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4461. The patient-physician relationship is in critical condition

. The cost of running a small practice is not feasible for many now due to ever-changing regulations, electronic medical record requirements and lower reimbursement for services. There are certainly benefits to larger health care organizations, such as more collaboration opportunities and convenience-of-care coordination for patients. However, physicians must continue to do what is right medically and lead rather than follow when it comes to delivering health care. Despite shifting practice demographics (...) , the larger problem we face collectively is a lack of unity. All too often, we are competing rather than collaborating. The turf battles between specialists and protecting our territory hurt physicians. Yet, we fall in line with regulations imposed on all of us which we know are illogical. We have become customer service specialists, held to the most stringent patient satisfaction expectations, even when doing the right thing medically opposes this. For example, if prescribing an opioid is clearly

2018 KevinMD blog

4462. Unintended consequences of health policies – heeding HL Mencken and Gary Klein

; there is always a well-known solution to every human problem—neat, plausible, and wrong.” ( When policy wonks and legislators and rule makers seek to solve problems in medicine they seemingly forget this admonition. Here are 3 examples of poorly considered solutions: Electronic health records – in the abstract this seems like an obvious idea. But the problem they address is very complex and we had to adopt them before they were really ready to make practice (...) . Myriad rules restricting physician prescribed opioids. My colleague Stephan Kertesz (and his national associates) have written extensively on this topic. Here is one example article – How does one avoid these problems? I have written previously about Gary Klein’s pre-mortem exam process. The concept is rather straightforward. Before one starts a project (and each of the examples I cite are actually projects meant to improve health), you bring in front line people (in health, physicians, nurses

2018 db's Medical Rants blog

4463. Doctors overcorrect too often

mg of warfarin. The doctor orders 7.5 mg daily without seeing that two months ago when the patient was given that dose, the INR shot up to 3.9. Even electronic medical records sometimes display the current value (and/or the place to order and “sign off” on it) in a whole different area from where we see historical values and dosing (Any reference to Greenway or eClinicalWorks here is purely coincidental). This causes a risk for overcorrection very much like my winter driving example. The same (...) been incidents of high potassium, causing physician worry and subsequent emergency prescriptions for the diarrhea-causing rescue medication. Looking back and forth in time, I realized that the patient’s kidney numbers had fluctuated in the same range two years before and two years after the stopping of the fluid pill. I restarted it and didn’t expect to have to fuss with high potassiums again. I believe this was another case of myopic laboratory analysis. Some amount of testing is necessary

2018 KevinMD blog

4464. The Painful EHR Transition

The Painful EHR Transition The Painful EHR Transition | The Skeptical Cardiologist Primary Menu Search for: The Painful EHR Transition For the past 6 weeks I and the several hundred other ambulatory physicians who belong to the St. Luke’s Medical Group have been going through a difficult transition; we’ve changed the software that we use to manage patient information. Seven years ago we made the painful transition from paper patient charts to an electronic health record (EHR) called eClinical (...) Works. This process required lots of scanning but by 2015 when i wrote “ ” I had become very facile and comfortable with the software. During this current transition to an EHR called Cerner, we had to drastically reduce the number of patients seen per day in the office as we learned how to streamline workflow and as bugs were worked out of the system. We have struggled mightily with the simplest of tasks such as renewing patient prescriptions, scheduling tests, or reviewing test results. Stress

2018 The Skeptical Cardiologist

4465. For mild hypertension in low-risk adults, harms of drug therapy outweigh benefits

. A recently published in JAMA Internal Medicine sought to clarify the benefits and harms of drug therapy in low-risk adults with mild hypertension using data from 40,000 patients in an electronic health records database in the United Kingdom. The authors compared the outcomes of persons aged 18 to 74 with mild hypertension who were prescribed anti-hypertensive medications within 12 months of diagnosis to those in similar untreated persons. Persons with a history of CVD, left ventricular hypertrophy

2018 The AFP Community Blog

4466. We need to make better use of the health team and technology

can do Perhaps there is something in the patient-centered medical home that can help move these things forward. Maybe it would help if a patient’s visit to the doctor’s office actually began before they arrive, with the electronic health record reminding them of health care maintenance items that need attention, testing they are due for, and then a way to think in advance about any prescriptions they need, any referrals they need, any forms that need to be filled out, and then a way to list out (...) in the electronic health record portal, wearable devices that nudge you to do what’s right, beeps and whistles on your cellphone, even financial penalties or rewards, seemed to do little to move our patients away from unhealthy behaviors towards what we think are the best things for their health. Doing the right thing now for the reward of health many decades in the future, is clearly a barrier built into our human nature, and one which we as a health care team are challenged to try to overcome. What the team

2018 KevinMD blog

4467. A conversation with a Rigvir flack

existing registration, but unfortunately your analysis is used to doubt the registration. Which is off course strange, because nowhere in the world rules and regulations (in our case standards for clinical trials) are used with backward date. Yes for new registrations - we know the rules – we will provide proper RCT data, but as for now, please respect that the medicine is prescription medicine that is prescribed only in national clinics and by certified doctors for last 13 years. They have (...) trials and most of the evidences is not published. Doctors and clinics in Latvia use this medicine for majority of melanoma patients in Latvia for many years. In Latvia medicine is prescribed only in national clinics and by certified doctors and they have also other alternatives, so probably they know what they do. 2 years ago we started EMA (centralised EU) commercialisation process and even obtained EU commission support from Horizon2020 grant, we also obtained EMA regulatory advice

2017 Respectful Insolence

4468. We have to deal with the trauma in veterans early on

elsewhere. They got admitted, I took the best care of them that circumstances would allow for whatever I thought they needed. In the community hospitals and in the office, I shared patients with the VA. And people came by who just happened to have been in the army as young adults but were pretty mainstream after that, going to college, joining a union or seeking jobs as they became available. As prescriptions became more expensive, the VA would often supply medicines to veterans like my father who saw (...) the doctor or nurse practitioner as a precondition for having the prescription supplied but regarded physicians external to the VA as their doctors. With systems, particularly governmental ones, process often becomes excessive. This being an important medical center initiative, the VA’s physician representative for this project presented our academic year’s first grand rounds. He extensively outlined process. Every patient admitted to the hospital would have a complete military history, where they served

2018 KevinMD blog

4469. Why physicians should embrace fitness trackers

Why physicians should embrace fitness trackers Why physicians should embrace fitness trackers Why physicians should embrace fitness trackers | | October 18, 2018 10 Shares I mused while staring blankly towards the electronic tracking board, where I foresee reading the triage call “My tracker said, I have AFib.” I delved into what is in my armamentarium to handle this crisis of the digital age. The stethoscope around my neck suddenly seemed archaic. We the physicians have resigned (...) to the redundant clicks on the electronic medical records (EMR). While still recovering from this inescapable occupational hazard of the new digital documentation, a technological surge of broadband-enabled technology has inundated us. These have surfaced as ingestible, wearable and embeddable based on the route of placement. Are, we physicians, labeling the data provided by them as patient health information (PHI)? The consumer benefits from the tracking devices in making healthy lifestyle changes and goal

2018 KevinMD blog

4470. EHRs are killing medical innovation

against diseases and optimized preventive, medical, surgical and palliative care outcomes. The gift of giving clinicians time to gaze, dream and work together to apply the art and sciences of medicine towards the advancement of health care innovation has been stolen by electronic health records (EHR) and insurance company prior authorization (PA) rationing industries. When EHRs were first introduced, health information technology seemed like a sound idea. Patient personal medical health information (...) and clinical experience to optimize preventive, medical, surgical and palliative outcomes and costs for their patients and their families. Physicians perform histories and physical examinations often resulting in prescriptions for medications, diagnostic orders, specialist referrals or recommended treatments to optimize prevention, medical, surgical and palliative outcomes for patients and their families. This science of the physician-patient interaction combined with the art of empathy is the essence

2018 KevinMD blog

4471. What is the perfect fee-for-service system?

of the treatments patients receive) accounts for 50 percent of the spending increase, followed by the increase in the size of the U.S. population (23.1 percent), and the aging of the population (11.6 percent). “Changes in service utilization were not associated with a statistically significant change in spending.” The takeaway from this study is that to lower U.S. health care expenditures, we must combat out-of-control pricing for prescription medications, medical testing, and hospital stays, and, dare I say (...) on today’s clunky electronic medical record systems to collect such data, further shifts a doctor’s focus towards compliance and away from patient care. The result is rampant burnout in the medical community, not better care. The first step towards better care in the U.S. is the removal of the excessive administrative burdens created by the U.S. government (E&M payment coding, HIPAA, MACRA, etc.), and insurance companies (prior authorizations, excessive denials). The next step is to develop usable

2018 KevinMD blog

4473. Doctors: Don’t forget to take care of yourselves

record, we oftentimes look at some action that we’re ordering for them and say, “Hey, don’t I need to do that?” When was the last time that you, a health care provider who knows best, saw your own primary care provider? Are you prescribing medicines for yourself, or having one of your partners send in prescriptions for you? Ordering your own labs, and reviewing them yourself? I guess all I really want to say is, to take care of everyone else we do need to take care of ourselves, especially as we try (...) , heal thyself” and William Osler’s quote, “The doctor who treats himself has a fool for a patient,” you probably have a recipe for disaster, or at least poor care. I can imagine that as each of us sits with our patients and struggles with them to get their health care maintenance items “up-to-date”, while we are simultaneously managing their acute and chronic medical conditions, trying to deal with our daily administrative and regulatory requirements, and navigating the lumbering electronic health

2018 KevinMD blog

4474. Should You Take An Antioxidant (Supplement or Vitamin) To Prevent Or Treat Heart Disease

in the 1950s suggested that excess free radicals generated by oxidative processes could be responsible for the chronic degenerative diseases of aging. Oxygen, which is essential to animal life, undergoes processing in cells which creates unstable free radicals. Free radicals are short an electron and seek other molecules which can donate an electron and make them more stable. This process is termed oxidation. The molecules produced by oxidation play an important role in a a number of biological processes (...) such as the killing of bacteria and in cell signaling. These same unstable molecules, however, have been implicated in a number of deleterious processes as they can participate in unwanted side reactions and create cell damage. Thus, too many free radicals have been implicated as potentially causal in diseases ranging from cancer to cardiovascular disease to dementia. Antioxidants can reduce damage from free radical reactions because they can donate electrons to neutralize free radicals or their offspring without

2018 The Skeptical Cardiologist

4475. I didn’t become a physician to do data entry

I didn’t become a physician to do data entry I didn't become a physician to do data entry I didn’t become a physician to do data entry | | August 18, 2018 6K Shares The trouble began when I needed to open the electronic health record (EHR) system for the tenth time that day. EHRs have significantly changed the way we practice medicine. They have completely eliminated the need for storage and transport of paper charts, reduced prescription errors secondary to illegible handwritings of physicians (...) clinical information without having bloated notes and cluttered screens that are catered for easy billing and coding. Clinicians together with hospital administrators and information technology professionals should be actively involved in the development, testing and optimization of new electronic features to streamline the workflow. For me, there will be no joy in the practice of medicine until my frustrating rendezvous with EHRs end. The names used in essay have been modified to maintain anonymity

2018 KevinMD blog

4476. Acceptance and Commitment Therapy for Prevention of Chronic Pain and Opioid Abuse

on developing pragmatic and innovative ways to improve the mental health and functioning of patients suffering from psychiatric and chronic medical conditions. In addition to developing 1-day interventions, she also examines the use of electronic technology to assess various psychiatric measures and to deliver treatment (e.g. Aburizk et al. 2013; Turvey et al., 2012). References Wylde V, Hewlett S, Learmonth ID, Dieppe P. Persistent pain after joint replacement: prevalence, sensory qualities (...) , Sydney Subscribe! All blog posts should be attributed to their author, not to BodyInMind. That is, BodyInMind wants authors to say what they really think, not what they think BodyInMind thinks they should think. Think about that! We aim to facilitate and disseminate good clinical science research. We love comments that engage with the research and are constructive and respectful. We do not prescribe treatments. Promotion of your particular therapy in the comments section is not appropriate here

2018 Body in Mind blog

4477. Life as a doctor is selfless and selfish at the same time

benzodiazepines if they were alcoholics and added or subtracted tubes and lines as needed. Eager for a post-rounds lull, I sank into a chair in the cardiac care unit and opened my email. Because I was still around, a nurse asked me to renew some orders for electronic housekeeping. Then the pager rang with a consult, and my lull was over. The consult was for Roy, an elderly gentleman with a history of a recent valve replacement who needed to be on anticoagulation. He was being followed regularly at his (...) Coumadin clinic, where his INR was checked biweekly and blood thinner dose adjusted appropriately. According to the primary team, the lab called his cell phone and instructed him to come to the hospital immediately for an INR level of 17. On questioning him, they found that he had been taking twice the prescribed dose of Coumadin. I went to the patient’s room to do a full history and physical exam. Roy was a 78-year-old gentleman with scraggly hair and pockmarked skin. He was probably five-foot-seven

2018 KevinMD blog

4478. Cognitive Biases and Young People’s Pain Experiences: What do we know and where to go next?

, Miranda A, Nurko S, Hyman P, Cocjin J, Di Lorenzo C, Saps M. Accuracy of pain recall in children. Journal of Pediatric Gastroenterology and Nutrition 55: 288-291, 2012. [10] Stinson JN, Jibb LA, Lalloo C, Feldman BM, McGrath PJ, Petroz GC, Streiner D, Dupuis A, Gill N, Stevens BJ. Comparison of average weekly pain using recalled paper and momentary assessment electronic diary reports in children with arthritis. The Clinical Journal of Pain 30: 1044-1050, 2014. [11] Boyer MC, Compas BE, Stanger C (...) Digital Strategy, Sydney Subscribe! All blog posts should be attributed to their author, not to BodyInMind. That is, BodyInMind wants authors to say what they really think, not what they think BodyInMind thinks they should think. Think about that! We aim to facilitate and disseminate good clinical science research. We love comments that engage with the research and are constructive and respectful. We do not prescribe treatments. Promotion of your particular therapy in the comments section

2018 Body in Mind blog

4479. A better way to follow-up your office visit is needed

for compliance with medication, send a prescription to their pharmacy with five refills — and then when they come in later for a blood pressure check, and it’s still high, they tell us they took the first bottle but then figured that’s all they needed to do to cure their hypertension. It’s clear that patients are often overwhelmed with all the things we tell them, all the tasks we assign them, all the referrals we make, all the medicines we prescribe, all the lab tests they undergo. So it’s no surprise (...) boxes in the electronic health record, to filling out forms, to getting prior authorization for medicines, to dealing with insurance companies and pharmacies, the one-to-one communication between the doctor and the patient is often lost, those precious opportunities to really sit and talk and counsel. Only by building a system that allows us to do that will we really be able to get back to doing the doctoring we want to do. We’ve tried printing out after-visit summaries which have detailed

2018 KevinMD blog

4480. Why blockchain technology might replace today’s EHRs

about today’s EHRs, alongside a variety of ways to address the problems they create. One solution may lie in blockchain, the technology currently powering the cryptocurrency Bitcoin. First, what’s to love about EHRs? Information is power. Electronic health records give doctors (somewhat) fast, reliable and secure access to patient medical histories, prescription records and past test results. With this data, several integrated, multi-specialty medical groups like Mayo Clinic, Intermountain (...) Why blockchain technology might replace today’s EHRs Why blockchain technology might replace today's EHRs Why blockchain technology might replace today’s EHRs | | April 24, 2018 19 Shares Physicians have a love-hate relationship with the electronic health record (EHR). On the one hand, doctors know they can’t provide the best possible medical care without them. And on the other, today’s EHR systems are cumbersome, clunky and slow physicians down. Indeed, there’s much to love and much to hate

2018 KevinMD blog

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