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 4th, 2010 by Bryan Vartabedian, M.D. in Better Health Network, Opinion
Tags: 33 Charts, Analog, Anemic Digital Adoption, Communication Gap, Digital, Disease State, Divide Between Online And Offline, Doctors and Social Media, Doctors in the Virtual World, Doctors on the Internet, Doctors Online, Dr. Bryan Vartabedian, General Medicine, Healthcare and the Virtual World, Johnson & Johnson, Online Medical Communities, Pharmaceutical Companies, Pharmaceutical Industry, Pharmaceutical Marketing, Pharmaceutical Reps, Physician Social Platform, Technology Gap
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It’s the great migration to digital. And as civilization makes its move, the pharmaceutical industry is trying to figure out how to reach out to physicians. Pharmaceutical reps are slowly becoming a thing of the past. Branded medication portals leave most doctors cold. Email outreach is marginal.
Pharma strategists ask me how to reach doctors in the new world. I don’t have an answer. It isn’t that I can’t come up with an answer. It’s just that a good one doesn’t exist. Why?
Doctors aren’t anywhere right now. They’re stuck somewhere between the analog and digital. Socially they’re nebulous. Their virtual communities are non-existent. Public social networks are sparsely populated. When they participate they watch and rarely create or discuss. Our profession is going through a lot right now and it’s evident in anemic digital adoption. Read more »
*This blog post was originally published at 33 Charts*
November 4th, 2010 by David H. Gorski, M.D., Ph.D. in Better Health Network, Health Policy, Opinion, Quackery Exposed, Research
Tags: Anti-Vaccine, Anti-Vaccine Movement, Anti-Vaccine Propaganda, Anti-Vaccine Quackery, Dr. David Gorski, Epidemiology, immunizations, Immunology, Medical Conspiracy Mongering, Misrepresentation of Vaccine Science, Public Awareness, Public Health, Public Knowledge, SBM, Science Based Medicine, Science-Based Evidence, Shots, Vaccine Controversy, Vaccine Education, Vaccine Efficiency
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We write a lot about vaccines here at Science-Based Medicine. Indeed, as I write this, I note that there are 155 posts under the Vaccines category, with this post to make it 156. This is third only to Science and Medicine (which is such a vague, generic category that I’ve been seriously tempted to get rid of it, anyway) and Science and the Media.
There is no doubt that vaccines represent one of the most common topics that we cover here on SBM, and with good reason. That good reason is that, compared to virtually any other modality used in the world of SBM, vaccines are under the most persistent attack from a vocal group of people, who, either because they mistakenly believe that vaccines caused their children’s autism, because they don’t like being told what to do by The Man, because they think that “natural” is always better to the point of thinking that it’s better to get a vaccine-preventable disease in order to achieve immunity than to vaccinate against it, or because a combination of some or all of the above plus other reasons, are anti-vaccine.
“Anti-vaccine.” We regularly throw that word around here at SBM — and, most of the time, with good reason. Many skeptics and defenders of SBM also throw that word around, again with good reason most of the time. There really is a shocking amount of anti-vaccine sentiment out there. But what does “anti-vaccine” really mean? What is “anti-vaccine?” Who is “anti-vaccine?”
Given that this is my first post for SBM’s self-declared Vaccine Awareness Week, proposed to counter Barbara Loe Fisher’s National Vaccine Information Center’s and Joe Mercola’s proposal that November 1-6 be designated “Vaccine Awareness Week” for the purpose of posting all sorts of pseudoscience and misinformation about “vaccine injury” and how dangerous vaccines supposedly are, we decided to try to co-opt the concept for the purpose of countering the pseudoscience promoted by the anti-vaccine movement. Read more »
*This blog post was originally published at Science-Based Medicine*
