Dying of old age in the era of modern medicine

Conditions and Diseases
May 8, 2010

He is 93 and has numerous medical problems, most of which involved aging blood vessels, as well as multiple orthopedic issues, including compression fractures and diffuse arthritis. The bony issues have resulted in a severely compromised mobility of late.

Despite ongoing treatment with both aspirin and clopidogrel, he presents after numerous hours of focal neurologic symptoms. A CT scan shows no evidence of bleeding and the diagnosis is a major stroke …

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Dying of old age in the era of modern medicine

Explaining chronic medical treatment to patients

Conditions and Diseases
May 7, 2010

Although some psychiatric conditions are acute and transient, most are chronic. They may wax and wane, but most of them do not go away. Likewise, psychiatric medications can significantly improve people’s functioning and quality of life, but they manage, not cure, mental illness.

It’s therefore not surprising that a common conversation that patients and psychiatrists have revolves around the question, “Do I have to be on this medication ‘forever’?”

I’ve previously written …

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Explaining chronic medical treatment to patients

Autistic enterocolitis may not be real

Conditions and Diseases
May 7, 2010

by Todd Neale

The status of a new inflammatory bowel condition identified in the retracted Lancet paper that linked the MMR vaccine and autism — autistic enterocolitis — appears to be in limbo.

The 1998 paper by Andrew Wakefield, MBBS, and colleagues was fully retracted by The Lancet in February, although the alleged and repeatedly disproven vaccine link was dropped in …

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Autistic enterocolitis may not be real

A pre-medical student writes to her gross anatomy cadaver

Medical Education
May 7, 2010

A letter from a pre-medical student honoring her gross anatomy cadaver.

Letter to the other side
by Hana Low

Thank you for donating your body to science and medical education. It’s so generous to give yourself to those you will never meet. I hope you’re having a good time, up there or wherever you are.

Working with your body has made me acutely conscious of the dangers in my everyday environment. I have to …

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A pre-medical student writes to her gross anatomy cadaver

China medical school and residency training

Medical Education
May 6, 2010

My husband and I recently traveled to Wuhan Medical School in the Hubei Province in central China.

Our medical school has partnered with Wuhan to help inform their curricular reform efforts. We spent 4 days touring the hospitals and teaching facilities, meeting students and faculty, going on rounds, and giving talks. Although the language barrier was challenging, we had incredible translators who worked to translate every slide we spoke …

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China medical school and residency training

Calorie counts in health reform is significant for patients

Health Policy
May 6, 2010

Counting calories as part of health care reform—who knew? But apparently it’s there on page 455 of the health-care reform act, according to Marion Nestle, Professor of Nutrition at NYU, writing in the New England Journal of Medicine. There will now be a national effort at posting calorie counts in chain restaurants.

There are many ways to improve the overall health of Americans, but tackling obesity is surely one of the …

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Calorie counts in health reform is significant for patients

Inhalant abuse remains prevalent in teens

Conditions and Diseases
May 6, 2010

by Todd Neale

Although inhalant abuse has become less prevalent since the early 1990s in all age groups, it remains a source of injury and death, particularly among teenagers, researchers have found.

From 1993 to 2008, intentional exposure to 3,410 different inhalants was reported to U.S. poison control centers, Toby Litovitz, MD, of the National Capital Poison Center in Washington, and colleagues reported in the May issue of Pediatrics.

The highest rate of …

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Inhalant abuse remains prevalent in teens

Social networking impact on patients, doctors, and non-profits

Social Media in Medicine
May 6, 2010

In its current listing of online social networks, Wikipedia presents 156 major, active websites. A neighboring link to view “now-defunct” sites accompanies the listing — a subtle reminder of the Internet’s competitive and volatile environment where promising endeavors rise and fall overnight.

But although the popularity of a specific website may fade with time, the practice of online social networking is here to stay.

In its simplest form, online social networking is …

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Social networking impact on patients, doctors, and non-profits

How Massachusetts can lead health IT modernization

Health Technology
May 6, 2010

Although healthcare reform has its supporters and detractors, healthcare IT reform – the use of technology to improve the quality, safety and efficiency of healthcare throughout the country – has broad support from all stakeholders.

The passage of last year’s $787 billion economic stimulus bill brought with it a healthcare IT modernization program that could inject about $30 billion into the economy. Since Massachusetts is a leader both in the use …

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How Massachusetts can lead health IT modernization

Family comes first for some who have finished residency

Medical Education
May 5, 2010

by Dr. Whoo, MD

I have met several women who have completed residency and maybe even practiced beyond that, but decide to quit and stay at home with kids. I wonder – why would a woman who has gone through all of that training just quit? It would seem like the hard part is behind them and I am perplexed by their decision but, of course, I …

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Family comes first for some who have finished residency

How Massachusetts controls health costs should be closely watched

Health Policy
May 5, 2010

A major criticism leveled at the health reform law is that it doesn’t do enough to control costs. Yet experience with a similar breed of health reform in Massachusetts indicates that the cost control issue will come to the fore sooner rather than later.

Recent stories have reinforced my conviction about this:

Massachusetts health plans have sued the state and stopped issuing new policies to small businesses and individuals after the …

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How Massachusetts controls health costs should be closely watched

Maternal death rates improve but hurts fund raising

Health Policy
May 5, 2010

by Mike Himowitz

When you’re advocating for a health cause, can good news be bad news?

It’s entirely possible — when science threatens fund-raising, and at the worst possible time.

Consider a study of worldwide maternal death rates by a team from the University of Washington that appeared online recently in The Lancet.

The group, led by Christopher Murray, of the school’s Institute for …

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Maternal death rates improve but hurts fund raising

Quality hospital care deserves to be celebrated

Physician
May 5, 2010

Last week my wife and best friend, Elaine, had massive abdominal surgery. We fully expected her to be an inpatient for a week, but she was home in four and half days. To watch her recover was to see what happens when everything converges: the deep knowledge and skills of excellent, humane physicians; a capable, caring clinical staff; wonderful new technologies; and a lifetime of eating right, being fit and …

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Quality hospital care deserves to be celebrated

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Health reform may mean meaningful changes for physicians

Health Policy
May 4, 2010

Jim called me late on a fall afternoon to report our mutual friend was in the local emergency room. “It looks like he had a stroke”. I immediately asked to speak to the ER doctor for the results of the CAT scan I knew would have been done. There were two metastatic tumors in the brain.

It has been over two years since my friend died. He was among the millions …

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Health reform may mean meaningful changes for physicians

Problem list problems with electronic medical records

Health Technology
May 4, 2010

In family medicine it has been common to keep a “Problem List” in patients’ paper charts. Usually placed on the left hand side, on top of the Medication List, it has given doctors like me an instant thumbnail sketch before considering the specifics of each patient’s visit for that day.

A typical Problem List would include diagnoses like diabetes, hypertension, high cholesterol or rheumatoid arthritis. It would list prior surgeries, like …

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Problem list problems with electronic medical records

Malpractice fears influence cardiology decisions

Physician
May 4, 2010

by Charles Bankhead

For nearly a quarter of cardiologist respondents, malpractice concerns influenced their decisions to order tests or treatment for hypothetical cases included in a national survey.

Almost 30% of cardiologists acknowledged ordering cardiac catheterization because colleagues did so in the same situation, according to an article published online in Circulation: Cardiovascular Quality Outcomes.

Concerns about malpractice had a significant association with regional use of tests and treatment, Frances Lee Lucas, PhD, …

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Malpractice fears influence cardiology decisions

Avoiding the ER and arranging a direct admit is not easy

Physician
May 4, 2010

Are emergency departments solely responsible for the bulk of unnecessary tests?

Most would like to believe so, but emergency physician Edwin Leap says that’s not the case.

He cites an instance involving a primary care doctor and hospitalist:

Local physician, who does not admit to the hospital, sees patient in the office. Patient has uncontrolled hypertension and is having some chest pain and shortness of breath. Local physician contacts hospitalist. …

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Avoiding the ER and arranging a direct admit is not easy

Defensive medicine worsens patient care and raises costs

Physician
May 3, 2010

Health care in the United States costs too much, and it doesn’t look like that’s going to change. Recent health care reform legislation doesn’t take any meaningful steps towards reducing or controlling costs. In fact, it explicitly forbids states from trying to curtail the costs of malpractice litigation in any way that would reduce lawyers’ fees.

How does a fear of lawsuits increase costs? The most direct way is …

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Defensive medicine worsens patient care and raises costs

Residency team changes can improve education and patient care

Medical Education
May 3, 2010

In the early 90s, I had the privilege of directing UCSF’s exceptional internal medicine residency program. It was a time of transition. A decade earlier, residency accreditation requirements (dictated by the Accreditation Council for Graduate Medical Education, ACGME) were fairly benign and largely ignored – marquee programs like ours were generally given carte blanche to organize our residents’ experience as we saw fit.

When I took over our residency in 1992, …

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Residency team changes can improve education and patient care

Money prevents patients from seeking timely heart care

Physician
May 3, 2010

by Crystal Phend

Lack of insurance and financial concerns keep patients from treating a heart attack like the emergency it is, researchers affirmed.

A delay in getting to the hospital for treatment of acute MI was 38% more likely among the uninsured and 21% more likely among insured patients with financial concerns, reported Paul S. Chan, MD, MSc, Mid America Heart Institute in Kansas City, Mo., and colleagues.

More than two in every …

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Money prevents patients from seeking timely heart care

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