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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 …

The grief men face when their wives undergo mastectomies

Anesthesioboist T., MD

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 …

Physical features of autism spectrum disorder (ASD)

William R. Yates, MD

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 …

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

StorytellERdoc, MD

Conditions

July 5, 2010

shutterstock_128891225

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 …

Ranking prestige of medical diseases

Jan Henderson, PhD

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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Ranking prestige of medical diseases

Why patients don’t value primary care doctors

Chris Rangel, MD

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 …

Patient handoff video that every medical intern needs to see

Kevin

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 …

8 insomnia tips to help you fall asleep without drugs

Jill of All Trades, MD

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 …

Heart catheterization worries that every cardiologist face

John Mandrola, MD

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 …

Tips for students who want to shadow doctors

Vineet Arora, MD

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 …

Doctors make far less money than most people think

Kevin

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 …

Primary care doctors at a competitive disadvantage to midlevels

Hans Duvefelt, MD

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. …

Don’t let a doctor make you feel uncomfortable

Kevin

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 …

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

Kevin

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 …

Ask your pharmacy to price match prescription drugs

Leslie Ramirez, MD

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 …

Wii Sports and Wii Fit Plus exercise equivalents

William R. Yates, MD

Conditions

June 11, 2010

Regular exercise has been shown to be helpful in the prevention and management of a variety of clinical neuroscience conditions including: Alzheimer’s disease, Parkinson’s disease, major depression and anxiety disorders. However, motivating people to get involved in a regular exercise program is a significant challenge. Wii Sports and Wii Fit Plus may provide the motivation edge for some patients to start and maintain an exercise program.

The Wii video game system …

Treating a child with fever and leukemia

StorytellERdoc, MD

Conditions

June 10, 2010

I walked into Room 35 to find a three year-old lying on the hospital cot. Her father sat alongside her bed, whispering softly to her. The patient appeared quite tired, wiped-out even, and if it weren’t for her complacent eyes tracking my every move, I would have thought she might be sleeping.

She was visiting our ER because, after a few days of cough and congestion, she had developed a fever. …

Demerol used to treat shivering in patients

Christian Sinclair, MD

Conditions

June 9, 2010

If you have spent anytime with a palliative care team in a hospital you will know of their efforts to essentially blacklist Demerol (meperidine) from use in the hospital.

Some hospitals have removed it or restricted it from the formulary all together. In medical culture, Demerol has been a go to opioid peri-OR and mostly favored by surgeons. The drug has been purported to be less likely to cause billiary spasm, …

Causes of stroke in young adults

Kevin

Conditions

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

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