How can doctors stop drugs prescribed by other physicians that are no longer effective?

Medications
January 30, 2010

Here are two vignettes illustrating the failure of doctors to master the obvious and maybe a window onto the future struggles to control medical costs.

A 90-year old is referred for care due to “end stage dementia.” End-stage dementia is medical speak and as such does not really convey the appropriate imagery. It means a skeletal man, in a wheelchair or mostly in bed, with diapers, who has does not know …

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How can doctors stop drugs prescribed by other physicians that are no longer effective?

How can doctors make America a better place to live?

Health Policy
January 29, 2010

What can physicians do to make American a better place to live, die, afford, and receive care? What can we do to bring about practical reform? What can we contribute?

These may seem odd questions, After all, we deliver care. Care goes through us. But Medicare, Medicaid, and private third parties are big players. They dictate terms of engagement and payment. But the answers lie at the core of the physicians’ …

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How can doctors make America a better place to live?

Will New York’s ban on salt really make patients healthier?

Conditions and Diseases
January 29, 2010

Originally posted in MedPage Today

by Mike Himowitz

I have a libertarian streak that compels me to shout “Nanny State!” when local governments put up speed-trap cameras to extort money from otherwise law-abiding citizens who drive a few miles over artificially low limits. Same for legislators who want to make me a criminal for calling my wife on my cell phone to ask her if I should pick up anything at …

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Will New York’s ban on salt really make patients healthier?

Nobody will be held accountable if healthcare reform fails

Health Policy
January 28, 2010

I must admit I’m a little weary of the entire debate on health-care reform. But something still haunts me. And that something is accountability. Of course, over the almost twenty years that I have borne the title ‘MD,’ I’ve learned a few things about accountability.

I understand that, almost without fail, the buck stops with me. The nursing home director knows the elderly lady wasn’t seriously hurt in that fall, but …

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Nobody will be held accountable if healthcare reform fails

Why health IT won’t help with medical risk management

Health Technology
January 28, 2010

The march is on across the American healthcare landscape to implement electronic health records that also function as decision-support systems.

These “advanced” electronic health records will both provide centralized records and assist providers in making care decisions such as implementing therapy and utilizing evidence-based practice on the individual patient level. And anyone that has had the opportunity to work with some of the systems out there knows that they can be …

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Why health IT won’t help with medical risk management

How to make your medical grand rounds thrive

Medical Education
January 27, 2010

Early last year, my boss Talmadge King and I were at an ABIM meeting (we’re both on the board), and the group was debating a controversial topic. Another participant at the meeting, like Talmadge the chair of a prominent department of medicine, said, “We polled 250 people at our grand rounds last week, and they said ‘X’.” The audience gasped – ‘X’ was a completely unexpected …

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How to make your medical grand rounds thrive

How to stop theft from your medical practice

Physician
January 27, 2010

Originally published in HCPLive.com

by Ed Rabinowitz

There’s a great scene in the movie The Big Chill where the main characters are having a discussion on the topic of rationalizations. One individual comments that he doesn’t know anyone who could get through the day without two or three juicy rationalizations. That may be true. But when a rationalization involves taking things from the office or workplace, and that office just happens to …

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How to stop theft from your medical practice

How President Barack Obama’s State of the Union speech will impact healthcare reform

Health Policy
January 27, 2010

Originally published in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

President Barack Obama’s State of the Union speech Wednesday night will likely focus on job creation and the economy and not — as many Democrats once hoped — on congratulations for the passage of healthcare reform.

In the week following the election of Republican Scott Brown to the U.S. …

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How President Barack Obama’s State of the Union speech will impact healthcare reform

How should patients decide which hospitals are best for them?

Physician
January 26, 2010

Johns Hopkins Hospital is consistently named one of the best in the country. I can’t disagree with that; after all, I just started working there as an internist in September. Coincidentally, in the midst of the raging debate around health care reform, the past few months have seen increasing discussion of a small but crucial question: why do some of the best hospitals spend more money than others? If other …

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How should patients decide which hospitals are best for them?

The National Consortium of Breast Centers (NCBC) response to the USPSTF breast cancer screening recommendations

Conditions and Diseases
January 26, 2010

I’ve been given permission to deliver the National Consortium of Breast Centers (NCBC) position statement. It does a far better job with a critique of the USPSTF Screening recommendations than I did when I shared my first thoughts. As the President for the NCBC, I want to acknowledge the work done on behalf of our organization by our Policy Chairpersons, Drs. John Bell and Barbara Rabinowitz, both of whom are …

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The National Consortium of Breast Centers (NCBC) response to the USPSTF breast cancer screening recommendations

Extended military deployments to combat areas increase stress, anxiety and depression among families

Conditions and Diseases
January 26, 2010

Originally published in MedPage Today

by John Gever, MedPage Today Senior Editor

The longer that U.S. Army soldiers spent in Iraq and Afghanistan, the greater the likelihood that their wives would seek psychiatric treatment, researchers said.

The risk that a woman would receive a new mental illness diagnosis during her husband’s deployment was significantly higher when he was overseas for a year …

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Extended military deployments to combat areas increase stress, anxiety and depression among families

10 ways United States health reform may fail

Health Policy
January 26, 2010

One, develop a plan that the presently privately insured Americans, estimated at 200 million, pay more in premiums, and to just make sure you succeed, immediately starting raising taxes by $400 billion over the next decade.

Two, alienate those over 65, the most dependable voting bloc, by promising to cut Medicare by $500 billion over the next ten years with the false promise, which you know you cannot …

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10 ways United States health reform may fail

10 cost effective preventive medicine services

Conditions and Diseases
January 25, 2010

Here are the top 10 preventive services. These items were chosen by the National Commission on Prevention Priorities, and highlight those preventive services including immunizations, screenings, preventive medications, and counseling that give “the most bang for the buck.”

For an in depth discussion of methods and results, read Am J Prev Med 2006;31(1):52–61

Discuss Daily Aspirin Use

This counseling does not mean everyone should take aspirin to prevent heart attack and stroke, but …

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10 cost effective preventive medicine services

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Can morphine help prevent post-traumatic stress disorder (PTSD)?

Medications
January 25, 2010

Originally posted in MedPage Today

by Todd Neale, MedPage Today Staff Writer

The use of morphine may prevent the development of post-traumatic stress disorder (PTSD) in military personnel injured in combat, an observational study showed.

Those who received the drug during resuscitation or trauma care were about half as likely to later develop PTSD (OR 0.47, P<0.001), according to Troy Lisa Holbrook, PhD, …

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Can morphine help prevent post-traumatic stress disorder (PTSD)?

Why the Mayo Clinic is refusing to see Medicare patients

Health Policy
January 25, 2010

Medicare, the government insurance company for everyone over age 65 (and for the disabled), pays fees to primary care physicians that guarantee bankruptcy.

Additionally, 70 percent of hospitals in the United States lose money on Medicare patients. That’s right, for every patient over age 65, it costs the hospital more to deliver care than the government reimburses. That is why Mayo Clinic has said it will not accept Medicare payments for …

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Why the Mayo Clinic is refusing to see Medicare patients

How television can shorten your life

Conditions and Diseases
January 24, 2010

Originally published in MedPage Today

by Todd Neale, MedPage Today Staff Writer

Too much television watching could be shortening lifespans, a study of Australian adults showed.

Aussies who reported watching four or more hours of TV a day were 46% more likely to die during a 6.6-year period than those who watched less than two hours a day, according to David Dunstan, PhD, of Monash University in Melbourne, and colleagues.

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How television can shorten your life

Why there needs to be a national healthcare information database

Health Technology
January 24, 2010

The majority of Americans have a great deal of personal health information in their physician’s medical record. Many of these physicians have an electronic healthcare record (EHR) to store this information.

Unless you are in an integrated healthcare system, and most Americans are not, this information is just not available to you or any physician seeing you who does not belong to the same physician group as your primary physician. Even …

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Why there needs to be a national healthcare information database

When are stroke patients more likely to receive clot busting drugs?

Medications
January 23, 2010

Originally published in MedPage Today

by Todd Neale, MedPage Today Staff Writer

Patients suffering an acute ischemic stroke are about 20% more likely to receive clot-busting therapy with tissue plasminogen activator (tPA) if they arrive at the hospital on the weekend, a retrospective study showed.

However, there was no difference in rates of inhospital mortality based on the time of admission, Abby …

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When are stroke patients more likely to receive clot busting drugs?

Why touchscreen computers are the future for electronic medical records

Health Technology
January 23, 2010

As I explore the latest EMR offerings, and read all the blogs and media releases for and against EMRs, I am forced to wonder, “Has anybody ever asked us doctors what we either want or need?”

Too often it seems the requirements of EMR’s are more suited to organizations, systems, and number-crunchers than to either doctors or our patients. I understand that the data is important, but why should the adaptation …

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Why touchscreen computers are the future for electronic medical records

Talking to a patient, without a translator, in mutual non-native languages

Patient
January 22, 2010

“Je m’a…,” I stuttered to Aristede Mezondes, the serious young man in a grey wool overcoat, standing before me with ramrod posture. “Je m’appelle Dr. Ofri.”

There. I’d gotten it out.

The language of Descartes, Voltaire, and Balzac had clearly vacated my cortex. Despite those years of French classes and one brief visit to Paris, “Je m’appelle” was the best I could come up with. And even that was a struggle. Pushed …

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Talking to a patient, without a translator, in mutual non-native languages

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