June 11th, 2009 by Paul Auerbach, M.D. in Better Health Network
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At Beneath the Sea I had the opportunity to walk the show floor and check out some new products intended for divers. One that immediately caught my eye was the Aqua Pencil, which is an innovative underwater pencil designed for divers, kayakers, boaters and researchers who will be underwater or wet. Because of its properties, it can be used when one needs to write in the rain, sleet or snow, such as out in the field or during a rescue. I tested it and it performs as advertised.
The Starter Kit includes an Aqua Pencil, Tether, Lead Pack (writing leads) and Eraser. The tethers are available in different colors, and the pencil is advertised to work well with any slate and to write well on waterproof paper.
According to the company, which is named Xit 404, it was formed to fulfill the need for specialized products and to develop ideas that are overlooked by other companies.
The Aqua Pencil Kit retails for $21.95.
This post, Aqua Pencil, was originally published on
Healthine.com by Paul Auerbach, M.D..
June 10th, 2009 by EvanFalchukJD in Better Health Network
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Did you know that doctors are paid too much, wrongly complain about medical school debt, and falsely believe there is a medical malpractice crisis?
Did you know that doctors are hopelessly conflicted sellers of medical care, motivated by the search for extra income?
Well, then you haven’t read the Washington Post’s Steven Pearlstein’s work on health care reform.
“It’s the doctors, stupid,” he begins his column today. At once, he recycles the tiredest of political phrases and tells his readers exactly what he thinks of them. But it’s not the column that is most telling, it’s the live web discussion that followed. I participated in it, and can share with you the highlights. It’s a revealing insight into the thinking of a mainstream DC columnist.
To save you the trouble, here’s a summary of Pearlstein’s views: Doctors learn a craft that they owe to the rest of us as a public good. But instead of doing this, they take advantage of knowledge to make as much money as they can. They do it willfully – like an insider-trading stock broker – but they also do it because they just aren’t all that competent at what they do.
Think I’m making this up? Read:
On medical school debt:
I think we allow doctors to make too much of their debt. . . In major metropolitan areas, that debt looks pretty small when compared to the lifetime earnings that doctors accumulate in private practice over many years. They more than make up for their investment, as it were. But they use this debt to justify their elevated incomes for the next 30 years — and make no mistake about it, doctors in the U.S. do make ALOT more than docs elsewhere, on average. . . . My suggestion is that we socialize the cost of medical education, that is have the government pay for it, in exchange for a couple of years of community service. That way, we get the community service and we eliminate the No. 1 reason given by docs to justify getting paid more than docs everywhere else.
According to the Bureau of Labor Statistics, a freshly minted family care doctor has a median wage of less than $140,000 a year. According to the AMA, these same doctors have, on average, about $140,000 in educational debt. Thirty years seems about how long it would take to pay off that debt, and you can forget about buying a house, a car, or paying for your own kids’ school under those circumstances. I’m sure many medical students would love the Joel Fleischman plan, but we should do that because maybe it will help more people become doctors, not because we think doctors are exaggerating the impact of debt equal to 100% of your gross pay.
On how our system ought to allocate medical resources:
There is no reason why people can’t travel an hour to a big hospital to have a baby, for example, in a big modern maternity ward that does lots of deliveries and has enough volume to be able to afford all the latest equipment in case something goes wrong. I mean how many times in your life do you have a baby that you can’t drive an hour to have it done, rather than insisting that every community hospital have its own maternity ward. It’s just one example of the inefficiency built into the system by people — that would be you and me — who insist on things that, in the end, don’t have ANY impact on the quality of care. In fact they have negative impact.
I don’t know if Pearlstein has ever had a baby before, but just being an hour away from a hospital is unthinkable for most expectant moms in the weeks prior to delivery. And what is someone to do who lives an hour away and has a complication during the pregnancy? Pearlstein’s prescription seems to be that they should eat cake.
On the freedom of patients to choose their medical care:
The emphasis on being able to choose your own doctor in every instance is another, as if most of us have a clue as to who are the best docs and who aren’t. These are the kinds of irrational things we need to try to work out of the system, because they wind up being very costly.
Yes, for goodness’ sake, let’s get rid of the irrational desire of a sick person to want to pick their own doctor. Even Senator Kennedy’s “American Choices Act” guarantees the right of patients to choose their own doctor. I don’t know where Pearlstein is on the political spectrum with this view, except perhaps a certain territory between China and South Korea.
On how doctors are hopelessly conflicted in giving medical advice by their desire to make money:
But first we need the evidence to show that it isn’t a good idea. Then, once we have the evidence the doc has to follow the protocol and explain to the family why it’s not a good idea and not merely blame the big, bad insurance company for being so heartless–which, by the way, a lot of docs do, so they can look like the good guys. Of course they’d love to do the surgery in many cases because they’d like the business and the extra income, so they are hopelessly conflicted. . . . .
[B]uying medical care is not like buying lawn furniture. . . in medical care you rely to an extraordinary extent on the advice of the doctors (i.e. the sellers). And its also not an area where you are inclined to be very price-sensitive — is anyone going to go the the Wal-Mart of surgeons if they think their life may depend on it. . . . But it is NOT true that a well-informed consumner will always make the right choice about medical options — they still need the advice of doctors, who under the current system have a very noticeable conflict of interest.
I’m actually not sure that Pearlstein has even been inside of a Wal-Mart. Because they consistently have high quality merchandise at the lowest prices. In fact, if more hospitals worked like Wal-Mart the problems that plague our health care system today probably wouldn’t exist.
Responding to a commenter who said that the notion that defensive medicine is a large expense is “totally false:”
Indeed. But doctors don’t believe this, no matter what evidence you present them.
Yes, evidence is like kryptonite to doctors.
I asked Pearlstein if a doctor ran over his dog or something. He didn’t directly respond, simply saying “Maybe you should talk to Atul [Gawande].”
Now that’s the only sensible thing he said.
June 10th, 2009 by admin in Better Health Network
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Have you ever thought about how much protein you are supposed to get each day? The answer to that question is not as black and white as you may think.
The Recommended Dietary Allowance (RDA) for protein is set at 0.8 grams (g) per kilogram (kg) of body weight. In order to figure out your weight in kg, divide your weight in pounds by 2.2. So if you weigh 150 pounds (68.2 kg), you need about 55 grams of protein. You can also use 0.36 grams per pound of body weight if you don’t want to convert to kg.
The RDA is set at a level of what you need to prevent deficiency. But many researchers believe that we actually need more than that for reasons of muscle building and for optimal satiety (to keep us full).
Here are some other recommendations:
Pregnancy/lactation: 1.1 g per kg body weight (0r 0.5 grams per pound). You can use pre-pregnancy weight for the calculation. The point is you need significantly more protein when pregnant. Add 25 grams more per day if you are carrying multiples. This extra protein is especially important in the second half and third trimester. You can also use 0.55 grams per pound body weight to calculate.
Endurance athletes: 1.2-1.4 g per kg body weight (or 0.55-0.65 grams per pound). Endurance athletes often think of carbs, carbs, carbs, and they ignore protein. But you are using your muscles quite a bit and need extra protein to repair them. Endurance athletes would be runners, bikers, long distance swimming, etc.
Strength athletes: 1.6-1.7 g per kg body weight (or 0.73-0.77 grams per pound). Strength athletes are pushing their muscles to the extreme and need more protein to build and repair those muscles. But don’t skimp on carbs because your body will break down protein for energy if you don’t get enough carbs. Strength athletes are people who do a signficant amount of strength training and may lift very heavy weights.
An upper limit of protein has not really been established, but many researchers believe that the body cannot use much more than 1 gram of protein per pound body weight.
This post, How Much Protein Do You Really Need?, was originally published on
Healthine.com by Brian Westphal.
June 10th, 2009 by Medgadget in Better Health Network
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Continuing this week’s streak of medical fashion coverage, we found these custom sonogram cufflinks that are advertised as a perfect present for an expecting father. It would probably be out of taste to present a cardiac patient with cufflinks featuring echocardiography scans of his mitral regurgitation or aortic insufficiency from endocarditis.
Product page: Sonogram Photo Cufflinks
(hat tip: BoingBoing)
*This blog post was originally published at Medgadget*
June 10th, 2009 by AlanDappenMD in Primary Care Wednesdays
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Eight years ago, the Institutes of Medicine published a paper entitled Crossing the Quality Chasm: A New Health System for the 21st Century, which envisioned the future medical practices. Many of the concepts discussed were adopted and endorsed in years to come by the American Academy of Family Practice, The American College of Physicians, the American Medical Association, among others.
The five major innovations of care outlined by this study include:
1. A communication-centered practice model,
2. Information management,
3. Technology replacing office staff,
4. Reduced pricing and transparency in billing, and
5. Removing external conflicts of interest between doctors/providers and patients.
Complete adoption of these innovative concepts can cut at least 30% of primary care costs while significantly improving patients’ quality of care, and further reduce overall health care costs by offering immediate and highly accessible care that avoids emergency room visits, enhances wellness, manages chronic illness and diagnoses disease early. These cost savings and quality improvements are enabled by utilization of advanced communications and information technology that replace much of office overhead and staff, and encourage patients to seek the most cost-effective and convenient care possible. Many medical practices have adopted some of the recommendations, yet less than 1% have transitioned to complete and consistent adoption because they frankly have few financial incentives to do so.
These innovations are the cornerstones of retooling our broken healthcare system, and in turn can pave the way to “fixing” many of the issues plaguing this system. The five cornerstones provide for what so many Americans are clamoring for yet are unable to find: continuous access to a medical provider team thus enhancing patient access, control, and convenience of care; increasing the quality and speed of treatment; reducing the cost of care; creating transparency in pricing; and removing external parties that create conflicts of interest between doctor and patient and often interfere with providing quality and speed of care to patients.
I’ve built my own primary care practice on these five concepts, and while all can significantly lower costs while vastly improving the patient experience, I’d like to take a look at the concept I find to play a pivotal role: a communication-centered practice model.
A Communication-Centered Practice Model
Twenty-first century, day-to-day-primary care starts with the primary care provider being the first in line to answer a patient’s phone call or email. During this call or email, the provider reviews a patient’s history, and bearing in mind that the provider already knows has a professional relationship with the patient, then can make appropriate decisions. At least 55% of the time, the patient’s situation does not require an office visit, however instead involves going straight to the pharmacy for medications, going to labs for tests, getting an x-ray, or recommending a referral. In this model of practice, the doctor spends at least half the time of the time answering phones and emails, thereby providing immediate access and convenience to the patient.
If either the clinician or the patient believes there is a need for an office visit, the visit is arranged immediately. Patients can talk to their medical expert or an on-call member of the medical team 24/7. This instantaneous access can result in patients having most of their day-to-day issues addressed within 10 minutes of reaching the practitioner, and can expect care from their personal provider from home, work or anywhere in the U.S.
As mentioned above, over 50% of medical issues can be addressed by telemedicine, specifically by phone or email, as long as a patient-doctor relationship exists. This results in people being healthier and on the road to recovery much faster, thus not taking time off from work. Office hours are flexible and can be arranged day or night and any day of the week including weekends.
The importance, barriers to adoption, and the unexamined assumptions as to why 97% of all medical care currently occurs in a medical office and nowhere else has been reviewed in several of our prior postings:
Are Face-to-Face Office Visits Really Required to Provide the Highest Quality Care?
In Defense of Remote Access Medical Visits
The Commonplace Tool That Can Revolutionize Health Care
Telemedicine Care: A Malpractice Risk? Au Contraire …
Telemedicine Checks In On Chronic Health Care Problems
In the future, I plan on taking a look at the additional four cornerstones that need to have traction if the Obama administration hopes to restore vitality to the primary care system.
Until next time, I remain yours in primary care,
Alan Dappen, MD
At Beneath the Sea I had the opportunity to walk the show floor and check out some new products intended for divers. One that immediately caught my eye was the Aqua Pencil, which is an innovative underwater pencil designed for divers, kayakers, boaters and researchers who will be underwater or wet. Because of its properties, it can be used when one needs to write in the rain, sleet or snow, such as out in the field or during a rescue. I tested it and it performs as advertised.
