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Latest Posts

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

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*

Research Looks At Effectiveness Of World’s Smallest Heart Pump


Cost scrutiny and comparative effectiveness research are playing a growing role in shaping healthcare delivery. In light of that, Abiomed Inc. (Danvers, MA) has recently announced the results of a study that showed the company’s Impella heart pump significantly reduced major adverse events at an incremental cost per quality-adjusted life year. “The cost-effective message is directly tied to the financial impact of these better clinical outcomes for patients treated with Impella,” Jeffrey Popma, MD, the director of the angiographic Core Laboratory at Beth Israel Deaconess told Medgadget. Popma was responsible for the planned analysis of the angiographic results.

The device, which the company describes as the “world’s smallest heart pump,” demonstrated an increase in ejection fraction of more than 20% and an improvement in Read more »

*This blog post was originally published at Medgadget*

Physician Organizes A Price List Of 56 Common Medical Tests

I am smacking myself on the forehead and saying, “Why didn’t I think of this?”  Dr. Richard Parker, Medical Director at Beth Israel Deaconess Medical Center,  has sent out a list to his physician colleagues of 56 common medical tests and procedures.  What is revolutionary is that there are prices next to each item.  You non-physicians may be surprised to know that we doctors have no idea what the tests or drugs we order actually cost.  Unless we get billed as a patient, we are as clueless as you are.

As I wrote before, the ostrich excuse just won’t fly any more.  We all need to be aware of the cost of care and have skin in the game.  Some will argue that price can’t be the only driver.  I’ve heard physicians say you can’t compare one price to another because “quality” costs more.  I say prove it. Read more »

*This blog post was originally published at EverythingHealth*

New Dietary Guidelines Give Little New Guidance

There isn’t much new in the latest iteration of the “Dietary Guidelines for Americans.” Three years in the making, the 2010 guidelines (released a tad late, on January 31, 2011) offer the usual advice about eating less of the bad stuff (salt; saturated fat, trans fats, and cholesterol; and refined grains) and more of the good stuff (fruits and vegetables; whole grains; seafood, beans, and other lean protein; and unsaturated fats). I’ve listed the 23 main recommendations below. You can also find them on the “Dietary Guidelines” website.

The guidelines do break some new ground. They state loudly and clearly that overweight and obesity are a leading nutrition problem in the United States, and that a healthy diet can help people achieve a healthy weight. They also ratchet down sodium intake to 1,500 milligrams per day (about two-thirds of a teaspoon of salt) for African Americans and people with high blood pressure or risk factors for it, such as kidney disease or diabetes. But the guidelines also leave the recommendation for sodium at 2,300 milligrams a day for everyone else, a move that the American Heart Association and others call “a step backward.”

Vague language spoils the message

One big problem with the guidelines is that they continue to use the same nebulous language that has made previous versions poor road maps for the average person wanting to adopt a healthier diet.

Here’s an example: The new guidelines urge Americans to eat less “solid fat.” What, exactly, does that mean — stop spooning up lard or Crisco? No. Solid fat is a catchphrase for red meat, butter, cheese, ice cream, and other full-fat dairy foods. But the guidelines can’t say that, since they are partly created by the U.S. Department of Agriculture USDA), the agency charged with promoting the products of American farmers and ranchers, which includes red meat and dairy products. “Added sugars” is another circumlocution, a stand-in for sugar-sweetened sodas, many breakfast cereals, and other foods that provide huge doses of sugar and few, or no, nutrients. Read more »

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

Improved iPad Usability On Hospital Wards

We recently reported our interview with Dr. Henry Feldman of the Beth Israel Deaconess in Boston and his experience using the iPad as his sole computing device while attending on the wards. Overall, his experience was positive, while accessing the hospital networks, using clinical applications and questions about security. Be sure also to check out Future Docs blog and Dr. Arora’s experience using the iPad on the wards to get more real-world perspectives on using the iPad on the wards.

Among the few difficulties Dr. Feldman had, one was that typing long notes on the glass keyboard was cumbersome, requiring the use a desktop computer for admission and discharge notes. This may now turn out to be one of the easiest problems to solve, if two recently announced iPad cases are any indication. Sena and Kensington are both releasing iPad cases with built-in bluetooth keyboards. Each has a built in battery and the cases fold into dimensions not much larger than a standard iPad case. Read more »

*This blog post was originally published at iMedicalApps*

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…

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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…

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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…

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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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