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Are white coats obsolete? Not yet, if you look at the evidence

Physician

February 4, 2014

The Society for Healthcare Epidemiology of America (SHEA) guidelines for health care workers attire were recently published.

Science Daily led with the headline “New Infection Control Recommendations Could Make White Coats Obsolete,” which is rather misleading since the guidelines say no such thing.

I won’t reproduce the entire 15-page document here since the full text is available online. But here are some highlights along with my comments.

The guidelines say that facilities may consider adopting a …

Be suspicious of the marketing for essential oils

Roy Benaroch, MD

Medications

February 3, 2014

Kayla wrote in:

Hello! I am curious what you think about essential oils. They have recently become incredibly popular in my community, but I am pretty skeptical because so much of the enthusiasm is coming from those who have signed up as ‘distributors’ with doTerra or Young Living (2 essential oil multi-level marketing companies.). The biggest concern I have is that these companies (and all these new distributors) recommend taking many …

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Be suspicious of the marketing for essential oils

4 reasons why hospitals can be very dangerous places to be

Robert Pearl, MD

Physician

February 3, 2014

Hospitals are commonly thought of as the safest place to be for sick people.

Patients have around-the-clock access to skilled care teams. Their vital signs are continuously monitored. A physician stops by every morning to check on them.

While it all sounds safe, a hospital can be a very dangerous place to be. Here are four frightening risks hospitals pose, along with their causes and some easy-to-implement solutions that could save hundreds …

5 ways to improve the adoption of medical apps

David Lee Scher, MD

Health Technology

February 3, 2014

Before the adoption of new technologies which will undoubtedly improve health care (as it has the retail and finance sectors), it must be introduced in ways which are digestible, scalable, and subject to rapid iteration.

Is mobile technology different from the adoption of any other change in health care delivery? I think not. The culture of care certainly requires change as care models are changing. The point of care is shifting to the home, professionals …

The meaning and depth of the primary care crisis

Stephen C. Schimpff, MD

Health Policy

February 3, 2014

First in a series.

The primary care physician (PCP) should be the backbone of the American healthcare system. But primary care is in crisis — a very serious crisis. The first statement is my considered opinion and I will attempt to convince you of its truth. The second sentence is a simple fact.

Accounting for only 5% of all health care expenses, the PCP can largely control the “if and …

Are you a victim of patient profiling?

Pamela Wible, MD

Physician

February 3, 2014

patient profiling

Ever felt misjudged by a doctor? Or treated unfairly by a clinic or hospital? You may be a victim of patient profiling.

Patient profiling is the practice of regarding particular patients as more likely to have certain behaviors or illnesses based on their appearance, race, gender, financial status, or other observable characteristics. Profiling disproportionately impacts patients with chronic pain, mental illness, the …

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Are you a victim of patient profiling?

What is a high risk patient?

Fred N. Pelzman, MD

Physician

February 2, 2014

“What’s a high-risk patient?” asked our newly hired care coordinator.

Interesting question, and, as you would expect, one without an easy answer.

One of our patient-centered medical home certifying agencies was performing an audit for recertification, and requested information on our high-risk patient registry, including how patients were identified and assigned to the registry.

When you ask doctors or any other providers, we all know one when we see …

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What is a high risk patient?

Using palliative care to save health care dollars

James Simmons, MD

Physician

February 2, 2014

“No Margin No Mission” was a common saying when I studied about non-profits in business school. No matter how good your intentions are, whether it be creating new systems to get people access to care or opening a new animal rescue, if it couldn’t pay for itself it wasn’t going to happen.

So it should come as little surprise that an up and coming darling of CEOs of health systems is …

The generational shift in the learning styles of medical students

Mihir Gupta

Medical Education

February 2, 2014

A recent survey published in H&P, the Stanford medical school magazine, asked twenty graduating students to recommend books to read during the clinical rotation in internal medicine. Surprisingly, the top vote-getters weren’t books at all. The two most popular resources were both banks of practice questions, while the next two included a review book and a pocket handbook.

“Is this how our students learn the subtleties of sickness and health? What happened to textbooks? …

An embolus in one but trauma in many at 30,000 feet

Melissa Stone

Conditions and Diseases

February 2, 2014

A middle-aged obese female with a past medical history of diabetes and congestive heart failure is in cardiac arrest after several hours of immobility on an airplane. What is the cause of her condition?

If this were a USMLE exam, my thoughts would race to Virchow’s triad: stasis, endothelial injury, hypercoagulability. But this wasn’t an exam. This was a few rows behind me on an airplane.

I sat only …

Death of the physician progress note

David Mokotoff, MD

Physician

February 2, 2014

I am not sure of the date or time of death. However, I am reasonably certain of the cause. Death was by electronic data and formatting. The victim was the time-honored physician’s progress note. To be sure, these notes, even the now “ancient” written ones, were far from perfect. And they were often illegible. Shortcuts such as “as above” or AVSS (all vital signs stable) littered the pages of the …

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Death of the physician progress note

Cloning: Great for Dolly the sheep, not so good for EHRs

Betsy Nicoletti, MS

Physician

February 2, 2014

Certain medical stories are irresistible to the popular press: ICD-10 external cause codes that are ridiculous (W61.43XD, pecked by a turkey, subsequent encounter) or medical practices using their electronic health records in a way that increases their revenue.

A recent headline was eye-catching, as headlines are meant to be, “Report finds more flaws in digitizing patient files.” The New York Times reported that the Office of Inspector …

Why imaging industry should pay attention to clinical trials

Dr. Saurabh Jha

Conditions and Diseases

February 1, 2014

Would you tell me, please, which way I ought to go from here?
That depends a good deal on where you want to get to.
I don’t much care where –
Then it doesn’t matter which way you go.
– Lewis Carroll

In the new world, payers will increasingly ask before reimbursing medical imaging: why did you bother finding out? This is why we must pay attention to clinical trials.

An instructive case is in the …

Address the primary care shortage and make the AMA more relevant

James M. Pritsiolas, MD

Health Policy

February 1, 2014

It saddens me to proclaim that the American Medical Association (AMA), the once-venerable organization that has advocated for the interests of physicians and patients alike since its founding in 1847, is on the precipice of irrelevancy. Membership has dwindled such that only 1/4 of physicians now belong to its ranks.

The attendant decrease in social and political influence that accompanies this decrease in membership arguably compromises the ability of the AMA …

Treating post-viral coughs: This too shall pass

Emily Gibson, MD

Conditions and Diseases

February 1, 2014

‘Tis the season to be coughing …

It no longer takes an epidemiologist looking at absenteeism rates in schools to predict the start of influenza season. For several years now there have been sophisticated models using search engine terms to monitor increasing incidence of febrile cough illness in regions of the world.

Or just ask a primary care clinic what its waiting room sounds like these days. A chorus of coughs, high, low, dry, …

What the Oregon Health Study has told us so far

Cedric Dark, MD, MPH

Health Policy

February 1, 2014

Recently, another installment was published from the research team of the Oregon Health Insurance Experiment. The major finding — Medicaid coverage results in a 40% increase in emergency department (ER) use. Many of the health care pundits quickly sifted through the scientific results to support their opinions.

You can read some of them here:

Sarah Kliff reports the facts: Expanding Medicaid doesn’t reduce ER trips. It increases them. Scott Gottlieb claims that Read more…

What the Oregon Health Study has told us so far

Affluenza: How to be sick without being sick

Janet Byron Anderson, PhD

Conditions and Diseases

February 1, 2014

The four pedestrians never saw it coming.

Around 11:45 p.m on June 15, 2013 on a road in Burleson, Texas (a suburb of Fort Worth), the driver of a stranded SUV and three people who had stopped to help her change a flat tire were killed when 16-year-old Ethan Couch smashed into them with his red pickup truck. Seven other teens were in the truck with him. Drunk, and driving 70 …

Declining care from physicians in training

Brian J. Secemsky, MD

Medical Education

February 1, 2014

Recently, I had the fortune of hearing the tale of Bob and his bum knee.

It all started when Bob picked me up at the end of a busy clinic day in his neon orange Subaru. Given that this particular shared car service promotes friendly conversation, Bob started up the gab by asking me what position I held in the medical center. After describing my work as a …

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