May 11th, 2009 by EvanFalchukJD in Better Health Network
Tags: Evan Falchuk, healthcare, New York Times, Obama, Physician, Second Opinion
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The New York Times interviews President Obama about health care:
I’m a pretty well-educated layperson when it comes to medical care; I know how to ask good questions of my doctor. But ultimately he is the guy with the medical degree. So, if he tells me, You know what, you’ve got such-and-such, I don’t go around arguing with him or go online to see if I can find a better opinion than his.
It’s shockingly bad advice.
Numerous studies show that patients get the wrong diagnosis as much as 20% of the time, and get the wrong treatment half of the time. Thirty-five percent of doctors and 42% of patients report errors in their own care or that of a family member. Studies show that most errors happen because of a failure to analyze the patient’s problem correctly. Experts, like Dr. Jerome Groopman from Harvard, say that doctors, strapped for time and dealing with complicated problems, easily fall prey to cognitive pitfalls that create poor quality.
Ask questions, be skeptical, disrupt your doctor’s thought process. Make sure the decisions about your care are right.
Above all, remember it is you, the patient, that are in charge, not the “guy with the medical degree.”
(h/t @epatientDave via twitter)
*This blog post was originally published at See First Blog*
May 11th, 2009 by KevinMD in Better Health Network
Tags: Cost Control, Finance, Health Policy, healthcare, KevinMD, Physician, Policy, Rationing, Salary
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One question that occasionally comes up is whether doctors should be paid a flat salary or not.
Currently, the majority of physicians are paid fee-for-service, meaning that the more procedures or office visits they do, the better they are reimbursed. This, of course, gives a financial incentive to do more, without regard to quality or patient outcomes.
One proposed solution is simply to pay doctors a flat salary, with bonuses for better patient outcomes.
Well, according to a recent Kaiser/NPR poll, that idea is a no-go for patients. 70 percent of patients think its better that a “doctor gets paid each time they see you,” while only 25 percent think a yearly salary is better.
As an aside, I find it interesting that any public poll result that goes against the progressive health policy agenda is considered a “weak opinion,” but really, this isn’t a surprising result.
Economist Uwe Reinhardt hinted at the cause when he said that most Americans believe “that they have a perfect right to highly expensive, critically needed health care, even when they cannot pay for it.”
Perhaps the public believes that a salary is similar to the capitation debacle in the 1990s, where doctors were paid a fixed fee, which gave them an incentive to deny care. And any perceived attempt to restrict care will be met with visceral opposition by the American public.
Which again shows how difficult it will be to engage patients with any dialogue that involves cost control.
*This blog post was originally published at KevinMD.com - Medical Weblog*
May 10th, 2009 by Joseph Banken, Ph.D. in Better Health Network, Health Tips
Tags: Coping, eDocAmerica, Joseph Banken, Mom Passed Away, Mother's Day, Psychiatry, Psychology, Without Mom
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Web pages and blogs are full of gift idea do’s and don’ts for your mother. I won’t go there. I think the topic has been covered quite nicely by better shoppers than I could ever hope to be.
You’ve also, no doubt, been bombarded with the plethora of tear jerker emails cautioning you to spend time with your mother while you can. She’s older than you, you know, and may not last until next year for you to make it up to her if you miss this Mother’s Day. That topic’s been covered too.
I’d like to talk with you a little bit about how to get through Mother’s Day after you’ve lost your mother. And I especially don’t want to forget the reverse situation; how to cope with Mother’s Day if you have lost a child, the hardest pain of all to overcome.
So how do you survive this Sunday if half of the equation is missing? You could hide under the covers until Monday. The protective property of the blanket works for monsters under the bed, why not against monsters of the heart as well? You could ignore that the day has any other meaning and treat it like any other Sunday, but that tends to backfire with a nasty trap of emotions smacking you back into reality the hard way at the worst possible time. Don’t let it catch you off guard; the day is coming whether you are ready for it or not. Or you could cry in your beer (over 21, please), but that just makes your eyes red and dilutes the beer.
Here are some coping strategies for bereavement:
- Talk about it with a friend or family member you trust to handle the sensitive and powerful emotions you feel towards Mother’s Day
- Realize that Mother’s Day is only one day out of the year and it has been commercially blown out of proportion and this too shall quickly pass
- Be around friends who understand and can help you cope with the day
- Acknowledge it can be a hard day and distract yourself with a movie or something that has a positive and endearing memory of what this day was initially designed to represent
And remember that your mother will always be your mother no matter where she is. And the same goes for mothers who have lost children. Once a mother, you will always be a mother even if you can no longer hold them in your arms.
If you are an eDocAmerica participant, you can send a message to the ePsych Psychologist for individualized coping strategies. Many people use this helpful option with good results whether it’s Mother’s Day or not.
All comments welcome.
*This blog post was originally published at eDocAmerica*
May 9th, 2009 by Medgadget in Better Health Network
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Materials based on spider silk have a very promising future in medicine (see flashbacks below). German scientists from the Max Planck Institute of Microstructure Physics were able to reinforce this natural material, which is already strong and flexible, with metal ions and develop super strong fibers:
The fact that spider silk treated with metal ions does not break under enormous tension is just one of the advantages it has to offer: “It can be expanded twice as much as natural spider silk,” says Mato Knez, who is heading the research at the Max Planck Institute. As the treated material withstands high levels of tension and strain, it absorbs ten times more energy than the natural material before it breaks. Thus, it is particularly suitable for braking at full speed or braking free fall, for example in the case of a mountain climber.
Materials with such properties could also be used in aircraft and vehicle construction or in space technology, generally for any application that requires light, strong, and flexible materials. “Our work promises great potential in terms of practical applications, as many other biomaterials can be made more break-resistant and ductile using our method,” explains Mato Knez. There is one important precondition, however: the natural materials must contain proteins as their main component. For example, Knez and his colleagues have already used the metal infiltration process to strengthen fibres made of the protein collagen which composes bones and skins in human body.
As the researchers discovered, the strengthening treatment for spider silk and other protein fibres only works when the metal ions can penetrate into the fibres. To achieve this, they adapted the atomic layer deposition (ALD) technique. This method is usually used to deposit individual layers of metal oxides on the surface of materials by exposing them to water vapour and a volatile compound comprising metal and organic appendages in rapid succession. Up to a few hundred of such gas pulses stream into the material and coat it with a more or less thick layer of oxide. “Because each pulse only lasts fractions of a second, the metal does not penetrate the material, however,” explains Mato Knez: “Therefore, we adapted the equipment so that we could extend an individual pulse to a duration of up to 40 seconds.”
In order to make it clear that the process involved here no longer involves a coating process as is the case in standard ALD, the researchers refer to the modified technique as “Multiple Pulsed Vapour Phase Infiltration” or MPI. By doing this, they wish to avoid any possible confusion in the future. “Actually, it was rather difficult for us to make it clear to colleagues that we are infiltrating materials using a process that previously was only used for coating.”
The researchers were able to detect under the transmission electron microscope that metal atoms from the vapour phase could also creep into the interior of the spider silk. For these tests, a scientist from the Martin Luther University Halle-Wittenberg cut 90-nanometer-thin slices of the spider silk. The microscopic images did not explain, however, why the metal atoms increase the strength of the protein fibres. “Up to now, we only have a few pointers about this,” says Mato Knez: for example, from NMR measurements, which the researchers at the University of Halle made of spider silks infiltrated with aluminium.
“This would indicate that the aluminium is present in a compound other than a typical aluminium oxide,” says Knez. And he has a good idea which compound it is: “We assume that the metal atoms bind the protein molecules to each other.” Hydrogen atoms usually form bridges between the molecules which, however, break far more easily than the strong compounds made using metal atoms. Thus, it becomes plausible for metal-infiltrated spider silk to withstand more weight than the natural version. The better ductility can also be explained in this way. A thread of spider silk can be extended in length because its protein fibres run together like tangled wool in areas referred to as amorphous. In other locations, they arrange themselves in an orderly line like a neat ball of wool. “In these crystalline areas, the hydrogen bridges are probably also replaced by metal ions,” says Mato Knez. Consequently, their order dissolves, the amorphous areas increase and with them the ductility.
Spider silk sutures on a straight needle, anyone?
Full story: Power thrust for spider silk…
Flashbacks: Spider Silk: Ancient Ideas, Great Future?; New Nanomaterial from Spider Silk and Silica; Super Stretchy Nanocomposite Developed ;
*This blog post was originally published at Medgadget*
May 9th, 2009 by Paul Auerbach, M.D. in Better Health Network
Tags: Dr. Paul Auerbach, healthline, Jellyfish Sting, Outdoor Medicine, StingMate, vinegar, wilderness medicine
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As many of you know, I serve as a medical advisor to the Diver’s Alert Network (DAN) regarding incidents involving hazardous marine animals. This includes jellyfish (and related animals) stings.
I’m always on the lookout for new therapies or modifications of existing therapies to treat marine stings (envenomations). At a recent gathering of Beneath the Sea, I was introduced to Smithwick’s StingMate intended for jellyfish sting first aid. The product is composed of 5% acetic acid gel containing menthol. Acetic acid 5% is usually the concentration found in household vinegar, and menthol is a component commonly used in topical anti-itch preparations. StingMate is sold in a 4 fluid ounce manual spray bottle. The instructions that accompany the product are standard for proper first aid treatment of a jellyfish (or related species) sting:
1. Apply the StingMate gel
2. Scrape the skin to remove the stinging cells (nematocysts)
3. Reapply the gel
4. Rinse the skin
I would annotate these instructions to allow an initial decontamination time (first application of the gel) to be a minimum time of two minutes. In terms of scraping the skin, the standard dictum is to apply shaving cream (foam) and use a straight-edge razor or very sharp edge to scrape the cream from the skin. The reapplication of gel should once again be for at least a few minutes.
How vinegar is effective is not without some controversy. Most authorities believe that it renders the stinging cells inoperative, so that they cannot fire. That makes the most sense, because it is unlikely that the vinegar could penetrate the skin and neutralize active venom, although it is possible that vinegar might inactivate surface venom that it is able to reach. The important thing is that vinegar is an effective remedy and absolutely essential to treat the stings of most of the world’s most hazardous (and potentially lethal) jellyfish, such as the Indo-Pacific box jellyfish. I have used vinegar effectively for years, so I have every expectation that StingMate will prove to be a clinically useful product.
Oceangoers should be aware that allergic reactions to jellyfish stings are possible, so should also carry allergy medications or an allergy kit with their first aid supplies.
Preview the Annual Meeting of the Wilderness Medical Society, which will be held in Snowmass, Colorado July 24-29, 2009.
Join me from January 24 to February 2, 2010 for an exciting dive and wilderness medicine CME adventure aboard the Nautilus Explorer to Socorro Island, Mexico to benefit the Wilderness Medical Society.
This post, StingMate: A New Treatment For Jellyfish Stings, was originally published on
Healthine.com by Paul Auerbach, M.D..
