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Showing posts from January, 2010

Do Doctor and Hospital Ratings Matter?

The organizations that rate hospitals and doctors have proliferated as the internet has become mainstream over the past 5 years. I'm sure you have seen some of these: U.S. World & News Reports, Consumer Reports Health, Health Grades, Leapfrog, Hospital Compare, Americas Best Doctors and 100 Best Hospitals. My local magazine lists the "top doctors" along with full page paid ads and promos that are very compelling. The questions is, do consumers care? Are these rating agencies really steering people toward top quality in health care?

Each of these agencies and organizations that "rate" have different measurements and criteria for their choices. The top rankings do not necessarily relate to quality outcomes. The Medicare data are two years old. Different treatments and conditions are judged, so a "top" hospital in one area may be a loser in another.

Even the mortality rates for acute myocardial infraction (heart attack) that were in the top 50 …

Get More Sleep to Avoid a Cold

It is always great when medical research supports the common sense that grandma knew decades ago. A study published in the Archives of Internal Medicine show that poor sleep increases our susceptibility to the common cold.

The researchers studied men and women ages 21-55 and monitored their sleep duration and efficiency (amount of time in bed actually sleeping) for 14 days. They then quarantined them and gave them nasal drops of rhinovirus (one of the common cold viruses) and monitored if they got a cold.

What did they find in this elegant experiment?

The subjects who slept 7 hours or less were almost 3X as likely to develop a cold than those with 8 hours or more of sleep. They looked at pre-test virus specific antibody titers, demographics, season of the year, body mass, socioeconomic status, health practices and psychological variables. None of those factor played a role in who caught the virus.

It is also interesting that 83% of the subjects were infected (blood tests showed increa…

EverythingHealth 3rd Anniversary

Thanks to KM for the 3rd Anniversary card for EverythingHealth. I can't believe it has been three years since I became obsessed with this little blog hobby. With readership now approaching 40,000/month I find I just can't stop.

Thank you to all the followers and commenters and readers. Please let me know if there are subjects you would like explored.

Does Hourly Pay Bring Happiness?

New research shows that money makes people happy and if someone is paid by the hour they are even happier. This strange study was done by Jeffrey Pfeffer at the Stanford Graduate School of Business and Sanford DeVoe of the University of Toronto. They studied both British and Americans who were paid hourly vs. salary wages and compared their general happiness. The surveys showed that pay determines the happiness of hourly workers more than it does for people paid a salary.

Pfeffer said that the study showed people who are paid by the hour think differently about money, time and happiness. They think about their income regularly and begin comparing the value of their time to the amount of their happiness.

I find this study rather strange. It was published in the Personality and Social Psychology Bulletin and I haven't read the entire study but there may be other variables that interfered with the conclusion about hourly pay and happiness.

Most low income people are paid by the ho…

Haiti Help

Photo credit to Operation Rainbow, Photographer Mike Lee.

Instead of writing a blog for EverythingHealth today, I am linking readers to the Sutter Helps Haiti blog that I have been writing. The medical volunteers that are on the ground make for interesting writing and reading. The medical issues that victims of the earthquake are facing will change as the days go on.

The initial amputations for crush injuries are about broken bones are being pinned with good orthopedic equipment and skilled surgeons. The problems with infections persist and the aftercare for patients will be prolonged. It takes about 6 months for an amputee to learn to cope and the only prosthetic manufacturer in Haiti was destroyed in the earthquake. Prosthetics and physical therapy will need to be imported.

The fact that many patients have no homes or family to care for them is the biggest issue medics face now. The medics are serving as family and sh…

Medical Relief for Haiti

Photo credit to Operation Rainbow, Photographer Mike Lee

No One knows what the death count in Haiti is. Whenever they start estimating "fifty to a hundred thousand", you know it is just a guess. But the number is huge. Entire schools, office buildings and hotels collapsed, crushing the people inside. Tens of thousands of people were injured and they are flooding the makeshift medical tents and hospitals in surrounding areas.

I staffed a medical site at Katrina. The problems there were fairly routine because the people had simple injuries and were mainly displaced and in shock. Hospitals were functioning in Baton Rouge and we had access to medication and supplies. That is not the case in Haiti.

The initial wave of victims had crush injuries and compound fractures where the bones were split and sticking out through the skin. Without X-ray equipment or orthopedic pins and bolts the only treatment is a makeshift splint or amp…

Why Haiti Disaster is Different

photo credit: Mike Lee with Operation Rainbow, deployed to the border of Haiti and Dominican Republic.

As the coordinator of Haiti Medical Relief for my generous employer, I find myself in contact with numerous organizations that are providing relief in Haiti. Our 15 person surgical team is being deployed today to Port au Prince. The fact that one week after the earthquake, relief is still spotty and millions of people are still without basic food and water is shocking to many of us following the disaster.

Katrina and other hurricanes and earthquakes worldwide were a major crisis...but victims were evacuated and many were able to return home after the crisis ended. In Haiti, the entire city of Port au Prince and surrounding cities were completely leveled. No-one can return home and most of the population is displaced and on the street. The entire government was also leveled with files, data, banks, stores. Many of the government employees are either dead, or seeking out their ow…

Why I am So Over Dr. Oz

The newest media Doc on the block is Dr. Mehmet Oz. When he was first seen on Oprah, he seemed engaging and answered some interesting questions in a real and professional way. The audience loved his blue scrubs and boyish clean cut open style.

That was then.

Let's face it...the media spotlight seems to corrupt even the best physicians. Dr. Oz now has his own show and website and production company. That is a pretty big infrastructure to maintain and we know that the public is fickle. So what does he do?

His "Real-Age" website got 27 million people to sign up and take a health quiz. That information was sold to pharmaceutical companies who used the direct emails for marketing. Real-Age also sends the participants a series of emails about conditions they may (or may not) have and drugs they can use to treat it, based on their answers to the on-line health quiz, sponsored by drug companies of course.

He does pieces on "men's health" and tells men to do mal…

Haiti Interview KCBS

Haiti News - Baby Winnie rescued under rubble

Local residents were trying to dig out the child who was crying under the rubble. She had been buried there for almost three days without any food or water. It was Deiby Celestino, [of the television crew's security detail], who pulled her out of the rubble. He then passed the child to Australian journalist Mike Amor. [...]

Winnie’s uncle, Frantz Tilin, arrived to find her after losing his own pregnant wife in the earthquake. Workers with Save the Children fed Winnie and gave her fresh water to drink. The charity’s doctors said she was dehydrated, but expected her to make a full recovery.

Haiti Disaster

I am so frustrated about the disaster in Haiti and have been actively engaged in relief efforts for the past 60 hours. I have been asked to lead the efforts for helping Haiti for my employer, a large hospital provider of health care in Northern California. I am proud to say that within the first 72 hours, Sutter Health has committed $1 million to Doctors with-out Borders and $250K to MedShare to get needed medical supplies to Haiti. Both organizations are on the ground providing this help right now and we chose them as partners because they can get the job done.

Getting needed professional help to Haiti is another story. The outpouring of volunteers wanting to help is huge. Our employees and doctors, nurses, engineers and computer experts are ready and willing to volunteer. But at this time the destroyed infrastructure makes sending this needed help impossible.

I know from my experience on the ground at Katrina that volunteers cannot just "show up". Volunteers need foo…

Medical Blog Awards

Head on over to Medgadget to see the nominees and categories for Best Medical Blog Awards. I am happy to report that EverythingHealth has been nominated. I don't know how the winner is picked but if you scroll down on the site you can "nominate here" and maybe it is done by the most comments posted. The competition is stiff but it would be cool to win. All the of various nominees are great and it is a good way to find other blogs.

Thanks readers!

Ostraceous Psoriasis

The answer to yesterdays Medical Challenge is #3: Ostraceous psoriasis. That was a stumper, but some of you got it. Of course, the dermatologist knew!

Psoriasis can present with many different appearances. It is a common, recurrent immune mediated disease of the skin and joints. It is found worldwide and has a strong genetic component. The scaling papules and plaques are circular with grey or silvery-white appearance. They usually appear on the scalp, elbows, knees,lumbosacral area and in body folds. The term Ostraceous psoriasis refers to the thickened plaques that have concave centers similar in shape to oyster shells.

Psoriasis is not contagious.

Todays Medical Challenge

I like to gross out the readers of EverythingHealth and today's medical challenge should do just that. In the interest of full disclosure...this is the first diagnosis I have personally missed in this challenge series from NEJM.

What is your diagnosis?
1. Lichen planus
2. Mycosis fungoides
3. Ostraceous psoriasis
4. Paraneoplastic phemphigoid
5, Staph scalded skin syndrome

Make your diagnosis (click the image for a better view) and the answer will be posted tomorrow.

Atul Gawande's Checklist

Dr. AtulGawande is one of the best physician writers of this decade. A Cancer Surgeon at Harvard Medical School, he also writes for The New Yorker and has written two best selling books, Complications and Better. Now he is on the speaking tour for his new book, The Checklist Manifesto: How to Get Things Right, and I heard him speak last night. This guy is a great speaker and he makes his case clearly and with anecdotal stories that bring it home to the listener.

Gawande knows that medicine has become so complex that there are thousands of tiny steps and decisions that come together to create a good patient outcome. There are also a thousand ways things can go wrong.

I think of the knee surgery I just had. If one nurse or physical therapist didn't wash their hands before they touched me, I could have gotten an infection that would destroy the surgery. If I didn't get my intraop antibiotic before the incision, that is another way to get infected. If the anticoagulant wasn…

Preventive Services for Medicare

Medicare policies are followed by most private insurance companies. Medicare sets the standard in what is covered and in payment rates. Currently, preventive health services are not adequately covered. Currently, some tests and treatments that are not proven to improve health ARE covered. Health Care Reform is our chance to put policies in place that will invest in preventive care that works to improve quality of life and eliminate things that do not work.

The Center for Medicare Services (CMS) authorizes 14 services that are given an "A" or "B" rating by the US Preventive Services Task Force (USPSTF). (This was the impartial task force that created the bruhaha about eliminating screening mammograms for women age 40last month.) These screenings include: high blood pressure, mammogram, pap tests, colon cancer screen, lipid testing, osteoporosis testing and diabetes screening if at risk.

Medicare will pay for a colonoscopy or cholesterol test or mammogram. Th…

Check Out Grand Rounds

Grand Rounds, the best of the Medical blogosphere is hosted this week by Dr.Rich.
Check it out for great reads. EverythingHealth was mentioned twice!!!

What No One Tells You About Fertility

I can't tell you the number of times women in their mid 40's come to me and announce "Well, I'm ready to get pregnant". Putting off pregnancy is understandable in our times. Women are building their careers, moving and traveling, going through a series of "Mr. Wrongs" and looking for the best baby-daddy. Women have thought that fertility was a given and they could get pregnant when the time was right. But, sadly, what they haven't been told is the cruel trick of nature. Fertility doctors know...after age 29 your chance of having a baby without medical treatment is diminishing every year. After age 40 there is a precipitous drop.

To bring that fact home, check this out. A woman age 19-26 has a 50% chance of getting pregnant during any one menstrual cycle if she has intercourse two days prior to ovulation. For women age 27-34 the chance was 40% and after age 35 it drops to 30%. And at 40 you are only 1/2 as fertile as you were at 35. That is …


The answer to yesterdays Medical Challenge guess it...frostbite. Frostbite occurs when tissue is exposed to temperatures below the freezing point of skin. It can happen to anyone, even those acclimated to cold climate. As the body gets colder and colder the blood vessels in the extremities constrict to send more blood to vital organs. That is why fingers, toes, noses and ears are so susceptible to frostbite. Deep frostbite causes swelling and blood-filled blisters. Clear blisters with intact sensation have a better prognosis than blisters with dark fluid.

The amount of final tissue destruction is proportional to the time it remains frozen. Rapid transport to a hospital is important for supervised warming. A water bath heated to 104-107.6F is best for rapid thawing. This can be very painful and dehydration is possible so IV fluids may be needed to treat hypothermia.

It's cold out there so bundle up, wear hats, gloves and heavy socks.

Medical Challenge 2010

The photos are of three different teenagers who live in Minnesota. Can you make the diagnosis? The diagnosis is the same in all three. Hint: Minnesota.
Answer will be posted tomorrow.

Obesity Body Scan

This body scan shows the fat distribution of a 250 lb woman vs. a 120 lb woman. Notice that the internal fat that can't be seen with the eye is quite different. There is fat around the heart and though out the abdomen. The liver (upper right side of abdomen) is enlarged with fat. This is called "fatty liver" and can cause liver failure. The bones and joints of the legs are showing the effects of the extra weight.

Obesity is a significant medical condition. We know that fad diets do not work. Quick weight loss schemes are ineffective at keeping weight off. Bariatric surgery is one of the fastest growing elective surgeries in the U.S. This person could lose significant weight if she restricted all white, processed foods including sugar.

This photo says it all.

Mayo Clinic Won't Take Medicare

Medicare, the government insurance company for everyone over age 65 (and for the disabled) pays fees to primary care physicians that guarantee bankruptcy. Additionally, 70% of hospitals in the United States lose money on Medicare patients. That's right...for every patient over age 65, it costs the hospital more to deliver care than the government reimburses. That is why Mayo Clinic has said it will not accept Medicare payments for primary care physician visits. Mayo gets it. Nationwide, physicians are paid 20% less from Medicare than from private payers. If you are not paid a sustainable amount, you can't make it up in volume. It just doesn't pencil out.

Mayo lost $840 million last year on Medicare. Since Mayo is considered a national model for efficient health care, if they are losing money it doesn't bode well for the rest of us who are much less efficient and who have fewer resources for integrated patient care. Instead of Medicare payments for clinic vis…

It's Post Secret Day Again

Post Secret is a website where people send in postcards of their secrets. It changes every Sunday. This week is especially poignant. Check it out.

Medical Recap of 2009

With over 670,000 published medical studies each year, doctors and patients have information overload. That's where EverythingHealth comes in. We keep up with the you don't have to read thousands of medical journals. It is as important to know what doesn't work, as it is to know what does. Save your money and save your body from unnecessary surgery. From 2009, here are a few bits of info you might find interesting:
Ginkgo Biloba- doesn't improve memory or cognitive function. A very well done study, published in JAMA, finally puts this supplement to rest. The herb is ineffective in slowing down decline in thinking associated with aging.Vertebroplasty for fractures-doesn't work better than placebo. Painful vertebral fractures of the spine have been treated with injecting a "cement" into the fracture site. Two studies this year (NEJM, Spine) showed no benefit from the procedure.TENS Unit for Back Pain-isn't worthwhile. The American Acad…

Welcome 2010

John Lennon

Imagine there's no heaven
It's easy if you try
No hell below us
Above us only sky
Imagine all the people
Living for today...

Imagine there's no countries
It isn't hard to do
Nothing to kill or die for
And no religion too
Imagine all the people
Living life in peace...

You may say I'm a dreamer
But I'm not the only one
I hope someday you'll join us
And the world will be as one

Imagine no possessions
I wonder if you can
No need for greed or hunger
A brotherhood of man
Imagine all the people
Sharing all the world...

You may say I'm a dreamer
But I'm not the only one
I hope someday you'll join us
And the world will be as oneHappy New Year, 2010