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Can chest pain patients be evaluated in the ER waiting room?

MedPage Today

Physician

June 12, 2010

by John Gever

Emergency department patients with chest pain may safely be evaluated in the waiting room when necessary, researchers said.

Among 303 patients triaged to waiting-room evaluation in a prospective study, no acute coronary syndromes were missed and adverse event rates overall were lower than among 804 patients who were assessed in conventional monitored beds, reported Frank Scheuermeyer, MD, of St. Paul’s Hospital in Vancouver, British Columbia, and colleagues online in …

Ask your pharmacy to price match prescription drugs

Leslie Ramirez, MD

Medications

June 12, 2010

As we have established repeatedly on LesliesList.org, prescription prices can vary a lot from one pharmacy to another.

But did you know that some pharmacies will actually match a competitor’s price? This could save you a ton of cash, but you have to know how, and whom, to ask for this service. Pharmacy retail chains all have different policies. I spoke to a pharmacist recently at each of the seven top …

AMA: Senate fails to stop a Medicare meltdown

Kevin

Health Policy

June 11, 2010

A guest column by the American Medical Association, exclusive to KevinMD.com.

by J. James Rohack, MD

Unbelievable as it is, for the third time this year the Senate failed to act on time to stop this year’s 21 percent Medicare physician payment cut. Senators cut and ran on America’s seniors and their physicians, heading home for the Memorial …

Diagnosis requires seeing patient problems with a wide lens

Jerome Groopman, MD and Pamela Hartzband, MD

Conditions and Diseases

June 11, 2010

Susan Sorensen, FACP, an internist and hematologist in Palo Alto, Calif., told us of a case where the correct diagnosis took more than a year to make. The patient was a 24-year-old woman who had developed weight loss, fatigue and intermittent chest tightness. She was seen in a local emergency department, and was told that she should consult a pulmonary specialist. A chest X-ray and EKG appeared normal.

Over the next …

Wii Sports and Wii Fit Plus exercise equivalents

William R. Yates, MD

Conditions and Diseases

June 11, 2010

Regular exercise has been shown to be helpful in the prevention and management of a variety of clinical neuroscience conditions including: Alzheimer’s disease, Parkinson’s disease, major depression and anxiety disorders. However, motivating people to get involved in a regular exercise program is a significant challenge. Wii Sports and Wii Fit Plus may provide the motivation edge for some patients to start and maintain an exercise program.

The Wii video game system …

Residents who specialize in surgery are influenced by family

MedPage Today

Physician

June 11, 2010

by Chris Emery

Single and childless surgical residents in the U.S. are more likely to pursue specialized surgical fellowships, and a majority of surgical residents believe a successful career depends upon specialty surgical training, a new survey found.

Of residents who responded to the survey, 28.7% believed general surgery is becoming an obsolete career path (30.1% of men and 25.9% of women, P=0.004), and 55.1% believed specialty training is necessary for career …

Third world doctors are the real physician heroes

Dr. Martin Young

Patient

June 11, 2010

I recently was involved in a web discussion on elective choices with a group of medical students.

Financial considerations aside, I was surprised how few were interested in visiting third world countries to see how medicine is practiced outside the first world comfort zone of unlimited expertise, investigation and therapy — where “want” often exceeds “need.”

The third world however is completely different. It’s an environment where doctors and nurses are in …

Treating a child with fever and leukemia

StorytellERdoc, MD

Conditions and Diseases

June 10, 2010

I walked into Room 35 to find a three year-old lying on the hospital cot. Her father sat alongside her bed, whispering softly to her. The patient appeared quite tired, wiped-out even, and if it weren’t for her complacent eyes tracking my every move, I would have thought she might be sleeping.

She was visiting our ER because, after a few days of cough and congestion, she had developed a fever. …

Electronic medical records and detail obsessed doctors

Paul Sax, MD

Health Technology

June 10, 2010

When it comes to writing consult notes, it often seems as if we ID specialists have a blatant form of obsessive-compulsive disorder. Every detail is fair game — travel history, dietary habits, all sorts of seemingly trivial exposures, and of course microbiologic data stretching back to the Cretaceous period.

I’ll never forget receiving sign-out from the graduating first-year ID fellow when I started my fellowship. It included a photocopy of a …

ABIM responds to doctors sharing board certification questions

Christine K. Cassel, MD

Medical Education

June 10, 2010

A guest column by the American Board of Internal Medicine, exclusive to KevinMD.com.

The American Board of Internal Medicine (ABIM) is sending a clear message to doctors this week: Compromise the integrity of the certification process and face swift and serious penalties.

ABIM is sanctioning 139 physicians for sharing, buying, or soliciting confidential, copyrighted questions that were part of the exam …

Primary care antibiotic resistance for common infections

MedPage Today

Medications

June 10, 2010

by Nancy Walsh

Primary care patients prescribed an antibiotic for a urinary tract or respiratory infection consistently developed resistance to that antibiotic lasting as long as one year, a British meta-analysis revealed.

In five studies that included 14,348 patients treated for urinary tract infections, within one month of receiving an antibiotic an individual patient’s odds ratio having a resistant pathogen was 4.40 (95% CI 3.78 to 5.12), according to Céire Costelloe, PhD, …

What medicine was like in ancient Babylonian society

Jan Henderson, PhD

Potpourri

June 10, 2010

Each issue of the Journal of the American Medical Association includes an excerpt from an issue of exactly 100 years ago (JAMA has been published continuously since 1883).

The May 7, 1910 issue of JAMA included remarks on how much physicians were paid and, by implication, how they were regarded in 2250 B.C.

Ability to pay and malpractice

According to the famous Babylonian Code of Hammurabi (“an eye for an eye”), a physician’s …

Demerol used to treat shivering in patients

Christian Sinclair, MD

Conditions and Diseases

June 9, 2010

If you have spent anytime with a palliative care team in a hospital you will know of their efforts to essentially blacklist Demerol (meperidine) from use in the hospital.

Some hospitals have removed it or restricted it from the formulary all together. In medical culture, Demerol has been a go to opioid peri-OR and mostly favored by surgeons. The drug has been purported to be less likely to cause biliary spasm, …

How to talk to patients with an EMR in the room

Edward Pullen, MD

Patient

June 9, 2010

I see a lot of articles by physicians complaining about how the use of a computerized medical record (EMR) in the exam room with patients detracts from the physician-patient experience.

The complaint usually follows the theme that the physician and patient are not able to have eye contact, and both the physician and the patient feel less intimate and connected during the visit because the physician’s need to use the keyboard, …

Causes of stroke in young adults

MedPage Today

Conditions and Diseases

June 9, 2010

by Todd Neale

The recent stroke suffered by Delaware’s attorney general Beau Biden, who is 41, has highlighted the fact that people of all ages are vulnerable, despite seemingly good health.

A statement from Timothy Gardner, MD, medical director of the Center for Heart and Vascular Surgery at Christiana Care Health System in Newark, Del., where Biden was initially treated, said he had suffered a “mild stroke,” although it remains unknown whether …

Read more…

Causes of stroke in young adults

Peer review may require random over-reads

Larry Husten, PhD

Conditions and Diseases

June 9, 2010

“Let’s kill all the lawyers.” It’s every doctor’s favorite Shakespeare quote. And if you’re giving a talk to doctors there’s no better way to get the audience on your side than by starting with a lawyer joke.

But perhaps we shouldn’t be too hasty about killing all those lawyers. As recent commentary about the Mark Midei case makes clear, modern medicine doesn’t know how to police itself. And until medicine does …

EMRs are ugly, and what the next generation of doctors can do

Josh Herigon, MPH

Health Technology

June 8, 2010

I was in our family practice clinic today and couldn’t help but noticing once again that the electronic medical record (EMR) system they use looks like it was designed in the 1980s.

Gray boxes with tiny free text fields and little check boxes. Unfortunately, the aesthetics are the least infuriating design element.

Why is nothing connected in current EMRs? The single most important thing that has led to the proliferation and usability …

Interruptions in the emergency department can lead to errors

MedPage Today

Physician

June 8, 2010

by Nancy Walsh

Busy clinicians in the emergency department reduce the time they spend on clinical tasks when interrupted, working faster and possibly cutting corners, a prospective observational study found.

Overall, clinicians were interrupted 6.6 times per hour, and 11% of all tasks were interrupted, according to Johanna I. Westbrook, PhD, of the University of Sydney, in Australia, and colleagues.

The mean “time on task” for uninterrupted tasks was 1 minute and 26 …

Clinical judgment and when neurologists should order an MRI

Vernon Rowe, MD

Conditions and Diseases

June 8, 2010

With healthcare reform dominating the news recently, MRI and other imaging tests have become the (misguided) targets of many critics.

Although MRI makes up only one-half of one percent of total healthcare expenditures, it is easy to demonize since the average healthcare consumer can understand imaging much easier than the diagnosis related groups (DRGs), hospital facility fees or insurance contracts that have a much greater impact on the cost of health …

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