Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

EMR And The Pathologist: A Winning Combo

A pathologist uses the EMR to find out just a little more about the patient whose cerebro-spinal fluid she has under her microscope — and changes her diagnosis:

This patient had a diagnosis of plasma cell myeloma with recent acute mental status changes. So the lone plasma cell or two I was seeing, among the lymphs and monos, could indicate leptomeningeal spread of the patient’s disease process. I reversed the tech diagnosis to atypical and added a lengthy comment – unfortunately there weren’t enough cells to attempt flow cytometry to assess for clonality of the plasma cells to cinch the diagnosis. But with the information in the EMR I was able to get a more holistic picture on a couple of cells and provide better care for the patient. I cringe to wonder if I might have blown them off as lymphs without my crutch.

The much-hoped-for improvement in quality due to the adoption of EMRs has been elusive to date, so anecdotal experiences like this will be important evidence to consider in judging the impact of the EMR on healthcare outcomes.

Kudos to pathologist Gizabeth Shyner, who writes over at Mothers in Medicine and her own blog, Methodical Madness,  for “thinking outside the box.”

*This blog post was originally published at The Blog That Ate Manhattan*

The Importance Of Diagnosing Birth Defects

Birth defects, particularly those of the blood vessels, account for the majority of infant deaths, especially after the first week of life. Congenital heart disease (CHD) — meaning defects of the heart — is responsible for one-third of deaths between birth and the first year of life. Therefore, the diagnosis of CHD is critical in order to plan life-saving treatments, such as the proper place for the delivery, the type of delivery, and its timing. If it’s known in advance that an unborn baby has a heart problem and is delivered in a hospital that provides special care, its survival and future health will increase dramatically.

Who’s at risk for having CHD and which expectant moms should have further evaluation? Families who have a history of CHD — especially mothers, fathers, and siblings — should receive genetic counseling. Multiple medical studies over the past fifteen years have demonstrated the significance of genetics as a main culprit of CHD. Parents of a child with CHD have a two percent to three percent chance of having another affected child. If a mother or father has CHD, a fetal cardiac echo (an ultrasound of the heart) is definitely warranted.

Because the treatment of CHD in many cases is surgical, there’s an increasing number of patients who have survived into adulthood and have ultimately become parents. Research has documented that 4.1 percent of their children will have CHD. Children with mothers who have CHD are at a greater risk of inheriting the disease than if they have fathers with CHD. Mothers with cyanotic heart disease — that is, blood that is without oxygen that bypasses the lungs and goes directly to the blood vessels — also have a greater risk of having a baby with CHD. Read more »

*This blog post was originally published at Dr. Linda Burke-Galloway*

Toner, Serum, Or Cream: Which First On Your Face?

Step-by-step skin care? It’s complicated. You have a cabinet full of toners, creams, and serums and you don’t know what goes on when. Using products in the wrong order could mean you’re not getting the most for your money. Here’s a guide to make it easier for you:

1. Toners

Toners are astringents, which means they contract tissue like pores, making your face feel tighter. They often contain alcohols and are used to remove oil from the skin as well as tightening. Therefore, you should use them first. If you have dry or sensitive skin, however, you might skip them completely because they can make dryness worse.

2. Serums

Serums are liquid cosmetics. They usually have antioxidants or peptides to minimize the day’s damage done to your skin and to give you a more youthful appearance. Serums are applied first so that there’s nothing between their expensive ingredients and your skin. The exceptions are serums that contain silicone or dimethicone. Silicone helps lock moisture in your skin, but it also acts as a barrier hindering anything above it from getting to your skin. Silicone serums should be applied last. Like expensive serums, any prescription medications should also be applied first to ensure that their active ingredients penetrate the skin unhindered. If you have both, then apply the prescription first and the serum second.

3. Eye cream and face cream

Face and eye creams can be simple moisturizers or complex anti-aging products. Eye creams usually have antioxidants to help restore this most delicate skin. If you have one, then apply it before your face cream. Otherwise, by applying your face cream first, you risk rubbing it into your eyes. Once your prescription medications (if any) serums, and eye creams have absorbed, then apply your face cream last. If your serum has silicone or dimethicone, then apply it last, so its protective ingredients are the outermost barrier.

*This blog post was originally published at The Dermatology Blog*

Faces Of Medical Error: The Story Of Michael Skolnik

I was very sad and quite angry after watching a powerful video this weekend entitled “The Faces of Medical Error: From Tears to Transparency.” It’s the story of Michael Skolnik. His mother, Patty, gave me the video when I met her recently. Michael had what may have been unnecessary brain surgery in 2001 and died three years later.

The Skolniks worked on this video as part of an educational campaign on medical error, and they created an organization now named Citizens for Patient Safety. Here’s a trailer to the video:

You can also watch a Today Show segment that profiled the Skolniks from a few years ago:

While much of the message is about medical errors and malpractice, the Skolniks also promote a message of the “critical need for shared decision-making.” In fact, I met Patty at a shared decision-making conference.

If you haven’t heard Michael Skolnik’s story, you should. And if you’re like me, you’ll need a tissue box close by for the sadness, and something else to help with the ensuing anger.

Thanks to Patty Skolnik for sharing the story and the video with me.

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

Book Review: “Tabloid Medicine: How The Internet Is Being Used To Hijack Medical Science For Fear And Profit”

This was the Guest Blog at Scientific American on February 23rd, 2011. 

In his new book, “Tabloid Medicine: How The Internet Is Being Used to Hijack Medical Science for Fear and Profit,” Robert Goldberg, PhD, explains why the Internet is a double-edged sword when it comes to health information. On the one hand, the Web can empower people with quality medical information that can help them make informed decisions. On the other hand, the Web is an unfiltered breeding ground for urban legends, fear-mongering and snake oil salesmen.

Goldberg uses case studies to expose the sinister side of health misinformation. Perhaps the most compelling example of a medical “manufactroversy” (defined as a manufactured controversy that is motivated by profit or extreme ideology to intentionally create public confusion about an issue that is not in dispute) is the anti-vaccine movement. Thanks to the efforts of corrupt scientists, personal injury lawyers, self-proclaimed medical experts, and Hollywood starlets, a false link between vaccines and autism has been promoted on a global scale via the Internet. The resulting panic, legal feeding frenzy, money-making alternative medicine sales, and reduction in childhood vaccination rates (causing countless preventable deaths), are sickening and tragic.

As Goldberg continues to explore the hyperbole behind specific “health threats,” a fascinating pattern emerges. Behind the most powerful manufactroversies, lies a predictable formula: First, a new problem is generated by redefining terminology. For example, an autism “epidemic” suddenly exists when a wide range of childhood mental health diagnoses are all reclassified as part of an autism spectrum. The reclassification creates the appearance of a surge in autism cases, and that sets the stage for cause-seeking.

Second, “instant experts” immediately proclaim that they have special insight into the cause. They enjoy the authority and attention that their unique “expertise” brings them and begin to position themselves as a “little guy” crusader against injustice. They also are likely to spin conspiracy theories about government cover-ups or pharmaceutical malfeasance to make their case more appealing to the media. In many cases the experts have a financial incentive in promoting their point of view (they sell treatments or promote their books, for example).

Third, because mainstream media craves David and Goliath stories and always wants to be the first to break news, they often report the information without thorough fact-checking. This results in the phenomenon of “Tabloid Medicine.” Read more »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »

Commented - Most Popular Articles