Participatory medicine and evidence from medical journals

Patient
July 20, 2010

I’ve only been studying healthcare for two years and I hesitate to be overly assertive.

But I have, finally, reached the point where I feel confident in citing cases where people are simply being unscientific: ignoring evidence. That’s always hazardous, and it becomes insidious when it’s caused by a blind, unquestioning belief in our institutions.

Case in point:

Julie Thoren is an active practitioner of Participatory Medicine who’s seen first-hand the tremendous value …

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Participatory medicine and evidence from medical journals

Health care needs public acceptance of evidence based medicine

Health Policy
July 20, 2010

Although a majority of Americans probably couldn’t give you an accurate description of the differences between fascism, socialism, and communism, they have no trouble applying–and often interchanging–those labels to any effort by government to reform health care.

And, based on their efforts, one might conclude that the defining characteristic of any government involvement in health care is rationing. As if we don’t already ration, but will as soon as the government …

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Health care needs public acceptance of evidence based medicine

Thinspiration and pro-ana sites perpetuate eating disorders

Social Media in Medicine
July 20, 2010

by Kristina Fiore

Websites that encourage teens to continue in their eating disorders tend to do so via “thinspiration” — a combination of images and prose that drive the viewer toward continued weight loss, researchers say.

About 85% of these sites provide thinspirational photos (or “thinspo”) of ultrathin women and oaths to “Ana” or “Mia” — nicknames for anorexia and bulimia — according to Dina L.G. Borzekowski, EdD, of Johns Hopkins, and …

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Thinspiration and pro-ana sites perpetuate eating disorders

5 principles of self-care for health professionals

Physician
July 20, 2010

As trained caring professionals, often we think of self-care as “selfish” or something that we do after we’ve taken care of our other “duties”, “responsibilities” and “obligations”.

Just for a moment, I invite you to think of self-care in a different way. I invite you to consider that your knowledge and practice of self-care is essential to creating a healing relationship with your patients and creating a healing environment in your …

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5 principles of self-care for health professionals

The value of comparative effectiveness reviews is locally based

Health Policy
July 20, 2010

by Craig A. Umscheid, MD, MSCE

In its 2010 comparison, the Commonwealth Fund has rendered the verdict yet again: the United States leaves other nations in the dust when it comes to healthcare costs — and yet provides its residents with the worst outcomes overall. In the study, the U.S. underperformed on virtually every front in comparison to Australia, Canada, Germany, Netherlands, New Zealand, and the United Kingdom.

The …

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The value of comparative effectiveness reviews is locally based

How Massachusetts can set hospital payment rates

Health Policy
July 19, 2010

My suggestion last year that Massachusetts move away from the “free market” approach it uses to set hospital reimbursement rates was not well received by the hospital world.

But, this year, as people notice that their rates are being set by insurance companies in an unaccountable and unreviewable fashion, more and more are saying, “Well, maybe. What would it look like?”

There is a range of options. Let me lay out …

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How Massachusetts can set hospital payment rates

What libraries and community centers have to do with health care

Health Policy
July 19, 2010

Our grandparents used to tell us, “if it ain’t broke, don’t fix it”.

Management gurus, in their race to the finish line have turned this sentiment on its head by telling us that, if it ain’t broke now, it will be soon, and if you do not fix it before it breaks, you will be behind the competition. This sentiment drives the annual corporate reorganization at every corporation that I or …

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What libraries and community centers have to do with health care

Watchful waiting may be appropriate for most prostate cancer cases

Conditions and Diseases
July 19, 2010

by Crystal Phend

Deferring curative treatment for low-risk prostate cancer may be a good option for many men ages 70 and younger, a population-based observational study affirmed.

In the national Swedish prostate cancer registry, the cumulative 10-year prostate cancer-specific mortality rate was only 2.4% for men at low risk who opted for watchful waiting or active surveillance, according to Pär Stattin, MD, PhD, of Umeå University Hospital in Umeå, Sweden, and colleagues.

This …

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Watchful waiting may be appropriate for most prostate cancer cases

What bored doctors can do after they retire

Potpourri
July 19, 2010

As the baby boom generation nears retirement, there will be a flood of doctors left wondering what to do with their time. Some doctors will continue to work in practice and, although it is certainly rewarding to work hands-on with patients and new staff, after 30, 40, or 50 years in the business many start to explore other options.

The motivation that drives one to medicine often stays with them for …

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What bored doctors can do after they retire

Prior authorization required by health insurers impedes primary care

Physician
July 19, 2010

by Charles R. D’Agostino, MD

It strikes fear in the hearts of doctors across the country; it is not the deadly Ebola virus or a new strain of cancer, but its malignancy is equally apparent.

It is the dreaded “PA”, which is insurance-speak for “prior authorization” and it seems that no matter which way we turn it appears, standing between our patients and the care they need.

To their credit, PAs are truly …

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Prior authorization required by health insurers impedes primary care

Cancer patients need compassion and balanced information

Patient
July 18, 2010

If you have to ask what jazz is, you will never know.
– Louis Armstrong

The stillness in the meeting room was electric.

First, one panelist addressed the audience members who have never experienced a malignancy. She described the unique and powerful bond that exists between cancer survivors. She described how the brush with mortality forces each survivor to renegotiate terms with Life itself. She reminded everyone that the cancer care system too often lets …

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Cancer patients need compassion and balanced information

A new primary care payment model with health savings accounts

Health Policy
July 18, 2010

by Charles Smith, MD

Everybody seems to be dissatisfied with the current model of primary care.

Concierge and retainer practices are all the rage, but they serve too few patients. While some highly integrated systems (Mayo Clinic, maybe Kaiser Permanente) may be thriving, they are difficult to replicate. Most primary care physicians are demoralized by a system that overburdens them with administrative hassles and liability while providing insufficient revenue to improve …

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A new primary care payment model with health savings accounts

How doctors can discuss advance directives with patients

Patient
July 17, 2010

A recent blog post and series of responses on KevinMD.com aroused my interest.

Dr. Kevin Pho posed the question: Why are doctors so reluctant to discuss end-of-life care? Responders, including patients, doctors, nurses, and even a veterinarian highlighted the stress inherent in this discussion for patients and for medical professionals alike.

To me, the real issue is not whether the discussion should occur, because clearly it should, but when and how? …

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How doctors can discuss advance directives with patients

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ER visits rise because of prescription drug abuse

Medications
July 17, 2010

by Michael Smith

The number of emergency room visits for nonmedical use of prescription painkillers more than doubled between 2004 and 2008, according to a CDC estimate.

The increase was part of a trend that saw emergency room visits for nonmedical use of all prescription and over-the-counter medications reach the same level as those for abuse of illicit drugs, the agency said in the June 18 issue of Morbidity and Mortality Weekly …

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ER visits rise because of prescription drug abuse

Unnecessary testing needs more than tort reform to cure

Conditions and Diseases
July 17, 2010

Recently, while covering for one of my partners on a weekend, I was consulted by a physician to do a procedure.

The doctor wanted his patient to undergo an EGD, which is a scope test that examines the esophagus, stomach and first portion of the small intestine called the duodenum. We gastroenterologists do this test routinely to search for an explanation for a patient’s symptoms, or to determine if these organs …

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Unnecessary testing needs more than tort reform to cure

Why general internists are quitting clinical medicine

Health Policy
July 16, 2010

The Association of American Medical Colleges predicts that by 2025, the US health system will have 46,000 fewer primary care physicians than it needs.

If the prediction proves correct and we fail to develop effective mitigation strategies, the manpower shortage will create quite a mess. Ironically, the health reform law signed by President Obama in March will exacerbate the problem by increasing demand for services provided by primary care physicians.

The American …

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Why general internists are quitting clinical medicine

Facebook friend issues between doctor and patient

Social Media in Medicine
July 16, 2010

My friend and colleague Katherine Chretien has a provocative op-ed in USA Today entitled, “A doctor’s request: Please don’t ‘friend’ me,” which asks the question whether doctors and patients should interact in social networking sites such as Facebook.

Social networking has huge potential in health care regarding the sharing of information and ideas, and could possibly even enhance communication between doctors and patients. However, as Dr. Chretien points out, many …

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Facebook friend issues between doctor and patient

Echocardiogram reading by cardiologists needs to improve

Conditions and Diseases
July 16, 2010

by Crystal Phend

Insufficient training among cardiologists in reading echocardiography results is wasting healthcare dollars and subjecting patients to unnecessary procedures, researchers said.

A review by sonographers of cardiologist-interpreted echocardiography findings at a Milwaukee medical center during a period of just over a year indicated major discrepancies in 29% of cases, leading to unnecessary further diagnostic testing or treatments for the wrong indication, according to a study presented here at the American …

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Echocardiogram reading by cardiologists needs to improve

Poliomyelitis doesn’t make the health reform cut

Health Policy
July 16, 2010

Early in paralytic poliomyelitis, the patient exhibits weakness; hyperesthesia; muscular pain, frequently quite severe; antalgic (reflexive) immobilization (spasm) of involved muscles; and normal or accentuated tendon reflexes.

This phase is rapidly followed by loss of motor function, which is usually asymmetric and noncontiguous: one or both legs in 60 percent of the cases; one or both arms in 25 percent. Involvement of the diaphragm and intercostal muscles reduces ventilatory capacity. Cranial …

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Poliomyelitis doesn’t make the health reform cut

Why doctors run late and how patients can help

Physician
July 15, 2010

A friend recently asked me in great frustration after her visit to her doctor why doctors “always run late.”

Why do doctors make their patients “dance around” the office, getting moved around to different spots in the clinic, but still having to wait and wait at each location? Instead of explaining what really goes on at the doctor’s office, I ended up emailing her a couple of links to some of …

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Why doctors run late and how patients can help

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