January 3rd, 2012 by DrWes in Opinion, True Stories
Tags: Call, Concerned Patients, Life, Medicine, Operator, Rule-Breaker, Rules
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The call never should have been made.
It broke every proscribed rule.
After all, I was not on call. Thanks to the wonders of computer technology, it was very clear that I was being covered by my colleague. And yet, despite this, it came.
“Dr. Fisher, I’m so sorry for calling you at home, but I received a call from Ms. X, the wife of your patient Mr. Y. who said she really needed to speak to you about her husband… she seemed quite concerned and insisted I call you…. I told her I’d see if I could reach you at home… I’m so sorry, but it sounded urgent… I have her number, could I connect you?” Read more »
*This blog post was originally published at Dr. Wes*
January 3rd, 2012 by Lucy Hornstein, M.D. in Opinion
Tags: Celebrex, COX2 inhibitors, Dangers, Elderly, Fatal, Medical, Perception, Primary Care, Quality of Life, Red Flags, Risk, Risk Factors, warnings
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Why is it easier to talk about quality of life with patients who are dying? Why don’t we factor these considerations into the decision-making for patients with conditions that aren’t fatal?
The presence of a terminal illness serves to focus everyone’s attentions. Widespread cancer metastases? Concerns about tight blood glucose control fade away. End-stage liver disease? Blood pressure control doesn’t matter so much any more. Bony pain from prostate cancer? Narcotic and sleeping pill addiction doesn’t even occur to anyone. I find it far more problematic to deal with patients with debilitating but non-fatal conditions when treatment options are perceived as limited because of co-existing diseases that produce so-called contraindications to certain medications.
I have a patient in his mid-70s with severe pain from osteoarthritis. Several fractures and a couple of unsuccessful joint replacement surgeries haven’t helped matters. Several years ago he found that a little drug called Vioxx worked extremely well for him, reducing his pain considerably and allowing him to do pretty much watever he wanted. As we all know, however, that drug was pulled from the market because of an unacceptable increased risk of heart attacks and other untoward cardiovascular events. Interestingly, Read more »
*This blog post was originally published at Musings of a Dinosaur*
January 3rd, 2012 by Nicholas Genes, M.D., Ph.D. in Opinion
Tags: Alerts, Apple, Apps, Bacterial Colonization, Cloud, Design, Devices, EHR, Electronic Health Record, Emergency Medicine, ER, Impact Resistance, iOS 5, iPad, Save feature, Technology
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I’ve been using my iPad in the ED, with my white coat’s sewn-in iPad-sized pocket, for some time now — mostly for patient and resident education, and to look up dosages or rashes. Hitting up my Evernote database or Dropbox documents is also useful. Occasionally I’ll use my iPhone, for its LED light (when the otoscope can’t reach to where I need to see) or rarely, its camera (in compliance with my hospital and department photo policy, naturally).
Our ED’s EHR isn’t quite accessible enough via iPad for me to quickly check results or place orders at the bedside — right now it’s just too cumbersome. But there’s been progress — enough so that I start to wonder about the flip side: instead of reviewing iOS medical apps and pining for an optimized EHR experience on the iPad, what if there are features of the iPad that could limit the utility of medical apps?
Well, there are some product design issues, like impact resistance and bacterial colonization, that have been discussed. But the operating system, iOS 5, has some quirks, too. Some have received a lot of attention. Some are maddening in their capriciousness. Read more »
*This blog post was originally published at Blogborygmi*
January 2nd, 2012 by PreparedPatient in Opinion
Tags: Angie's List, decision-making, Doctor Reviews, health care, medicaid, Prepared Patient, Ratings, Social Media, Tara Lagu, Yelp
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“We’re Listed With the Plumbers Now”
Angie’s List can help you locate a reputable handyman. Yelp can push you in the direction of the perfect restaurant for your anniversary dinner. Amazon’s consumer reviews can even help you choose the TV that will fit in the corner of your den. So why wouldn’t you turn to the Internet to find your next doctor?
39-year-old Jennifer Stevens did just that when she needed an obstetrician for her first child. Not wanting to reveal her pregnancy too soon by asking friends for suggestions for a good OB, she turned to the Web for more information on potential physicians. She soon found that a lot of the information she needed to make this important decision was missing. “A lot of sites gave stars, but I didn’t really know what those stars meant. I just wasn’t comfortable picking an OB based on that kind of vague information,” she said.
Lindsay Luthe, a 30-year old Washington, D.C. resident, consulted the popular ratings website Yelp after asking her friends to recommend a physician. “I perused the reviews for this particular doctor and saw how positive they were. Those reviews, combined with my friend’s personal recommendation, led me to make an appointment with the doctor. I think I even used the contact info on the Yelp page to call the office,” she said.
The success of physician ratings websites—such as HealthGrades, or RateMyMD, among many others—has been mixed. Read more »
*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*
January 2nd, 2012 by EvanFalchukJD in Health Policy, Opinion
Tags: ACO, Blogging, Diagnosis, Employee Benefits, Health Care Reform, Health Insurance, Healthcare Benefits, Predictions
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How Did My 2011 Predictions Turn Out?
Pretty well, actually.
As predicted last December, there was no big change to health care reform, doctors still didn’t have enough time with their patients, Microsoft (disclosure: Microsoft is a Best Doctors client) made moves to create a “Windows” for electronic health records, and “ACO” became the hot buzzword in health care. Some state governments started major redesigns of their benefits programs, saving money in the same ways private sector employers do. Meanwhile, more than ever, private sector employers are penalizing employees who don’t take care of themselves.
Misdiagnosis finally started to be recognized as a public health problem. At Best Doctors we got a great deal of press coverage in 2011 on this (for a few examples, go here, here, here, here and here). I will sneak in a 2012 prediction and tell you that you will hear a lot more about this this year, and not just from us.
What did I get wrong? Read more »
*This blog post was originally published at BestDoctors.com: See First Blog*
