February 7th, 2011 by EvanFalchukJD in Opinion, True Stories
Tags: A Doctor's Brain, Best Doctors, Decision Support, Doctor Patient Relationship, Doctors' Judgment, Electronic Medical Records, Evan Falchuk, Good Clinical Judgment, Healthcare and Internet Technology, Healthcare IT, Healthcare Technology, Human Fallibility, Human Judgment, Hydrocephalus, Quality Care, Shunt
No Comments »
Some people may tell you that healthcare IT will solve many of the quality and cost problems in healthcare. I don’t believe them.
I know a 70-year old man named Carlos (not his real name) who was hospitalized following a bout of hydrocephalus. Hydrocephalus is a build-up of fluid in the skull, which affects the brain. Among other things, people with hydrocephalus can be confused, irritable, and nauseous. Carlos had all of these symptoms.
Carlos’ problem was fixable by inserting a special kind of drain in his head called a “shunt.” This kind of shunt is, essentially, a series of catheters that runs from the brain into the abdomen, and which drain the excess fluid. You can’t see it from the outside, so it’s meant to stay inside of you for a very long time.
For a week after Carlos’ shunt was installed, his symptoms completely disappeared. But they soon started to re-emerge. Worried, his family took him to the hospital. Doctors found that his hydrocephalus was back — the shunt wasn’t draining properly. They admitted him to the hospital, and the next day they put in a new shunt. The surgery went well.
But again, about a day later, he started to have the same kinds of symptoms. The doctors sent him for a CT scan, which showed, to their surprise, no problems with the shunt. Unsure of what to do, they decided to wait and see if the symptoms resolved. It was possible, they thought, that the symptoms were from the quick drainage of fluid through the shunt. Read more »
*This blog post was originally published at See First Blog*
February 7th, 2011 by Bryan Vartabedian, M.D. in Better Health Network, Opinion
Tags: 33 Charts, Casual Medical Advice, Children's Health, Digital Correspondence, Dr. Bryan Vartabedian, General Medicine, Good Clinical Judgment, Healthcare Law, Medical Advice By Email, Medical Advice Online, Medical Malpractice, Medicine and Legal Issues, Off-The-Cuff Medical Advice, Pediatrics
1 Comment »
It’s happening more frequently: Requests for medical advice by email. The more I do, the more people I meet. The network grows and friends of friends learn about what I do.
So junior has a little pain and shows at the local ER where the requisite CT shows a little thickening of the ileum. Someone suggests that the family drop me a line. Here’s the problem: There’s more to this than digital correspondence will allow.
While the statistical reality of this child’s situation is that this finding represents a little edema from a virus, the differential is precarious: Crohn’s disease, lymphoma, tuberculous ileitis, eosinophilic enteropathy.
A case of this type requires the thorough exploration of a child’s story and a compulsive exam that takes into consideration the problems in the differential. Worrisome considerations need to be framed and discussed in the context of the child’s total presentation and real likelihood of occurrence. The sensitive dialog surrounding our diagnostic approach to this child requires a relationship. And the various approaches require an element of negotiation with the family. All of this takes time, emotional intelligence, and good clinical judgment.
Children are complicated creatures. Parents are more complicated. Loose, off-the-cuff advice based on shotty information shortchanges both parties.
Of course the easiest response to these regular queries is that my employer, malpractice carrier, and the Texas State Board preclude offering medical advice without an established relationship or the maintenance of a medical record available for peer review. Everybody understands legalese. Few, however, understand the complexity of a properly executed medical encounter.
*This blog post was originally published at 33 Charts*
February 6th, 2011 by DrWes in Better Health Network, Opinion
Tags: AHA, American Heart Association, American Heart Month, Cardiology, Cardiovascular Disease Risk, Cardiovascular Healthcare, Cardiovascular Research, Dr. Wes Fisher, February, Healthcare Public Relations, Heart Care, Heart Disease, Heart Health, Heart-Marketing Month, Irresponsible Medical Marketing, Medical PR, National Heart Month, National Wear Red Day, Public Awareness, Women's Heart Attack Risk
No Comments »
Heart disease and February: What relationship could be more cozy? From the scary risks of shoveling snow (yep, you could die, so be sure to lift a little at a time), Mercedes-sponsored red dress parades and government-sponsored National Wear Red Day®, to tips for identifying heart attacks in women (men, you need a different month I guess), February has all the important stories to improve your awareness. Such a polite term “awareness.”
But I wonder, now that the Internet is upon us and people are seeing their insurance rates and co-pays skyrocket, if maybe we’re shooting ourselves in the foot with all this heart-month marketing hype. People are sick and tired of testing “just to be sure.” It’s starting to directly cost them a fortune, and people are frustrated at having to pay a fortune for healthcare, let alone heart care.
I know, I know — I should be at the forefront of working with patients to stomp out heart disease. And goodness, people DO need to be attuned to diet, exercise, and weight loss. But the reality is, if we’re giving you the 10 latest tips on how to detect a heart attack, we’re probably a bit too late.
That’s the problem with all these press releases: While there’s a need to raise “awareness” of heart health, there’s also a very real need for people to take us — heart disease professionals — seriously to help cut costs in healthcare here. The last thing our healthcare system needs is more frivolous testing. Yet this is exactly what all this marketing does for our healthcare system — and it helps those with the largest PR budgets most of all. Read more »
*This blog post was originally published at Dr. Wes*
February 6th, 2011 by Linda Burke-Galloway, M.D. in Health Policy, Opinion
Tags: Dr. Linda Burke-Galloway, Healthcare Competition, Healthcare Politics, High-Risk Childbirth, Hospital Politics, Hospital Reimbursement, Hospitals Closing Labor Rooms, Infant Health, Labor And Delivery, Maternal-Child Health, Maternal-Fetal Medicine, Maternity Ward, Medical Malpractice Insurance Rates, OB/GYN, Obstetrics And Gynecology, Patient Safety, Pregnancy and Childbirth, Pregnant Women, Prenatal Care, South Seminole Hospital, Teaching Hospital, Uninsured Patients, Women's Health
2 Comments »
When our country starts closing obstetrical units in hospitals because they “cost too much” money to operate, pregnant women need to pay attention because their babies are in serious trouble. Such was the case of the most recent casualty, South Seminole Hospital, a 200-bed hospital, that’s located within 30 minutes of my neighborhood.
More than 20,000 babies were born in South Seminole Hospital during the past 18 years, and many of the babies were delivered by a local obstetrician who died approximately three years ago. I recall sitting in the emergency room of the hospital with a fractured ankle and listening to a chime that used to ring every time a baby was born. It was a soothing and humbling sound knowing that a new life was making its grand entrance each time that chime rang. Now, it will be replaced with silence.
Unfortunately, this phenomenon is not unique to Florida. In 1997 the closing of a North Philadelphia hospital (Northeastern) affected six additional hospitals in the community and their 23,570 annual births. In my hometown of Brooklyn, New York, Long Island Hospital had an annual delivery rate of 2,800 babies, but still closed its doors to the community and sold the hospital as prime real estate to the highest bidder, citing low reimbursement rates and high premiums for malpractice insurance as the culprit behind the decision. The Bedford Stuyvesant community of Brooklyn lost St. Mary’s Hospital, a delivery center of thousands of babies in 2005. Read more »
*This blog post was originally published at Dr. Linda Burke-Galloway*
February 5th, 2011 by KevinMD in Opinion, Research
Tags: Dr. Kevin Pho, Dr. Pauline Chen, Female Doctors, Financially Penalized, Gender Gap In Medicine, General Medicine, Health Affairs, Healthcare Politics, How Men and Women Practice Medicine, KevinMD, Male Physicians, Medical Practice Style, More Time With Patients, New York Times, Physician Compensation, Physicians' Salaries, Sexism In Healthcare, Women In Medicine
No Comments »
Female doctors make less than male physicians. That conclusion gained major media traction recently. A recent post on KevinMD.com by medical student Emily Lu had some great conversation discussing reasons why women make less money in medicine.
To recap, the study from Health Affairs concluded that,
newly-trained physicians who are women are being paid significantly lower salaries than their male counterparts according to a new study. The authors identify an unexplained gender gap in starting salaries for physicians that has been growing steadily since 1999, increasing from a difference of $3,600 in 1999 to $16,819 in 2008. This gap exists even after accounting for gender differences in determinants of salary including medical specialty, hours worked, and practice type, say the authors.
Everyone hypothesized all sorts of reasons. Female doctors prefer more family-friendly hours and less call, which may impact their salary. Women are simply worse negotiators than men. Blatant sexism exists when hiring new physicians. Money isn’t as important to women as it is to men. All of which may, or may not, be true. Read more »
*This blog post was originally published at KevinMD.com*
