January 21st, 2011 by KevinMD in Better Health Network, Opinion
Tags: Accurate Health Information, Consumer Health Information, Cyberchondria, Doctor-Patient Communication, Doctor-Patient Encounter, Dr. Kevin Pho, Dr. Zachary Meisel, Evidence-Based, Health Information on the Web, Internet-Based Health Information, KevinMD, Online Health Information, Online Symptom Searches, Patients Who Google Symptoms, Peer-Reviewed, Pew Internet & American Life Project, Possible Medical Conditions, Researching Online, Searching For Health Information On The Internet, Self-Diagnosis, Symptom Checkers, TIME.com, Trusted Health Information, YouTube
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Many doctors roll their eyes whenever patients bring in a stack of research they printed out, stemming from a Google search of their symptoms. A piece by Dr. Zachary Meisel on TIME.com describes a familiar scenario:
The medical intern started her presentation with an eye roll. “The patient in Room 3 had some blood in the toilet bowl this morning and is here with a pile of Internet printouts listing all the crazy things she thinks she might have.”
The intern continued, “I think she has a hemorrhoid.”
“Another case of cyberchondria,” added the nurse behind me.
It’s time to stop debating whether patients should research their own symptoms. It’s happening already, and the medical profession would be better served to handle this new reality.
According to the Pew Internet and American Life Project, 61 percent of patients turn to the web to research health information. That number is from 2009, so presumably it’s higher today. Health information online is akin to the Wild, Wild West. Stories from questionable sites come up on Google as high — or higher — than information from reputable institutions. Read more »
*This blog post was originally published at KevinMD.com*
January 20th, 2011 by PJSkerrett in Better Health Network, Health Tips
Tags: American Academy of Pediatrics, Bug Buster, CDC, Centers For Disease Control and Prevention, Children's Health, FDA, Food and Drug Administration, Harvard Health Blog, Harvard Heart Letter, Harvard Medical School, Harvard University, Havard Health Publications, Head Lice, Head Louse, Human Hair, Lindane, Malathion, Natroba, Nit Comb, Nix, Over-The-Counter Insecticide, Parasites, Pediculus Humanus Capitis, Permethrin, PJ Skerrett, Public Health, Pyrethrins, Rid, School and Health, Spinosad, Tips For Parents
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Good news for parents, teachers, pediatricians, and others engaged in the ongoing battle against lice: The Food and Drug Administration (FDA) just approved a new treatment for head lice in children age four and older. Called Natroba, it’s a liquid that is rubbed into the hair and allowed to sit for 10 minutes before being rinsed off. Natroba is a useful addition to the anti-lice arsenal, since some head lice have become resistant to permethrin and pyrethrins, the active ingredients in over-the-counter anti-lice products such as Nix and Rid.
Head lice are tiny insects that go by the big name Pediculus humanus capitis. They thrive in the warm tangle of human hair, feeding off blood in the scalp and breeding with abandon. A female lays eggs called nits that she attaches to strands of hair. Nits hatch after about eight days, become adults in another week or so, feed for awhile, then begin to make more lice.
CDC photo of the stages of the life of a head louse, with a penny for size comparison.
What To Do
First off, here’s what not to do: Don’t shave your or your child’s head, or coat it with petroleum jelly or mayonnaise or anything else designed to “suffocate” the parasite. You’ll probably end up with greasy, smelly, lice-infested hair.
Current guidelines from the American Academy of Pediatrics call for the use of an over-the-counter product containing permethrin or pyrethrins as a first salvo against head lice. Shampoos and rinses made with these substances are generally effective. Most treatments for head lice need to be used twice, seven to 10 days apart, along with combing wet hair with a fine-toothed nit comb. Some lice are resistant to pyrethrin and permethrin. Stronger prescription drugs, such as malathion and lindane, also work but aren’t as safe for humans. That’s where Natroba comes in. Read more »
*This blog post was originally published at Harvard Health Blog*
January 20th, 2011 by Medgadget in Better Health Network, Research
Tags: Behavioral Medicine, Direct-To-Consumer Genomewide Profiling, Disease Risk, Genetic Risk Assessment, Genetics, Health Risk, Hereditary Disease Risk, Medgadget, Navigenics Health Compass, NEJM, New England Journal of Medicine, Patient Behavior, Patients' Anxiety, Personal Genetic Testing, Personal Genomics, Psychology, Scripps Translational Science Institute, Test Anxiety, Test-Related Stress
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Genome-wide profiling is increasingly being marketed towards consumers to assess their risk of developing certain diseases. However, there has been little research into the psychological effects of these tests.
Researchers from Scripps Translational Science Institute have now looked into these effects in a large group of patients. They followed 2,037 participants who took the Navigenics Health Compass, a test that assesses the risk for about 20 common diseases, for a period of three months.
Taking the test did not increase anxiety symptoms, dietary fat intake, or exercise behavior. There was some test-related distress correlated with the average estimated lifetime risk of getting the diseases tested for, but at the same time 90.3 percent of all subjects had no test-related distress at all. The use of screening tests did not change among the group and notably health effects of the test were not studied.
In conclusion, personal genetic testing does not seem to generate a lot of distress, although the study was clearly limited by a high dropout percentage of 44 percent and the self-selection of participants who opted to do the test.
Article in New England Journal of Medicine: Effect of Direct-to-Consumer Genomewide Profiling to Assess Disease Risk
Flashback: An Interview with Navigenics…
*This blog post was originally published at Medgadget*
January 20th, 2011 by Harriet Hall, M.D. in Better Health Network, Opinion
Tags: American Family Physician, Dr. Harriett Hall, Encyclopedia Britannica, Encyclopedia of Public Health, Healthcare Language, Library Index, Medical Terminology, Preventive Health, Preventive Medicine, Primary Prevention, Science Based Medicine, Secondary Prevention, Stedman's Medical Dictionary, Tertiary Prevention, U.S. Preventive Services Task Force, USPSTF
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A November letter to the editor in American Family Physician chastises that publication for misusing the term “secondary prevention,” even using it in the title of an article that was actually about tertiary prevention.
I am guilty of the same sin. I had been influenced by simplistic explanations that distinguished only two kinds of prevention: Primary and secondary. I thought primary prevention was for those who didn’t yet have a disease, and secondary prevention was for those who already had the disease, to prevent recurrence or exacerbation. For example, vaccinations would be primary prevention and treatment of risk factors to prevent a second myocardial infarct would be secondary prevention.
No, there are three kinds of prevention: Primary, secondary and tertiary. Primary prevention aims to prevent disease from developing in the first place. Secondary prevention aims to detect and treat disease that has not yet become symptomatic. Tertiary prevention is directed at those who already have symptomatic disease, in an attempt to prevent further deterioration, recurrent symptoms and subsequent events.
Some have suggested a fourth kind, quaternary prevention, to describe “… the set of health activities that mitigate or avoid the consequences of unnecessary or excessive interventions in the health system.” Another version is “Action taken to identify patient at risk of overmedicalisation, to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable.” But this is not a generally accepted category. Read more »
*This blog post was originally published at Science-Based Medicine*
January 19th, 2011 by StevenWilkinsMPH in Better Health Network, Health Tips
Tags: Accurate Diagnosis, Diagnostic Technology, Doctor-Patient Communication, Doctor-Patient Interaction, Doctors' Diagnosis, Doctors' Diagnostic Skills, Dr. Robert Cantor, Dr. William Osler, Driving Up Healthcare Costs, Empowered Patients, General Medicine, Hands-On Diagnostic Skills, Hands-On Diagnostician, History and Physical, How To Talk To Your Doctor, Listening To Patients, Mind The Gap, Overtesting, Patient Empowerment, Patient Examination, Patient-Centered Medicine, Steven Wilkins MPH, Test-Centered Medicine, Too Many Tests, Too Much Testing, Unnecessary Risks, Why Doctors Should Listen
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We’ve all been there. It often starts with some kind of recurring pain or dull ache. We don’t know what’s causing the pain or ache. During the light of day we tell ourselves that it’s nothing. But at 3:00am when the pain wakes you, worry sets in: “Maybe I have cancer or heart disease or some other life-ending ailment.” The next day you make an appointment to see your doctor.
So now you’re sitting in the exam room explaining this scenario to your doctor. Based on your previous experience, what’s the first thing your doctor would do?
A. Order a battery of tests and schedule a follow-up appointment.
B. Put you in a patient gown and conduct a thorough physical examination, including asking you detailed questions about your complaint before ordering any tests.
If you answered “A,” you have a lot of company. A recent post by Robert Centor, M.D., reminded me of yet another disturbing trend in the doctor-patient interaction. The post, entitled “Many doctors order tests rather than do a history and physical,” talks about how physicians today rely more on technology for diagnosing patients than their own “hands-on” diagnostic skills — a good patient history and physical exam, for example.
Prior to the technology revolution in medicine over the last 20 years, physician training taught doctors how to diagnose patients using with a comprehensive history and physical exam. More physicians today are practicing “test-centered medicine rather than patient-centered medicine.” Medical schools focus on teaching doctors to “click as many buttons on the computer order set as we possibly can in order to cover every life-threatening diagnosis.” The problem is that medicine is still an imperfect science, and technology is not a good substitute for an experienced, hands-on diagnostician. Read more »
*This blog post was originally published at Mind The Gap*
