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Reducing Mortality From Sepsis

I spent the day today with 60 physicians and nurses at a symposium focused on quality improvement and reducing mortality from sepsis.  Sepsis (overwhelming infection) is the number 1 cause of hospital deaths and the mortality rate can be as high as 60% if the patient goes into shock from infection.  Survival depends upon thousands of independent pieces coming together in an organized way.  A patient doesn’t come to the emergency department and say “I have sepsis”.  He may arrive by ambulance or be brought in by a relative and simply feel weak, or confused or have a fever.

To make the diagnosis, the doctor or nurse has to be thinking sepsis is a possibility and it is critical to get the right tests and treatments within a very short time frame.  There are complicated steps that must be taken quickly and the entire hospital team (lab, pharmacy, transport, doctors and nurses) must act Read more »

*This blog post was originally published at EverythingHealth*

Venus Williams Sidelined From Pro Tennis With A Chronic Auto-Immune Disorder

I was lucky enough to see Venus Williams play her first professional tennis match when she was a teenager.  It was obvious she was something special and her coach-father said “If you think she’s good, wait until you see her little sister.” (Serena Williams).

Venus and her sister, Serena have dominated women’s tennis over the past decade but she is currently sidelined with a diagnosis of Sjogrens Syndrome. (pronounced Show-grins).  It is a chronic auto-immune disorder where white blood cells (immune function cells) target the body’s moisture-producing glands.  Symptoms include dry eyes, dry mouth, extreme fatigue and joint pain.  Sometimes it co-exists with other auto-immune diseases like thyroid disease or rheumatoid arthritis.

Symptoms can wax and wane and getting the right diagnosis can take time.  I can imagine Venus going to her doctor and complaining of fatigue and dry mouth.  Considering her athletic schedule, she was probably told to get some rest and fluids.  The diagnostic key should have been Read more »

*This blog post was originally published at EverythingHealth*

Use Of Prescription NSAIDS During Early Pregnancy Linked To Miscarriage?

A new study of more than 52,000 pregnant women in Canada shows that miscarriage rates were more than twice as high for women who took a nonsteroidal anti-inflammatory drug (NSAID) compared to women who did not.  The study, published in the Canadian Medical Association Journal reported that women who used prescription NSAIDS for just 4 days during early pregnancy had an increased risk for miscarriage.

These medications are commonly prescribed for pain, cramps, headaches and fever and can be bought over the counter as Advil, Aleeve or Ibuprofen.  We have thought they were safe in early pregnancy but this study shows that may not be the case. Read more »

*This blog post was originally published at EverythingHealth*

Attempts To Reduce Re-Admissions To Hospitals May Not Be Worth It

Hospitals across the country are working on quality initiatives to reduce re-admissions to hospitals.  There are consultants, conferences, forums, meetings, physicians, nurses and administrators who are spending hours upon hours (and lots of $$$) to find ways to keep patients who have been discharged from being readmitted within 30 days.  Why all of this activity?  It is one of the quality measures that is being tracked by Medicare and Medical (CMS) and decreased reimbursement will be next if a patient is readmitted to any hospital within 30 days of a discharge. The diagnosis doesn’t matter.

A new study shows all of this focus and cost may not be worth it.  Readmission after a hospital discharge may not be an indication of poor care.

The study, published in the Canadian Medical Association Journal looked at 4,812 patients and had medical experts review the cases of the 649 who needed urgent readmission within 6 months. (Not one month as we are measuring).  They found that Read more »

*This blog post was originally published at EverythingHealth*

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*

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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