August 11th, 2009 by GruntDoc in Better Health Network, Opinion
Tags: Going Postal, Mental Health, Murders, Psychiatry, Sociopath, Suicidality
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One of the joys of having a blog with 10 readers is that a bunch of them actually add content. From the comments to this post (about the Collier Township, PA mass shooting) by CHenry:
Sadly a recurring pattern of tragedy. A mentally ill person: depressed, angry, frustrated and paranoid, socially isolated largely due to the behavioral features of his disordered personality (I say “his” particularly because it is true, most of these mass-killer-suicides are men) and then some event that triggers the lethal cataclysm of violence. It doesn’t even have to be something most people would think would trigger someone to break, maybe the failure of a brief relationship, or something more significant like a job loss.
U. Texas at Austin, Port Arthur, Tasmania, San Ysidro, California, Ecole Polytechnique, Quebec, Kileen, Texas, Dunblane, Scotland, Virginia Tech. All very similar, and there have been many more.
The gun control activists point to the weapons of choice. They have a point: semiautomatic firearms give an assailant a huge advantage of speed in making a body count when turned on unarmed and trapped victims. But even in places where gun ownership is tightly controlled, those with the determination to kill have found weapons of their choice.
We live in a society where it is startlingly easy to be alienated and alone, even in a crowd. For whatever reasons, the ties that bind us to one another, community, family, church, friendship and work are much more tenuous than ever before. People with thought disorders and violent tendencies have probably never been freer, both of the laws that once gave a society powers to confine them and of the observation and social controls that a world of smaller communities once imposed on their behaviors.
The lonely berserk stranger, hell-bent on wreaking as much destruction as possible before his own destruction has become the dark meme of modern living. Going postal.
I don’t see a practical answer to this problem. Good comment.
*This blog post was originally published at GruntDoc*
August 11th, 2009 by DrWes in Better Health Network, Opinion, True Stories
Tags: Anger, Frustration, Healthcare reform, Protests, Town Hall Meetings
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It was a remarkable day in clinic yesterday.
Not because of the number of people I saw (12) or the clinical diversity seen, but rather how many people (4) asked me what I thought of the current health care reform bill before Congress.
The political spin being posed by Democrats is that people are staging town hall protests about their displeasure about the current health care reform efforts underway.
I don’t think so.
Rather, I think people are finally realizing that the health care reform proposal on the table is no longer about the “47 million” uninsured, but rather, “Hey, this health care reform thing, why, it’s about ME!”
-Wes
*This blog post was originally published at Dr. Wes*
August 10th, 2009 by eDocAmerica in Better Health Network, Opinion
Tags: ePatients, Journal of Participatory Medicine, Participatory Medicine, Personal Responsibility
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Participatory Medicine is a cooperative model of health care that encourages and expects active involvement by all connected parties (health care professionals, patients, caregivers, etc.)
When patients are aware of such things as their weight, BMI, blood pressure, recent key laboratory results, and so on, and when they come to the office motivated and prepared, outcomes are likely to be much better. The patient who passively waits for advice and direction from the physician is more likely to forget instructions, make excuses for failures, lack the discipline to lose the needed weight or stay on the required diet, and so forth.
Patients themselves, not their doctors, must be the ones to make the essential decisions about their health. They must be able to obtain the necessary information to make key decisions, then act on them.
How does this process happen? A patient may agree with this statement and want to begin to operate in this mode, but not know how to do it. Here is a short list of the essential steps necessary to begin the practice of participatory medicine:
1. If possible, find a physician who understands, and supports, this concept, including one who is willing to communicate with you by e mail and directly answer your phone calls.
2. Consider the option of using a service like edocamerica, that is dedicated to providing you with the information necessary to make decisions about your own health care. They can supplement your physician and are available to you 24/7 and always welcome your questions. Moreover, they are dedicated the concept of PM and are oriented towards health and wellness, not just managing your diseases.
3. Start following blog and twitter posts by persons who are now actively discussing how Participatory Medicine is going to change the way health care is practiced.
4. Keep a current list of your medications, including the Brand name, generic name, dose and frequency of each one.
5. Look up the most common side effects of each of your medications.
6. Check your medications for any drug-drug interactions. You can use a web site such as drugstore.com for this.
7. Keep a list of all of your current medical conditions and review the basic information about each of them. A site such as Mayo Clinic or Medicine Net are good, trustworthy sources for this review.
8. Start making a list of questions that you want your doctor to answer for you. If he doesn’t have time to answer all of them at the next visit, ask him if you can e mail them to him. If not, ask one or two at each visit until you get them all answered. If you can’t get him to address all of your questions in a satisfactory and timely fashion, consider getting another doctor who will.
Participatory medicine, working on an equal footing with your provider, in a partnership for your optimal health, is the only way you can get the most out of the health care system. So, get on the train before it leaves the station!
Your comments and dissenting opinions are always welcome.
*This blog post was originally published at eDocAmerica*
August 10th, 2009 by DrRob in Better Health Network, Opinion
Tags: Blood Tests, Internal Medicine, Lab Tests, Reference Ranges, TMI, Too Much Information, What Do The Values Mean?, What's Normal?
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Let me kick the hornets’ nest again. I still have misgivings about sending information like this to my patients:
How does one not trained in what to overlook interpret the above? To me, this lab result is entirely expected for this patient – given the other medical history that is there. My concern is that this will either cause unneeded worry, or it would prompt a phone call to ask about labs that I would be quick to accept. Yes, there are times when this may help the doctor who overlooked abnormal tests in error, but the majority of abnormal lab values are not significant. The vast majority are insignificant. I’d put the rate at nearly 10:1.
When we e-mail patients their lab results, we have two options: to send the actual report, or send an abbreviated form of it. Here is what I sent this patient (for these actual labs):
I had a woman complain to me when I didn’t send her this “sanitized” version of her thyroid labs. She didn’t understand the lab report and just wanted my explanation. Which would you rather have? Do patients really need to know their MCHC, RDW, RBC count, and absolute eosinophil count? Do they want to? I don’t care about those numbers 99.9% of the time I look at them.
Here’s another example:
“Doctor! I am really worried about my Bun Level and Carbon dioxide levels. I read that these can all mean I am dehydrated! They also can mean I am going into kidney failure. I don’t want to go on dialysis! And what about the monocytes and MPV levels? One website I saw said this could mean leukemia.”
Sound outlandish? Sound like something that won’t happen much? Wrong. We spend a very large amount of time explaining these basically normal (MPV?? Absolute Monocytes??). All lab tests need to be put in the perspective of the patient’s age, disease state, race, and medications they are taking. They also need to be seen as a single point on the graph and so must be looked at in comparison with previous lab tests. How would I interpret this? Normal.
Do you, my readers, REALLY want to see the absolute monocyte counts and MPV?
Here’s another:
Look at all the extra information put at the bottom of the lab report. What does it mean?
Most of this is fluff meant to keep the lawyers happy. The average patient will not quite know where to look here and will either just be confused by it or become anxious and want to question this as being abnormal. ”I thought you said my diabetes control was good, but the diabetes test was high according to this!” or “A hemoglobin of 6.5 is dangerous, isn’t it?” I have had both of these comments from patients.
Here’s a typical echocardiogram report:
What percent of patients want all of this? I don’t! I really could care less about everything above the “Impression” section from the cardiologist. I was not even aware that pressure had a halftime. None of these findings are significant.
The cardiologist has to include all of these in his note for herself because of documentation requirements and because the fine details mean something to her. But they mean nothing to me, and I would prefer just getting the “Impression” sent to me. Why should patients be different from me?
Wouldn’t you rather get from me something that says: “Your echocardiogram looked good”?
I really think that giving full access to all information opens a hornet’s nest of its own. We will spend a lot of time educating our patients to the nature of medical information and medical terminology. Again, I am fine with having folks who feel they need this information; but I am a little skeptical that they really do need it.
I don’t need most of this stuff, and would be much happier if I got only what I asked for.
*This blog post was originally published at Musings of a Distractible Mind*
August 8th, 2009 by Joshua Schwimmer, M.D. in Better Health Network, Opinion
Tags: Index Medicus, Information, Information Overload, Medicine, PubMed
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Image by Nuevo Anden via Flickr
The growth of medical knowledge is difficult to visualize. One classic representation is the Index Medicus — a comprehensive index of medical journal articles — whose bound copies filled the shelves of medical libraries for 125 years. In 2004, however, the National Library of Medicine decided to stop publishing the Index. The first reason was practical: the Index Medicus had grown from 82 pounds in 1985 to an estimated 152 pounds in 2004. The second and more important reason was the widespread availability of the search engine PubMed — an electronic database of medical literature available for free via the Internet — which made the printed index obsolete. Compared to the Index Medicus, PubMed was more convenient, could be searched more easily, could be updated more quickly, and certainly weighed less. Copies of the Index Medicus are now a historical curiosity; many physicians now search the medical literature exclusively through PubMed.
The story of the Index Medicus and its successor, PubMed, illustrates three ideas.
First, the quantity of new medical information is more than any single physician can absorb, and keeping up to date with this expanding body of knowledge is challenging. As of April 2009, for example, PubMed contained information on 18,782,970 citations in the medical literature and was adding over 670,000 new entries per year. Doctors must not only absorb this flood of new ideas about treating, diagnosing, preventing, and understanding disease — deciding which information is relevant and which is not — but also learn how to apply and explain this knowledge to the patient sitting with them in the exam room or laying ill in a hospital bed.
Second, in parallel with this unprecedented expansion in medical knowledge, new media and technologies have emerged — of which PubMed is one example — which has made the task of searching, organizing, and retrieving relevant information easier. Potential sources of information for physicians include not only printed journal articles like those indexed in PubMed, but lectures, case conferences, and newer Internet resources such as reference tools (e.g., UpToDate), discussion groups, online expert systems, clinical resource tools, and podcasts.
Third, the expansion of medical information and proliferation of new technologies has required physicians to develop new skills and strategies to keep their knowledge current. Often, the availability of new knowledge overwhelms physicians’ ability to process it, a condition known as information overload. In physician’s offices, one symptom of information overload is the common spectacle of unread piles of medical journals stacked up on every available horizontal space.
While many medical schools now require classes on searching the medical literature and evidence-based medicine, few resources have been available designed to teach physicians how to learn and practice medicine more efficiently. (That’s why, over two years ago, I started writing The Efficient MD blog.)
Since then, I’m glad to report that online resources for physicians have proliferated. Ways of improving efficiency and reducing information overload are now common topics on medical blogs. For example, see recents posts in Life in the Fast Lane, Clinical Cases and Images, and Musings of a Distractible Mind.
Thanks for reading!
—
(Much appreciation to Jacque-Lynne Schulman, Stephen Greenberg, Margaret Vugrin, and Dean Giustini for helping me with an updated estimate of the weight of the Index Medicus. Any inaccuracies in this post are, of course, my own.)
This post, Medicine & Information Overload, was originally published on
Healthine.com by Joshua Schwimmer, M.D..
