I lost a patient this season, an infant, to whooping cough (pertussis). After falling ill, he lived for nearly a month in the intensive care unit on a ventilator, three weeks of which was spent on a heart/lung bypass machine (ECMO) due to the extent of the damage to his lungs. But all our efforts were in vain. The most aggressive and advanced care medicine has to offer couldn’t save his life. The only thing that could have saved him would have been to prevent him from contracting pertussis in the first place.
He was unvaccinated, but that was because of his age. He was part of the population that is fully dependent on herd immunity for protection, and that is exquisitely prone to a life-threatening course once infected. This is a topic we’ve coveredad nauseum, and I’m not inclined to go into greater depth in this post. Suffice it to say his death is a failure at every level. We, both as medical professionals and as a society at large, need to do a better job of protecting our children from preventable diseases. Read more »
One of the more surprising twists and turns in the continuing debate over healthcare reform is that many physicians who now object to the Affordable Care Act (ACA) were just a few years back advocates for more federal regulation. In fact, in the early 2000s, more than 200 “provider” and consumer groups — including many state medical and national medical specialty societies that now oppose the ACA because of concerns about “excessive regulation” — were among the fiercest champions of federal legislation to mandate that health insurers comply with a Patient Bill of Rights.
A bipartisan bill introduced by Senator John McCain (R-AZ) and the late Senator Ted Kennedy (D-MA) would have ensured that patients have the “right” to appeal insurance company denials to independent reviewers, to choose a specialist of their choice, and to access emergency room services when needed. This effort to enact a federal Patient Bill of Rights failed, because of opposition from the insurance industry and President George W. Bush.
I bring up this history lesson because most of the key provisions in the McCain-Kennedy bill are now the law of the land, thanks to the ACA. Yet instead of applauding the new protections, many of the same physician organizations who called for a federal patient bill of rights now want to “repeal” the same consumer protections established by the ACA. Read more »
Bradley Merrill Thompson, an attorney with expertise in the FDA approval process for medical devices, is stating that the FDA is actively monitoring app stores on various platforms. Regulating medical devices and health care-related applications falls under the FDA’s jurisdiction.
James Kendrick from JkOnTheRun spoke with Thompson, where he stated the following:
The FDA is actively engaged in surveillance of various app stores to see if apps should trigger their involvement. Applications where a smartphone is connected in any way to imaging are under scrutiny, in particular. Any app that is used to transmit images to a medical facility requires FDA approval.
By “various app stores,” Thompson is likely referring to the App store [Apple], Palm App Catalog [Web OS], App World [BlackBerry], and the Android Marketplace [Android OS]. Read more »
*This blog post was originally published at iMedicalApps*
Hint: Being Designated As A Patient-Centered Medical Home Is Not One
We hear a lot about patient-centered care these days. In particular, a growing number of physicians across the country are now referring to their practices as a “Patient-Centered Medical Home.”
But how can you tell if your physician’s practice really is patient-centered, no matter what he or she may call themself? More importantly, why should you care? What is patient-centered care, you ask?
It’s quality care delivered in a manner where you feel that your provider:
Knows who you are personally as well as clinically.
Understands, respects and honors (where practicable) your previous health experiences, beliefs and preferences.
Facilitates and supports your health choices and behavior barring a serious conflict of beliefs or principles.
Since each of us possess a different set of experiences, beliefs and preferences, patient -entered care by definition is tailored to individual patients. Read more »
*This blog post was originally published at Mind The Gap*
Everyone understands the need for a robust primary care workforce in making healthcare more affordable and accessible while keeping those in our care healthy. With the aging of America and healthcare reform, even more Americans will need primary care doctors at precisely the same time doctors are leaving the specialty in droves and medical students shun the career choice.
As a practicing primary care doctor, I’ve watched with great interest the solutions for the primary care crisis. And I’ve been utterly disappointed.
Thank you for your consideration of my profession for your career. I am a primary care physician (PCP) and have practiced for the past 16 years in a privately-owned practice. (At some point I intend to stop practicing and start doing the real thing. It amazes me at how many patients let me practice on them.)
Anyhow, I thought I’d give you some advice as you go through what is perhaps your biggest decision regarding your career. Like me, you probably once thought that choosing to become a doctor was the biggest decision, but within medicine there are many options, giving a very wide range of career choices. It is the final choice that is, well, final. What are you going to do with your life? ”Being a doctor” covers so much range, that it really has little meaning. Dr. Oz is a doctor, and he has a very different life from mine (for one, he’s not the target of Oprah’s contempt like I am -– but that’s a whole other story).
Here are the things to consider when thinking about primary care:
1. Do you like talking to people who are not like you?
Primary care doctors spend time with humans -– normal humans. This is both good and bad, as you see all sides of people, the good, bad , crazy, annoying, funny, and vulnerable sides. If you see mental challenge as the main reason to do something, and would simply put up with the human interaction in primary care, don’t do it. The single most important thing I have with my patients that most non-PCPs don’t have is relationship. I see people over their lifetime, and that gives me a unique perspective.
2. Do you prefer variety over predictability?
Every room I walk into is different –- often vastly different -– from the last. I could be walking in on a crisis or a stable recheck. The person could be elated or crying. They could be 90 years old or two days old. They could have something wrong with any system, and it could range from mild to life-threatening. I’d go nuts doing the same thing every day, be it looking just at skin or just dealing with the kidney. But some folks do better with routine and a lack of surprise, they don’t want their days to be unpredictable. Read more »
Doug Farrago is a family physician in Maine and the editor of the entertaining Placebo Journal. He uses his Placebo Journal media platform to show his audience what primary care is all about. In this video, “Doug Unplugged,” Dr. Farrago gives us a little taste of that journey. Hollywood, take notice.
*This blog post was originally published at KevinMD.com*
As a primary care physician, I am becoming painfully aware of how hard it is to be good –- I mean really good — at what we do today. I would prefer to believe that it has always been so, yet I do not believe that our predecessors in the medical profession found it nearly as difficult to excel in their time as we do now.
With all of the technological and medical advances, you might ask how I could believe this to be true. Too, you might consider it pessimistic or even crazy to suggest that physicians 20, 30, or 100 years ago found it easier to practice medicine well in their time.
You could counter with numerous or obvious examples such as antibiotics, pharmaceuticals, robotic surgical procedures, or even our wondrous ability to peer inside the human body without cutting it open. You also would be correct to point out that the technological advancements of the 20th century opened the way for the medical profession to become a real science thus giving me and my colleagues the chance and knowledge to make a real difference in our patients’ lives today. Read more »
In a surprising report from the Archives of Internal Medicine, we learn that most hospitalized patients (82 percent) could not accurately name the physician responsible for their care and almost half of the patients did not even know their diagnosis or why they were admitted.
If that isn’t enough, when the researchers queried the physicians, 67 percent thought the patients knew their name and 77 percent of doctors thought the patients “understood their diagnoses at least somewhat well.” I would call that a pretty significant communication gap.
Ninety percent of the patients said they received a new medication and didn’t know the side effects. Although 98 percent of physicians thought they discussed their patients’ fears and anxieties with them, only 54 percent of patients thought they did. Read more »
*This blog post was originally published at ACP Internist*
Researchers at Lund University in Sweden successfully used magnets to guide clot-dissolving drugs (fibrinolytics) directly to the site of a thrombus stuck within a coronary stent. They did this by attaching the drugs to magnetic nanoparticles and using external magnets to move them to the right spot.
From the press release:
Guiding drug-loaded magnetic particles using a magnet outside the body is not a new idea. However, previous attempts have failed for various reasons: It has only been possible to reach the body’s superficial tissue, and the particles have often obstructed the smallest blood vessels.
The Lund researchers’ attempt has succeeded partly because nanotechnology has made the particles tiny enough to pass through the smallest arteries and partly because the target has been a metallic stent. When the stent is placed in a magnetic field, the magnetic force becomes sufficiently strong to attract the magnetic nanoparticles. For the method to work the patient therefore has to have an implant containing a magnetic metal.
Update From Haiti: Despair Sets In And Women Consider Suicide
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Researchers at Lund University in Sweden successfully used magnets to guide clot-dissolving drugs (fibrinolytics) directly to the site of a thrombus stuck within a coronary stent. They did this by attaching the drugs to magnetic nanoparticles and using external magnets to move them to the right spot.
