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Many doctors order tests rather than do a history and physical

Conditions and Diseases

September 25, 2010

“Take a good history, do a good exam.”

I have not contributed to my treasure of quotes with this title. No one reading the headline well hit their head and mutter, “Wow!” Yet one can wonder about the lack of careful history taking and basic physical examination skills.

This delightful new blog post written by an internal medicine resident says it well: Defensive medicine supersedes quality medicine.

You should read the …

Wanting better health care shouldn’t be conservative or liberal

Aaron E. Carroll, MD

Health Policy

September 25, 2010

I remember this one moment back in the midst of health care reform when I was sitting in a radio studio, feeling pretty glum about the whole ordeal, and I mused aloud, “I wonder if anyone is enjoying this at all.”

For some of us, improving the health care system is more than a passing fancy. I’m a health services researcher. It’s my job. Those people on the TV pay attention …

Why health IT usability matters to patients

Dave deBronkart

Health Technology

September 24, 2010

It’s widely rumored that a health IT industry executive was unhappy about suggestions that systems have to be usable in the eyes of employees who use them while caring for us. (Us. The patients. Your mother.)

According to the rumor, the exec said, “Over my dead body.” As if he ran the agency.

Whether or not the rumor’s true it’s not funny. So when I was asked to represent the patient perspective …

Converting paper charts to electronic medical records tips

Peter J. Polack, MD

Health Technology

September 24, 2010

We are a little over two years into our electronic medical records implementation at the time of this writing. Since we have been performing a gradual rollout, the entire process has been relatively uneventful. Most of the credit for this goes to our chief information officer (technospeak for the head of our IT department) and our practice administrator.

One of the biggest challenges we have been facing is how to convert …

Physicians deserve to be compensated for time spent on email

Jared Sinclair, RN

Health Technology

September 24, 2010

Dr. Wes, a blogging cardiologist, posted a follow-up to his recent post on e-mail correspondence between physicians and patients.

The majority of emails he receives tend to be for very simple things like checking a lab result.

Current EMRs don’t make reviewing and sharing lab values efficient. Dr. Wes writes:

[O]ur current model of the electronic medical record sending every single result to our inbasket, even though it contains …

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Physicians deserve to be compensated for time spent on email

10 reasons why doctors over-order tests

Kevin

Conditions and Diseases

September 24, 2010

by Neel Shah, MD

What are the top reasons doctors over-order tests?

1. How we’re taught. Doctors are taught to consider whether a procedure is safe and whether it’s likely to work. We’re almost never taught to consider cost — it’s considered taboo.

2. Trying to do our best for the patient. We’re worried. Often we over-order because of our personal risk aversion.

3. Pre-emptive ordering. For residents, who do much of …

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10 reasons why doctors over-order tests

The $100 question about patient empowerment

Kevin

Patient

September 24, 2010

by Devin Gross

Here’s a question. It’s not a 5¢ or $5 question that anybody can solve on their own without much thought or effort. It’s a $100 ask-an-expert or think-about-it-for-a-second question.

What’s the point of patient empowerment?

Much of the current discussion of empowerment deals with patients who for one reason or another have had to fight for their care. CNN’s Elizabeth Cohen opens her book, …

Should reduced ER use be a measure of health reform?

Brad Wright, PhD

Health Policy

September 23, 2010

In making the case for health care reform, inappropriate utilization of emergency rooms is frequently cited as an example of our inefficient system and an important factor behind the staggering cost of U.S. health care.

At first, the logic makes sense: emergency rooms have to treat people, so the uninsured often turn there for care, including primary care, which is very expensive to provide in an emergency room, and would be …

A difficult time for health insurance companies in Massachusetts

Paul Levy

Health Policy

September 23, 2010

This has to be a very difficult time for insurance companies in Massachusetts. Notwithstanding that they are non-profits, they are under a lot of scrutiny with regard to reserve margins and profitability. Much of this is unfair, but I think that is just a sign of the times. Hospitals face a similar issue, too. Doctors are certainly next in line.

But the Massachusetts insurers have an additional problem. They have been …

Are toning shoes safe or effective?

Orly Avitzur, MD

Patient

September 23, 2010

Grandmother Pat LaColla, 82, was lured by the hype—”get in shape without setting foot in a gym”—when she bought a pair of Skechers last year, wincing at the $100 price tag. Toning shoes like those she bought are the newest craze in athletic footwear, projected to grow 500 percent to become a $1.5 billion market this year.

Although the designs vary, toners typically have strongly curved, thickened soles. From the moment …

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Are toning shoes safe or effective?

Cycling helps this patient with a sarcoma

Kevin

Conditions and Diseases

September 23, 2010

by Kristina Fiore

Jennifer Goodman Linn, 39, has been through five surgeries and six rounds of chemotherapy since 2004, trying to control the sarcoma that keeps growing in her abdomen.

Goodman Linn has what her doctors call a rare form of a rare cancer — an MFH sarcoma, also known as an undifferentiated high grade pleiomorphic sarcoma. It’s remained confined to her retroperitoneal …

Tips for patients during an emergency department visit

Kevin

Patient

September 23, 2010

An excerpt from Treat Me, Not My Age: A Doctor’s Guide to Getting the Best Care as You or a Loved One Gets Older.

by Mark Lachs, MD

Over my twenty-five-year medical career, the route by which people are admitted to the hospital for an overnight stay has subtly evolved in ways that most patients (and even many doctors) may not realize. Specifically, the proportion of patients who …

Marginal treatments at a high emotional cost from families

Marya Zilberberg, MD, MPH

Conditions and Diseases

September 22, 2010

My father passed away about two weeks ago after battling a brain tumor for some time.

Initially diagnosed with an extensive inoperable mass one and one-half years ago, upon presenting with a focal seizure, he did well with only one medication for seizure control for about ten months. Around Christmas of 2009, however, he landed in the hospital in status epilepticus that took three days to control. After these days of …

When patients are willing to share their stories

Bruce Campbell, MD

Conditions and Diseases

September 22, 2010

We say we exchange words when we meet. What we exchange is souls.
-Minot J. Savage

It was Monday evening. The shelves in the electronics department overflowed with different styles, prices, and brands of headphones, all displayed in sealed plastic cases. I was in the mood to buy but was baffled by the array of options in front of me. This was not going to be as simple as I had thought.

A young …

How you can avoid skin cancer risk

Juliet K. Mavromatis, MD

Conditions and Diseases

September 22, 2010

Skin cancer is the most common form of cancer diagnosed in the United States.

There are three major types: basal cell, squamous cell and melanoma. Of those, basal cell and squamous cell are most common, accounting for about 3.5 million cases in the United States per year. Although, these types typically do not metastasize, they can be quite disfiguring, particularly after resection when they occur on the face. On a population …

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How you can avoid skin cancer risk

Why the expansion of Alzheimer’s may not be helpful

George Lundberg, MD

Conditions and Diseases

September 22, 2010

You probably saw the July press reports: balmy tropical breezes, azure surf, cerebral plaques and tangles, and new criteria for Alzheimer’s.

Who could deny an opportunity to spend some time at the best non-oil-spoiled beaches for those who toil at the benches and bedsides for Alzheimer’s victims — and on taxpayer money yet.

It seems to me like, just as human hip and knee joints and premolars and molars are not preprogrammed …

10 cancer signs women shouldn’t ignore

Karen Lu, MD

Conditions and Diseases

September 22, 2010

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If you’re relatively young and healthy, gynecologic cancers probably aren’t on your radar. But they should be.

This year, more than 80,000 women in the United States will get a gynecologic cancer, such as endometrial (a.k.a. uterine), ovarian or cervical cancer. In general, gynecologic cancers occur more frequently in women after menopause, although they can occur in younger women. While all women …

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10 cancer signs women shouldn’t ignore

What motivates health care workers is needed to explain health care costs

angienadia, MD

Health Policy

September 21, 2010

As part of the new health care legislation, the government has instituted Medicare’s Physician Quality Reporting Initiative (PQRI) in an attempt to motivate health professionals to do the right thing.

According to the legislation, PQRI asks physicians to report how the care they furnish aligns with evidence-based clinical guidelines for a variety of medical conditions, such as diabetes or heart disease. In 2010, physicians who successfully report these measures will receive …

DTC advertising is annoying but should it be banned?

Michael Kirsch, MD

Medications

September 21, 2010

Should the public be shielded from medical information that can mislead it?

Many argue against direct-to-consumer (DTC) advertising, which is omnipresent in print and on the airwaves. Opponents of this practice argue that it promotes the use of expensive medications when patients ask their doctors if the “drug is right for them,” the tag line that appears at the end of every ad. This phrase is the drug company’s limp disclaimer …

Switching diabetes patients from Avandia to Actos

Matthew Mintz, MD

Medications

September 21, 2010

I have a lot of diabetes patients and have been an avid user of the thiazolidinediones (TZD) class. There are many reasons to like the TZD’s:

The older, generic medicines like metformin and sulfonylureas are known to fail over time. After 3 years, most patients on one of these drugs lose control of their blood sugar. In contrast, patients on TZD’s maintain glycemic control (at least up to 4-5 years which …
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Switching diabetes patients from Avandia to Actos

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