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Certified stroke centers and ischemic stroke treatment realities

Kevin

Conditions and Diseases

July 28, 2010

by John Fauber

Time is brain. Every minute wasted seeking treatment is measured in neuronal death, which is why stroke specialists were early supporters of certified stroke centers. Getting a stroke patient to the right center — a center that could administer clot-busting therapy quickly, and safely — was considered the surest way to “save brain.”

That was the concept behind the certified …

The way we practice primary care doesn’t make sense

Kenneth Lin, MD

Physician

July 27, 2010

You’ve probably had the experience of going to see a primary care physician and wondering about the many aspects of that visit that just didn’t make sense.

Why is it so important for me to arrive on time when, in reality, I won’t be called back until half an hour (or more) later? What’s the point of waiting for another 20 minutes in a chilly examining room for the doctor …

The art of medicine and whether computers can replace doctors

Eric Van De Graaff, MD

Conditions and Diseases

July 27, 2010

My medical school at the University of Utah developed a clever computer program in the late 80s that was meant to both educate medical students and assist in the treatment of patients.

For several years the tech geeks at the school had collected an immense database of information from all the patient admissions at the hospital—presenting symptoms, exam findings, tests, and final diagnoses. They took all this data and crunched …

Preventing postop infections need to be implemented as a package

Kristina Fiore

Physician

July 27, 2010

by Kristina Fiore

Measures designed to prevent postoperative infections work if measured as a package, but looked at individually they provide no improvement, researchers found.

When analyzing the six components of the Surgical Care Improvement Project (SCIP) on an all-or-nothing basis, there was a 15% reduced risk of infection, according to Jonah J. Stulberg, MD, PhD, MPH, of Case Medical Center in Cleveland, and colleagues.

But the three core infection prevention measures taken …

Sometimes more expensive care is better treatment

Kevin

Conditions and Diseases

July 27, 2010

by James Gaulte, MD

A recent publication in the publication Health Affairs has evoked comments and some concern from advocates of comparative effectiveness research and admirers of the Dartmouth Atlas.

A survey of “consumers” found a level of skepticism that is alarming to those folks who are in the business of claiming to know what aspects of medical care should be offered.

The idea that more care and more costly care gives inferior …

How seniors will accept cuts in Medicare from health reform

Richard Reece, MD

Health Policy

July 26, 2010

Everybody knows politics is a balancing act. One must balance promises against reality.

For example, how does government keep Medicare intact for seniors while cutting $500 billion out of Medicare when government has no track record of cutting entitlement spending?

And how one do it without losing the vote of seniors, who hold the key to the balance of power?

The Obama administration and the Democrats hope to keep power by winning the …

What doctors think about drug and device marketing

Charles Bankhead

Medications

July 26, 2010

by Charles Bankhead

Increased emphasis on conflicts of interest has yet to sway physicians’ generally positive attitudes toward drug and device manufacturers’ marketing activities, a survey of almost 600 attending physicians and trainees showed.

More than 70% of respondents saw nothing inappropriate about attending sponsored lunches, and 25% had no problems with accepting large gifts from industry representatives, according to an article in the June issue of Archives of Surgery.

Surgeons, trainees, and …

Defensive medicine forces residents to use test oriented care

a medical resident, MD

Conditions and Diseases

July 26, 2010

A recent article in US News and World Report, Most U.S. Physicians Practicing Defensive Medicine, claims that physicians are ordering more tests and escalating the work-up of sick patients, all in the name of defensive medicine.

Is it true? Absolutely.

It is especially true in the emergency department, where we have one shot to get things right, or else. Ironically, by practicing defensive medicine we are not practicing …

The Apple Genius Bar could learn some bedside manner

Rahul K. Parikh, MD

Health Technology

July 26, 2010

My life is wired by Steve Jobs and Apple. When I was a kid, my first computer was an Apple IIc, followed by Macintosh Plus for college. In residency, I used a Newton for a while to take notes on patients. I have a MacBook, an iPod (I’ve actually had 3 and my wife has had 2), an iPhone, iPhone 3gs; an iPhone 4 on order; an iPad, AirPort Express, …

Chronic illness needs to be managed at home, not at the hospital

Shantanu Nundy, MD

Conditions and Diseases

July 25, 2010

“You know, what Mr. HD really needs is for his mom or somebody to chain herself to him…” [the ICU team laughs] …

“But seriously, he needs to be watched over, he needs to be talked to. He needs someone to give him his medications, someone to take him to his appointments, someone to take care of him. With that somebody he can live for years to come. Without that somebody …

Parents who want genetic testing for their children

Kristina Fiore

Conditions and Diseases

July 25, 2010

by Kristina Fiore

More than a third of parents who have been tested for genetic breast cancer risk say they’d support similar testing for their children — despite scant evidence of any benefit for young people, researchers have found.

In interviews with 246 parents who were tested for the BRCA1/2 mutation, 37% supported testing minors, compared with 55% who opposed screening, according to Angela R. Bradbury, MD, of Fox Chase Cancer Center …

Best Doc in a magazine, the inside story

Doctor Grumpy, MD

Physician

July 25, 2010

You’ve seen it, somewhere.

Every city in America, and likely the world, has a local magazine. And once a year, that magazine publishes a “Best Docs” issue, usually listing 10 doctors from each specialty who they consider the best of the best.

Dr. Grumpy, for the record, is not biased against this. I’ve been named a “Best Doc” in my field several times.

And I know most of the other neurologists on the …

Paying cash to doctors affects the treatment plan

Jay Parkinson, MD

Physician

July 24, 2010

If we really want to find out how to damn near perfectly manage any medical problem as efficiently and cost-effectively as possible, we should be studying how doctors manage the medical problems of the cash-paying doctors they see in their own practice.

Read part one here.

My visit with Dr. Grubman was fairly simple. We discussed allergy shots and how they could possibly help significantly with my dust allergy. Since I always …

Hearing loss from iPods and other MP3 players

Crystal Phend

Patient

July 24, 2010

by Crystal Phend

iPod users beware. Listening to an MP3 player for even an hour can induce short-term hearing loss, researchers affirmed.

Compared with controls, hearing deterioration among MP3 users was 3.97 to 4.40 times more likely when listening to pop/rock music through earbud headphones at different output levels, found Hannah Keppler, MS, of Ghent University in Ghent, Belgium, and colleagues.

Listening to an iPod with over-the-ear headphones also boosted the odds of …

Good medicine sometimes makes patients unhappy

Ralph Gordon, MD

Physician

July 24, 2010

As physicians, we all strive to practice good medicine. Good medicine means evidence based medicine in the patient’s best interests. In the ideal world this will make patients happy and satisfied. If you are getting the best treatment for your condition you should be happy, right?

In the real world, though, keeping patients or their families’ happy and practicing good medicine might not be possible at the same time. This is …

Talking with patients about their impending death

Kevin

Patient

July 23, 2010

by Brad Stuart, MD

The emergency department phoned my office right before lunch.

I was on call for our general IM group, so when I was done with my morning schedule I walked across the street to the hospital. Greg, my partner’s 38 year old patient, was a woodworker admitted with fever, chills, cough, a sharp pain in his right side, and a WBC of 18,000. On the chest x-ray, I …

Does restricting work hours hurt surgical training?

MedPage Today

Medical Education

July 23, 2010

by Michael Smith

Life is better but the quality of surgical training has gone down in the wake of a Swiss law restricting surgical residents’ hours.

That was the view of both the residents and the surgical consultants who supervise them in a survey conducted by Daniel Oertli, MD, of University Hospital Basel in Basel, Switzerland, and colleagues.

Less than 9% of residents and less than 5% of surgical consultants saw the change …

Can patients demand changes in the healthcare system?

WarmSocks

Health Policy

July 23, 2010

Are healthy people patients? Sometimes I wonder.

If you’re healthy, you rarely see a doctor. If you go for a “routine” checkup every five years, you just aren’t very affected by the system. You might not even know what the system is. Your health insurance premium is deducted from your paycheck, so you never really see that money — not the way you would if you had to write a check in that …

The Massachusetts gift ban benefits health insurance companies

Kevin

Medications

July 23, 2010

by Edison Wong, MD

With the recent proposal to repeal the so-called Massachusetts “gift ban” (more appropriately referred to as the “interaction ban”), I asked myself who stands to gain the most from such bans?

Is it the consumers or patients? Is it the physicians or their practices? Is it the federal or state governments? Nope. Sadly, it is the insurers who gain the most, at the expense of patients.

The …

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