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How CTs and MRIs Drive The Cost Of Healthcare

It’s well known that the use of imaging scans, like CTs, MRIs and PET scans, have been growing at an alarming rate. But a recent study provides some stark numbers. According to a recent CDC report, “MRI, CT or PET scans were done or ordered in 14 percent of ER visits in 2007.” That’s four times as often as in 1996. Although a physician called that growth “astounding,” it’s really no surprise.

Emergency departments are becoming more crowded, and with patient satisfaction scores becoming more influential in financial incentives for physicians, sometimes just ordering a test is the path of least resistance. Factor in the spector of defensive medicine which, according to a survey from the Massachusetts Medical Society, accounts for up to 28 percent of tests ordered, it’s a wonder that more scans weren’t ordered.

Imaging scans are a clear cost driver in healthcare, contributing $12 billion to Medicare’s bill. But costs won’t resonate with patients requesting the tests or the doctors ordering them. One encouraging sign is the recent trend of publicizing the harms of scans, like radiation from CTs. I’m finding that patients are becoming increasingly aware of the risk, and making a more informed decision after I explain it to them. It’s a small step forward.

*This blog post was originally published at KevinMD.com*

Take A Look At Your Genes

As I’m doing my PhD in clinical genomics, I’m really interested in the connection between the Internet and medicine. I was happy when Pathway Genomics, one of the newest direct-to-consumer genetic companies, offered me a free genetic test.

After an interview I did with them, I sent my saliva sample back and 3-4 weeks later, I received an email that my results were ready. This is my experience and the things I found interesting. As I got a free test from Navigenics a year ago, I plan to compare these services. I was very interested in the service of Pathway Genomics because of what they analyze:

1) Sampling: It was quite an easy process with only a few papers to fill (though it’s always hard to solve FedEX issues from Europe) and clear instructions. A video about a patient showing the whole process in 1-2 minutes, including saliva collection and filling out the paperwork, would be useful. 

2) Preparations: I liked that I had to complete a questionnaire focusing on my lifestyle and patient history (Your Environment and Lifestyle, The Shape You’re In, and You and Your Family). As family history is the best genetic test out there, so it’s important to use that data while analyzing genetic results. Though, I couldn’t calculate my BMI (couldn’t use kg and centimeter) and the family history application wasn’t working for me. Read more »

*This blog post was originally published at ScienceRoll*

Modern Surgery Founded On The Kitchen Table: The Amazing Dr. William Halsted

One night in 1882, a critically ill 70-year-old woman was at the verge of death at her daughter’s home, suffering from fever, crippling pain, nausea, and an inflamed abdominal mass. At 2:00AM, a courageous surgeon put her on the kitchen table and performed the first known operation to remove gallstones. The patient recovered uneventfully. The patient was the surgeon’s own mother.

This compelling story is the beginning of an excellent new biography of William Halsted, the father of modern surgery, Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted, by Gerald Imber, M.D. Read more »

*This blog post was originally published at Science-Based Medicine*

The Human Arm: An Information Superhighway?

Scientists at Korea University in Seoul have demonstrated a prototype of a new biomonitoring system that transmits data through the body, replacing wires and minimizing the need for batteries.

The device is 300 micrometres thick and in a test, using a metal electrode coated with a flexible silicon-rich polymer, the researchers transmitted data at a rate of 10 megabits per second through a person’s arm. The device was tested for skin safety after continuous wearing and the data was transmitted via low-frequency electromagnetic waves through the skin.

The technology may have implications for diagnostics, as it can be used to detect electric fluctuations as is currently done by ECG and EEG machines.

Read on at New Scientist: Human arm transmits broadband…

Abstract in Journal of Micromechanics and Microengineering: Wearable polyimide-PDMS electrodes for intrabody communication

*This blog post was originally published at Medgadget*

What Primary Care Physicians Need To Know About Healthcare Reform

DrRich is obviously far more intelligent than those wayward Democrat Congresspersons, whose last-minute “yes” votes Speaker Pelosi is seducing with her winning smile, and with her double-super-hope-to-die promise that the Senate will surely agree with the reconciliation package the House has finally assembled.

Unlike Pelosi’s reluctant Blue Dogs, DrRich understands that once the House has deemed the Senate bill to have been passed, and the President signs it into law, and the confetti drops and the champagne pops and the press goes into raptures and the work begins to revise Mt.Rushmore, the odds immediately become vanishingly small that the President, the Senate, or even the 200 House Democrats who really like the new law, will actually then embark on a new, prolonged, contentious spectacle of a reconciliation fight in the Senate.

Rather, once healthcare reform becomes law, political expediency dictates that we in the teeming masses never hear another word about healthcare until after the November elections. We will be distracted by more pressing matters, from which there will be many to choose — gasoline prices, Iranian nuclear weapons, economic collapses in the PIIGs, etc.

Now, DrRich does not have the stamina to study the new law all at once as a whole. He must bite off little pieces. And the first thing he sought in embarking on his study of our new healthcare system was evidence of how the new law would rescue the Primary Care Physician (PCP). Read more »

*This blog post was originally published at The Covert Rationing Blog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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