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    Thursday, April 07, 2005

    Celebrity Medical Watch: Neil Young is recovering from minimally invasive brain surgery:

    Singer-songwriter Neil Young is out of hospital and expected to make a full recovery after undergoing surgery in New York for a potentially fatal brain aneurysm.

    'He's out of the hospital and recuperating in New York,' the 59-year-old rock legend's agent, Bob Merlis, said on Monday.

    Young underwent what doctors described as 'minimally invasive neuroradiology' last week, after an MRI scan - conducted after Young complained of blurred vision - revealed a dangerous brain aneurysm.


    Scroll down past the "Make an Appointment" section to read about minimally invasive neuroradiology here.

    UPDATE: More here, and with illustrations.
     

    posted by Sydney on 4/07/2005 09:50:00 AM 0 comments

    Of Popes and Things: Woke up this morning to the sound of NPR pontificating about the pontifical succession. There are two points of conventional wisdom often repeated this past week about the election of the new pope which just aren't true.

    The first is that the next Pope has to be a Cardinal. Not true. Any Catholic can be named Pope. That person just has to be approved by the Cardinals. Of course, human nature is such that the Cardinals historically limit themselves to their own. But, an accidental Pope is still possible.

    The other is that the Cardinals will choose a quiet, stodgy insider to give the Papacy a rest after the vitalilty of Pope John Paul II. There's a good chance they will elect a stodgy, boring insider, but who are they kidding about the need for a rest? This Pope lost his vitality years ago when his Parkinson's destroyed his ability to effectively lead the Church. The Vatican has enjoyed complacency for too long. Exactly what it needs is a mover and shaker - someone who isn't afraid to roll up his sleeves and clean house. The American hierarchy, for one, needs some major renovation. And that doesn't mean making superficial in the ritual of the mass, or making the parents who coach CYO basketball take ongoing sex abuse prevention courses. It means bishops need to be accountable for the bad management that made the sex abuse scandals possible. They need to be told by their boss that asking people to pray for them in these difficult times is not enough. They need to take responsibility for their decisions and ask forgiveness. And they need to make it clear that they're willing to fairly investigate abuses of power among the clergy now and in the future. This they have not done.

    Of course, the American Church is just one small part of the Church at large, and although our sex abuse scandal may not be relevant to the world Church, the corruption of absolute power that is its cause is relevant. If Catholicism is to remain vital in the 21st century, the Vatican is going to have to reform its own totalitarian tendencies. Here's hoping the Cardinals choose wisely.
     
    posted by Sydney on 4/07/2005 09:08:00 AM 0 comments

    Wednesday, April 06, 2005

    Reaching Out: In an effort to improve their image, pharmaceutical companies are pooling together to offer prescription drug assitance to the uninsured:

    Abbott Laboratories teamed with other pharmaceutical companies in launching a one-stop shop where uninsured consumers, struggling with prescription drug costs, can access a variety of programs that offer free or discounted medicines.

    The initiative, unveiled Tuesday, comes amid calls for legislative action to allow importation of drugs from countries like Canada, where prices are lower.


    They probably won't be able to stop the re-importation bill, though. It's the middle class who goes to Canada and Mexico for drugs.

    Details of the program are here.
     

    posted by Sydney on 4/06/2005 08:29:00 AM 0 comments

    An Ill Wind: A medical records privacy breach in Cleveland:

    After falling out of a delivery truck, about 3,000 itemized patient statements from Lakewood and Marymount hospitals, part of the Cleveland Clinic Health System, blew high in the wind near East Ninth Street and Superior Avenue.

    The statements, which included patient names, addresses, insurance information, admission and discharge dates, physician names and billing information, were on their way to be stuffed into envelopes, said Angela Calman, a Clinic spokeswoman.


    Wonder if HIPAA makes exceptions for acts of God? And why on earth can't these things be submitted electronically? Or at least stuffed in the envelope at the same place they're printed?
     
    posted by Sydney on 4/06/2005 08:15:00 AM 0 comments

    Carnival of Science: The Tangled Bank, in the spirit of "Dear Journal Editor, It's Me Again."
     
    posted by Sydney on 4/06/2005 08:08:00 AM 0 comments

    Tuesday, April 05, 2005

    You Know You're Working Too Hard: When taking the afternoon off to go to the dentist feels like a vacation.
     

    posted by Sydney on 4/05/2005 09:01:00 PM 0 comments

    When Giants Walked the Earth: Dr. Michael De Bakey sewing a Dacron artery on his wife's sewing machine:

    The years 1953-54 marked a turning point in cardiovascular surgery. Working at home on his wife's sewing machine, Dr. DeBakey constructed the first Dacron artificial artery to replace the damaged segments of artery.

    Somehow, it's hard to imagine that sort of thing happening today.
     
    posted by Sydney on 4/05/2005 02:56:00 PM 0 comments

    Depressive Therapy: Which is the better approach to depression - pills or talk therapy? A recent study says talk therapy is:

    After 16 weeks of treatment, patients in both the medication and cognitive therapy groups showed improvement at about the same rate; however, cognitive therapy patients were less likely to relapse in the two years following the end of treatment. According to the researchers, the return of symptoms might demonstrate that the medication may have blunted the appearance of depression but did not affect underlying disease processes.

    "Medication is often an appropriate treatment, but drugs have drawbacks, such as side effects or a diminished efficacy over time,' DeRubeis said. 'Patients with depression are often overwhelmed by other factors in their life that pills simply cannot solve. In many cases, cognitive therapy succeeds because it teaches the skills that help people cope.'

    The researchers also noted slight differences in the response to treatment between the two testing locations, with cognitive therapy performing better at Penn and medications performing better at Vanderbilt. Researchers surmise that the medication worked so well at the Vanderbilt clinic because more of the patients there were markedly anxious, in addition to being depressed, and the medications used in the research have anti-anxiety properties"


    Or maybe the doctors at Penn were better cognitive therapists.

    The study was a small one, only 240 people, but still larger than most studies on depression and its treatment. (Abstract here).

    It would be nice to see more psychiatrists return to cognitive therapy. Too many these days rely on others to do the talking - pastors, psychologists, etc. , and confine themselves to monitoring the side effects of pills. We've all - doctors and patients - succumbed to the seduction of the promise of a quick and and easy fix from pharmaceuticals when it comes to depression and anxiety.
     
    posted by Sydney on 4/05/2005 08:55:00 AM 0 comments

    Monday, April 04, 2005

    Where I've Been: Sorry for the prolonged and unannounced absence. Wish I could say I was whisked off unexpectedly to exotic ports, but I've been doing drone work. Switching to an electronic medical record has been more time-consuming than expected.

    Sorting through the patients' paper records and summarizing the important points - last pap smear, mammogram, rectal exam, colonoscopy, and other pertinent past history, adds 1-2 hours to my day. And I've just been doing it as patients come in for appointments rather than a wholesale mass conversion.

    But it's the scanning of current information as it's received that's really taking the toll. I have a small, portable scanner that I can carry home with me. As I review the day's labs, x-ray results, and correspondence, I also scan them into the chart. It's a much slower process than my old pre-EMR way, which was to look them over, put aside the abnormals to have the charts pulled by the staff, sign off on the normals and put those in a pile to be filed away later by the staff. The old way was faster for me, but not necessarily better. With the digital chart, I don't have to wait a for the chart to be pulled (This was often not until the next day, since the only time I have to review results is the end of the day after the staff has gone home). I just pull up the chart on the computer and make my decision then and there. And as far as that stack of filing - too often it went undone. It would pile up for a month at a time, despite my constant admonitions. When they finally got around to filing, they would just stick the papers in the chart thinking that when the patient came in for the next appointment the papers could be placed in the correct slot within the chart. But that often didn't get done, either. I would see a patient and discover lab results and letters just loosely adrift within the chart.

    And although it seems like filing would be an easy task, for some reason, very few people can perform it well. When my staff did take the time to actually file the papers, they often put them in the wrong spots. Correspondence would be in the lab results sections, x-rays would be in correspondence, and just about any combination possible. The only time this wasn't the case was when I worked for a staff-model HMO where we had a full-time filer who took pride in doing a good job. That's not a financially feasible option for a solo physician.

    So, I spend another 1 to 2 hours a day scanning things into the chart. I could hire someone, but it's hard to find someone willing to work just 1 to 2 hours a day. What I need is a free-agent professional scanner who works in several offices - kind of like my cleaning service. But, as with cleaning services, the job may not always be done well.

    So, I spend my time in drone mode scanning. But at least my records are well-organized and current.

    UPDATE: Advice on scanning from various readers:

    There are scanning services who do just this (on their premises however). They will do a significantly better job than you can at a very high level of accuracy. This is possible because they have equipment
    and software which is significantly better than what you've got. They charge by the page (typically $1.00-$2.00 per page depending).


    That's a pretty steep price. I can have anywhere from 30 to over 60 pieces of paper come through my office in any given day. Just this past weekend, some 30 of my patients decided to have their blood work done, for example. And that was just blood work. There were also X-rays and consultant letters and emergency room visits and hospital discharge summaries that came in as well. Such is our obsessive need for documentation that there's no end to the paper that comes through a typical doctor's office. I would take the time to quantify it, but knowing the number would probably depress me.

    And this:

    What is most time-consuming part of scanning documents?

    HP makes a series of products called a Digital Sender. (I know that Xerox has similar products)

    These are basically scanners that can scan quickly, send e-mail (with PDF attachments), save scanned files on a file server and, with the correct software, interface with document-management systems so you can enter a case number and the document will be automagically be filed with that case. I know that many law offices use these machines.


    The most time consuming part is the scanning. I have a scanner, made by Brother, that can send email and faxes and can scan multiple pages at a time. It is only partially compatible with Windows XP Pro, however. Everything works except the document feeder. That only works with older versions of Windows.

    The other problem is the set-up of my EMR software. It requires opening the chart of each patient before scanning in the report. The software company does offer a separate module that allows the direct entry of results from particpating diagnostic laboraties, so it must be possible to do this sort of automatic filing. I just don't have that capability.

    In addition, each piece of paper has to be placed in a proper category. It can't just be scanned into one common spot, but has to be categorized as "lab results," "radiology," "correspondence," etc. I'm sure there are subtleties to my software and hardware that I just haven't learned yet, but for now I'll muddle on.
     

    posted by Sydney on 4/04/2005 08:03:00 AM 0 comments

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