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Survey Asks Doctors And Patients If Doctor’s Notes Should Be In The EHR

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We are fast entering the era of the electronic health record, when it will be possible to call up our medical records on our computers and mobile devices. Medication lists, lab results, appointment schedules—they’ll all be available with clicks of your mouse or taps on the screen of your smartphone or tablet.

But one question that’s far from settled is whether the electronic health record should include the notes that doctors make about them. A doctor’s notes can be straightforward, such as a reminder that an additional test might be needed. But they can also include somewhat speculative observations and hunches about a patient and his or her medical conditions. The Open Notes project is a research program designed to test the consequences of giving patients access to doctors’ notes. Harvard-affiliated Beth Israel Deaconess Medical Center is one of the test sites.

The Open Notes project is far from finished. But results of a survey of the expectations that doctors and patients have for note sharing are being reported in today’s Annals of Internal Medicine.

I don’t think there are any great surprises here.  More than half of the primary care physicians Read more »

*This blog post was originally published at Harvard Health Blog*

The Effects Of Obesity Go Beyond One’s Health

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Obesity impacts income, especially among women, according to a report from The George Washington University School of Public Health and Health Services’ Department of Health Policy.

In 2004, wages among the obese were $8,666 less for females and $4,772 lower for males. In 2008, wages were $5,826 less for obese females, a 14.6% penalty over normal weight females, the researchers concluded after examining years 2004 and 2008 in the Bureau of Labor Statistics’ National Longitudinal Survey of Youth.

The research shows that there are significant differences in wages dependent upon race that couldn’t be accounted for by measuring pre-recession (2004) and recession (2008) measures. In 2004, Hispanic women who were obese earned $6,618 less than those who were normal weight. In 2008, Read more »

*This blog post was originally published at ACP Internist*

The New Science Of Social Networks Shows The Spread Of Weight And Happiness Among Friends

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The people you live with, work with, talk to, email, chatter with on Twitter and Facebook—your social network—can be good medicine, or bad.

The intriguing new science of social networks is demonstrating how personal interconnections can affect our health. Ideas and habits that influence health for better or for worse can spread through social networks in much the same way that germs spread through communities. In social networks, though, transmission can happen even though the people may be hundreds of miles apart.

An article in the December issue of the Harvard Men’s Health Watch explores how social networks can affect weight and mood.

Spreading weight

A study of people taking part in the landmark Framingham Heart Study found that Read more »

*This blog post was originally published at Harvard Health Blog*

Tired Health Care Workers And Patient Safety: Tips To Avoid Fatigue

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Health care facilities should take five steps to ensure staff aren’t becoming sleep fatigued, according to a Sentinel Event Alert from The Joint Commission.

Shift length and work schedules impact job performance, and in health care, that means patient safety, the alert stated. A study of 393 nurses over more than 5,300 shifts showed that nurses who work shifts of 12.5 hours or longer are three times more likely to make an error in patient care.

Furthermore, residents who work traditional schedules with recurrent 24-hour shifts:
–make 36 percent more serious preventable adverse events than individuals who work fewer than 16 consecutive hours,
–make five times as many serious diagnostic errors,
–have twice as many Read more »

*This blog post was originally published at ACP Hospitalist*

Small Study Looks At The Use Of Abdominal Panniculectomy In Patients Awaiting Kidney Transplants

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There is an interesting article in the current edition of the Plastic & Reconstructive Surgery Journal (December 2011). The focus of the article is a small subset of renal patients who need kidney transplants but whose abdominal panniculus excludes them due. A significant panniculus creates an infrapannicular area prone to increased moisture, skin maceration, and elevated bacterial counts, predisposing the patient to postoperative wound infections, necrosis, and dehiscence. Not good for anyone, but really not for someone on immunosuppression.

The article discusses the use of abdominal panniculectomy in these patients in preparation for the transplant. Nine patients, 3 men and 6 women, with a mean age of 54.5 years and a mean BMI 28.3 are the focus of the article. The focus is not Read more »

*This blog post was originally published at Suture for a Living*

Latest Interviews

Caring For Winter Olympians In Sochi: An Interview With Team USA’s Chief Medical Officer Dr. Gloria Beim

I am a huge fan of the winter Olympics partly because I grew up in Canada where most kids can ski and skate before they can run and partly because I used to participate in Downhill ski racing. Now that I m a rehab physician with a reconstructed knee I…

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How Do Hospital Executives Feel About Locum Tenens Agencies And Traveling Physicians?

I recently wrote about my experiences as a traveling physician and how to navigate locum tenens work. Today I want to talk about the client in this case hospital side of the equation. I ve had the chance to speak with several executives some were physicians themselves about the overall…

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Latest Book Reviews

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…

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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…

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Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

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