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EMR conversion doesn’t always help physician communication

Kevin

Health Technology

March 16, 2010

by Stuart Sutton, MD

Our very large and very integrated health care system is plowing ahead with EMR implementation. All the offices are gradually converting from paper charts and all the hospitals have completed the process.

As a member of one of the last offices to be converted to the EMR, I’ve had the pleasure of patients being assured that the notes were sent to me (albeit via the EMR we are …

Physical exam evidence and whether it’s still useful

Zackary Berger, MD, PhD

Conditions and Diseases

March 15, 2010

A number of respected physicians have called for a renewed emphasis on the physical exam. Perhaps most prominently, Abraham Verghese has joined with colleagues at Stanford University to publicize the Stanford 25, a list of physical-exam maneuvers that they hold should be required of internal medicine residents.

These calls reflect in part the fear that checklist medicine will lead to doctors’ obsession with what Jerome Groopman calls the “iPatient” (the …

Use iPhone apps for emergency room wait times with caution

Satish Misra, MD

Health Technology

March 15, 2010

Emergency rooms are notorious for their long waiting times – that’s pretty common knowledge. But now the Hospitals of Central Connecticut are looking to a new medical app for the iPhone to help improve their emergency room wait times.

Having spent a fair amount of time recently working in an emergency room, I (and probably everyone with similar experiences) can assure you that no one – physicians, nurses, administrators – want …

PSA for prostate cancer screening is likely to continue

Kevin

Conditions and Diseases

March 15, 2010

Originally published in MedPage Today

by Crystal Phend

The ASCO Genitourinary Cancers Symposium met recently, just after the American Cancer Society updated its prostate cancer screening guidelines to emphasize shared decision making and Congress heard testimony over use of prostate specific antigen (PSA) in prostate cancer screening.

Now urology is no stranger to debate. Controversy continues on overdiagnosis, overtreatment, and other issues raised …

PSA screening for prostate cancer debated in Congress

Kevin

Conditions and Diseases

March 14, 2010

Originally posted in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

A day after the American Cancer Society (ACS) released updated prostate cancer screening guidelines, the group’s chief medical officer was before Congress urging the government to fund research into alternative screening methods for prostate cancer.

Otis Brawley, MD, an oncologist and chief medical officer for the ACS, told the House Oversight …

Poetry that your patient can appreciate

Danielle Ofri, MD, PhD

Patient

March 13, 2010

When I make rounds with my students and interns, I always try to sneak in a poem at the end. I think poetry is important because it helps convey the parts of the medical experience that don’t make it into textbooks. It’s important because it teaches creative thinking—something of immense value to doctors.

It’s important because interpreting metaphors is a critical clinical skill in diagnosis; patients’ symptoms often present in metaphorical …

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Poetry that your patient can appreciate

7 ways inmates can receive quality medical care from doctors

Jeffrey Knuppel, MD

Patient

March 12, 2010

Many non-correctional health care providers will also treat inmates from time to time. This may occur in the office or hospital. How can one best approach the challenges of working with the incarcerated in order to deliver the best possible care while simultaneously managing risk?

1. Treat the patient with respect. Not submissive respect, but mutual respect — the way we all want to be treated. I believe that this principle …

Children with special healthcare needs are underinsured

Kevin

Health Policy

March 12, 2010

Originally published in MedPage Today

by Chris Emery, MedPage Today Contributing Writer

Nearly a third of children with special healthcare needs are underinsured, and where a child lives strongly influences whether he or she will have adequate healthcare coverage, a new study found.

The unadjusted proportion of underinsured special-needs children varied strongly by state, ranging from 24% in Hawaii (standard error=1.75) to 38% …

AMA: Health insurance consolidation can undermine physicians

Kevin

Health Policy

March 11, 2010

The following is part of a series of original guest columns by the American Medical Association.

by J. James Rohack, MD

Physicians in nearly every area of the country face a David and Goliath scenario when negotiating with entrenched health insurance companies. This is clearly illustrated by a new AMA study showing that competition in the health …

Health care reform needs to pass now, and here’s why

Matthew Mintz, MD

Health Policy

March 11, 2010

There are certain actions we take even though we know that ultimately we will not be successful. Sometimes we do this out of hope for a better tomorrow (like playing the lottery) or because we are taking a moral stand (like supporting a candidate that has no chance of winning).

Supporting health care reform is probably a little of both.

Even if any of the currently proposed health care reform plans pass, …

Autism in children can be missed early in life

Kevin

Conditions and Diseases

March 11, 2010

Originally published in MedPage Today

by Chris Emery, MedPage Today Contributing Writer

The symptoms of autism tend to emerge in children after six months of age, with a loss of social and communications skills that is more common and more subtle than previously thought, according to a new study that questions previous assumptions about the progression of the condition.

At six months, …

Patient handoffs limit residents work hour cap gains

Vineet Arora, MD

Medical Education

March 10, 2010

Anyone affiliated with a teaching hospital knows that the controversy regarding resident work hours is heating up again. It’s been over 5 years since the ACGME limited resident hours to 80 hours per week with a maximum of 30 consecutive hours. While this may not sound like ‘reform’, as someone who trained prior to these rules, it is definitely a change.

More recently, the Institute of Medicine issued a …

Help doctors to best care for their patients

Alex Lickerman, MD

Patient

March 10, 2010

Part four of a series. See also parts one, two, and three.

When dealing with your doctor’s biases, you have on your side a fact I firmly believe to be true: most doctors want to do a good job and help their patients as best they can. So what exactly can you do to maximize your doctor’s ability to help you?

1. Position your symptoms and requests carefully. Don’t demand medications …

Primary care needs to be valued first before it can be saved

Toni Brayer, MD

Physician

March 9, 2010

I went to my physical therapist yesterday for knee treatment and we talked about the fact that Blue Cross is cutting their reimbursement to the point that the cost of providing care will not even be covered. All I could do was lament with him and listen.

One insurer even told him (the owner of the business) to just “make the sessions shorter and don’t give as much care.”

Clearly the insurance …

Aggressive behavior in children and the family dynamic

Claudia M. Gold, MD

Patient

March 9, 2010

In the Tony award winning play God of Carnage two couples meet in an elegant living room for an ostensibly civilized conversation about the aggressive act of one couple’s child against the other’s. The meeting soon degenerates to reveal the underbelly of conflict in the two marriages. Husband and wife hurl insults, precious items and even themselves with escalating rage. We see, as they attempt in vain to focus on …

Vaccine safety still concerns parents

Kevin

Medications

March 9, 2010

Originally published in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

Even though 90% of parents believe vaccines protect their children against disease, many are also concerned about potential adverse effects, a new survey found.

More than half of survey respondents said they were concerned about vaccine safety profiles, particularly for newer immunizations, Gary L. Freed, MD, MPH, of the University …

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Vaccine safety still concerns parents

Helping organ donation with donor advocate teams

John Schumann, MD

Physician

March 8, 2010

One of the joys of practicing at an academic center is that I get to do many different things in my job.

The foundation of my work is seeing my own patients in a large group (more than thirty doctors!) primary care practice.

Two months a year, I take my turn rotating on the hospital inpatient services, supervising teams of residents and students who are the primary caregivers for patients with illnesses …

Why physicians are working fewer hours

Kevin

Physician

March 8, 2010

Originally published in MedPage Today

by Michael Smith, MedPage Today North American Correspondent

Physicians are working fewer hours than they once did, the result of a decade-long decline that coincided with lower fees for their services, a study showed.

After two decades of stable hours, a steady decrease began in 1997, according to Douglas Staiger, PhD, of Dartmouth College, and colleagues.

The decline coincided …

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Why physicians are working fewer hours