January 16th, 2011 by Dinah Miller, M.D. in Better Health Network, Opinion
Tags: American Psychiatric Association, APA, Diagnostic and Statistical Manual, Dr. Dinah Miller, DSM-5, DSM-V, Gary Greenberg, Mental Health, Mental Illness, My Three Shrinks, Psychiatric Diagnosis, Psychiatry and Psychology, Science and Medicine, Scientific Certainty Of Diseases, Shrink Rap, Wired Magazine
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I’ve followed in bits and pieces — sometimes for Shrink Rap, sometimes because the issues fill my email inbox, sometimes because there’s no escape. Oh, and lots of the players have familiar names.
In the December 27th issue of Wired magazine, Gary Greenberg writes a comprehensive article on the debates around the revision of the American Psychiatric Association’s (APA) upcoming revision of the Diagnostic and Statistical Manual (DSM) entitled “Inside the Battle to Define Mental Illness.” Do read it. Here’s an excerpt:
I recently asked a former president of the APA how he used the DSM in his daily work. He told me his secretary had just asked him for a diagnosis on a patient he’d been seeing for a couple of months so that she could bill the insurance company. “I hadn’t really formulated it,” he told me. He consulted the DSM-IV and concluded that the patient had obsessive-compulsive disorder.
“Did it change the way you treated her?” I asked, noting that he’d worked with her for quite a while without naming what she had.
“No.”
“So what would you say was the value of the diagnosis?”
“I got paid.” Read more »
*This blog post was originally published at Shrink Rap*
January 15th, 2011 by Iltifat Husain, M.D. in Better Health Network, Opinion
Tags: Cellphones and Healthcare, Developing Countries, Global Health, iMedicalApps, International Health, James BonTempo, Jhpiego, Johns Hopkins University, Medical Technology, Medicine and Smartphones, mHealth Summit, Mobile Phones and Medicine
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The potential of mobile phones to improve health is most acutely visible in developing countries. iMedicalApps covered the recent mHealth Summit, where there were many inspiring demonstrations of how voice and simple text messages can have a profound effect on the health of those countries’ citizens. Jhpiego has successfully worked on these problems for three decades and was recently awarded a $100m grant. James Bon Tempo has extensive experience in this field and we are thrilled that he is sharing his insights with the readers of iMedicalApps.
This is a guest post from James BonTempo.
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Mobile Health In Developing Countries
I am a user and an implementer of technology, not an inventor or developer, so my constraints, challenges and requirements are different than those of many attendees of the recent mHealth Summit. And for others like me who work in international aid and development, mobile technology is simply a tool, and one of many in a large toolbox that includes various best practices and proven approaches. At Jhpiego (an affiliate of Johns Hopkins University), we have piloted a number of different mobile interventions — from simple SMS to Java & smartphone-based applications — but the challenge for us is to identify the most appropriate technologies, the tools that will help us to strengthen health systems in limited resource settings most effectively and most efficiently. Read more »
*This blog post was originally published at iMedicalApps*
January 15th, 2011 by Lucy Hornstein, M.D. in Better Health Network, Opinion
Tags: Anti-Vaccine Movement, Children's Health, Children's Vaccinations, Dr. Lucy Hornstein, Dr. Paul Offit, Family Medicine, Flu Shot, Flu Vaccine, immunizations, Immunology, Musings of a Dinosaur, Parent Preferences, Parents' Decisions, Pediatrics, Primary Care, Vaccine Complacency, Vaccine Controversy, Vaccine-Averse Parents
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I got a package in the mail today: My very own (complimentary) copy of Paul Offit’s new book, “Deadly Choices; How the Anti-Vaccine Movement Threatens Us All.” Needless to say, I can’t wait to read it. Not coincidentally, Dr. Offit has been making the rounds of interviews in the wake of the book’s release. Although I haven’t heard any of them directly, I did see a reference to this NPR interview on the FaceBook page of an old friend, who quoted from it thusly:
IRA FLATOW: You write that some pediatricians will not see kids who are not vaccinated. Is that a good solution to the problem?
DR. PAUL OFFIT: I don’t know what’s a good solution to that problem. And I feel tremendous sympathy for the clinician who’s in private practice. On the one hand, and my wife sort of expressed this, she’s a general practitioner, a pediatrician, you know, she’ll say, you know, parents will come into her office and say I don’t want to get vaccines, including, for example, the Haemophilus influenzae vaccine, which is vaccine that prevents what was, at one point, a very common cause of bacterial meningitis.
And, you know, we’ve had three cases or three deaths, actually, from this particular bacterial form of meningitis in the Philadelphia area just in the last couple years.
And, you know, to her, it’s like, you know, let me love your child. Please don’t put me in a position where I have to practice substandard care, which can result in harm, which can hurt your child. Please don’t ask me to do that.
And I certainly understand the sentiment. On the other hand, if you don’t see that child, you know, where does that child go? Do they go to a chiropractor who doesn’t vaccinate?
I think it’s hard because then you lose any chance to really immunize the child.
My friend then offers his take, that of a pediatrician in private practice. Read more »
*This blog post was originally published at Musings of a Dinosaur*
January 13th, 2011 by Medgadget in Better Health Network, Research
Tags: Cornea, Diagnostic Test, Eniko Enikov, Eye Exam, Eye Health, Eyelid, Glaucoma, Intraocular Pressure, Medgadget, Ophthalmology, Optometry, Post Cataract Surgery, Tonometer, University of Arizona College of Engineering
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Intraocular pressure is usually measured by applying a force on the cornea using a tonometer. Although sufficiently accurate, tonometers are only used in ophthalmologist offices and so don’t measure intra-day pressures. They also fail with people post cataract surgery that have a thicker cornea. Researchers at University of Arizona have developed a new device that measures intraocular pressure through the eyelid.
From the University of Arizona College of Engineering:
The self-test instrument has been designed in Eniko Enikov’s lab at the UA College of Engineering. Gone are the eye drops and need for a sterilized sensor. In their place is an easy-to-use probe that gently rubs the eyelid and can be used at home.
“You simply close your eye and rub the eyelid like you might casually rub your eye,” said Enikov, a professor of aerospace and mechanical engineering. “The instrument detects the stiffness and, therefore, infers the intraocular pressure.” Enikov also heads the Advanced Micro and Nanosystems Laboratory.
While the probe is simple to use, the technology behind it is complex, involving a system of micro-force sensors, specially designed microchips, and math-based procedures programmed into its memory.
Link: New Glaucoma Test Allows Earlier, More Accurate Detection…
*This blog post was originally published at Medgadget*
January 12th, 2011 by Bryan Vartabedian, M.D. in Better Health Network, Opinion
Tags: 33 Charts, Beyond Spoken Language, Doctor Patient Relationship, Doctor-Patient Communication, Doctor-Patient Connection, Doctor-Patient Experience, Dr. Bryan Vartabedian, General Medicine, Language Barrier, Language Gap, Language Translation, Non-English-Speaking Patients
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I can’t say that I enjoy the patient encounter as much when it involves a translator. There’s just something about communicating through a third party that changes the experience. But there are some things you can do as a provider to bridge the language gap:
Look. Even thought the translator is doing the talking, look at the patient just as if you are asking the question yourself. There’s a tendency to let the translator act as a surrogate with respect to eye contact and visual feedback.
Smile. A smile doesn’t need translation. It conveys very clearly that have a sincere interest in making a connection.
Touch. I never leave the exam room without some type of sincere physical contact. A firm handshake or a hand on the shoulder go a long way in closing the language barrier.
Say something funny. Patients don’t expect jokes to come through a translator. And there’s nothing better than watching a silly, lighthearted remark make its way into another language. It’s powerful and fun.
It’s important to think about how we can recreate the elements of a one-on-one dialog. What do you do to make a connection beyond spoken language?
*This blog post was originally published at 33 Charts*
