How might we think about EHRs globally while acting locally?

Health Technology
July 6, 2011

American health care information technology is undergoing two enormous leaps.

First, it is moving onto Web-based and mobile platforms – which are less expensive and facilitate information exchange – and away from client-server enterprise-centric technologies, which are more expensive and have limited interoperability. In addition, more EHR development activity is headed into the cloud, driven by large consumer-based firms with the technological depth to take it there. Both these trends …

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How might we think about EHRs globally while acting locally?

Cost containment strategies for emergency care

Health Policy
July 6, 2011

It strikes me that in developing payment reform related, compensation driven cost-containment strategies aimed at constraining the cost of emergency care, policy makers, emergency physicians, and health insurers should adhere to certain principles.

The American College of Emergency Physicians should be at the forefront when it comes to establishing these principles, which I hope will be focused on protecting our patients first, and our specialty second.

The concept and practice of …

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Cost containment strategies for emergency care

When the parent becomes child and child becomes parent

Patient
July 6, 2011

I bet you didn’t know that the war for independence is being fought on a daily basis throughout our glorious country. From the time we are born until the time we die, each of us strives to assert our independence. Once the toddler learns to run, he insists on running wherever he wants to. As he ages, we foster his need to be independent and teach him …

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When the parent becomes child and child becomes parent

Why Jack Kevorkian had a profoundly correct message

Physician
July 6, 2011

Although Jack Kevorkian was only a few years older than I was, and we both practiced pathology in southern California for many of the same years, I never met Dr. Kevorkian.

I found him from a distance to be a deeply odd character, and a profoundly flawed messenger but with a profoundly correct message.

I can’t improve on the quick summary of Jack Kevorkian by an unnamed author that the New …

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Why Jack Kevorkian had a profoundly correct message

Use the National Cancer Institute’s Cancer Information Service

Patient
July 5, 2011

Brenda Bryant learned she had breast cancer while she was sitting alone in her car in the parking lot of her grandson’s day care center. It was early evening on a Friday two years ago, and her surgeon called to tell her the results of a biopsy. “He just gave me my results and that was it,” says Bryant, who lives in Northern Virginia. “It was like there was …

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Use the National Cancer Institute’s Cancer Information Service

Cost of care is related to the advancements in medicine

Health Policy
July 5, 2011

Much is being written about the ever increasing cost of health care in the US, especially compared to the rest of the developed world.

As a nation, we spend nearly 16% of our GDP on health care.  All estimates predict that this amount will continue increasing unless costs can be controlled now.  Hence the passage of the Affordable Care Act.  Not only was it designed to extend coverage to more …

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Cost of care is related to the advancements in medicine

Using genomic data to understand disease entities

Medications
July 5, 2011

Three recent studies point to the continued presence and increasing importance of genomic information to improving health care.

We have discussed the power of personalized medicine in multiple posts and highlighted the potential of genomics and though this movement is really still in its infancy it is a burgeoning component of medicine.

The first study, published in the American Journal of Gastroenterology, explores Helicobacter pylori, a common …

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Using genomic data to understand disease entities

Vaccines to prevent or treat non-infectious chronic illnesses

Medications
July 5, 2011

A major megatrend in medicine will be the use of vaccines to prevent or treat (non infectious) chronic illnesses.

Although we tend to think of vaccines for preventing infections there are now two vaccines that prevent cancer (via preventing the infections that are in part causative), one vaccine on the market to treat residual cancer and many vaccines in development to prevent or treat other cancers …

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Vaccines to prevent or treat non-infectious chronic illnesses

Why HB 155 undermines the trust doctors have with patients

Physician
July 5, 2011

Do doctors have any business asking patients about whether or not they own a handgun?

Like many other paternalistic inquiries with which doctors routinely harass their patients (car seats, bicycle helmets, smoke alarms, etc), my answer to this question is “no.’”

There is a fairly well delineated sphere of knowledge which is medical in nature and in which I have some expertise and other topics which are purely personal, moral, or lifestyle considerations and in …

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Why HB 155 undermines the trust doctors have with patients

Death is inevitable, but it is almost always seen as tragic

Physician
July 4, 2011

Everyone liked him.  Though his later years (the only ones in which I knew him) took away his ability to do most things, and though he was in great pain every day, it was easy to see the mischief in his eyes.  The subtle humor was still there, coming out of a man who was weak, in pain, dying.

She lived for him.  She was always telling me of his pain, …

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Death is inevitable, but it is almost always seen as tragic

Not engaging in end of life discussions is grounds for malpractice

Physician
July 4, 2011

by Barry Massie, MD

It’s not that I am fixated on death, but recently, the CMS (Medicare) has decided not to pay for discussions with patients about prognosis and planning end of life care.

Reimbursement for such discussions was a key aspect of the health care reform legislation passed this year, and was widely mischaracterized as establishing “death panels.” I cannot imagine a legitimate justification …

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Not engaging in end of life discussions is grounds for malpractice

Medicare should stop paying for prostate cancer screening in men over age 75

KevinMD
July 3, 2011

The following op-ed was published on June 1st, 2011 in the New York Times’ Room for Debate blog.

Medicare should stop paying for prostate cancer screening in men over the age of 75.

You may be surprised to hear that, especially coming from a primary care doctor. But evidence is mounting that screening for prostate cancer is not only ineffective in older men, but may actually be harmful.

The cornerstone of …

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Medicare should stop paying for prostate cancer screening in men over age 75

Medicine and the examples of unintended effects of technology

Health Technology
July 3, 2011

The interaction of humans and technology will always be unpredictable.  A few months ago this thought was driven home to me in a rather malodorous manner.

I have obstructive sleep apnea (OSA) and use a CPAP machine every night to sleep comfortably.  With OSA your airway collapses when you fall asleep.  A CPAP machine is a small technological marvel, quietly delivering heated, humidified air under gentle pressure through a …

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Medicine and the examples of unintended effects of technology

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The FDA needs to issue guidance on the use of social media

Social Media in Medicine
July 2, 2011

The issue of social media being used by the pharmaceutical and health care industry has raised a variety of concerns from consumer groups and industry critics. Most recently, several consumer groups filed a complaint with the Federal Trade Commission (FTC) alleging that the pharmaceutical industry’s use of social media was deceptive and unfair.

Consequently, a recent article in the New England Journal of Medicine also covered the issue of social …

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The FDA needs to issue guidance on the use of social media

MKSAP: 69-year-old woman with pain and swelling in the knee

Conditions and Diseases
July 2, 2011

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 69-year-old woman is evaluated for a 5-day history of pain and swelling in the right knee that developed after a prolonged period of gardening in her backyard. Her pain worsens when she walks and is relieved with rest. She has no morning stiffness.

On physical examination, …

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MKSAP: 69-year-old woman with pain and swelling in the knee

What do hospice nurses and teenage heroin addicts have in common?

Medications
July 1, 2011

What do hospice nurses and teenage heroin addicts have in common? One may be an unintended consequence of the other.

A pair of articles published recently in two prestigious medical journals help make the case.

The Lancet reported that 47 million of the 58 million deaths occurring annually worldwide take place in developing countries, and that of these, fully 27 million die without having received proper palliative care. The article attributes …

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What do hospice nurses and teenage heroin addicts have in common?

Measuring physician trust in patients

Patient
July 1, 2011

Members of the  American public are frequently surveyed about their trust in various professionals.  Doctors and nurses usually wind up near the top of the list, especially when compared to lawyers, hairdressers and politicians.  Trust in professionals is important to us: they possess expertise we lack but need, to solve problems ranging from the serious (illness) to the relatively trivial (appearance).

How much professionals trust us seems irrelevant: our reciprocity is …

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Measuring physician trust in patients

How Twitter is a library and field work combined

Social Media in Medicine
July 1, 2011

Recently, I dashed off this tweet:

PhD student just asked me which journals I read to stay up to date on health + tech. My answer: Twitter.

It was classic RT bait and indeed it was echoed dozens of times by fellow Twitter geeks — more than any other tweet I’ve written.  But I would like to qualify it with a fuller explanation.  I don’t just read Twitter and ignore journals.  …

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How Twitter is a library and field work combined

Analyzing the reporting of lung cancer CT screening

Conditions and Diseases
July 1, 2011

It’s been another challenging week for journalists covering various screening stories.

First the new analysis of Swedish mammography studies: Some familiar flaws surfaced in some stories.

Then came the followup analysis of the National Lung Screening Trial – first reported last fall.

This week various headlines announced:

  • More evidence CT scans better at detecting lung cancer
  • Study bolsters evidence that screening reduces lung cancer deaths
  • Nat’l Study Shows Long-Term Smokers Should Get Lung …

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Analyzing the reporting of lung cancer CT screening

Dwyane Wade and the NBA’s insensitivity to his migraines

Conditions and Diseases
July 1, 2011

by Diana E. Lee

Sports journalists recently discussed discussing Dwyane Wade’s migraines and his decision to try wearing goggles to deal with light sensitivity.

News outlets like ESPN proved once again they know how to treat migraine disease as a serious, burdensome medical issue in reporting on Wade’s health situation. But somehow at the eleventh hour the story got way more complicated and the NBA revealed they don’t …

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Dwyane Wade and the NBA’s insensitivity to his migraines

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