October 5th, 2010 by Davis Liu, M.D. in Better Health Network, Health Tips, News, Opinion, Research
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The New York Times recently ran a piece that wondered if doctors were treating patients with cholesterol-lowering medication unnecessarily because a web-based calculator over estimated a person’s risk. The program was proudly sponsored by the pharmaceutical roundtable and was available at the American Heart Association.
The implication was obvious. Simple tool determines an individual’s risk for heart attack or death from heart attack. It over estimates risk. Patients treated unnecessarily. To be also clear, the program did underestimate risk as well.
Unfortunately, the article missed an important point. While the simplified calculator may not be as accurate as the more complex algorithm used by the National Cholesterol Education Program, the truth is doctors are likely to be overtreating patients not because the former program is presented by the pharmaceutical roundtable, but for another reason. Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
October 1st, 2010 by Jennifer Shine Dyer, M.D. in Better Health Network, Health Policy, Health Tips, Research, True Stories
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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 »
October 1st, 2010 by Michael Sevilla, M.D. in Better Health Network, Health Tips, News
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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*
September 30th, 2010 by RyanDuBosar in Better Health Network, Health Policy, News, Opinion
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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*
September 29th, 2010 by Lucy Hornstein, M.D. in Better Health Network, Health Policy, Health Tips, News, Opinion, Quackery Exposed, Research
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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*
