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Showing posts from March, 2012

What is Diabetes?

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Diabetes(diabetes mellitus) is a metabolic disease where there are high levels of sugar (glucose) in a person's blood. Type 1 diabetes is caused by the pancreas not producing enough insulin and Type 2 diabetes occurs when the cells do not respond to insulin to metabolize sugar. Type 2 diabetes is more common, is often genetic,  and there is an epidemic if this type of diabetes occurring because of high obesity rates. Gestational diabetes occurs in pregnant women who do not usually have diabetes. It usually resolves with the birth of the child but must be treated because of potential harm to the fetus from elevated glucose in pregnancy.

 Diabetes affects more than 20 million Americans and is the leading cause of blindness and kidney failure.

 Many people with Type 2 diabetes do not know they have it because it develops slowly over time. Diabetes is easy to diagnose with blood tests.  If a patient has two fasting blood glucose tests over 126, the diagnosis of diabetes is confi…

This is what gastroenteritis looks like

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Good news:  It only lasts a day

Spots on the Scrotum

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The answer to yesterday's Image Challenge was #2 - Fordyce's angiokeratomas.

Like many unusual medical names, the condition was first described by John Addison Fordyce in 1896.
These tiny blood vessels (capillaries) are under the superficial dermis and can be found on both men and women in the scrotum and vulva area.  They are painless and appear in the 2nd and third decade and may continue to appear as the person ages.

Fordyce's angiokeratomas should not be confused with warts, herpes or other conditions.  They are completely benign and require no treatment.

There are a number of chat rooms on-line where men are concerned about these lesions and want them removed by laser.  That can be an expensive and time consuming treatment and there is no guarantee that they will not recur. 

 The best treatment is awareness and acceptance that every body is varied and Fordyce angiokeratoma is just another appearance.

Thanks everyone for your guesses and great diagnostic acumen!

Image Challenge

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What is the diagnosis?  You be the doctor.  This 32 year old man wonders about the raised spots on his testicles.  They are non-tender and non itchy.  (click on the image for a close-up view)
1. Beta-galactosidase deficiency
2. Fordyce's angiokeratomas
3. Radiation dermatitis
4. Scabes
5. Varicocele

The answer will be posted tomorrow so be sure to check back.  Make your guess in the comments section.  The winner gets bragging rights.

Goal Play Leadership Lessons

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My blog friend,  Paul Levy,  former CEO at Beth Israel Deaconess Medical Center in Boston,  was the first hospital CEO to create a blog ("Running a Hospital")  that became famous for it's honesty and look into a hospital's inner workings.  He is now embarking on the next chapter of his life with the publication of his new book," Goal Play - Leadership Lessons from the Soccer Field."   Who knew that being a soccer coach for his daughter's team would provide him with a new platform to use in communicating his wisdom?

Paul has taken his considerable leadership skills and uses his Soccer experience to show us how to communicate, handle adversity and fix problems.  One wouldn't think of soccer coaching and running a hospital as having similar issues, but Mr. Levy skillfully weaves his experiences with both and shows that leadership knows no boundaries.  It is not a book about soccer...it is a book about how to be the best leader we can be by using self …

How Doctors Get Paid

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Medical economics is more confusing than "advanced derivatives" and the entire banking industry collapse.  Have you ever wondered how doctors get paid?  I will try to give a brief tutorial.  Consider it "Doctor Reimbursement 101".

First of all, all payments made by Medicare or Insurance companies are based on a weird rating called the Relative Value Scale.  A group of mainly specialty dominated physicians have been appointed to an "expert panel" called the Relative Value Scale Update Committee (RUC) and they assign value ratings to the work a physician does.  For example, the RUC might proposed that an office visit is worth 2.53 value units while placing a catheter is worth 23.5 units.   Each procedure gets a value rating and through a complicated formula these value ratings are converted to actual money $. 

 This committee meets 3 times a year and their work is secret.  Their recommendations are accepted, rejected or modified by CMS (Medicare).   Only…

Electronic Health Records Don't Cut Costs

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A new study was published in the Journal Health Affairs that reports computerized patient records are unlikely to cut health care costs and might encourage doctors to order more expensive tests.

Save your research dollars, Health Affairs...I could have told you that!

The electronic health record gives doctors information about the patient instantly and helps coordinate care between specialists who are on the same system.   Communication and patient safety are improved.  Some are built to allow the patient access to their test results and to even make on-line appointments with their doctors.  The EHR should create a more accurate record and allow complex data to be aggregated in a way that is understandable.  It should create a more efficient system but it will never lower the cost of health care and here is why.

The technology itself is very very expensive.  The cost to an individual doctor to install and maintain the EHR can be tens of thousands of dollars a year and  large health s…

500 Years of Women in Art

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Beautiful and a reminder of the gift of Women

Spam Comments on EverythingHealth

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Dear Readers,
I am seeing more and more comments on EverythingHealth that are not real but are simply there to drive readers to commercial webpages, advertisers or porn. 

All bloggers love comments and the dialog that goes with social media.  That is why we blog and I never delete controversial comments or criticisms.  Most commenters are respectful and very thoughtful and I learn a lot from my readers.  I read all comments and reply when warranted.

I am going to add a function to the blog where I will approve comments before they are posted.  This will allow me to delete the spams early as they are showing up on my old posts also.  We'll see how this goes!

Please comment on any subject that stirs your interest.

Embezzlement in Doctors Offices

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I just read an article that talked about more medical practices being victims of embezzlement.  In a 2009 survey of members of the Medical Group Management Association (MGMA), 83% of 945 respondents said they had been the victim of employee theft.  I guess this means I can come out of the closet now.  I have always been ashamed that my practice of 5 Internal Medicine doctors was embezzeled by our trusted long-time book keeper.  It made me feel so stupid and I didn't know how prevalent the problem is.

Our medical practice was a small business with about 100-150 patient visits a day.   Each of us ran an individual business with shared overhead and employees.    At that time patients paid small copays of $5-20,  mostly in cash.  We thought we had good record keeping but Medical Practices are actually easy to rob from because doctors have no idea what they are getting paid for a patient visit.  The documented visit charge is seldom paid in full by the insurance company.   Partial pa…