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How to talk to patients with an EMR in the room

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 …

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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 …

Why patients file medical malpractice lawsuits

John Schumann, MD

Physician

June 7, 2010

Time to turn our attention to an unpleasant topic: Lawsuits.

Who files them?

Why? And what actually happens?

There have been oceans of ink spilled about medical malpractice. An oversimplification of the various positions on malpractice and malpractice reform goes something like this:

(+) Malpractice suits are good. They keep healthcare professionals and hospitals on their toes; if the threat of a big payout improves safety and quality, then lawsuits provide an important regulatory …
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Why patients file medical malpractice lawsuits

MRI abuse can be dangerous and expensive for patients

Chris Rangel, MD

Conditions and Diseases

June 7, 2010

What is “MRI Abuse”? This is when the health care provider orders MRIs (Magnetic Resonance Imaging) in excess or for the wrong reasons. There are many causes of MRI abusive behavior but most evolve out of a significant misunderstanding of how to properly utilize this diagnostic tool. MRI imaging has a high sensitivity to detect anatomic abnormalities, does not expose the patient to high doses of radiation like a CAT …

Whistleblowers endure stress and personal hardship

Charles Bankhead

Health Policy

June 7, 2010

by Charles Bankhead

Whistle-blowers in the healthcare industry endure substantial hardship and often pay a high personal price for cooperating with Justice Department investigations, according to a report based on detailed interviews with more than two dozen informants.

Loss of employment, financial ruin, divorce, and a host of mental and physical health problems were common consequences of individuals’ decisions to report corporate fraud.

Cases can drag on for years before reaching a resolution, …

Tort reform for doctors in exchange for less salary

Jeffrey Parks, MD

Health Policy

June 7, 2010

Matt Steinglass at The Economist has interesting take on tort reform, specifically that limiting physician liability for adverse patient outcomes must come with an equable cost to doctors.

In Europe, the costs accrued due to medical errors are covered by the wide-ranging social safety net; the lottery system of massive medical malmalpractice judgments is virtually absent.

It’s part of the social contract: doctors accept limited salaries in exchange for limited liability; …

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Tort reform for doctors in exchange for less salary

The New York Times changes the Dartmouth Atlas narrative

Kevin

Health Policy

June 7, 2010

Several have asked me to comment on the New York Times versus Dartmouth Atlas spat.

In summary, the Dartmouth Atlas comprises of studies showing variation in care for Medicare recipients. Their main, take home message is that high-spending areas of the country sometimes had poorer outcomes than lower-spending ones.

Their work has been influential with the current administration, and among progressive health reformers. Last week however, the New York Times published a …

How drug information fine print fails to communicate

Steve Woodruff

Medications

June 6, 2010

As someone deeply immersed in pharma communications, and especially the newer realm of social networking, I’ve been closely following the ongoing process of the industry/FDA dance, trying to figure out how social media/web 2.0 approaches “fit” with pharmaceutical manufacturers and their various audiences.

And I keep wondering if we’re going about the whole thing the wrong way.

Think about the fine print PI (Product Information) you see in a magazine, accompanying a …

Should Americans be forced to buy health insurance?

MedPage Today

Health Policy

June 6, 2010

by Joyce Frieden

When it comes to the healthcare reform law, no provision is more controversial than the individual mandate – the part that requires every citizen to purchase health insurance or pay a penalty.

More than 20 state attorneys general are suing the federal government over the health reform law, in large part because of this provision. Several states have already passed laws declaring an individual mandate unenforceable in their state, …

Cocaine and drug addiction from work exposures

Jan Gurley, MD

Medications

June 6, 2010

It’s hard to look at the mug-shot of the 60-year-old woman charged with tampering with forensic drug evidence (basically, stealing police-confiscated cocaine) without wondering how things got to this point. I mean, surely they weed out the felons, and the known addicts, and do a background check, and then make you pee in a cup before they even hire you for a job like this. Right?

So just exactly how can …

Smartphones will be the hub of digital medical care

Jaan Sidorov, MD

Health Technology

June 5, 2010

As a former New Yorker, the Disease Management Care Blog has always had an abiding respect for the Big Apple’s taxi drivers.

That increased considerably after it left its wallet in a Manhattan cab and it turned up in Virginia a year later — in the possession of an individual allegedly involved in organized crime. This and other evidence of the cabbies’ shrewd business acumen makes the DMCB wonder why Hizzoner …

Choosing between Lasik and Lasek eye surgery

Kevin

Physician

June 5, 2010

by Tim Harwood

Hundreds of thousands of people each year are taking the plunge and choosing to have the life changing procedure that is laser eye surgery.

It is currently the most popular elective surgery in the world and the number of people having it done is likely to increase as the procedure becomes safer and more accurate. If you yourself are considering having laser eye surgery, then you will almost …

Will healthcare reform survive the Supreme Court?

MedPage Today

Health Policy

June 5, 2010

by Joyce Frieden

Partisan wrangling aside, the Supreme Court will have to address serious constitutional questions about the healthcare reform law, and it’s far from clear how the justices will decide the issues, legal scholars say.

So far, 21 state attorneys general are suing to overturn the law on constitutional grounds. One of their arguments is that by forcing individuals to either buy health insurance or pay a fine, the law violates …

Adoption lessons after Artyom Savelyev

Claudia M. Gold, MD

Patient

June 5, 2010

The trauma for Artyom continues. After having been given up to an orphanage by his alcoholic mother who lost her parental rights, being adopted by a US family, sent back to Russia alone when his adoptive mother allegedly was unable to cope with his psychological problems, he has now become the object of a tug-of war between Russia and the US over his citizenship. His future seems to hold unimaginable …

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Adoption lessons after Artyom Savelyev

How health reform will help breastfeeding mothers

Kenneth Lin, MD

Conditions and Diseases

June 4, 2010

Pharmaceutical companies and their shareholders are always looking for the next “blockbuster” drug, the label given to a drug that generates more than $1 billion of revenue per year.

Blockbuster drugs don’t necessarily have to save many (or any) lives – slick marketing more than compensates for marginal improvements in treatment efficacy — but they do need to target conditions that are common enough that millions of patients will buy them. …

Machine and technology fixation is why health costs are high

Richard Reece, MD

Health Policy

June 4, 2010

Obsession with medical technologies and machines characterizes American’s cultural expectations. We tend to think of our bodies as perpetual motion machines, to be preserved in perpetuity.

If the face of our machines sag, we lift it up. If our pipes clog, we roto-rooter or stent them. If impurities gum up our machinery, we filter them out. If our joints give out or lock up, we replace them. If we want to …

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