"When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov
''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.'' -Robert Ehrlich, drug advertising executive.
"Opinions are like sphincters, everyone has one." - Chris Rangel
IBM Medicine: Maybe the day isn't so far away when different medical record software can communicate with one another:
IBM on Monday will unveil software it developed in coordination with U.S. health agencies and private hospitals that makes it easier for health care workers to exchange clinical data in a medical crisis.
The software, developed as a response to the anthrax attacks in Washington and other U.S. cities in 2002, is designed to vacuum up data from a range of conflicting databases while ensuring patient privacy in the event of a flu outbreak or the spread of tainted food. It can also track long-term health problems such as diabetes or detect adverse drug interactions in patients.
IBM will also announce on Monday, that Canada's government has purchased the software to conduct a pilot on an early warning and response system for biological threats in Winnipeg.
The new software, known as Health care Collaborative Network (HCN), is designed for use by local or regional medical communities, IBM said.
It helps public and private health organizations to tap into national electronic networks that can alert them to unusual medical patterns; identify the origin or spread of any problems, and target solutions. posted by Sydney on
2/07/2005 06:58:00 AM
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ABC Television, which has captured big audiences in recent years with reality programs chronicling alterations to people's physical appearance and to their homes, will apply that formula this year to people's health.
The network agreed late last week to place an initial order of six episodes for a program with the working title "Miracle Workers," according to two people who were briefed on the deal but who said being identified by name might scuttle the project. In the program, a team of physicians will scour the country seeking people who urgently need medical care but do not have the wherewithal to obtain it.
.... One person apprised of the deal said that 'Miracle Worker' would involve no games or other competition, but would instead seek to improve the lot of at least one family each episode. For example, the program's 'dream team' of physicians, who will serve as recurring characters, might arrange a heart procedure for one critically ill family member, while also securing psychological care for the person's spouse and children.
Because families will be filmed over the course of several weeks, each episode could include some follow-up scenes.
Because the program's producers intend to bring medical care to the sick, their efforts raise questions about who will be responsible for paying for a procedure and who will be held liable should it fail. Such details, including the contents of waivers that participants may be asked to sign, have yet to be resolved, those close to the program said.
But one person said that the program, while seeking to showcase 'breakthrough medical procedures that people might not know about,' would seek to steer clear of 'life-threatening surgeries.'
Cutting Budgets: The Administration is cutting back on veteran's benefits, which has some people upset:
Veterans groups attacked the proposals. Richard B. Fuller, legislative director of the Paralyzed Veterans of America, said: 'The proposed increase in health spending is not sufficient at a time when the number of patients is increasing and there has been a huge increase in health care costs. It will not cover the need. The enrollment fee is a health care tax, designed to raise revenue and to discourage people from enrolling.'
Mr. Fuller added that the budget would force veterans hospitals and clinics to limit services. 'We are already seeing an increase in waiting lists, even for some Iraq veterans,' he said.
In Michigan, for example, thousands of veterans are on waiting lists for medical services, and some reservists returning from Iraq say they have been unable to obtain the care they were promised. A veterans clinic in Pontiac, Mich., put a limit on new enrollment. Cutbacks at a veterans hospital in Altoona, Pa., are forcing some veterans to seek treatment elsewhere.
One reason there are long waiting lists at some VA centers is that they're being inundated with affluent older veterans who use them as a source of cheap drugs and free healthcare - even though they have generous medical coverage through their employers and Medicare. Going to the VA allows this group of veterans to drive a nicer class of car, take better vacations, and spend more on their kids and grandkids than they could if they relied only on their Medicare and their secondary insurance. In fact, their use of the VA system as a sort of Sam's Club pharmacy is pretty transparent. Most of them go through perfunctory doctor's visits at VA clinics and promptly ignore their advice. They go to their local primary care doctors for their regular check-ups and to their local hospitals when they need hospital care. And most of them were never injured in the line of duty. At least, that's been my experience.
And it's that group who are, rightly, the targets of the budget cuts, which are rather modest:
The president would increase the co-payment for a month's supply of a prescription drug to $15, from the current $7. The administration says the co-payment and the $250 "user fee" would apply mainly to veterans in lower-priority categories, who have higher incomes and do not have service-related disabilities.
Note the Paralyzed Veteran's of America shouldn't be affected, at least if they became paralyzed in the service and not as a civilian on their Harley. posted by Sydney on
2/07/2005 06:21:00 AM
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Saturday, February 05, 2005
When Similes are Too Much: I'm on call this weekend and just had a conversation with another doctor's patient about whether or not I can give him a note to go back to work. I was trying to explain why there was no way I could make that judgement over the telephone. I wasn't getting through, so I told him it was like calling me up to ask me if he was dressed appropriately for work. His answer? "My clothes look OK." Sometimes, you just have to say "No," and hang up. posted by Sydney on
2/05/2005 02:41:00 PM
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Florida's Medicaid is more comprehensive than many private plans. Such generosity comes at a price. For the past six years, Medicaid spending has climbed 13 percent annually and now soaks up about a quarter of the state budget. And the worst is yet to come, with costs expected to rise to 35 percent of state revenue in the next four years. As a result, Governor Bush proposes something innovative: getting his state out of the business of micromanaging Medicaid.
Under his plan, those eligible for Medicaid would qualify for a set, need-based amount of money. With this money, recipients could pick a plan among competing insurance company offerings--from more comprehensive coverage to less comprehensive but at a lower premium, with part of the money saved going to a recipient's flexible spending account for out-of-pocket medical expenses. In addition, the state would offer incentives in the form of better benefits to those who live healthier lives.
The contrast between Florida's approach and that of other states couldn't be starker. At a time when state governments are developing more and more elaborate ways of controlling Medicaid, Jeb Bush envisions Tallahassee doing relatively little. Besides funding, Florida would ensure transparency of the private plans and counsel Medicaid recipients about their choices.
Governor Bush's plan offers a way out, overcoming the federal-state divide. It allows governors to give recipients more choice, yet rein in spending by increasing competition among insurance plans. It's an innovative approach that controls costs, particularly since it involves recipients more in their health decisions. Notes Frogue, 'It's fiscally wise and pro-patient.
The usual approach to cutting Medicaid costs is to cut back on reimbursements to hospitals, doctors, and pharmacies, who then turn around and decline to participate. The result is less access for Medicaid patients. As the article points out, in one study in California, only 2 out 50 orthopedists were willing to see Medicaid patients. posted by Sydney on
2/05/2005 02:03:00 PM
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Friday, February 04, 2005
Suffering the Children: More bad news for anti-depressants. Babies whose mothers took Paxil during pregnancy withdrawl:
Sanz and his team searched the World Health Organization (WHO) database on adverse drug reactions for convulsions and withdrawal symptoms in newborns associated with the use of SSRIs in 72 countries.
Ninety-three cases had been reported by November 2003, which they said suggested a causal relationship.
'Nearly two-thirds of reported cases of suspected SSRI-induced neonatal withdrawal syndrome were associated with paroxetine,' Sanz said.
All of cases reported in the study recovered after a few hours or a day.
Vladislav Ruchkin and Andres Martin, of Yale University School of Medicine in the United States, said the research raises the question of how concerned we should be about exposing the youngest patients to SSRIs.
'It remains to be seen whether ... (the) report ultimately reflects a minor problem for a particular antidepressant, or further evidence of a larger set of serious problems for SSRI use in young people,' they said in a commentary.
In the meantime, they suggested doctors use non-drug therapies and review prescription thresholds, particularly during pregnancy.
EMR Saga: Yesterday was the one week mark of our computerized medical record. It's nearly brought one staff member to tears at times because she's fallen behind on her paperwork, and I've been up past midnight most nights entering patient histories in the summary page for future reference. (Truthfully, that's because I come home for dinner, kid extracurricular events, and sometimes a nap before resuming the job.) But yesterday, everyone seemed to find their rhythm with the process. I was able to see 27 patients and finish on time instead of 22 and running 40 minutes behind. I noticed the pile of paperwork was gone from the stressed-out employee's desk, and I have no pile of paperwork waiting for me on my desk at work. Everyone's prescriptions have been called in or faxed, everyone's cholesterol letters have been sent, everyone's lab results have been filed. The staff still tends to think in terms of paper charts, though. Yesterday I heard the receptionist tell the medical assistant that she could have the chart in just a few minutes because she still had to enter the demographic data. They haven't yet grasped that more than one person can use an electronic chart at the same time. Nevertheless, we've made enormous progress in just one week. posted by Sydney on
2/04/2005 07:42:00 AM
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EMR Saga: Yesterday was the one week mark of our computerized medical record. It's nearly brought one staff member to tears at times because she's fallen behind on her paperwork, and I've been up past midnight most nights entering patient histories in the summary page for future reference. (Truthfully, that's because I come home for dinner, kid extracurricular events, and sometimes a nap before resuming the job.) But yesterday, everyone seemed to find their rhythm with the process. I was able to see 27 patients and finish on time instead of 22 and running 40 minutes behind. I noticed the pile of paperwork was gone from the stressed-out employee's desk, and I have no pile of paperwork waiting for me on my desk at work. Everyone's prescriptions have been called in or faxed, everyone's cholesterol letters have been sent, everyone's lab results have been filed. The staff still tends to think in terms of paper charts, though. Yesterday I heard the receptionist tell the medical assistant that she could have the chart in just a few minutes because she still had to enter the demographic data. They haven't yet grasped that more than one person can use an electronic chart at the same time. Nevertheless, we've made enormous progress in just one week.
UPDATE: Today the system will be put to the test. The Hellboys are coming. They're two brothers of preschool age who wreak havoc in the office every time they come in. No matter where I am, I know when they've arrived. The last time they were in the office they pulled a drawer out of its cabinet, dropped it on the floor and sent all of its contents sprawling. The time before that, they left the water cooler spigot turned on and flooded the waiting room. I've instructed the staff to keep their computers away from the little hellions. They're not even to take them in the same room with them. Maybe we'll have to stick with paper charts just for them. posted by Sydney on
2/04/2005 07:42:00 AM
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The Lawsuit Abuse Reduction Act, which Rep. Lamar Smith, R-Texas, introduced Wednesday, would also require that plaintiffs in civil tort actions could only be permitted to sue in the jurisdiction in which they live or suffer their injury, or where the defendant maintains its principal place of business. Tort reform advocates claim that such a requirement is needed to reduce so-called “forum-shopping.” That occurs when plaintiffs in interstate class actions seek out the most plaintiff-friendly state jurisdictions in which to file their actions.
“This common sense civil justice reform would help solve one of the worst problems small businesses and many others face: frivolous claims,” said Sherman Joyce, president of the American Tort Reform Assn., in a statement released Wednesday morning. “Far too often, the system allows, in effect, legal extortion.”
More on Sex and Intellect: An interesting observation on sex and career choice from a reader:
I have been wondering for some time about women in medicine.
I graduated from med school in 1971 in a class of 120 men and 7 women.
My father-in-law graduated from the same school in 1929 in a class that
had no women. I'm sure that in his day the admissions committee members
would have been quite candid about expressing their opinions that women
were innately unfit to be physicians. In may era, the committee members
would have told you that women were fit to be physicians but they were
likely to be less productive.
By 1975, med school classes were 20-30% women ( by my recollection .)
Now there is parity.I don't remember much external pressure. Do you know how these changes came about? I think the same thing happened in law schools over a similar time frame. Will it really be a surprise if we see it happen in math and engineering? When I was in grade and high school, there were some real smart girls in my arithmatic classes.
Yeah, how did that happen? When I was a teenager in the late 1970's, and I began to dream of going into medicine, my father tried his best to discourage me. I seem to recall him saying, "Who would want to go to a woman doctor?" But, by the time I entered medical school in 1984, women made up almost 50% of medical school classes nationwide. What happened in those years between 1976 and 1984? Well, the women from the medical school classes of 1975 had come into professional maturity. Just by being there they made it possible for other, younger women to realize they, too, could become physicians.
There's no reason a similar phenomenon can't happen in the hard sciences. We've got Dr. Barbie. Will we have mathematician Barbie? (Oh, she's already here!) posted by Sydney on
2/01/2005 10:25:00 PM
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So, How is That EMR Going? Not too bad. Although at this point it does slow down things - a lot. I usually run on time. I pride myself on it. But since going electronic I've been routinely running 30 to 45 minutes late. It's taking a couple of minutes longer to check patients in, a couple of minutes longer to put people in a room, and couple of minutes longer for me to see them. All those couple of minutes add up to 30 to 45 by the time ten to twelve patients have passed through. I'm hoping this will get better as we get used to it. I live in fear of prescriptoin typos, and find that I make more of them the more behind I am.
As for my staff, they're having trouble breaking old habits, and that's slowing things down, too. Instead of checking to see if a patient has a computerized record, they automatically go to the paper charts and start searching if there's an abnormal lab result. They still bring me phone messages written on paper and attached to the paper chart instead of entering the message in the computer chart. In the paper system, when I had to write a letter to a patient, I would type it out on the computer, print it, sign it, and give it to the staff. They would make a copy for the chart and mail off the original to the patient. The computerized record prints and saves the letter to the patient's file. All the staff has to do is put it in an addressed envelope. And yet, this afternoon, I found a copy of an electronic-record-generated letter in the "to-be-filed" folder, waiting to be filed away in the old paper chart. No wonder we're always running behind.
And yet, there are definite advantages. Today, I received some lab results on a patient who is a transplant recipient. The results were not good, and needed immediate attention. This particular patient usually goes to a tertiary care center about an hour from here for her care, so I had no idea whether or not these results were far from her baseline. And as often happens, I couldn't reach the patient during office hours. It was late tonight before I made any contact. Thanks to the EMR, I was able to talk to the transplant fellow on the phone, with her chart and lab results in front of me - from home. But it was nice to be able to pull up the details of her visit last week, too, to accurately fill in the background for the other doctor.
I'm still optimistic that in the long run having computerized records will be better and more efficient than paper records. They certainly take up less storage, at any rate. posted by Sydney on
2/01/2005 10:00:00 PM
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Healthcare Blog Collective: I've been too busy these past couple of weeks to do much blogging, but there's plenty of good stuff at Grand Rounds XIX. posted by Sydney on
2/01/2005 03:03:00 PM
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