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All About Hands: Guidance And Germs

Some interesting items this week involving hands. The one which has gotten much news coverage is the issue of handwashing. Take a look at some of the headlines:

High five! Handwashing on rise (Chicago Sun-Times)

For Many, ‘Washroom’ Seems to Be Just a Name (The New York Times)

93% of women wash their hands vs. 77% of men (USA Today)

All the above are reporting on the same study, but the difference in presentation is amazing to me.

The study doesn’t involve handwashing in a hospital or doctor’s office setting. The JAMA article (2nd reference below) does, but this article focuses on whether public reporting of handwashing compliance is helpful or not. Do we inflate our numbers to make ourselves look better? Read more »

*This blog post was originally published at Suture for a Living*

Primary Care: Has It Been “Oversold?”

Citing a new study by the Dartmouth Atlas, the Wall Street Journal’s health blog provocatively asks: “Has the notion of ‘access’ to primary care been oversold?”

The Dartmouth researchers found “that there is no simple relationship between the supply of physicians and access to primary care.” That is, they found that having a greater supply of primary care physicians in a community doesn’t mean that the community necessarily has better access to primary care. Some areas of the country with fewer primary care physicians per population do better on access than other areas with more primary care physicians.

The researchers also report that the numbers of family physicians is more positively associated with better access than the numbers of internists, although they call the association “not strong.” Although both general internists and family physicians are counted as primary care clinicians, “in [regions] with a higher supply of family physicians, beneficiaries were more likely to have at least one annual primary care visit. In [regions] with a higher supply of general internists, fewer beneficiaries had a primary care visit on average.” Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

To Change Patient Behavior, Change How You Talk To Them

According to Marshall Becker, PhD, MPH, a one-time professor of mine and prime mover behind the Health Belief Model (HBM), four things must be in place for health behavior change to occur. I am paraphrasing here: 

  1. A person has to know that they have a particular health condition.
  2. A person has to believe that having said health condition is bad.
  3. A person must perceive the benefits of behavior change to outweigh the difficulties of behavior change.
  4. There must be a “call to action” to spark the change.

Absent any one of these steps and the likelihood that behavior change will occur is diminished. Read more »

*This blog post was originally published at Mind The Gap*

Less-Invasive Science: Not Always Better Science

One of the disturbing trends I have been observing in physiology is the tendency to move away from many of the gold standard, invasive measurements classically described in the scientific literature to non-invasive measures which may or may not accurately reflect the parameter of interest.

One of these non-invasive measurements (which is not used in any of the manuscripts on my desk) that has become the bane of my existence is to use the saturation of hemoglobin in arterial blood (SPO2) as a surrogate for the partial pressure of arterial blood (PO2). SPO2 is measured with a device called a pulse oximeter.

Pulse oximeter

 Figure 1: A fingertip pulse oximeter. This device indicates that this individuals arterial hemoglobin is 98 percent saturated and his heart rate is 73 beats/min. Read more »

*This blog post was originally published at On Becoming a Domestic and Laboratory Goddess*

Debunking Fake Diseases

Ever heard of adrenal fatigue? Wilson’s temperature syndrome? If not, there’s a good reason: They exist only on the Internet.

The Hormone Foundation, an affiliate of the Endocrine Society, recently issued two fact sheets for patients debunking these so-called conditions, which were “apparently conceived only in an effort to sell products promoted to treat them,” the LA Times reported. No medical evidence supports either faux disease and there are no tests or treatments for them, but patients still try to alleviate them with supplements, some of them potentially dangerous, the Times said.

Adrenal fatigue is characterized by such “symptoms” as having salt and sugar cravings and needing coffee to get you through the day, while the man who discovered Wilson’s temperature syndrome also coincidentally promotes a product to treat it, according to the Times. (Hormone Foundation, LA Times)

*This blog post was originally published at ACP Internist*

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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