Echocardiogram reading by cardiologists needs to improve

Conditions
July 16, 2010

by Crystal Phend

Insufficient training among cardiologists in reading echocardiography results is wasting healthcare dollars and subjecting patients to unnecessary procedures, researchers said.

A review by sonographers of cardiologist-interpreted echocardiography findings at a Milwaukee medical center during a period of just over a year indicated major discrepancies in 29% of cases, leading to unnecessary further diagnostic testing or treatments for the wrong indication, according to a study presented here at the American …

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Free clinics need more government funding

Policy
July 14, 2010

by Cole Petrochko

The nation’s free clinics provide medical service to 1.8 million patients annually — more than half of those clinics operate without government funding and serve patients who are almost all uninsured — according to the first census of free clinics in 40 years.

Responses to a national mail survey by 764 free clinics in the U.S., reported in the June issue of the Archives of Internal Medicine, revealed that …

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What residents and medical students should wear in the hospital

Education
July 13, 2010

At a recent meeting I attended, a vigorous discussion broke out about what medical students, residents and attendings should wear, and more importantly what they should not wear.

Interestingly, patients have been asked to weigh in on this discussion. What to wear is also on the mind of many current second year medical students who may find themselves trying to take study breaks from USMLE 1 to go buy …

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How to treat slouching in children

Conditions
July 9, 2010

“I’m worried about my daughter’s posture. What can I do about it other than constantly nagging her to stand up straight?”

You’re probably talking about “kyphosis,” which is the rounded-shoulders, hunched forward kind of posture common in children and many adults. It’s often called “postural kyphosis” because it can be corrected if the child tries to stand straight up. Rarely, there’s a genuine spinal deformity, called Scheuermann’s Kyphosis or Scheuermann’s Disease, …

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How to implement CPOE successfully at your hospital

Tech
July 9, 2010

One in every 10 patients admitted to six Massachusetts community hospitals suffered serious and avoidable medication mistakes. This has created a new urgency for all hospitals in the state to install computerized physician order entry (CPOE).

At BIDMC, we implemented CPOE in 2001 and have not had a handwritten order in most areas, except for the 2 days of our network outage in 2002. Implementing CPOE is challenging and requires …

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The grief men face when their wives undergo mastectomies

Conditions
July 8, 2010

I have given anesthesia for a lot of breast surgery. I don’t think I’ll ever get used to the fog of pain and sorrow surrounding a double mastectomy.

All surgery is invasive in some way. Amputations, in particular, have a horror all their own; the idea that destroying someone – cutting off a body part, violating a coherent whole – should be necessary in order to save a life is almost …

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Physical features of autism spectrum disorder (ASD)

Conditions
July 6, 2010

Social and language issues dominate most of the discussion about the features of autism spectrum disorder (ASD).

A neglected area of study are the physical feature characteristics that have been known to be associated with ASD. Unlike some of the diagnostic physical changes in disorders such as Down Syndrome, physical features found in ASD are often subtle and missed by most clinicians.

Ozgen and colleagues from the Netherlands, UCLA and the UK …

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Kidney stone pain, as experienced by a man and a woman

Conditions
July 5, 2010

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As a typical guy, there are several painful illnesses that can hit our brotherhood in an instant. No warning was given. No “Get out of jail free” pass, either. Just cruising along, having another fine, healthy day, and bam! — suddenly, you are lying on the floor in severe distress.

The most feared? A testicular torsion. It can happen spontaneously. It can …

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Ranking prestige of medical diseases

Conditions
July 4, 2010

Among medical specialties, some are more prestigious than others. You can generally tell which ones are more prestigious by how well they pay. Surgery and cardiology, for example, rank at the top of the prestige scale. Psychiatry and dermatology are near the bottom.

One can also ask if some diseases are considered more prestigious than others, in the opinion of doctors.

A Norwegian doctor, Dag Album, has been investigating the prestige …

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Why patients don’t value primary care doctors

Physician
June 30, 2010

“Hey doc, all I need is this referral.”

I’ve been encountering more of this lately. A patient who has not been seen in the office for months to years (well beyond when they were supposed to come back for a follow up visit) walks in and requests a “referral” for a specialist visit but they can’t be bothered with actually being seen and evaluated in the office or to be compliant …

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Patient handoff video that every medical intern needs to see

Education
June 23, 2010

Patient handoffs increase the risk of medical errors.

As I wrote recently in USA Today, as residency hours are restricted, more of these handoffs will take place. It’s imperative that this source of error be minimized.

Vineet Arora, associate director at the University of Chicago’s Internal Medicine residency, is one of the nation’s authorities on patient handoffs. She recently made a video for the incoming interns about the …

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8 insomnia tips to help you fall asleep without drugs

Conditions
June 19, 2010

Difficulty with sleep is one of the most common patient complaints presenting to the primary care office.

Chances are, you will suffer from difficulty with insomnia at some point in your lifetime. It can be distressing, and cause difficulty with functioning during your wake hours. The first thing you may want to do is to run to the doctor for a prescription for a medication to help you sleep.

However, you don’t …

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Heart catheterization worries that every cardiologist face

Physician
June 18, 2010

Malpractice and heart catheterization have been in the news recently.

A spicy concoction for sure. An epidemiological study published in an online subsidiary of Circulation addresses the role of three major medical issues facing cardiologists today: malpractice, heart catheterization, and medical costs.

It is hard to get more controversial.

Heart catheterization, the invasive assessment of the coronary artery lumen, has always been a hot-potato topic. The “percent-normal” was the buzz word when I …

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Facebook friends with patients can violate HIPAA privacy laws

Social media
June 18, 2010

Should you friend your doctor on Facebook?

It’s a question that’s gaining increasing relevance as Facebook increases its social networking dominance.

I’ve touched upon the issue in the past. So has the New England Journal of Medicine.

Washington, DC physician Katherine Chretian gives her take on the issue in a recent USA Today op-ed. She is an expert of the Facebook-medicine intersection, having authored a JAMA study on the …

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Tips for students who want to shadow doctors

Education
June 17, 2010

On a recent Saturday, I rounded in the hospital.  I met up with Zainab, the president of the minority premed association for the University of Chicago, who asked to shadow me.  While she was doing research at the hospital, she had not ever rounded in the hospital before.  It was Saturday so our team was mostly off so it was just me and my very capable resident who is about …

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Doctors make far less money than most people think

Policy
June 15, 2010

A video excerpt from The Vanishing Oath, a film directed by Ryan Flesher, MD.

The average physician salary in the United States is $146,000 — which is undeniably a lot of money at face value.

But it’s a lot less when you factor in the overhead costs that doctors incur.  And that’s not including the medical school debt which, on average, exceeds $150,000.

This clip shows how the take home pay of …

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Primary care doctors at a competitive disadvantage to midlevels

Physician
June 13, 2010

A primary care resident wrote in one of the journals recently about making the limited time she has with each patient matter the most.

How refreshing, I thought when she concluded that time ultimately is an absolute and finite resource. We often feel as if we are battling time as much as we are battling disease, and we sometimes have trouble admitting when we are losing either one of those battles. …

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Don’t let a doctor make you feel uncomfortable

Physician
June 12, 2010

by Diana E. Lee

One member of my health care team is a migraine specialist in another state. Since we don’t have many opportunities to work together in person, we generally try to pack a lot into my periodic two-day visits.

Last time I was there I had an experience that has left me feeling guilty all these months later.

My doctor, who I respect and admire greatly, asked if I was interested …

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

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 …

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Ask your pharmacy to price match prescription drugs

Meds
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 …

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