August 10th, 2009 by Berci in Better Health Network, News
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The Rorschach test is used for examining the personality characteristics and emotional functioning of patients as their perceptions of inkblots are recorded and then analyzed.
New York Times had a report about Dr. James Heilman who posted all 10 pictures on the site, along with research about the most popular responses to each. Of course, it led to a heated debate whether this information should be accessed on Wikipedia or not.
The article is protected from editing until 6, August but there are serious debates on the talk page. One example:
All of the pictures of the Inkblot Cards need to be removed. Posting them contaminates this tool, The Rorschach Test. Posting the popular responses further contaminates this test. It is a simple case of scuppering a professional clinical tool and needs to be stopped. – Comment of Edith Meyers who has PhD in Neuroscience and Clinical Psychology.
It has recently been suggested to use the hide template that would hide the word associations, so only those who want to read them would be motivated to click “show”.
As a medical student and Wikipedia administrator, I believe such things happen. It’s impossible to hide that kind of information, but revealing these possible answers can really ruin the test itself. Solution? A hide template with a clear warning for possible patients might be one of them. What do you think?
*This blog post was originally published at ScienceRoll*
August 10th, 2009 by DrRob in Better Health Network, Opinion
1 Comment »
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 10th, 2009 by EvanFalchukJD in Better Health Network, Health Policy
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If you were hoping for a thoughtful discussion on the reform of our health care system, I have bad, bad news.
It turns out that health insurers are “villians.” Public anger over the massive, mostly unread, reform bills is “manufactured,” and anxiety created by the expectation of unknown changes to people’s most valued benefits is the result of disinformation and “fishy” stories.
It’s like an employee benefits roll-out gone horribly awry.
The protests and disastrous town halls look to me just like the kinds of angry protests that happen all the time when employers make important changes to a benefit plan and the employees either don’t understand them or don’t agree.
Blaming the people who don’t follow what you’re doing and why is a big mistake. Sure, there is politics. But health care is a serious, emotional issue, and it should be no surprise that people react badly when they think something to do with it may be taken away.
Dreaming up ideas of how health care ought to work is relatively easy. But figuring out how to implement it is hard, and there are no short cuts. The people who actually run benefits plans – employers, benefits consultants, HR professionals – can tell you: there is no replacement for communication, engagement and respect for opposing views.
The strategy of demonizing those who aren’t on board is a mistake, and is as likely to set back the cause of reform as it is to further inflame an already volatile audience.
*This blog post was originally published at See First Blog*
August 9th, 2009 by Paul Auerbach, M.D. in Better Health Network, Health Tips
1 Comment »
Dr. Jeremy Joslin is a wilderness medicine aficionado and has without question posted the greatest number of intelligent and useful comments to posts at this blog. So, I’m pleased to learn that he has created a very useful iPhone application named TickDoctor.
TickDoctor provides a stunning visual atlas of the most common ticks encountered in North America. Although not yet comprehensive, most common ticks are represented. For each tick species, the user is able to identify males, females, and nymphs. In many instances, there are included images of the engorged female, which often looks very different from its non-fed state.
More than just a beautiful atlas, TickDoctor provides instructions for prevention of tick bites and how to remove them if bites should occur. If a bite has occurred, or if you’re just plain curious, Dr. Joslin has included medically relevant data on each species, describing which diseases have been associated with it.
While this application should never substitute for the advice of a physician, it will help guide you to the identification of the tick in question and provide a framework of reference for dealing with “what to do next.”
I’ve been informed by Jeremy that, “if you have a great photo of a tick and want it considered for the next application update, let me know. You can do this by posting a comment and I’ll follow up with you. We’re always interested in making the atlas better.”
This post, The iPhone TickDoctor, was originally published on
Healthine.com by Paul Auerbach, M.D..
August 9th, 2009 by KerriSparling in Better Health Network, True Stories
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I stood there with my best friend as she rubbed her pregnant belly. The whole waiting room was filled with these lovely women and their round beachball bellies of varying sizes.
And I felt oddly self-conscious with my lack of roundness.
Last Friday was my first official appointment at the Joslin pregnancy clinic. It’s located at Beth Israel in Boston and is a beautiful hospital, different from the Joslin Clinic across the street that feels like home at this point. I’m not pregnant, and we aren’t trying to become pregnant YET, but this appointment puts things into full swing to bring me to a safe level of pre-pregnancy health.
Sigh. This all sounds redundant, even to me. I’ve talked the Big Talk before. “Oooh, look at me! I’m going to really wrangle in my numbers and have an A1C you can bounce a quarter off!” And I’m all gung-ho for a week or two, armed with my little log book and my good intentions, but within a few days, Other Things start to creep in. Like work. And stress. And getting to the gym. And social stuff, like hanging out with my friends and going to RI on weekends. Eventually my good intentions end up in the spin cycle, and my log book starts to gather dust. My workload piles up. And my stress levels skyrocket.
I’m so frustrated because I want to have a career. And I want to have a baby. (I’d also love some tight control of my diabetes, too.) These things would be excellent, but it feels like tightly managing type 1 diabetes is a full time job unto itself. Slacking off is easy, and frustrating, and not healthy for me or any baby I’d like to have.
But I also realize this is one of my biggest hurdles when it comes to pregnancy planning – the whole “sticking with the pre-program.” This becomes more and more obvious to me when I go back and re-read old blog posts where I’m so excited to get back into better control, only to be derailed by those Other Things. So during the course of my appointments on Friday with the endocrinologist, the registered dietician, and the certified diabetes educator, I admitted my faults freely.
“I need help being held accountable.”
They didn’t quite hear me at first. “We can do some tweaking, and in a month or two, we can revisit your A1C and see if it’s lower and then we can give you the green light for pregnancy.”
I knew I needed more than that. I had to be completely honest.
“Guys, I really need to be held accountable. I know this sounds crazy and I seem very compliant, but I have trouble following through. I’m great out of the gate, but I lose steam after a few weeks and I’m at the point where it isn’t good enough anymore. I’m out of excuses. And I’d really like to join the ranks of those pretty pregnant ladies out there. Please help me?”
And they listened. We spent the rest of the day working out a plan for me. One that will actually make a difference. One that will get me there.
I’ll be in Boston every three weeks until I’m pregnant. This is a huge commitment but I need to make diabetes a priority without fail. I want this. I want to succeed at this more than anything else. I’ll have my blood sugars logged for those three weeks and we (my husband and my diabetes team and I) will all review them together. Chris is in charge of my meals, in that he’ll be helping me plan my day, food-wise, and he’ll be counting carbs and measuring things for me. I’ll be eating relatively similar items every day so I can manage the trends and control them. I’ll continue to test all the live long day and wear the pump and the CGM, but I’ll actually use these devices to their fullest potential, instead of just going through the motions.
With these appointments spaced just a few weeks from one another, I hope I can stay tuned in to intense diabetes management for three week stints. Being sent out for three or four months is too much for me. Obviously, because I burn out well before my follow-up appointments. I just plain can’t pay rapt attention for that long. But three weeks? Can I do that?
I have to do that.
I will do that.
*This blog post was originally published at Six Until Me.*
