Spring cleaning is a tradition in many homes. The occupants open up the home to the spring air, thoroughly clean the home, and sort through the accumulated goods, getting rid of things not used for a long time and which no one wants anymore. It gives one a sense of accomplishment, makes for a more pleasant surrounding and frees up space.
Is this something that you do at your healthcare site …
Clean your healthcare site to become more efficient
As reported in MedPage Today, the FDA announced the end for CFC-propelled inhalers. Of the seven inhalers with deadlines for removal, only three are still being made:
Flunisolide (Aerobid Inhaler System) on June 30, 2011
Albuterol and ipratropium combination (Combivent Inhalation Aerosol) on Dec. 31, 2013
Pirbuterol (Maxair Autohaler) on Dec. 31, 2013
The reason for this is because CFC’s are harmful for the environment, and the newer inhalers have to be replaced with …
Your asthma or COPD inhaler is not available, and what to do
There is an aspect of professional sports that I greatly admire. This transcends the athleticism and skill of the athletes, the work ethic, coaching expertise, teamwork and the thrill of the game. This is one of the only institutions that is a pure meritocracy. The philosophy is simple and not blurred by arguments for diversity or massaging the qualifications for admission to serve another agenda. Coaches, managers and owners want …
How doctors choose which specialists they refer to
In April 2010 the American Society of Anesthesiologists (ASA) published updated guidelines for the management of chronic pain. The guidelines were based on a review of recent scientific evidence as well as a survey of expert opinion. As I read through the guidelines, summarizing the efficacy of various therapies for chronic pain ranging from epidural injection to medication management, some of my most challenging clinical cases involving pain management …
How primary care should manage chronic pain patients
Female sexual dysfunction has been reported in up to 40% of women, and described as causing actual distress in approximately 12% of women.
Therefore, it is an important topic to familiarize with and screen for as a primary care physician, as many patients may not report these symptoms unless they are elicited during the history taking process of the patient encounter. Female sexual dysfunction is often multifactorial and complex; it is …
Female sexual dysfunction treatment options
by Sandeep Grewal, MD
We as doctors and patients as well as medicine as a whole have evolved over time. What used to be a simple conversation of between a doctor and a patient has turned into a melee of medical issues, legal issues, insurance and financial issues and not to mention the complicated ICD 9 and CPT code system.
Conversation between a doctor and patient in 1960s:
Patient: Sir, I am …
Patient relationships with their doctors over time
Those who hate hospitalists believe that students and residents are choosing hospital medicine over primary care so hospitalists are to be blamed for the primary care shortage. They also believe that the rise of hospital medicine has made primary care less attractive. Then, there is the salient argument that care transitions are more inherent and vulnerable due to hospitalists.
Of course this hatred is not new. As a …
Hospitalists are killing primary care, and other myths debunked
by Michael Smith
It’s a classic good-news, bad-news story.
The vaccine against shingles, already shown to be effective, is both safe and well-tolerated, researchers found after following more than 38,000 participants in the randomized trial that led to the 2006 approval of the vaccine.
On the other hand, few people are getting the vaccine, and for a variety of reasons — including its cost — researchers noted in a separate study. Both analyses …
Few receive the shingles vaccine because of cost to doctors
Whenever I diagnose a person with asthma or allergies, I usually ask a few questions about his or her living environment. Is there shag carpeting in the bedroom? Is the air conditioning filter changed every month? Is there evidence of roaches and other vermin? I ask these questions because mold, dust mites, animal saliva and insect droppings can worsen the symptoms of asthma and other illnesses.
But some of my patients …
Rental housing can worsen your health
An excerpt from Stay Healthy At Every Age: What Your Doctor Wants You to Know.
When you were growing up, somebody probably told you that “an ounce of prevention is worth a pound of cure.”
Many of us have learned from experience how much better it is to prevent a bad thing from happening than to try to fix the consequences once it has happened. Most people can agree that prevention …
Failing to prevent disease in patients costs lives
Health care in the United States is struggling to redefine itself. We have been spending twice what other countries spend on health care, yet our citizens are less healthy. We now have legislation to create more or less universal insurance coverage, and we are about to embark on a technology-driven quest for quality and uniformity. At the same time, Americans are increasingly turning to alternative health care practitioners, mostly at …
Evidence based medicine at the expense of the art of medicine
Ahhh spring.
The lovely blooms unfurling. The trees budding.
It’s enough to make a girl get tears in her eyes.
And sneezes in her nose.
And itching on her face.
Yes, it’s allergy season again — but what can you do to make yourself more comfortable without emptying your wallet?
1. Avoidance. Close the windows. Make someone else cut the grass. Stay inside. (Yes, I hate this one too- let’s move on.)
2. Neti pot or other nasal saline rinsing. LOVE …
Allergy drug recommendations for patients on a budget
A common clinical problem in aging is when should driving a motor vehicle be discontinued. When does driving become a significant safety hazard as cognition and motor skills decline?
The American Academy of Neurology recently published a Practice Parameter update: Evaluation and management of driving risk in dementia. This important review provides clinicians and family members with assistance in making an accurate and timely decision.
The authors of the guideline review research …
Patients with dementia and when they should stop driving
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by Todd Neale
Clinicians should actively persuade families not to participate in the ritual cutting of female genitalia, the American Academy of Pediatrics urged.
However, the organization suggested that legislatures and doctors might ultimately consider legalizing ritual “nicks” to satisfy cultural or religious demands without more serious and problematic cutting.
The centuries-old practice, which is illegal in the U.S. and several other developed countries, carries with it a host of physical and psychological …
Female genital cutting complications
I try to read as much as I can of everything floating around the medical blogosphere. I think the most recurrent topic I come across is why current medical students aren’t choosing to go into primary care.
It’s a great topic that relates to health care reform, making it ripe for medical bloggers to comment on relentlessly. Probably the most often cited reason is low reimbursement for primary care (read: primary …
Why primary care doesn’t appeal to this medical student
Massachusetts has a problem.
In April 2007, they became the first state to require residents to have health insurance. Reportedly this has resulted in 300,000 newly insured patients and lowered the uninsured population to 5%. But of course, given the relatively poor reimbursement rates for primary care providers, especially when it comes to government insurance, the state is facing a growing shortage of primary care providers.
Without an adequate supply of primary …
Doctors may be forced to accept Medicare rates to stay licensed
In reference to the seemingly “simple” name change being proposed for Physician Assistants to Physician Associates, I take great exception to the commentary offered by Dr. Zilberberg in her recent article entitled, Physician assistant name change rubs doctors the wrong way.
She states: “Physicians have been only too successful at becoming the final word in health, at the exclusion of all others.”
Physicians are the highest and most extensively trained group …
Physician assistant not associate: Reasons against a name change
by Kristina Fiore
The scale of the obesity epidemic may be much worse than currently believed, because the usual measure, body mass index (BMI), is a very insensitive measure of excess body fat, researchers said.
In a single-center study, 66% of patients classified as obese on the basis of DEXA scanning had BMI values in the nonobese range, according to Eric Braverman, MD, of New York Presbyterian Hospital/Weill Cornell Medical Center.
Among more …
Body mass index (BMI) may not measure obesity accurately
by Crystal Phend
One of the most effective ways to prevent child abuse may be for pediatricians to identify domestic violence against a child’s caregiver, according to a report from the American Academy of Pediatrics.
Intimate partner violence in the home has a profound effect on kids, Jonathan D. Thackeray, MD, of Columbus Children’s Hospital in Columbus, Ohio, and colleagues wrote in the May issue of Pediatrics.
They pointed to elevated risk of …
Pediatricians have a role in reporting domestic violence
Last week, I again had the privilege of teaching pediatricians in training. These students were very bright, challenging and asked excellent questions. They all agreed about the limit of the pediatric model of “giving advice.” One resident, who had young children of her own, spoke of new mothers using blogs for emotional support. Many of these mothers speak less than kindly about their pediatricians, who they perceive as “not getting …
Pediatricians need to wonder when dealing with behavior problems
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