April 21st, 2011 by AndrewSchorr in Opinion, True Stories
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It is happening several times a day now. The phone rings. I get stopped at Starbucks, or at the dog park, or at the supermarket. “My friend may have a brain tumor,” “I have been short of breath,” “I am tired all the time.” Then come the questions: “What do you think I should do? Who should I see?” I am not a doctor, but people are increasingly looking to me as if I were one. It’s a little daunting.
As you may know, I’ve been producing and/or hosting programs on medical topics for patients since the mid 1980’s. First it was erectile dysfunction, then breast surgery, then multiple sclerosis, cancer, diabetes – you name it, I’ve interviewed someone about it. Town meetings, live audio webcasts, radio shows, and videos. I feel like I’ve gone to med school two or three times. And like a med student I’ve worried common symptoms could mean the worst diagnosis. That headache could be too much coffee OR it could be a brain tumor. Feeling tired could be you are snoring and have sleep apnea OR you have leukemia.
A number of years ago, having just moved from Los Angeles to Seattle, Hollywood called. A friend sold a 5 day a week medical show to MGM and he needed wife/partner Esther and me to be producers. We were the ones who wrote what flashed on the screen when a patient described their symptoms to one of the real docs who were stars of the show “Group One Medical.” “I have had some blood in my stool, the patient would say. Flash on the screen: could be hemorrhoids. Could be advanced colon cancer. We walked around the home/office worrying about every ache and pain. I am told that’s just what med students do. The most mundane could be life-threatening. Read more »
*This blog post was originally published at Andrew's Blog*
April 21st, 2011 by Richard Cooper, M.D. in Health Policy, Opinion
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In a recent op-ed in the San Francisco Examiner, William Dow, a professor of health economics at UC Berkeley, commented on the importance of education as a means of enabling more people to afford health care insurance. In my view, education is important not simply because an educated population can more easily pay for health care. The main importance is that educating children will allow those children and their children to have healthier childhoods, less burden of disease as adults, access to more personal and communal resources to deal with whatever disease they have and less need for health care, and that translates into less health care spending. Let me frame this in terms of the San Francisco Bay Area.
In a series of articles in the Contra Costa Times last year, Susanne Bohan and Sandy Kleffman described the striking differences in life expectancy in poor vs. wealthy ZIP codes in East Bay. Life-expectancy in Walnut Creek (94597) was 87.4 years, but it was only 71.2 years in Sobrante Park (94603), where household incomes are about half and poverty >20%. That’s a gap of 16.2 years. We find that, in addition to a shorter life-expectancy in Sobrante, the inpatient hospital utilization rate is double the rate in Walnut Creek. Poverty is not only tragic. It’s expensive. Read more »
*This blog post was originally published at PHYSICIANS and HEALTH CARE REFORM Commentaries and Controversies*
April 20th, 2011 by Stanley Feld, M.D. in Health Policy, Opinion
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In 2009 President Obama stated that Accountable Care Organizations (ACOs) were going to be pilot programs in real world settings. The goal was to see if they effective in reducing costs and increasing “quality of care.” The results of the pilot programs have not been published.
Last week despite the lack of proof of concept HHS and CMS announced new proposed regulations for ACOs.
The new delivery and payment model the agency estimates could serve up to 5 million Medicare beneficiaries through participating providers, and also potentially save the Medicare program as much as $960 million over three years.
How were these estimates derived? It could be another accounting trick by President Obama’s administration.
The idea of coordinating care and developing systems of care is a great idea theoretically. From a practical standpoint, execution is very difficult.
I tried to execute something similar in 1996 with the American Association of Clinical Endocrinologists; a national Independent Practice Association. AACECare received little cooperation or interest from Clinical Endocrinologists.
The problem is coordinated medical care is dependent on physicians cooperating and not competing with each other. It also depends on hospital systems developing an equitable partnership with physicians.
The equitable partnerships between hospital systems and physicians are difficult to achieve if past results are any indication of future results. Read more »
*This blog post was originally published at Repairing the Healthcare System*
April 20th, 2011 by Mary Lynn McPherson, Pharm.D. in Health Tips
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Imagine your mother telling you she’s starting a new pain medicine, only to learn that she ended her life three days later due to a medication error. That’s exactly what happened to Linda Sanders, a 62 year old woman who thought she was getting the pain reliever Lyrica, but she accidently got Lamictal, an antiseizure medication. The mistake was probably caused by the similarity in the two medications names. Unfortunately, suicide is a known risk associated with Lamictal therapy.
Medication mistakes involving pain-relievers have consequences that range from inconvenient to potentially deadly. Why are errors fairly common and potentially serious with this group of medications? There are an estimated 75 million Americans who suffer with chronic pain, which results in a lot of prescriptions being written and filled for pain relievers. Also, people can react differently to specific pain medications. In fact, taking the wrong medication can make an unrelated medical condition worse, or even be fatal!
A large new research study recently analyzed over 2,000 prescribingerrors involving pain medicationsthat were caught before being given to patients that occurred at a teaching hospital. The errors ranged from doctors ordering the wrong dose of the medication or giving incorrect directions to the patients, to prescribing a medication inappropriate for a patient (patient allergic to medication). Most troubling was the fact that pain medicines with names that “look alike” or “sound alike”were also a cause of prescribing errors.
Medications whose names look similarwhen written or sound like other medication names have long been identified as a source of medication errors. The Institute for Safe Medication Practices (ISMP) even publishes a list of “Confused Drug Names.” Doctors aren’t the only ones who make medication errors because of confusing drug names. Pharmacists can accidently dispense the wrong medication, nurses can administer a drug with a similar sounding- or looking-name and patients frequently take wrong medications due to this confusion!
Looking at the list of confused drug names provided by ISMP, we see several pain medications on the list. Here’s a partial listing:
• CeleBREX (a nonsteroidal anti-inflammatory pain medication),CeleXA (an antidepressant) and Cerebyx (an antiseizure medication)
• Codeine (an opioid) and Lodine (a nonsteroidal anti-inflammatory pain medication)
• Hydromorphone (an opioid) and morphine (a different opioid)
• Lyrica (a medication for nerve-damage pain) and Lopressor (a blood pressure medication)
• Methadone (an opioid) and methylphenidate (a stimulant medication)
• Tramadol (an opioid) and trazodone (an antidepressant medication)
What can you do to minimize your risk of a medication misadventure caused by medications whose names look or sound like other medications? Here are some tips that may help:
• Ask questions. Doctors, pharmacists and nurses can make mistakes and you shouldn’t be afraid to question them.It’s your health.
• Use your health care team! Make sure your doctor and pharmacist provide important information about ALL of your medications before you leave the office or pharmacy.
• The National Council on Patient Information and Education (NCPIE) has a terrific handout of “Helpful Steps to Avoid Medication Errors” that you can print out and take with you when you visit your doctor or pharmacist.
• Make sure your doctor and/or pharmacist cover all the following points for each of your medications (and take notes for later):
o What is the name of the medicine and what is it for? Is this the brand or generic name?
o How and when do I take it – and for how long?
o What side effects should I expect, and what should I do about them?
o Should I take this medicine on an empty stomach? With food? Is it safe to drink alcohol with this medicine?
o If it’s a once-a-day dose, is it best to take it in the morning or evening?
o What foods, drinks or activities should I avoid while taking this medicine?
o Will this medicine work safely with any other medicines I am taking?
o When should I expect the medicine to begin to work, and how will I know if it is working?
o Are there any tests required with this medicine (for example, to check liver or kidney function)?
o How should I store this medicine?
o Is there any written information available about the medicine? Is it available in large print or a language other than English?
To quote the National Council on Patient Information and Education – “Educate Before you Medicate!” And if you have ANY lingering questions about your medications, call your pharmacist. It’s part of a pharmacist’sjob to answer patient questions, and it’s your health on the line!
April 20th, 2011 by IsisTheScientist in Research
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These last several weeks I have been absolutely overwhelmed with science, meetings, writing, and reviews. I might complain, but I should also be flattered that I am as busy as I am. Mama is in demand, little muffin. Still, things are beginning to slow down to a tolerable level on my end, which means I will be back to blogging.
Today I was working on some writing when I had cause to review some historical texts. It gives me pause to stop and consider things that we take for granted. For example, think about how blood flows through the heart and lungs…
Figure 1: Blood flows from right to left, across the lungs.
I can’t tell you how many times a day I look at a heart and take for granted that blood should flow from the venous circulation, into the right side of the heart, across the lungs, back to the left side of the heart, and out to the arterial circulation. When all is right with the world, such is the way it should be.
But, we didn’t always know that. Read more »
*This blog post was originally published at On Becoming a Domestic and Laboratory Goddess*
