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Showing posts from April, 2008

New Doctors - New Culture

I attended a hospital retreat this weekend and the subject was how do we recruit new physicians into a medical community when they don't want to do private practice medicine? New young doctors want controlled lifestyle, guaranteed salary, benefits and predictability. The type of practice most primary care doctors have is just the opposite. We have no salary eat what you kill (pardon the awful metaphor). Patients don't get sick during predictable hours and there have been many years when I funded my employees IRA but there was no money left over to fund my own. That is just business "crazy" and the young doctors are smart enough to know that.

Today's article in the Wall Street Journal , "As Doctors Get a Life - Strain Shows" addresses this very issue. U.S. medicine is undergoing a cultural revolution that will change how patients receive care. It has already begun, with the emergence of "hospitalists", doctors who only wor…

I Love Health Blogging

I love being a health care blogger. Friends and family and acquaintances ask me why I blog. "Do you get paid to blog" The answer is No. "Is it hard to blog?" The answer is No. "How do people find you?" The answer is "I don't always know". Some people have told me they pass an interesting blog on to friends. I think that is "viral marketing". I have return visitors that bookmark the page or sign up for google alert. Most people find me when they google a certain topic. I am happy to say EverythingHealth is often at the top of the google page on a subject. I am not sure why, but I hope it is because my facts are researched and credible. I don't rant and rave on my blog and I keep it non-political (Although I am a VERY political person with strong opinions).

So why do I blog? I was blessed to receive a fantastic medical education and as a general Internist my medical knowledge is vast. I read constantly and try t…

How to be a Health Advocate for a Loved One

I have been dealing with a personal family illness and it reminded me of a blog I did last year. I went back to review it and realized it is pretty damn good advise. I'm repeating it here for readers who may just now be reading EverythingHealth.

Five Things You Can Do for a Sick Loved One

When a loved one is sick, we often feel totally helpless and caught up in the medical world. If people only knew how important their role as caregiver really is. Credit goes to Elizabeth Cohen, CNN, for these wonderful tips on how to fight for and protect a sick loved one.
Don't be afraid to intervene: If you see something going on that strikes you as wrong, say so. A medication that you've never seen before, a dressing that remains after a doctor said it would be removed, IVs that should be given on a regular schedule. It's OK to push and not accept the first answer.
Ask Questions until you understand the answer: If the doctor says surgery is needed and you don't understand why or …

Dr. Rating - Here to Stay

Once "google" became a noun as well as a verb, the cat was out of the bag in terms of getting information...all kinds of information...on doctors. There are a reported 31 online sites that use different rating systems and allow patients to post comments on service, promptness, kindness of staff and other parameters. There is a glut of venture capital money going into these sites and some are easy to navigate, some are a mess. See my prior post on rate your doctor.

Some doctors are none too happy about the new transparency. They say the rating systems are arbitrary and can be easily manipulated. They say patients don't have a clue about skill, or competence or the things that really make a good physician. One disgruntled patient can unfairly dis a doctor and influence others. Others feel the comments are random and meaningless.

The online rating systems cannot really tell a patient if the doctor is competent. Many brilliant physicians have lousy offices or gruff m…

Basic Genetics Quiz

Genetics and genomes are in the news every day. Genetics is the study of how human characteristics are inherited from one's parents. Since my son is studying genetics now in Science, here is a quiz to test your basic knowledge. The answers will be posted tomorrow. Have fun, and no "googling."

1. Genes are contained in a person's cells. About how many genes are in each human cell?
a. 100
b. 500
c. 5000
d. 25,000

2. What is the chemical that genes are made of that carries the genetic instructions for making living things?

3. Humans have 23 pairs (46 total) of packets of genes in a cell. What are these packets called?

4. When DNA is altered or changes, it is called a m________.

5. The order of nucleotides in DNA that produce specific sequences of amino acids is known as the____________ code.

6. The inherited pre-disposition to getting a medical disease (cancer, heart disease, certain mental illnesses, cystic fibrosis) is called a trait. These diseases can also…

Going Green

The mostEverythingHealth thing we can do is live in a healthy environment. No one says it better than author Michael Pollan. Please take the time to read his amazing article in the New York Times...Why Bother?
I've often wondered if "going green" is just a meaningless fad to make us feel more rightous. Michael Pollan addresses this issue and more. Check it out!

Health Care - No criminals allowed

I just finished reading a fascinating and disturbing book called "Blind Eye" by James B. Stewart. It is the true story of a mass murderer, Dr. Michael Swango, who went from State to State and Country to Country, killing his patients with poison injections. Surprisingly, he finished his medical school and residency training the same years that I did and his ability to evade his professors, teachers, hospital administrators and police was shocking. Even as a skilled sociopathic killer, I was amazed that he would be arrested and suspended from practice and then be able to pick up and go to another hospital and get privileges to work in the hospital as a doctor.

These egregious crimes occurred in the 1980's before implementation of the National Practitioners Data Bank. The NPDB was put into law in 1986 to encourage state licensing boards, hospitals, professional societies and other health care entities to identify and discipline those who engage in unprofessional behavior…

Medicare new "No Pay" Conditions

Medicare/Medicaid covers about 45% of American health care through payment for the disabled and old folks. (I know, I know, "65 is the new 35", but you get Medicare anyway). The rules and payment strategies of Medicare are adopted by the entire industry, and what Medicare pays for and doesn't pay for, eventually is picked up by private insurers too.

Starting in 2008, Medicare has identified 7 conditions that they will not pay for if the patient gets them after they are admitted to a hospital. Some of them make good sense as a push for quality improvement and patient safety. These include blood incompatibility, objects left in after surgery and wrong site surgery. These events are 100% preventable. Others are difficult for even the best caregivers to prevent, like patient falls. Unless you tie a patient into bed (which will definitely affect your "customer satisfaction" scores), a wobbly person, somewhere, sometime, will fall.

Now Medicare has completely l…

Satans Blog

Testosterone and Women's Sexuality

The Annals of Internal Medicine has published results of a randomized trial that studied the effects of testosterone on women's sexual satisfaction. Testosterone is the sex hormone that is present in both women and men. Men have much higher levels (of course) and there has always been speculation that testosterone and sexual desire/satisfaction are linked.

This study administered testosterone spray in three different doses vs. placebo. They surveyed the women on their sexual "well-being" on a weekly basis by self rating.

Guess what they found? Yes, testosterone did increase these women's libido and "sexually satisfying events". But placebo was just as effective.

Score another one for the placebo effect and the fact that the most important sexual organ may just be the mind.

Myths dispelled - Hair

There are so many "old wives tales" and myths in health care, that each week EverythingHealth will pick a subject and give you a quick dose of truth. Today's topic is Hair. Everyone is interested in hair and that makes for lots of hair myths.

1. Split ends can be repaired: When the tips of hairs are damaged and fray, it is called a split end. Once split there is no product that can bond the ends together. Some products smooth the surface but the only way to end a split end is to cut it off.

2. Shampooing makes hair fall out: The hairs that clog the drain are part of the natural cycle of shedding. Some times more hairs fall out but scrubbing with shampoo does not cause it. The lifespan of a hair is 2-4 years and hairs are falling out and regenerating all the time.

3. Brushing is good for your hair. Do 100 strokes/day: The opposite is true. Vigorous brushing can tear and damage hairs and even pull hair out. In the old days when people didn't bathe regularly, b…

Medical Privacy - "just me being nosy"

UCLA is facing a bit of a crisis as it reveals that more than 60 patient's health records had been improperly accessed by an employee that had no right to view those confidential records. Most of these records were celebs (Brittney Spears, Tom Cruise, George Clooney, Farah Fawcett, Maria Shriver) or other high-profile people. The fired employee who snooped says "it was just me being nosy".

All hospitals and doctors follow HIPPA (Health Insurance Portability and Accountability Act) guidelines that should protect patients. They are allowed to share confidential health information only with other care givers that have a "need to know" for the benefit of patient care. But all the regulations and guidelines in the world cannot fully protect privacy. Access to records, whether paper or electronic, cannot be fully secured.

I don't know that more laws are the answer. The electronic health record does have the ability to block from view anyone who is not authori…

Obesity and Baby Boomers - business opportunity

The obesity epidemic in America will create new business opportunities for the innovative businessman or woman if they can just project themselves into the future. The baby boomers are getting older and America is getting fatter. This is a recipe for someone to create new products and services.

The New York Times reports on new ambulance equipment that has been developed to accommodate large patients as they are transported. There are already supersize beds and operating equipment for bariatric surgery.

For some other opportunities one just needs to just look around. Airports are ripe for services. By 2020 millions of traveling aged boomers or obese travelers will need electronic carts to transport them over the blocks of walkways at the airport. Carry on luggage will need to be electric so it can be easily pushed and have features so one can stop, sit and rest on the luggage. Airplane seats will definitely need to be larger and there will need to be special storage for walker…

Paroxetine vs. Placebo for depression

Depression is a serious condition and Paroxetine (Paxil®) has been in my toolbox as one of many treatment choices for over a decade. I've seen patients who are put on SSRI medications like Paroxetine have dramatic improvement in just a few weeks.

Now new evidence has emerged that shows placebo is as good as Paroxetine for treating depression and (of course), placebo has fewer side effects.

We all know that trials favorable to a product are more likely to be published. Investigators in Italy report a large study of 29 published and 11 unpublished randomized trials that included patients with moderate to severe depression. When they compared the patients who received placebo to Paroxetine, they found that it was not better in therapeutic effectiveness. The Paroxetine patients improved on some features but the placebo patients were less suicidal. More patients dropped out of the Paroxetine study because of side effects.

Damn, we physicians hate it when data proves us wrong, but if…

Participate in Torture - Lose your License

The California Senate will be voting on a bill this week that says California regulators would notify physicians in the military that if they participate in torture, they will loose their license to practice medicine and could be prosecuted by the State.

During a Senate committee hearing, there was testimony that cited the International Red Cross, military records and first-person accounts about torture. These reports said physicians, psychologists and nurses licensed by the State of California have participated in torture or its coverup against detainees in U. S. custody.

Dr. Vito Imbascini, state surgeon of the California National Guard testified that "a few Californians were among practitioners in the healing arts involved in torture" at Abu Ghraib prison in Iraq and Guantanamo Bay, Cuba.

President Bush- with an emphatic "We do not torture" - has defended these interrogation practices as lawful.

I have written before on physicians and torture and there is no doubt…

Medical Journal Update

Watch out for elevated triglycerides: Most patients (and physicians) are concerned about their cholesterol but triglycerides get over looked. An excellent study has shown that elevated levels of nonfasting triglycerides were associated with increased risk for death, heart attack and ischemic heart disease in both women and men. The other risks for heart disease and strokes are age, blood pressure, diabetes, smoking , family history in close relatives (mother, father, siblings) and LDL and HDL cholesterol levels. Triglycerides are lipoproteins from fats in the diet. Lower fat, lower triglyceride!
(Journal of the American Medical Association)

Self monitoring of blood glucose in patients with diabetes didn't improve control: This study was a surprise to most clinicians. In patients with type 2 diabetes, treated with pills rather than insulin, there was no benefit to self testing their blood glucose levels. Type 2 diabetes is one of the fastest growing conditions due to world…

Universal Healthcare? Not without Primary Care

I've written about the primary care shortage before so I am happy to see the New York Times feature it today.

In Massachusetts they have mandated insurance coverage for everyone (Universal coverage) but the unintended consequence is that these newly insured people cannot find a doctor. There are not enough primary care doctors available and the ones that practice in clinics and offices are full. Taking on more patients just leaves less time for everyone and makes for harried, rushed medicine.

The article is a must read but here are some highlights for you ADD readers.
With the aging population, we will need 40% more primary care doctors by 2020Presidential candidates on both sides have stressed the importance of primary care but...There are no plans to overhaul an unfair payment system that undervalues primary careThe majority of general practitioners are aging and planning retirement over the next decadePresident Bush has proposed eliminating $48 million in federal support for pri…

Step it Up

I just read about an intriguing small study done in Sweden that worked "backwards" and showed that reduced exercise promoted chronic disorders and premature mortality.

They took healthy non smoker men who took no medication and without any family history of diabetes. These people walked over 3500 steps a day (measured with a pedometer) or did more than 2 hours of exercise a week. In summary, active, healthy people (just like you?).

The study had the subjects reduce their daily steps. They had them ride in elevators instead of stairs and ride in cars instead of walk or bike. They reduced their daily steps to 1500 but they kept their diets the same. That's all they did!

Within three weeks the subjects developed impaired glucose tolerance, increased triglyceride levels and 7% increase in intra abdominal (waist) fat.

Think about it working backward they created serious health risk problems in healthy guys by making them sedentary. It reminds me of the great docu…

Mickey the Wonder Border Collie

Mickey was a rescue dog that we brought into our lives over 14 years ago. Herding was in his DNA and herd he did. Because we never had a flock of sheep, he had to find his own jobs to do. Making sure his flock (us) was safe and rounded up became his passion.

They say Border Collies are the smartest breed of dogs. I believe that. Mickey could open doors, climb trees and understand moods and gestures better than most humans. When young, he was the fastest dog at "dog park" and watching him glide at top speed, herding the other dogs was a joy to behold.

Mickey had more friends than I do. A walk downtown would have strangers saying "Hi, Mickey" and I would wonder about his life and how he knew so many people.

Mickey passed on this week and we are sad, but his spirit and good will remains. All we can do is be good guardians to our pets while they bless us with their love.

Food Tees

I'm too busy to surf the case you are too, here is a neat idea that is fun and promotes healthy eating. They have a lot of cute items at this site. I guess this is my contribution to free advertising (my blog) , capitalism and the American Way. When the going gets tough, we Americans go shopping. Check it out: Food Tees

Nurses as Doctors

The Wall Street Journal wrote today that more than 200 nursing schools will launch a doctorate of nursing program so "Nurse-doctors" will graduate with the "skills equivalent to primary-care physicians."

Whoa there, Kimosabe. By whose standards is a two year program that includes a one-year residency, equivalent to the rigors of four years of medical school followed by three -plus years of internship and residency? How is a voluntary (yes, voluntary) certification exam the same as the multiple and ongoing certification exams that physicians are subject to?

We already have advanced nurse practitioners who work under the supervision of physicians and are able to write prescriptions and practice within specific guidelines. They are valued members of treatment teams and serve a vital role in health care. So what is the purpose of allowing a nurse to use "Doctor" before his/her name? We already have PhD in Nursing along with EdD and DNSc degrees that cover…

Obesity - the last discrimination

The journal Cancer has published a review that found obese, white women are less likely than other women to undergo regular screenings for breast and cervical cancer. Obese women were 10-40% less likely to undergo these screening tests when compared to other women.

We can only speculate why this is so. One theory is that heavier women have emotional barriers such as embarrassment and fear of being weighed. There might also be fat bias from physicians. It is difficult to perform good pap tests on larger women and some Doctors, like others in society, may see obesity as a sign of someone who just doesn't care for their own health.

Obesity and lower economic status also go hand in hand. Perhaps these women are uninsured and have minimal access to screening programs.

Lets be honest, there is definite "fat" discrimination in our society. Despite the fact that obesity is an ever growing problem, it is still seen as a moral or laziness issue. Fat people can be discriminated ag…