As I have mentioned before, all surgeons think they are the best. Of course when we ourselves need surgery, there is a bit of a dilemma deciding who is the best qualified to carry out the procedure. So when I realized there was a strange looking skin lesion in my right inner thigh, I decided only the best would do to operate me.
In my rooms I informed the sister I …
Operating on myself: What could possibly go wrong?
There is an epidemic of gun violence. This is a serious health problem. Watching your diet, exercising, and taking pills is all for naught if a bullet kills you.
In Newtown, Conn., one of the worst mass shooting occurred last week when a gunman shot his mother at home, apparently with her own gun, then walked into an elementary school and shot six other adults and 20 children, before shooting himself. …
Minimize the tragedy of gun violence
Use of generic drugs has the potential to reduce annual consumer spending on prescriptions by billions. A study published in the New England Journal of Medicine and discussed in the New York Times’ Economix blog in 2012 looked at Medicare Part D expenditures and correlated them with drug prescribing patterns. The regions of the United States with the highest Medicare expenditures were those where …
Are generic drugs as safe and effective as name brand drugs?
For just a moment, let’s take a scientific viewpoint about gun control here and try to leave emotions (and the Constitutional argument) out.
The best type of study to determine whether gun control and/or regulation would be a randomized trial: randomizing a state or country to regulation or not.
Since that’s not going to happen, the next best type of evidence we have to go by is observational, either case-control or cohort …
We need an evidence-based, randomized trial on gun control
I knew he was sick when he told me he’d thrown out his cigarettes on account of how badly he felt.
Mr. P had gotten used to the breathlessness when he climbed stairs and the hacking, dry cough that followed him everywhere. What else could he expect after smoking three packs a day since he was six years old? But he had shown …
Smoking has become hidden in the shadow of obesity
From 1974 to 1982, a group of researchers conducted the RAND Health Insurance Experiment. In lay terms, what they did was assign people to different levels of insurance coverage, with a particular focus on the amount of co-payments, co-insurance, and deductibles that people had to pay, and then they observed their use of the health care system. As you might expect, those who had to pay more out of their …
Expanding Medicaid and cost sharing: A recipe for disaster?
It has always been my assumption that my new practice will be as “digital” as possible. No, I am not going into urology, I am talking about computers.
[Waiting for the chuckles to subside]
For at least ten years, I’ve used a digital EKG and spirometer that integrated with our medical record system, taking the data and storing it as meaningful numbers, not just pictures of squiggly lines (which is how EKG’s …
Imagine a doctor actually trying to save money for his patients
One of the toughest situations in oncology is the discussion about next steps, particularly when it comes to treatment of recurrent or metastatic disease. I believe very much that it is realistic to offer a patient the hope of cancer as a “chronic disease,” that treatment can result in disease stability, even though I cannot predict how chronic “chronic” is.
I was …
Physicians: Improve the experience of communication
Right now, the technology exists to completely transform healthcare.
A doctor should be able to walk into the room where a patient is waiting for them and get everything they need to make an informed decision about that patient’s care.
Location-based technology should sense the doctor approaching and already know which patient is waiting for them. A computer or a tablet in the room should have access to thousands of data points …
Technology is being held back from transforming healthcare
No one knew just how long Freddy had been homeless nor what circumstances had brought him to the doorstep of the Baltimore Rescue Mission shelter. As far as Dr. Dalton – our physician supervisor – and his students knew, Freddy had been there forever. Residents of the shelter were required to help out, sweeping floors or cooking for the other residents. Freddy always volunteered for clinic duty and was charged …
What draws me to primary care: Building relationships
There are an estimated 15,000 medical apps presently on the market and is expected to grow 25% per year according to one study. There are issues which are common in the development of these apps and other categories of apps. However, some technical and non-technical issues are unique to the sector. As someone who does not design apps, …
5 reasons why mobile health apps fail
I recently read an article on the RAND Corporation’s analysis of electronic health records (EHRs). As a practicing pediatrician currently using EHRs, and given the reality that EHRs are still a relatively new addition to the U.S. medical profession and have created a fundamental shift to the care delivery process, I am compelled to respond to assertions made in this article.
The first RAND study, sponsored by a …
Refuting RAND: Why I am optimistic about EHRs
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 67-year-old woman is evaluated for a 2-day history of severe muscle weakness. The patient experienced significant weight gain and developed hypertension and type 2 diabetes mellitus 2 years ago. She also reports developing muscle weakness of the lower extremities 6 months ago. Her diabetes is only partially controlled by metformin; her blood glucose …
MKSAP: 67-year-old woman with severe muscle weakness
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Office-based medical practice is changing fast. The government is providing incentives to those practices that use electronic prescribing and electronic records systems and will soon penalize those that don’t. Health reform will shortly deliver many newly insured patients to your office. A host of new patient care models aimed at making healthcare more team-based are emerging. Reimbursement tied to outcomes will demand a greater level of patient management and engagement …
Your EHR needs a population health management system
Former Boston Red Sox closing pitcher Jonathan Papelbon may have opened up a can of worms with his remarks about his frequent use of the injectable anti-inflammatory drug Toradol (ketorolac) during his time with the Red Sox.
Papelbon, who now plays for the Philadelphia Phillies, told ESPNBoston.com that several Red Sox players were frequently injected with the drug:
“It was kind of …
Toradol in sports: A culture change is needed
Over the past several months, the state of Oregon has been pursuing an aggressive approach to solving the healthcare crisis that many states are dealing with.
A couple of years ago Oregon was facing a $2 billion deficit in their Medicaid program, with few solutions to repair the situation. The governor was reluctant to take the obvious step of cutting doctors’ pay for …
Look to Oregon to see if Obamacare will succeed
Disclosure. I am a pathologist, and I work at the interface of molecular oncology and information technology.
Approximately 600,000 American cancer patients emerge uncured from standard of care treatment by medicine, surgery, and radiation each year. That is 1,600 every day. What then?
Enlightened palliation on the way to hospice care does make sense for many. But now there are additional options based upon emerging science.
Molecular testing of the actual cancer tissue …
Pathologists face a stark career choice
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 28-year-old man is evaluated 24 hours after a new diagnosis of a left calf deep venous thrombosis. One week ago, he underwent orthopedic surgery. Two weeks ago, he returned from vacationing in Italy on an 8-hour flight. Current medications are enoxaparin, 80 mg subcutaneously twice daily, and warfarin, 5 mg/d.
On physical examination, temperature …
MKSAP: 28-year-old man with left calf deep venous thrombosis
Sam burst into the office, a two-year-old wild bundle of energy. Squealing with delight — or was it distress; it was hard to tell — he ran from toy to toy not looking at me or his mother, Jane. He was unable to engage with anything. Jane had brought him to see me in my pediatric practice because, “he hits me, has explosive tantrums, and I can’t take him anywhere.” …
Raising a child alone in a culture of quick fixes
America consumes 80% of the world opioid supply (99% of the world hydrocodone supply), but has about 5% of the world’s population. If you don’t think America has some kind of opioid problem, then move along because this rational, evidence-based, experience-laden way in which I’m going to discuss opioid use and misuse will not interest you.
To combat our opioidification the Read more…
Why the American problem with opioids and chronic pain is here to stay
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