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Latest Posts

Reducing The Use Of CT Scans In Children

Well, this is satisfying. Over the years, in our ER we have mirrored the nationwide trend and have significantly increased the utilization of CT scans across the board. The reasons are manifold. Some cite malpractice risks, and indeed in our large group we have had one lawsuit for a pediatric head injury and another for a missed appendicitis which probably did contribute. But, in my opinion, there have been many other drivers of the increased use. For one, CTs have gotten way, way better over the last 15 years, which quite simply has made them a better diagnostic tool. They’ve also gotten way faster. As the facilities have invested in CT scanners, they have increased their capacity and increased their staffing, so the barriers to their use have rapidly diminished. I am so old that I remember when ordering a CT involved calling a radiologist and getting their approval! No more of that, I can tell you.

But a couple of years ago, we really started paying attention (perhaps belatedly) to Read more »

*This blog post was originally published at Movin' Meat*

Monitoring An API For Your Body: How Could This Tool Be Helpful?

As self-quantification tools becomes more accessible, we’re able to monitor and collect all that’s coming, going and happening with our bodies. Some are beginning to think of this aggregate data as something of a health code, a repository of personal information which can be opened up to others – an API for your body. Once opened and tapped, others can create tools for manipulating and analyzing the data. Aggregated information that’s presented in the right way can give us and our providers valuable information about our physical status.

Loic Le Meur, the founder of Europe’s biggest Internet conference, raised the dialog here. It’s a fascinating concept and one that plays on the themes of personalization, measurement, and mobility.

This has implications in pediatrics, of course. Read more »

*This blog post was originally published at 33 Charts*

Mobile Application Shown To Enhance Diabetes Care

It seems intuitive (at least to Medgadgeteers) that mobile technology can be used to improve health outcomes, but we still need studies to actually put data behind this idea.  A recent study of the DiabetesManager mobile health platform from WellDoc is a step in this direction. We last reported about WellDoc’s mobile diabetes application in 2010, and since that time it has been tested in a clinical trial and was shown to reduce HgbA1c by 1.9%.

The DiabetesManager is a behavioral coaching and clinical decision support system.  Patients enter details about blood glucose values, medications, and behaviors via mobile phone, and health care providers receive quarterly summaries based on this information. Read more »

*This blog post was originally published at Medgadget*

Pediatric Physician Joins Collaborative Network And Sees Improvement In His Work

I never thought I’d change the way I practice medicine.  But I recently enrolled as a provider in the Improved Care Now (ICN) collaborative network and I’m already working differently.

ICN is an alliance of gastroenterologists and patients working in a new model of pediatric inflammatory bowel disease care based on the analysis of thousands of doctor–patient visits as well as the latest studies and treatments.  Doctors and patients apply this information, experiences are tracked in an open registry, the results are then shared and refined to improve care.  I can see what I’m doing well and where I’m falling short relative to other clinics and pediatric gastroenterologists.

ICN is under the direction of Dr. Richard Colletti of the University of Vermont.  ICN is supported by the Chronic Collaborative Care Network (C3N), the brainchild of Cincinnati Children’s qualitymeisters, Peter Margolis and Michael Seid.  I flew to Cincinnati earlier this week to catch up on C3N and what appears to be a first step into medicine’s future.  More on the specifics later.  But suffice it to say that I’m stoked about where this is all headed.

A couple of thoughts after enrolling my first few patients: Read more »

*This blog post was originally published at 33 Charts*

Kids Gone Wild: Intimidation Of Parents In The ER

Ah, the benefits of sand therapy!

Time for little Bettina’s daily afternoon face plant!

Not only does it appear my colleague is about to lose her grip on her patient, I’m concerned about her choice of body mechanics.

I predict a lumbar strain in 3…2…1……

(This photo is from the Library of Congress collection.)

**********

I love my pediatric patients. While it is hard to see children feeling sick, they can be bright spots in occasionally hellacious shifts.

I’ve blogged before on my observation that the kids seem to be the adults in the some families.

  • They don’t want to undress for an exam, so they fight the parents who are helpless in the face of taking a shirt off a three-year-old.
  • They have to be restrained so they don’t run rampant in the ER, and they slap their parent across the face. The parent doesn’t respond.
  • They are told they need to cooperate with a procedure and they answer their parent with a loud, clear, “F*** YOU!” At the age of five. The parent retreats. Read more »

*This blog post was originally published at Emergiblog*

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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