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Quality Of Life And The Importance Of “Shay Days”

As a medical professional who often treats children with chronic diseases, my patients turn to me not only for treatment advice but often for advice on how to improve their quality of life. I often have difficulty addressing the latter as there is a paucity of research on quality of life outcomes as compared to biomedical outcomes.

However, preliminary data from DR Walker et al. (1) have shown that comprehensive disease management improves quality of life and thereby reduces medical costs for some common chronic illnesses. Recently, a patient shared a story with me that was written by an anonymous author which demonstrates the powerful effect of seemingly small efforts on the quality of life of a disabled child. Read more »

Tech-nitis: New “Overuse Injuries” From Too Much Personal Technology

It’s not surprising to people that I’m a “techy” type of guy. Reading tech stories about the latest gadgets is a nice occasional escape from work. One of the ways that medicine and tech intersect is in some “overuse injuries” that I’ve seen and talked with people about. When the Nintendo Wii first came out, there were many stories of “Wii-itis” and tendonitis-related injuries.

Last week American Medical News interviewed me for a story posted on their site [on September 27th] called “New Personal Technology Creating New Ailments.” The article opens like this:

When Mike Sevilla, MD, sees young patients at his Salem, Ohio, family practice, he often finds them text messaging or listening to music on portable media players. These tech-savvy patients may not realize it, but they could be on the way to developing health problems related to overuse of personal technology. That’s why Dr. Sevilla uses such exam room encounters as a springboard to talk about the potential health impact of today’s tech devices.

“I talk about listening to loud music and being distracted while driving. … I bring up those examples of people who were hurt or killed because they could not disconnect themselves from their cell phone,” he said. Dr. Sevilla and other physicians across the nation are adding questions about cell phone use and computer habits to the office visit at a time when dependence on electronic devices has reached unprecedented levels.

The article goes on to say that the most common physical problems that are seen include problems with vision, elbow, thumb, and wrist. These are due to prolonged use of computers and mobile devices like cell phones and electronic handheld devices. Read more »

*This blog post was originally published at Doctor Anonymous*

The Government’s Involvement In New Primary Care Models

Government healthcare reform efforts are picking up the pace to roll out new reimbursement and practice models for primary care.

Medicare is giving out $10 billion for pilot projects encouraging new models of primary care, including the patient-centered medical home. New Jersey just passed legislation to explore the patient-centered medical home. Now, Massachusetts, the early adopter of mandatory health insurance, is now ambitiously planning how to take on the fee-for-service reimbursement system and moving toward accountable care organizations. Under discussion are the scope of power for state regulators, what rules will apply to accountable care organizations, and how to get rid of the existing fee-for-service system.

Blogger and pediatrician Jay Parkinson, MD, MPH, comments about the “bureaucrats in Washington” that, “they’ve decided for doctors that we’ll get paid for strictly office visits and procedures when, in fact, being a good doctor is much, much more about good communication and solid relationships than the maximum volume of patients you can see in a given day.”

Now, it’s those same bureaucrats who are changing the system, trying to find a model that will accomplish just those goals. (CMS Web site, NJ Today, Boston Globe, KevinMD)

*This blog post was originally published at ACP Internist*

Why Pain Can’t Be A Vital Sign

There’s been a movement afoot for several years now to quantify pain as the so-called “Fifth Vital Sign.” It all started as a well-intentioned effort to raise the level of awareness of inadequate pain control in many patients, but has gotten way out of hand. The problem is that the word “sign” has a specific meaning in medicine that, by definition, cannot be applied to pain.

When you hear us medicos talk about “signs and symptoms” of a disease, it turns out that they are not the same thing. “Symptoms” are things the patient experiences subjectively. “Signs” are things that can be observed objectively by another person.

Headache is a symptom; cough is a sign. Itching is a symptom; scratch marks over a blistery linear rash are a sign. Vertigo, the hallucination of movement, is a symptom; nystagmus, the eye twitching that goes with inner ear abnormalities that can cause vertigo, is a sign. If someone other than the patient can’t see, hear, palpate, percuss, or measure it, it’s a symptom. Anything that can be perceived by someone else is a sign. Read more »

*This blog post was originally published at Musings of a Dinosaur*

The Medical Profession: Is It Devolving?

I had lunch with a group of physicians recently, and along for the ride was a college student thinking of applying to medical school. When talking about the future, I suggested that the work of a physician 30 years from now will be hardly recognizable to today’s physician. Everybody disagreed and the student was confused. There was a lot of denial and myopic rationalization.

But I can’t blame them, really. Most of us see what’s immediately changing in our day-to-day work and the bigger picture gets lost. For most of us, the role of the physician is hard to see for anything other than it always has been. Most live and work as the self-determined independent care coordinator, reactively working to treat disease just as its been done for over a century. But change is happening around us. Read more »

*This blog post was originally published at 33 Charts*

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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