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

Latest Posts

One Physician Learns To Efficiently Manage Her Electronic Medical Records

My practice has been using the EPIC electronic medical record for 5 years now, and it’s taken about that long for me to figure out how to tweak the system to make myself more efficient, and for the system to evolve to a place where I could tweak it myself.

Case in point – Quick Actions.

EPIC’s most recent upgrade includes little self-made macros called “quick actions” that turn repetitive tasks into a mouse click. I’m using quick actions to manage my results in basket in much the same way you may be using Rules in Outlook to manage your email.

Some of my macros are actually little work-arounds for a system that is not yet entirely integrated and a patient population that has not yet embraced online results communication. About half of my patients sign up for online results – I’m working hard on the rest…

Like many of you, I like a clean inbox, but need a place to park messages that are awaiting some future task for completion. I’ve decided to use the “results notes” inbasket for this purpose, so you’ll see some of my macros moving messages there.

I now have the following Quick Action options whenever I view a lab report – Read more »

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

Finding Cheap Birth Control Even As States Withdraw Planned Parenthood Funding

If you live in New Hampshire, or some other state that is withdrawing Planned Parenthood funding, you may need to find an alternate source of affordable birth control, at least until the states get their heads screwed back on straight. In the meantime, please, don’t stop your birth control because you think you can’t afford it – the costs of not using it are much, much higher.

But what can you do to make the choice to use birth control even more cost effective?

Birth Control Pills

  • Buy them cheap locally. Walmart, Target and Kroger sell very low priced birth control pills – only $4 to $9 a pack. It’s only a few brands (Trinessa, Sprintec and Trisprintec), but ask your doctor if it makes sense to switch if cost is a barrier for you.

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

What To Do If Your Doctor’s Appointment Isn’t Soon Enough

A friend of mine had a hard time getting in to see her doctor for an urgent visit last week. Reeling from an unexpected and sudden family upset, she was depressed and anxious, unable to sleep or function, and her therapist was advising an antidepressant.  She called her family doc, who works at a large hospital-based multispecialty group, and told the woman at the call center that she wanted to see the doctor on an urgent matter. She was given an appointment 6 weeks in the future.

Summoning her courage, my friend told the woman her story – and that she was really worried about herself and did not think she could wait that long.

“Sorry, that is the best I can do” was the reply.

Increasingly upset, my friend told the woman that if she had to wait that long, she just might kill herself in the interim. Read more »

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

Supreme Court: Data Mining OK, Even When Physician Privacy Is Compromised

The Supreme Court has sided with Big Pharma in their challenge to the Vermont Law limiting the pharmaceutical Industry’s access to physician prescribing information.

The nation’s high court handed down a verdict Thursday in the Sorrell v. IMS Health case, striking down by a 6-3 vote a 2007 Vermont law that that bans the practice of data mining — the sale and use of prescriber-identifiable information for marketing or promoting a drug, including drug detailing — unless a physician specifically gives his or her permission to use the information.

Apparently, Big Pharma’s right to “free speech” trumps my right to privacy. How getting access to my prescribing information has anything to do with free speech is beyond me.  In the twisted logic of the pro-business, anti-citizen Supreme Court –

Speech in aid of pharmaceutical marketing… is a form of expression protected by the Free Speech Clause of the First Amendment. Read more »

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

Annual Ovarian Cancer Screening Does More Harm Than Good

In a large multicenter study enrolling over 70,000 women, annual screening with transvaginal pelvic ultrasound and ca125 blood testing did not reduce deaths from ovarian cancer, and in fact led to an increase in complications due to screening.

Investigators in the NCI-sponsored Prostate, Lung and Ovarian Cancer (PLCO) Screening trial randomly assigned over 78,000 women age 55-64 years of age to either annual screening with transvaginal pelvic sonograms for 4 years plus CA125 testing for 6 years or usual care at 10 study sites across the US., and followed the groups for up to 13 years. Over that time period, ovarian cancer rates in the screened group were 5.7 per 10,000 person-years vs 4.7 per 10,000 persons-years in the usual care group, with 3.1 deaths vs 2.6 deaths per 10,000 person years, respectively. Over 3000 women had false positive screening results, a third of whom had surgery and 15% of those operated on had a complications from their surgery. Deaths from other causes did not differ between the groups.

The investigators concluded that annual screening for ovarian cancer does not reduce mortality, and in fact caused harms among women with fals positive abnormal results.

This is not the first study that failed to find efficacy for ultrasound and ca125 in reducing mortality from ovarian cancer, but Read more »

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

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 »