management, which is why I like to solicit …

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Lifestyle tips for aging family members

Being sick is not always abnormal

Doctor Grumpy, MD

Patient

June 26, 2010

“You can’t afford to be sick!”

I hate these ads.

You’ve seen them. They’re in newspapers and regional magazines across the country. Some smiling mom and her cute kid. It’s an ad for some local clinic, always with a tagline like “You can’t afford to be sick!” or “You don’t have time to be sick!”

And they list things they treat, like headache, sore throat, ankle sprain, runny nose, and skinned knees. They …

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Being sick is not always abnormal

Difficult needs to be embraced in medicine

Alex Lickerman, MD

Physician

June 25, 2010

When I was a second-year medical student I remember thinking, after meeting with an attending physician in a physical diagnosis class, how impossible it seemed that my brain would ever contain as much medical knowledge as his.

And even if somehow one day it did, how would I ever be able to call on it, manipulate it, twist it, bend it, and turn it upside down with the same apparent ease …

Obese patients present challenges in the ICU

Ralph Gordon, MD

Physician

June 25, 2010

Obesity is a huge healthcare problem in the United States.

It has reached the proportions of an epidemic and continues to get worse. Multiple medical problems including heart disease, hypertension, diabetes, sleep apnea and cancer are closely associated with obesity. The patients with extreme obesity can reach a body weight of five, six or seven hundred pounds and even higher. Riddled with chronic medical conditions, these patients often end up in …

Healthcare reform’s focus on outcome and how that affects doctors

David B. Nash, MD, MBA

Health Policy

June 25, 2010

With the signing of national healthcare reform into law, the U.S. healthcare system faces almost immediate — and substantial — transformation. I spent a recent Sunday reading all that I could find in order to get my arms around this massive piece of legislation and to understand its health policy implications.

Here is my view from 50,000 feet.

I needn’t list all of the aspects relating to expanded coverage and insurance reform …

Doctors are stuck in the same system as patients when they get sick

Jay Parkinson, MD

Patient

June 25, 2010

I’ve had disgusting congestion in my nose/sinuses for the past month or so.

I’ve never had a sinus infection in my life despite having horrible allergies to dust. I take Claritin every day for my allergies. But this time, the issues just wouldn’t go away. I needed to go see a doctor. So last night around 8pm I made an appointment with Dr. Samuel Grubman via ZocDoc for 9am this morning. …

Nurses are underappreciated but key to patient care

Alex Smith, MD

Patient

June 24, 2010

“No man, not even a doctor, ever gives any other definition of what a nurse should be than this — ‘devoted and obedient.’ This definition would do just as well for a porter. It might even do for a horse. It would not do for a policeman.”

-Florence Nightingale, 1859

Please take a moment to celebrate the nurses in your life. Florence Nightingale was the first to publicly decry the sorry …

7 disruptive changes that will affect medicine

Stephen C. Schimpff, MD

Health Policy

June 24, 2010

Generally we prefer calm seas but often they don’t get us anywhere.

We need disruptions, transformations to make the changes necessary for real progress in medicine. Sometimes it is a new technology; sometimes a cultural change. But then a refinement may occur. The refinement may not seem like a “disruption” but indeed it can be because the refinement may create a demand for change.

Here a few more disruptive changes or refinements …

Healthcare providers still aren’t washing their hands enough

MedPage Today

Physician

June 24, 2010

by Chris Emery

Nurses and other healthcare providers complied with hand hygiene guidelines less than half of the time before participating in medical procedures, results of a new study showed.

Compliance was better after procedures, with 72% following guidelines after procedures compared with 41.7% before procedures, according to a report published in the May issue of Applied Nursing Research.

Overall compliance with hand hygiene guidelines was just 34.3%.

“It is important to note that …