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Balance the risk of stroke versus the risk of bleeding

Medications

December 4, 2012

There was good news recently in the atrial fibrillation world.

Though no surprise to heart rhythm doctors, an FDA investigation reveals no evidence that new cases of bleeding are any higher with dabigatran (Pradaxa) than with warfarin.

The full statement from the FDA is here.

The assessment was undertaken because after approval of the novel anticoagulant (blood-thinner) a large number of adverse events were reported to the FDA. Despite conscientious medical …

Stopping extensive pre-op testing requires malpractice reform

Skeptical Scalpel, MD

Physician

December 4, 2012

As predictable as the leaves falling this time of year, another paper on the subject of unnecessary preoperative laboratory testing has appeared.

A group from the University of Texas Medical Branch looked at more than 73,000 elective hernia repairs in the National Surgical Quality Improvement Project (NSQIP) database. Almost 2/3 of the patients had preoperative laboratory tests. Of that group, 58.6% had a CBC, 53.5% had electrolytes, 23.7% …

Does the Independent Payment Advisory Board need physicians?

Zackary Berger, MD, PhD

Health Policy

December 3, 2012

I was chatting with someone who asked what I did for a living, and I told him I am a doctor. “The kind that helps people?” he joked.

I knew what he meant. The MD is the practical fixer, the PhD the omphalocentric academic. Many believe in this dichotomy, as false as it is. And such a philosophy underlies the opposition to some elements of the PPACA, aka Obamacare.

There’s a board of …

Hold your disgust: A nuanced look at paternalism in medicine

PalMD

Physician

December 3, 2012

Over at his blog Gene Expression, Razib Khan expressed his disgust with the paternalism of the medical profession. His disgust was not misplaced, but he did bypass some of the subtleties.

Razib, a respected science blogger, ran smack into a frightening piece in Time. In it, doctors discuss whether and how much genetic information should be given to parents about their kids. The doctors featured evaluated a child’s …

ED boarders: A new focus to mitigate overcrowding

Ishani Ganguli, MD

Physician

December 3, 2012

The crowded emergency department (ED): It has become a symbol for our fragmented, inefficient health care system.

In the wake of Hurricane Sandy, the visual has become more familiar than we’d like – the young and the old slumped forward on rigid plastic chairs in the waiting room, occupied stretchers lined up in tandem in the hallway. Some of these patients are sick enough to warrant a hospital admission but languish …

I admire the strength and determination of cancer survivors

J. Leonard Lichtenfeld, MD

Physician

December 3, 2012

I was recently sitting on an airplane on my way to a far off destination for a meeting preceded by a couple of days of rest and relaxation.

In and of itself, nothing particularly special about that except that maybe a couple of folks will be jealous. But to me, right now it is an incredible moment, the culmination …

Debunking 8 persistent health myths

Leana Wen, MD

Conditions and Diseases

December 3, 2012

I recently a session at the Asian American Women Leadership Conference to high school and college students about taking care of our bodies. One the topics is common health myths. Despite our best efforts at debunking them, here are 8 pervasive myths:

1. You can catch a cold from being too cold. Growing up, how many of us have heard this from well-meaning parents and grandparents? It’s easy to see how …

Read more…

Debunking 8 persistent health myths

Who should lead the patient centered medical home?

Kevin Bernstein, MD

Health Policy

December 2, 2012

The American Academy of Family Physicians (AAFP) took a bold stance in a report regarding the future of primary care in the US by reinforcing its endorsement of the Patient Centered Medical Home (PCMH), specifically led by physicians. The report was supported by other large national physician organizations including the American Academy of Pediatrics, the American Medical Association, and the American Osteopathic Association.

The report took a close look at independent nurse …

The EHR user interface and my personal moment of Zen

Margalit Gur-Arie

Health Technology

December 2, 2012

Every time someone publishes an article or a paper or a blog post that has anything remotely to do with electronic health records (EHR), there is usually a flurry of reactions in the comments section, now available in most publications, and these always include at least half a dozen anonymous statements, usually from clinicians, decrying the current state of EHR software, best summed up by a commenter on THCB: “It …

Getting your orders online reduces risk in the practice

Rosemarie Nelson

Health Technology

December 2, 2012

You’re using an EHR. You’re e-prescribing. You’ve eliminated pulling the old paper chart (most of the time!). That’s good.

But how about those orders?

Are you still writing on the bottom of your fee slip or encounter ticket that you want the patient to be scheduled for a test or with another physician? That’s not good.

Get the order in your EHR.

Instead of taking the time to write on paper, keep your hand …

MKSAP: 42-year-old man with elevated liver chemistry tests

mksap

Conditions and Diseases

December 2, 2012

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

A 42-year-old man is evaluated in follow-up for elevated liver chemistry tests. He is asymptomatic. He has a 6-year history of type 2 diabetes mellitus, hyperlipidemia, and hypertension. His current medications are metformin, simvastatin, and lisinopril. He does not drink alcohol.

On physical examination, temperature is 37.0 °C (98.6 °F), blood pressure is 130/74 mm …

Eliminate waste and reduce variation in your medical practice

David B. Nash, MD, MBA

Physician

December 1, 2012

At the heart of healthcare operations are their processes – processes that must run correctly all the time to avoid unnecessary risk to patients’ lives and health.

Once the healthcare industry acknowledged the fact that we all make mistakes – even physicians – it began to look into methodologies used by other industries to structure more “perfect” organizations.

Two such process improvement methodologies — LEAN and Six Sigma — are now being …

MKSAP: 46-year-old woman with an intensely pruritic rash

mksap

Conditions and Diseases

December 1, 2012

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

A 46-year-old woman is evaluated for a 4-day history of an intensely pruritic rash on her face and neck. She started using a new facial moisturizer about 1 week before the onset of the rash. She has stopped using the moisturizer, but the rash has persisted. She has treated the rash with calamine lotion …

How I learned to appreciate the struggles of others who don’t fit in

Alex Lickerman, MD

Physician

November 30, 2012

When I was ten I once found myself walking with my brother on a Lake Michigan beach when we came upon a half-empty bottle of beer. Curious, I picked it up and looked inside at the swirling dark liquid. Then, impulsively, I took a sip. It was hot, having baked in the sun for who knows how many hours or days, and tasted awful.

I never took another drink of alcohol …

Learning to fly and getting my new practice off the ground

Rob Lamberts, MD

Physician

November 30, 2012

This is my new office. I signed the lease for this property yesterday – another big step in the process of getting my new practice off the ground. I should feel good about this, shouldn’t I? I’ve had people comment that I’ve gotten a whole lot accomplished in the 4 weeks since I’ve been off, but the whole thing is still quite daunting. Yes, there are days I feel good …

Finding the balance in calorie count regulations

Peter Ubel, MD

Physician

November 30, 2012

As a fan of free markets, I recognize that sometimes intelligent government regulations (not always an oxymoron!) can improve markets by requiring companies to provide consumers with information that will help them make better choices. Informed consumers, after all, are a central ingredient of a successful free market. That’s why even most libertarians support regulations that ban fraudulent advertising.

That’s also why, at first glance, the federal government seemed to be …

Should we reconsider the benefits of exercise and weight loss?

Wes Fisher, MD

Physician

November 30, 2012

Diet and exercise: they were supposed to be the answer to all that ails America’s obesity and health care cost problem.

Signs of this Utopian vision are everywhere. From entire government departments encouraging healthy lifestyles through fitness, sports and nutrition, government websites that encourage “healthy lifestyles,” and entire community efforts to partner with health care organizations to fight obesity with the hope of cutting health care costs.

What if, believe it or not, …

What being a cancer survivor has taught me about food

Elaine Waples

Patient

November 30, 2012

It’s no surprise that Americans are tilting the scales in the wrong direction. We are straining our waistlines and health coverage beyond the limits.

Unfortunately we live in a culture that promotes it.

Recently, I tuned into my favorite TV food channel to watch famous chefs create exotic dishes with quail eggs and artichokes. Instead I tapped into back-to-back shows that claimed to represent American food. The hosts were a well-known southern …

The movement against obesity threatens many livelihoods

Michael Kirsch, MD

Physician

November 29, 2012

One cannot escape the issue of rising obesity rates in the United States. A current statistic predicts that by the year 2030, 42% of us will be obese. The ramifications of this ponderous eventuality could indeed weigh down and sink the nation. Some of the consequences include:

Zillions of health care dollars spent treating obesity directly.
Gazillions of health care dollars treating medical consequences of obesity.
Loss of economic productivity from a bloated …
Read more…

The movement against obesity threatens many livelihoods

The benefit of CT scans for the diagnosis of appendicitis

Skeptical Scalpel, MD

Conditions and Diseases

November 29, 2012

Amid the mounting concern about radiation exposure and future increases in cancer rates comes a report from Washington State describing the benefits of imaging, particularly CT scanning, for the diagnosis of appendicitis.

The authors collected data from some 55 hospitals of all types and sizes over a six-year period for more than 19,300 patients older than age 15; 91% of patients underwent one or more imaging studies. There were …

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