Why EMR companies don’t care about usability

Tech
June 26, 2013

I overheard nurses praising the pilot of a new technology with the promise of improving communication, safety, and saving on healthcare spending. The innovation: two-way texting. That’s one of the many indicators that hospitals are stuck the technological stone age.

Imagine how many eyes light up when you offer providers fewer logins, autopopulating forms, and uncluttered menus. There’s an assumption that technology, in the context of healthcare, has to be bad …

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When a child can’t feel his poops

Conditions
June 26, 2013

Kathy wrote about her son: “What can cause a 9-year-old boy to poop in his pants occasionally and not feel it? He was completely potty trained at age three. I have found dirty underwear and poop on the bathroom floor–and it just concerns me that he is unaware of it. It has been suggested at checkups that he may be constipated. My mother suggests he may simply not be paying …

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Should doctors be available to patients around the clock?

Physician
June 25, 2013

Nothing exemplifies more the complete lack of understanding of the issues surrounding our healthcare system than an article that appeared in the New York Times recently.

Author Jane Brody’s piece attempts to address issues with the astronomical costs and misuses of emergency department (ED) visits in the US today.  While I agree that ED visits for routine issues are a waste of resources and money, her suggestion that physicians should …

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Using Google Docs to manage patients more efficiently

Education
June 25, 2013

During my sophomore year of college as a pre-med, I volunteered at the front desk of a free clinic, where it was typical to see patients waiting sometimes for more than two hours. At first I figured it was just because some patients took longer to examine than others. It wasn’t until I got certified as a nurse’s aide and started working in the medical department at the same clinic …

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A pediatrician’s approach to dehydration in children

Conditions
June 24, 2013

Our bodies are mostly water — about 60% water, in fact. This varies a little with age and sex, but it is a good rough estimate. Of that 60% water, about a third of it is outside the body’s cells, so-called extracellular fluid, and two thirds of it is inside the body’s cells, so-called intracellular fluid. The easiest way to remember this is the “60/40/20″ rule: total body water is …

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How a heart rhythm specialist approaches PVCs

Conditions
June 23, 2013

Here is an edited email I received from an athletic colleague:

John,

A 50 year-old male healthy athlete has the new problem of occasional periods of premature beats. She (or he, doesn’t matter) has visited the doctor and an ECG shows PVCs, or premature ventricular contractions. Otherwise the history, exam, ECG, ECHO and electrolytes are normal.

What’s up with PVCs? Why? Could they be 1) consequence of (chronic) exercise or 2) related in …

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Every doctor can learn from a medical coder

Education
June 23, 2013

Mrs. B was washing dishes in the kitchen when she heard a thump where her twelve-month-old son was asleep. She ran to him and found her son had fallen from a chair (code: e884.2). He was crying (code: 780.92) and visibly shaken, but did not have overt signs of bleeding, bruising, or trauma. She picked him up and immediately brought him to the emergency room.

There, he was triaged by the …

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A hospital transfer may not always be a good thing

Physician
June 20, 2013

Injury to the brain continues to be a unique thing in medicine. These injuries are scary and unfamiliar to many health care providers. There is a finality to them. Their consequences are hidden a little bit; the asystole is easy to figure in the emergency room but the suppression and brain death isn’t something so easily recognized.

They’re what you might imagine, along with polytrauma, as poster child conditions for tertiarization …

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The reality of medicine’s inherently unequal power dynamic

Education
June 20, 2013

As part of the first-year curriculum, medical students at the David Geffen School of Medicine at UCLA are required to attend chaplain rounds at local hospitals during which they accompany chaplains to offer spiritual care to patients. This is designed to encourage students to empathize with patients who are enduring difficult end-of-life issues and is part of a ubiquitous and important theme that inundates almost every medical student across the …

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The problem with a negative BRCA test

Conditions
June 19, 2013

There is nothing so horrifying as when your doctor is too nice to you. During my first mammogram at Kaiser Permanente, I knew I had cancer before they even told me because of the hushed voices, the pats on my shoulder, and the way, suddenly, no one cared how much time was being spent on my visit. When that happens to you before the diagnosis is official, there is nothing …

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Thanks for the compliment, but I’m not a nurse

Physician
June 17, 2013

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Let’s get one thing clear from the start: I love nurses. My grandmother was a nurse’s aide. My aunt is a nurse. My mother is a nurse. Nurses have been by my side for the most frightening and important experiences in my life (in the hospital and out). However, I’m not a nurse. I’m a doctor. And when someone calls me …

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What if doctors worked for free?

Policy
June 15, 2013

Today I am going to write about how the US could save up to 10% on its healthcare bill.

The US spends more on health care than any other nation, $8,500 per person per year. Multiply that by 300 million people and try to grasp the vast sum of $2,5 trillion.

A lot of changes are taking place with the intent to save healthcare dollars. So far, many of those changes have …

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When can you override an advance directive?

Physician
June 14, 2013

An 85-year-old woman with moderate Alzheimer’s disease who enjoys walking in her nursing home’s garden with her walker has fallen and broken her hip. An advance directive signed by the patient states a preference for “comfort measures only,” and specifically states that she does not want to be transferred to the hospital. The physician believes that surgery would provide long-term pain relief and the chance to maintain some mobility.

What do …

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Quality, cost, and value in health care: How to solve the puzzle

Policy
June 14, 2013

I sometimes explain to medical students that they are entering a profession being transformed, like coal to diamonds, under the pressure of a new mandate.

“The world is going to push us, relentlessly and without mercy, to deliver the highest quality, safest, most satisfying care at the lowest cost,” I’ll say gravely, trying to get their attention.

“What exactly were you trying to do before?” some have asked, in that wonderful way …

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Reflection after attending an Alcoholics Anonymous meeting

Education
June 13, 2013

I’m two weeks into my psychiatry clerkship, sitting quietly in the back of a crowded Alcoholics Anonymous meeting and watching a middle-aged man discuss his past struggles with alcoholism. He starts with his difficult childhood, describing his abusive father. When he was eleven years old, his parents divorced. Soon after, he resorted to alcohol as an escape from his loneliness, drinking to “fit in” and impress his friends at social gatherings. As …

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How to stop medical students from becoming jaded

Education
June 12, 2013

Recent research suggests that medical students lose empathy during the third (the main clinical year) of school.

Talking with end of the year third year students might make you think differently. Understanding the psychological changes that likely occur during the third year should make you think differently.

Medicine seems easy during the pre-clinical years. You get smokers to stop and prevent COPD and coronary artery disease. Patients just need to listen to …

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The spiritual bond between two souls

Physician
June 12, 2013

Being a part time hospitalist, I am frequently on overnight call in the hospital, spending the night admitting sick patients from the emergency room, or dealing with any calamities that happen on the medical floors. I would have to say the that the most dreaded events are: “Code blue” (this means a hospitalized patient in cardiac or respiratory arrest waiting to be resuscitated), followed closely by a nurse calling with: …

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What should a surgeon do with an impossible case?

Physician
June 12, 2013

For the first time in my career I asked myself that question. Over the years, I’ve had more than my share of difficult cases. I’ve had patients with life threatening conditions whom I wished I could offer more than to just shake my head and speak empty words of encouragement. They stare back at me and I see their eyes full of hope. How many times have been forced to …

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