April 9th, 2011 by Happy Hospitalist in Health Tips, Opinion
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After eight years of hospitalist medicine and seeing inaccurate urinalysis results day after day, year after year, I’ve come to the conclusion that the straight cath vs clean catch debate is not a debate. If the urine didn’t come from a straight cath, I have zero faith in the accuracy of the results.
I know, I know. It takes time and effort for a nurse to perform the straight cath. It’s not comfortable for the patient to have a catheter inserted into their urethra. Plus, with bad nursing technique, one could introduce bacteria into the bladder when performing a straight cath urinalysis.
All that aside, if I’m a physician trying to make medical decisions based on accurate data, then having bad urine results that don’t represent the true picture is worse than not having any data at all. For example, here’s a classic case of what I have to deal with day in and day out when trying to make medical decisions on my patients. Below is a snap shot of three UA results obtained from Happy’s ER over two visits. I’m sure it’s the same no matter where you get your care in this country. The first two urinalysis results came from a clean catch sample of a horribly weak 89 year old female who presented with family complaints of “fever and weakness”, both days. Read more »
*This blog post was originally published at The Happy Hospitalist*
March 31st, 2011 by Elaine Schattner, M.D. in Opinion
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The Times ran an intriguing experiment on its Well blog yesterday: a medical problem-solving contest. The challenge, based on the story of a real girl who lives near Philadelphia, drew 1379 posted comments and closed this morning with publication of the answer.
Dr. Lisa Sanders, who moderated the piece, says today that the first submitted correct response came from a California physician; the second came from a Minnesota woman who is not a physician. Evidently she recognized the condition’s manifestations from her experience working with people who have it.
The public contest – and even the concept of using the word “contest” – to solve a real person’s medical condition interests me a lot. This kind of puzzle is, as far as I know, unprecedented apart from the somewhat removed domains of doctors’ journals and on-line platforms intended for physicians, medical school problem-based learning cases, clinical pathological conferences (CPC’s) and fictional TV shows. Read more »
*This blog post was originally published at Medical Lessons*
March 27th, 2011 by AndrewSchorr in Expert Interviews
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If you follow me regularly, you know I enjoy watching the Fox television drama House M.D. on Monday nights (although I often watch the recording later in the week). Doctor Gregory House (Hugh Laurie) is a sorry character but a terrific diagnostician. In almost every episode someone is on the brink of death from an elusive illness when House’s “light bulb” goes on and, in a flash, he saves the patient’s life by proving himself to being the world’s best medical detective.
Doc Hollywood???
Dr. Lisa Sanders is watching 3,000 miles away in New Haven, Connecticut where she teaches first and second year med students at Yale how to learn to be House-type medical detectives – but much more respectful ones. She is like that herself. She’s so good at it she writes a medical column for The New York Times Magazine. That column was actually the inspiration for the television show. And it won Dr. Sanders a job as technical adviser on the medical drama. Read more »
*This blog post was originally published at Andrew's Blog*
February 28th, 2011 by Elaine Schattner, M.D. in Opinion, Research
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There’s a new study out on mammography with important implications for breast cancer screening. The main result is that when radiologists review more mammograms per year, the rate of false positives declines.
The stated purpose of the research*, published in the journal Radiology, was to see how radiologists’ interpretive volume — essentially the number of mammograms read per year — affects their performance in breast cancer screening. The investigators collected data from six registries participating in the NCI’s Breast Cancer Surveillance Consortium, involving 120 radiologists who interpreted 783,965 screening mammograms from 2002 to 2006. So it was a big study, at least in terms of the number of images and outcomes assessed.
First — and before reaching any conclusions — the variance among seasoned radiologists’ everyday experience reading mammograms is striking. From the paper:
…We studied 120 radiologists with a median age of 54 years (range, 37–74 years); most worked full time (75%), had 20 or more years of experience (53%), and had no fellowship training in breast imaging (92%). Time spent in breast imaging varied, with 26% of radiologists working less than 20% and 33% working 80%–100% of their time in breast imaging. Most (61%) interpreted 1000–2999 mammograms annually, with 9% interpreting 5000 or more mammograms.
So they’re looking at a diverse bunch of radiologists reading mammograms, as young as 37 and as old as 74, most with no extra training in the subspecialty. The fraction of work effort spent on breast imaging –presumably mammography, sonos and MRIs — ranged from a quarter of the group (26 percent) who spend less than a fifth of their time on it and a third (33 percent) who spend almost all of their time on breast imaging studies. Read more »
*This blog post was originally published at Medical Lessons*
May 12th, 2010 by AlanDappenMD in Better Health Network, Health Policy, Opinion, Primary Care Wednesdays, True Stories
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A common problem in healthcare is the number of times that small adjustments are needed in a person’s care. Often for these little changes, a physical exam and face-to-face time have nothing to do with good medical decision making.
Yet the patient and doctor are locked in a legacy-industrialized business model that requires the patient to pay a co-pay and waste at least half of their day driving to and from the office, logging time in a waiting room, and then visiting five minutes with their practitioner for the needed medical information or advice.
Today I’d like to visit the case of a patient I’ll call “DD,” who I easily diagnosed with temporal arteritis (TA) through a 15-minute phone call after she’d spent four weeks as the healthcare system fumbled her time with delays and misdirection via several doctors without establishing a firm diagnosis. Read more »
