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Showing posts from December, 2009

Take a Nap

Do yourself a favor...get an hour extra sleep tonight.

Regional Variation in Total Knee Replacement

It has been proven than there is tremendous variation in the practice of medicine across the United States. The Dartmouth data (Wennberg et al) has documented the differences in how medical resources are used and how different physicians practice medicine, depending upon where they live. The Dartmouth studies are mainly focused on cost and outcomes and make the case that improved quality is often inversely related to the cost of care. More (expensive) care is not necessarily better care.

Now that I am recovering from a total joint replacement, I am amazed to see the differences in how physicians, doing the same surgery, treat the patient. Total knee replacement (TKA) is one of the most common orthopedic procedures done today. Despite this, the patient cannot expect the same post op care.

I am in contact with a patient in rural Minnesota who had the same surgery 8 days prior to me. Here are some differences in treatment for the same surgery (TKA):

San Francisco - Hospital Stay was 4 …

Abortion Rights and Health Care Bill

Now that the Senate and the House have each approved a health care bill, we can expect the debate to continue into 2010 as they try to merge the language and fight for their different language and approaches to providing coverage and paying for it. "The Republicans vow to make the process as difficult as possible in hopes of stopping the legislation", according to the Washington Post. Nothing will be more contentious than abortion.

The current Senate bill allows any state to bar the use of federal subsidies for insurance plans that cover abortion. Only dollars from private premiums would be used to pay for abortions. This requires the States to divide subsidy money into separate accounts.

Since there is already a 30 year-old-rule that prohibits the use of federal money for elective abortions, I do not see why new language is needed that will hold up the process. Abortion opponents want new health care legislation to prevent women from buying plans that cover abortion, no…

Total Knee Replacement

When I took a hiatus from blogging I had no idea it would have lasted this long. My absence was a planned one...I got a new right knee. After years of watching my activity level decline because of severe osteoarthritis in my knees, I decided to join the millions of other baby boomers and get a total knee replacement. Extreme? Yes! But I believe it will be "life transforming" and there aren't too many times you can have those expectations with a medical decision so I went for it.

So here I am on Day 11 after the surgery. Experiencing life as a patient is a wonderful grounding experience and every day I learn new lessons. Here are a few:
Everyone has a different pain threshold. Doctors should not question or try to imagine some one's pain level. It is what it is!Even when the nurse gives good, clear discharge instructions...the patient will probably not remember any of it. (I have no idea when I am supposed to see the doctor again!)Pain is much worse at night. …

Blog Break

I will be taking a blog break for the next week or so. Please visit EverythingHealth in about a week and in the meantime, click on some of the blogs on the right for great medical reading and some funny ones too.

Women and Hormones

Just when you thought it was there is another article in the NewYorkTimes about the pharmaceutical industry pushing hormones for post menopausal women. It is a long and somewhat "shocking" article about how women have been sold a bill of goods regarding estrogen and progesterone after menopause and Wyeth Pharmaceutical paying multimillion dollar claims for women who took hormones and developed breast cancer.

Let me say...don't believe everything you read. As readers of EverythingHealth know, I am not a shill for big Pharma and have written critiques of their corporate tactics many times. But when it comes to Estrogen replacement it isn't just doctors and Pharma pushing drugs on unsuspecting women.

The link between breast cancer and endometrial cancer and estrogen (ERT) has been open dialog for decades. The pharmaceutical companies have had it listed in their marketing literature and good physicians make it part of the risk/benefit discussion. I have nev…

Who Likes Free Drug Samples?

Most doctors have a closet in their office filled with various pharmaceutical samples. The pharmaceutical industry has had "drug reps" or account reps or pharmaceutical sales staff making the rounds on doctors offices in every city and town across the United States for decades. The industry spent $33.5 billion promoting drugs and sending reps to doctors offices with samples in 2004. That is a lot of samples!

Most of us thought we were doing the right thing for our patients when we accepted drug samples. I was able to give patients a month (or more) free to make sure it worked and that they tolerated it. Other patients had no insurance and I supplied them with all of their medication for free from my sample closet. I had a good relationship with the rep and they kept my office stocked with the medication my patients needed. It seemed like a win-win for everyone.

But new information is coming out that makes me take pause. A 2008 study published in Medical Care said that…

Become a Vegetarian

Healthy diet, healthy body.

hat tip to Shadowfax

Concierge Poll

As of right now (9:21 PST) the EverythingHealth poll on concierge medicine shows:
59% of readers agree with the principle of concierge and would pay the retainer if they could. Twenty-one% think it is "elitist" and unfair and 18% don't have a clue what "concierge medicine" is. For that 18%....please scroll down and read yesterday's post. You can't vote a 2nd time but you can comment here, if you now have an opinion.

Concierge Medicine

A significant percent of people do not know what "concierge medicine" is. Also known as "retainer" practice, concierge is a growing type of medical practice where the patient pays the physician an up front fee (retainer) for services. The fee can range from $100/month to $20,000/year, depending upon the practice and the services offered. The fee usually covers all visits to the doctor, phone calls, more prompt service and email access. Labs, tests, Xrays, referrals to specialists, and hospitalization are not included.

More and more primary care physicians are forgoing the hassle of dealing with insurance companies and Medicare and are becoming concierge doctors. Because of the retainer, physicians can have a smaller practice and be more accessible to patients. The doctors that charge $20,000 a year have only 100 patients and provide "spa" service. (you do the math!) One of my colleagues has a long waiting list!!!

Patients who go to concierge docto…

Survivor Voices

Thanks to KM for alerting EverythingHealth to a great website called Voices of Survivors. The spoken word is a powerful medium and the internet gives us a chance to hear from people we would never encounter in all of our lives.

If you or a friend have a chronic disease or cancer or just need inspiration to face life problems, click away on this site and read how others cope with a raw deal.

Answer to Medical Challenge.

The answer to yesterdays Medical Challenge is
B: Staph impetigo. The patient spread the infection by shaving. He was treated with a topical antibiotic and an oral antibiotic to cover methicillin resistant Staphylococcus aureus. The rash resolved without a problem.

Thanks for your good guesses!

What's the Diagnosis?

This 28 year old young man is generally healthy but has had this rash on his chin for the last week. What is the diagnosis? (answer will be posted tomorrow...make your best guess)

A. Streptococcal impetigo.
B. Staphylococcal impetigo.
C. Candida folliculitis.
D. Acne.
E. Rosacea.
F. Contact dermatitis.

(from consultantlive)

Should Santa Get a Flu Shot?

When you think about occupational hazards, it seems that Santa might be at a big disadvantage during holiday season. He is in constant contact with kids and babies crawling on his lap, whispering close to his face and coughing and sneezing. Santa better have a rock solid immune system or make sure he got both seasonal and H1N1 flu vaccine this year!

I wonder what the rate of illness is for shopping mall Santa?

Healthy Giving

It is always great to find out the New York Times has learned from EverythingHealth. Today's article by Tara Parker Pope on 29 Days of Giving follows my Thanksgiving post. Taking the 29 days of giving pledge does keep you in the conscious giving mode. Give it a try. It's good for your health and immune system.