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The CSI effect and high tech medicine are driving up tests

Evan Falchuk

Physician

September 4, 2011

I’m in Israel, home to some of the most innovative care in the world. Doctors here wanted to know if the high-tech tests that are an increasing part of their work help. A couple of weeks ago, they published their results.

It turns out that in about 90% of cases, it didn’t matter.

A physical exam, the patient’s history, and the basic set of tests that doctors have done for decades …

Should the elderly with dementia be given anti-psychotic drugs?

Merrill Goozner

Medications

September 4, 2011

The inspector general of HHS recently reported that nearly half of the anti-psychotic drugs fed to the demented elderly in nursing homes are inappropriately prescribed. That’s about one in fourteen nursing home residents.

Forget about cost, which is over a quarter billion dollars a year. “Government, taxpayers, nursing home residents as well as their families and caregivers should be outraged and seek solutions,” wrote Daniel R. Levinson, the HHS I.G. wrote …

How the price of preventing a preterm pregnancy went up

Allen Perkins, MD

Medications

September 4, 2011

One of the reasons cited for our expensive health care system is that drugs cost more in America (part of our capitalistic system). In June of 2003, a study was published in the New England Journal of Medicine about the use of a form of progesterone to delay the birth of certain preterm infants. This particular hormone is found in the human body, but the formulation …

A real doctor will first do no harm

Emily Gibson, MD

Patient

September 3, 2011

I’m really miserable and need that 5 day antibiotic to get better faster.

Ninety eight percent of the time it is a viral infection and will resolve without antibiotics.

But I can’t breathe and I can’t sleep.

You can use salt water rinses and decongestant nose spray.

But my face feels like there is a blown up balloon inside.

Try applying a warm towel to your face.

And I’m feverish and having sweats at night.

Your temp …

Read more…

A real doctor will first do no harm

Tips for doctors looking for the right EHR

Margalit Gur-Arie

Health Technology

September 3, 2011

Here we are going to talk about the second stage of shopping for an EHR. We are going to assume that you did your homework, defined your goals and constraints and prepared a comprehensive list of requirements for an EHR (if you have not done so already, go back and read part 1).

To continue our car shopping analogy, we are now ready to go kick some tires, and …

How diet and exercise beat high blood pressure

Eric Marcotte, MD

Patient

September 3, 2011

All day I badger and cajole my patients to take better care of their bodies:

“We really need to get some of this weight off, Mr. Jones.”

“This blood sugar level means diabetes is right around the corner – it’s time to get serious about changing your diet, Ms. Smith.”

“This blood pressure reading tells me that you’re not getting enough exercise, Bill.”

I’ve got pills for everything, it seems. I just wish I …

Improving efficiency and requiring Congress to live under our healthcare rules

Mitchell Brooks, MD

Health Policy

September 3, 2011

Here are my next two principles of affordable healthcare reform.

First, medicine must be practiced in a manner and in a place that is consistent with economic efficiencies, evidence based outcomes and the needs of the specific community that it serves.

In healthcare delivery, quantitative must be balanced by qualitative. Specific community needs and the culture of that particular community must have equal and in certain cases, greater value than the …

An informed screening choice for breast cancer

Margaret Polaneczky, MD

Conditions and Diseases

September 2, 2011

Most women in their 40′s believe they should have annual mammograms, regardless of what screening regimen their doctor might recommend.

So say researchers in Massachusetts who surveyed women (primarily white, highly educated) ages 39-49 presenting for annual checkups. They gave the women a fact sheet about the new USPSTF guidelines on mammogram screening in their age group, and asked them to read one of two articles either supporting or Read more…

An informed screening choice for breast cancer

Heart valve repair without open surgery

Stephen C. Schimpff, MD

Conditions and Diseases

September 2, 2011

A major innovation are the recent reports of success in replacing or repairing diseased or damaged aortic or mitral valves via catheter-based techniques instead of open surgery.

Mitral regurgitation is when the valve becomes unable to close tightly. Once the regurgitation becomes sufficiently severe to cause heart failure, the death rate reaches about 5% per year. Most such individuals are referred for cardiac surgery to either try to repair the valve, …

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Heart valve repair without open surgery

Overcoming barriers to building a direct primary care practice

Dave Chase

Physician

September 2, 2011

The federal health reform bill included a little-noticed clause allowing for Direct Primary Care (DPC) models to be a part of the state health exchanges. I believe this will fundamentally alter the health insurance market and is leading to what I call a “Do it Yourself Health Reform” movement. That little-noticed clause (item #3 in 1301(a) of HR 3590) should have the effect of massively …

Money keeps a physician practice running

Stewart Segal, MD

Physician

September 2, 2011

“Doc, it’s only $10. I can’t believe you’re throwing me out of the practice for a measly $10. You, docs, are all the same. It’s all about the money!”

Unfortunately, the money is important. It costs money to keep a practice running. It costs money just to collect the money owed to the practice.

So, let’s look at some simple facts. Your physician’s office is one of the few places where you …

Will replacing fee for service really reduce costs?

Jaan Sidorov, MD

Health Policy

September 2, 2011

In this enlightened era of evidence-based medicine, you’d think that the progressive academics, viziers, and mandarins who are cluttering the policy making commentariat would pay more attention to what was tried before. That should be doubly true if those lessons come from that health care nirvana called Europe, where enlightened central bureaucracies wisely allocate health care for its caffè sipping, plaza strolling and beret adorned citizenry.

Case in point is …

Control and be responsible for your diabetes

Trey Stephens

Conditions and Diseases

September 2, 2011

Diabetes tries to steal moments from me every second of every day. I choose to steal these moments back. Thus, the chosen name for my attitude toward diabetes, Outlaw Diabetic.

Unlike the majority of the 360 million diabetics worldwide, I did not become a diabetic in my adult life. I became a type I diabetic at 14 months old. As a result, I have never had to change my way …

Natural language processing in electronic health records

Joe Petro

Health Technology

September 1, 2011

80 percent of the clinical documentation that exists in healthcare today is unstructured. It is sometimes referred to as “the text blob” and is buried within electronic health records (EHRs). The inherent problem with “the text blob” is that locked within it lies an extraordinary amount of key clinical data – valuable information that can and should be leveraged to make more informed clinical decisions, to ultimately improve patient …

When parents respond to the meaning of a child’s behavior

Claudia M. Gold, MD

Patient

September 1, 2011

It was a peaceful Saturday morning at Fuel, a local coffee shop in Great Barrington. People sat quietly murmuring with friends over coffee and muffins, or intently working at their laptops. I was doing the final edits for my forthcoming book Keeping Your Child in Mind, when I looked up to see a small boy of about two years tottering down the narrow aisle holding a plate with an …

How medical students can prepare to be hospitalists

Happy Hospitalist, MD

Medical Education

September 1, 2011

A second year medical student reader asked me to comment on what rotations to take in medical school to prepare for an internal medicine or hospitalist medicine career.

I am a second year medical student, very interested it practicing the art of Hospital Medicine, and I was wondering if you had any advice/comments on any specific electives to consider to help prepare me for an Internal Medicine residency.

Great question. As …

The medical legacy of Rick Perry

Robert Luedecke, MD

Health Policy

September 1, 2011

While liability reforms have been good for the health of Texans, many laws favored by Governor Perry have damaged health. As a physician on the Committee on Public Health of Bexar County Medical Society, I have been trying for many years to help not only my patients, but also Texans in general. San Antonio, my home for the last 30 years, is reported to have a population mix very similar …

Read more…

The medical legacy of Rick Perry

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