November 5th, 2010 by Lucy Hornstein, M.D. in Better Health Network, Opinion, True Stories
Tags: After Hours Care, Doctor's Lifestyle, Doctor's Well-Being, Doctors Who Work Weekends, Downtime For Doctors, Dr. Lucy Hornstein, e-Prescriptions, EHR, Electronic Health Record, Electronic Medical Record, EMR, Family Medicine, General Medicine, Musings of a Dinosaur, Personal Boundaries, Prescription Refills, Primary Care, Professional Boundaries, Work-Life Balance
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I’ve had a longstanding policy in my office that routine prescription refills will only be addressed during regular office hours. No evenings; no weekends; if you need a refill of your long-term chronic medications, you need to call during regularly scheduled office hours, five days a week. You can leave a message if you like, but you should not expect us to call in the medication until the office is open.
The main reason for this policy has always been medical: prescription medication requires appropriate monitoring. From the moment I hung out my shingle, I’ve made it my habit always to write enough refills on your medication to last until the next time I need to see you. In all likelihood if you need a refill, what you really need is a visit.
The logical reason for the policy is the need to consult the medical record before authorizing refills. And when those records are contained on bits of dead trees on shelves in the office, there’s no way I can access them if I’m not physically there. I’ve been known to drive out to the office at decidedly odd hours for the express purpose of consulting those records so that I can provide appropriate care to my patients. That has always been the bottom line for me, and always will. Read more »
*This blog post was originally published at Musings of a Dinosaur*
November 5th, 2010 by KevinMD in Better Health Network, Health Policy, Health Tips, News, Opinion, Research
Tags: CT Scan, Dr. Kevin Pho, Incidentalomas, KevinMD, Lung Cancer, National Cancer Institute, National Lung Screening Trial, NLST, Oncology, Preventive Medicine, Pulmonology, Quitting Smoking, Radiation Exposure, Screening Tests, Smokers, Stop Smoking
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Lung cancer screening has been an area of considerable controversy. Before today, there had been no evidence that screening patients for lung cancer, either with a CT scan or chest x-ray, saved lives.
For years, doctors have been waiting for the results of the large, randomized National Lung Screening Trial (NLST), conducted by the National Cancer Institute.
[Yesterday] it was announced that the trial was stopped early, with a bold, positive finding:
All participants had a history of at least 30 pack-years, and were either current or former smokers without signs, symptoms, or a history of lung cancer.
As of Oct. 20, 2010, the researchers saw a total of 354 deaths from lung cancer in the CT group, compared with 442 in the chest x-ray group.
That amounts to a 20.3% reduction in lung cancer mortality — a finding that the study’s independent data and safety monitoring board decided was statistically significant enough to halt the trial and declare a benefit.
Previously, only breast, colon, and cervical cancer has had the evidence back up its screening recommendations. It’s still early in the game, but it appears that lung cancer may be following in that same path. That said, there are a variety of concerns before opening up the floodgates to screening chest CTs. Read more »
*This blog post was originally published at KevinMD.com*
November 5th, 2010 by Davis Liu, M.D. in Better Health Network, Health Policy, Health Tips, News, Opinion
Tags: America's Health Insurance Plans, Choice of Health Plan, Dr. Davis Liu, Family Medicine, Health Plan Performance, HMO, Inadequate Healthcare, Journal of General Internal Medicine, Kaiser Permanente-Northern California, Kaiser Permanente-Southern California, National Committee of Quality Assurance, Primary Care, Sacramento Bee, Save Your Life, Saving Money and Surviving the Healthcare Crisis
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The Sacramento Bee recently ran the following opinion piece of mine below. A couple of additional comments not published follow. Enjoy.
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Viewpoints: Choice of health plan can be a lifesaver
It’s that time of year when most of us pick a health insurance plan based simply on cost. It’s a belief that is often perpetuated by friends, family, and advice dispensed by many articles in magazines and newspapers. As a practicing primary care doctor, I can tell you that the advice is frankly wrong.
Health insurance isn’t a commodity like auto insurance. It’s not just about the price. They aren’t all equally good at keeping you healthy and well. The recent annual report by the National Committee of Quality Assurance, which has been evaluating health plans for twenty years, continues to report tangible differences among health insurance plans across the country as well as in California.
In a ranking of 227 HMO plans nationwide in important areas like immunization rates for children, appropriate use of antibiotics, blood pressure and cholesterol control, cancer screening in adults for breast cancer, cervical cancer, and colon cancer, only two of nine California HMO health insurance plans ranked in the top 15 percent. The remaining seven were in the bottom half. If all health plans across the country performed at the level of the top 10 percent, 186,000 Americans would be alive today. They would have consistently and routinely received the preventive care and medical interventions that have proven to save lives. Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
November 5th, 2010 by Toni Brayer, M.D. in Better Health Network, Health Tips, News, Research
Tags: Archives of Internal Medicine, CAM, Chinese Red Yeast Rice Supplements, Citrinin, Complementary And Alternative Medicine, Dietary Supplements, Dr. Toni Brayer, Everything Health, FDA, Food and Drug Administration, High Cholesterol, Monocolins, Natural Medicines, Natural Remedies, Red Yeast Rice Extract, Statins Medications, Toxic Ingredients
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People are always on the search for “natural” ways to stay healthy and reduce cholesterol. Chinese red yeast rice supplements have been touted as a natural, safer way to lower cholesterol compared to statin medications. The yeast that grows on a particular type of rice contains a family of substances called monocolins, which lower cholesterol by inhibiting cholesterol production in the liver in the same manner as prescription statin drugs. Some studies have shown as much as a 15 percent drop in cholesterol.
All of this sounds good until you dig a little deeper. Supplements are not regulated by the Food and Drug Administration (FDA), and a new study in the Archives of Internal Medicine showed that different brands of red yeast rice supplements have dramatic variation in levels of active ingredients. Furthermore, some contained toxic manufacturing by-products. Read more »
*This blog post was originally published at EverythingHealth*
November 5th, 2010 by RyanDuBosar in Better Health Network, Health Policy, News
Tags: A Divided Congress, A Pledge to America, ACP Internist, American College Of Physicians, Democrats, Harry Reid, Healthcare Policy, Healthcare Politics, Healthcare reform, New U.S. Healthcare System, Newly Elected Officials, Republicans, Seniors
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Republicans who had opposed healthcare reform before the election are now elected officials with a say in how the programs are funded. At federal and state levels, the program’s opponents either have a larger voice or are now in charge of implementing elements of reform. Sen. Majority Leader Harry Reid said he’d consider adjustments to healthcare reform.
Frightened seniors flipped toward opposition to healthcare reform, while flipping on the issue may have saved a few Democrats. Exit polling showed 48 percent would repeal healthcare reform, 16 percent would leave it as is, and 31 percent would expand it.
Now that Republicans have a larger say in the matter, take a look at their plan for healthcare in A Pledge to America, starting on page 25, and decide for yourself. (New York Times, Kaiser Health News, Reuters, Wall Street Journal, Politico, CBS News, GOP.gov)
*This blog post was originally published at ACP Internist*
