To do nothing is sometimes a good remedy.
-Hippocrates
Edna Frost is 88 years old, a slender, slow-talking woman with a dry sense of humor and a blood pressure that’s all over the place. At best, she runs ten points higher than any of her previous doctors wanted to put up with. At worst, she flirts with systolics over 200, but that doesn’t seem to be a common occurrence.
Edna has been my …
Sometimes the treatment is worse than the disease
It was early Saturday morning, I was making my plans for the day, crossing-off a few items that seemed unreasonable with others that had been accomplished. As I moved toward the kitchen, a voice from the living room bellowed “the coffee is ready.”
Turning my head I could see bright rays of sunshine making a visible path through the open front door. My morning greeting followed …
Imagine using Skype to contact your physician for a consult.
In the midst of this rapidly progressing technologic era, our delivery of medical services is being transformed by health information technology (HIT), electronic medical records (EMR), and advanced telecommunications. In meeting criteria for “meaningful use,” physicians are driven to use these technologies to empower patients with communication through electronic medical records. A primary goal is to allow patients to …
Online physician access is key to future patient communications
Walgreens is being sued by customers who are not happy that their prescription information – even though it has been de-identified – is being sold by Walgreens to data-mining companies.
The data privacy and security concerns surrounding the transfer of de-identified data are significant. To “de-identify” what is otherwise protected health information under HIPAA, some outfits will simply strip data of 18 types of identifiers listed in …
Pharmacies selling prescription information to data mining companies
It happened 25 years ago and I never forgot it. I’d been in the forefront of women’s consciousness-raising; I recognized that women had been professionally downtrodden for years (in certain fields), and hoping to do my part to balance the inequity, I opted for female doctors whenever possible.
But using gender as sole determinant for my choice of doctor would prove to be a huge mistake … as I’d learn.
At …
Using gender as sole determinant for a choice of doctor
To measure is to know.
-Lord Kelvin
If you can not measure it, you can not improve it.
-Lord Kelvin
Versus:
Asking science to explain life and vital matters is equivalent to asking a grammarian to explain poetry.
-Nassim Nicholas Taleb
Technology is at its best when it is invisible.
-Nassim Nicholas Taleb
How can technology help us live healthier lives? Why did Google Health fail? Why are Klout and Twitter Grader publicly issuing a number to me …
Google Health failed because consumers did not see the value of a PHR
by John Kaegi
We all complain about the cost of health care and health insurance. Ours is by far the most expensive health care system in the world. And for the money, our health isn’t so hot either. On the world stage, the U.S. ranks 37th in health care efficiency (a measure of health outcomes such as infant mortality, incidence of chronic disease, etc.) as reported by the World Health Organization. America …
Reverse our attitudes and values to control health costs
As a recently minted physician, I am often on the receiving end of the gripes and grouses about the medical profession.
Often I get complaints of office visits that are too short, doctors who seem too preoccupied to hear their patients’ complaints, medical bills that are too high and medications that do nothing but cause adverse effects. On the other hand, I can’t count the number of times I have …
Patients are often intimidated and confused by the medical experience
Sometimes, you just can’t win! In medicine, sometimes is way too often. “Doc, do I need that test?” reviewed the issues surrounding screening colonoscopy exams. The dilemma is always the same. Do I order a test or don’t I?
If I order a test, there are consequences. Some are obvious; some are not. Tests cost money and money is in short supply. One consequence of ordering a test …
How ordering tests sometimes have consequences for patients
When I was 8, my mom went to a parent-teacher night at school. When she sat down with my teacher, the teacher smiled and said: “So how are Susan’s swimming lessons going?”
My mom frowned, confused. “Susan isn’t taking swimming lessons – perhaps you’ve confused her with someone else?”
“No, I’m sure,” my teacher insisted. “Susan told me that she has to leave at 3 o’clock every afternoon, right when the bell …
Avoiding confrontations and the difficulty of standing up for yourself
by Grayson Wheatley, MD
It was supposed to be a routine office visit for my patient.
Unexpectedly, it turned into a real-world health economics lesson for me, the treating physician. The old adage “listen to your patients; they will always give you the answer” became exceedingly true in this case, even when it dealt with an issue beyond a medical diagnosis, such as lack of transparency …
The challenge of pre-authorization for an elective procedure
Google Health is dead.
There have been plenty of post-mortems as to why, ranging from the fact that it’s not social enough (uh … no), to the realization that only a minority of practices have electronic medical records, yet alone a patient portal that can incorporate PHRs like Google Health.
I’ll chip in with my own reason — it suffered from “one more thing” syndrome.
PHRs today aren’t seamlessly incorporated into …
One more thing: Works for Apple, but killed Google Health
I lived in Japan in 1991. When I was having a conversation with someone, they would always nod their head as if they completely understood the message I was trying to convey.
It turns out that was not the case. The nodding was a sign of respect. When I began to inquire if they understood what I was trying to say — it became clear that the answer was usually no.
Many …
Closing the communication gap between patients and physicians
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 75-year-old man with type 2 diabetes mellitus is evaluated in the emergency department for a draining chronic ulcer on the left foot, erythema, and fever. Drainage initially began 3 weeks ago. Current medications include metformin and glyburide.
On physical examination, he is not ill appearing. Temperature …
MKSAP: 75-year-old man with a draining chronic ulcer on the foot
The following op-ed was published on June 7, 2011 in USA Today.
More than ever, I find myself fielding questions from patients about the health care reform law. The most common one is, “How will reform affect me?” It’s a complicated question, with a different answer for each patient. But as the law’s full effects unfold, one of the more significant changes will be in how patients interact with their …
Team based care in health reform needs patient involvement
“I don’t study because it gets in the way of my video game time”
-15 year old patient.
Sorry mom and dad, video games are here to stay. In my clinic, this is a topic of discussion every day:
“How many hours of screen time does Mikey get every day?” I ask.
“Tell the truth”, Mom says looking at Mikey.
“brmfbr mbbrm,” says Mikey looking away.
Mother turns to me with the familiar look that …
Using video games to fight childhood obesity
A lot of people express frustration when visiting their doctor’s office. They don’t feel they are listened to, cared about, or have their issues adequately addressed. If this sounds familiar, it could be that your doctor is evil, or what’s more likely, he’s trying to practice medicine within a difficult system.
Due to decreasing reimbursement and increasing expenses, many doctors are forced to see more patients just to keep their …
Make the most of the time spent with a doctor to minimize patient frustration
I highly recommend you take a look at “10 Dumb things you do at the doc’s office.” Be sure to scan the article, but what you really need to look at is the comments, all 700+ of them.
While by no means a representative sample of how we think about physicians, there is a clear pattern to the comments. A lot of people feel disrespected by their doctors, …
How physicians should deal with angry patients
by Dennis Grace
The Internet’s been rife, lately, with discussions of evidence-based medicine (EBM) and its alternative, experience-based medicine (which, to avoid conclusion, I’ll call XBM).
Look up either phrase on Google if you want more details, but be warned, it’s like trying to get a sip from Niagara Falls. Ideally, though, EBM is guided by information generated by studies conducted as rigorous, double-blind, randomized, …
Evidence versus experience based medicine for patients
What is the year 2011’s best diagnostic and therapeutic medical device?
Is it the PET scan with special bells and whistles to detect early Alzheimer’s?
Is it the robotic surgery that reams out the worst prostate cancers remotely?
Is it the Total Genomic Analysis that predicts what your genetic future holds?
Is it the GI endoscope that checks out your innards from stem to stern?
Is it the latest drug-eluting stent that promises to …
The best diagnostic medical device is right in your own home
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