Thursday, January 31, 2008

Limited Health Literacy

Limited Health Literacy: "And I think it is ironic that health providers of all kinds, and health educators -- I'm afraid to say -- as well, have used the complexity of their language as a marker of their own sophistication and education. In fact, it is the exact opposite. It is far harder to explain something in simple terms than it is to use textbook phrases, and I think that's the objective that we have to move toward, to turn back the responsibility and the definition of doing a good job to one that includes plain speak and ordinary conversations in the delivery of medical care."

ePatients: Engaging Patients in Their Own Care

ePatients: Engaging Patients in Their Own Care: "Every day, more people get healthcare online than those who see a physician. About two thirds of Americans have sought health information online -- although this fraction is relentlessly rising -- and half changed their behavior as a result of their online activities.[1,2] Many don't discuss this activity with their physicians, and most physicians don't welcome it.

These eEmpowered healthcare consumers are simply behaving rationally. Patients are, after all, the biggest stakeholders in their own health. They know the traditional office setting is not user-friendly: It's hard to get a doctor on the phone for advice, difficult to get a timely appointment, and coming in for the appointment obligates up to a half-day away from home or work. So naturally, they look for alternatives. And why shouldn't they? The doctor's office should be reserved for people who really require the special skills offered by physicians."

Improving the Health of Patients and of the Whole Population

Improving the Health of Patients and of the Whole Population: "To summarize, the more physicians practice good health habits ourselves, the more likely we are to counsel patients to do likewise. And if we disclose our healthy habits to our patients, we are even more effective in helping patients make lifestyle changes. Physicians should therefore be especially encouraged to have more healthy personal habits -- this could not only improve the health of physicians, but also be an extraordinarily efficient way to improve the health of all their patients.

Such improvement in health habits may be accomplished by incorporating more emphasis on personal health habits in medical school curricula, in residency training, in practice environments, and in continuing medical education. Furthermore, this personal-clinical link should also be explored in other health professionals. For now, physicians at all stages of training and practice should be particularly encouraged to have healthy behaviors, since this helps our patients and even the whole population to make healthier decisions in their own lives."

Tuesday, January 29, 2008

When Medicine Meets Literature: Scientific American

When Medicine Meets Literature: Scientific American: "Charon is trying to change that. Besides being a general internist and a professor of clinical medicine at Columbia University's College of Physicians and Surgeons, she holds a Ph.D. in English. She and others are seeking to improve the relationship between physicians and patients using literature and writing. The goal is to make doctors more empathetic by getting them to articulate and deal with what they feel and to develop sophisticated listening skills, ears for the revelations hidden in imagery and subtext. The field--alternatively called narrative medicine, literature and medicine, or medical humanities, depending on the approach--began by most accounts about 30 years ago and is now widely reflected in medical school curricula around the country. According to the American Association of Medical Colleges, 88 of 125 surveyed U.S. medical schools offered humanities courses in 2004; at least 28 required literature or narrative study in some form."

Monday, January 28, 2008

Knowing What Works in Health Care: A Roadmap for the Nation

Knowing What Works in Health Care: A Roadmap for the Nation: "There is currently heightened interest in optimizing health care through the generation of new knowledge on the effectiveness of health care services. The United States must sustantially strengthen its capacity for assessing evidence on what is known and not known about 'what works' in health care. Even the most sophisticated clinicians and consumers struggle to learn which care is appropriate and under what circumstances. Knowing What Works in Health Care looks at the three fundamental health care issues in the United States--setting priorities for evidence assessment, assessing evidence (systematic review), and developing evidence-based clinical practice guidelines--and how each of these contributes to the end goal of effective, practical health care systems. This book provides an overall vision and roadmap for improving how the nation uses scientific evidence to identify the most effective clinical services. Knowing What Works in Health Care gives private and public sector firms, consumers, health care professionals, benefit administrators, and others the authoritative, independent information required for making essential informed health care decisions."

Friday, January 25, 2008

19 Percent of Office-Based Physicians Refuse to See Pharmaceutical, Biotech and Medical Device Sales Reps

19 Percent of Office-Based Physicians Refuse to See Pharmaceutical, Biotech and Medical Device Sales Reps: "Based on a comprehensive telephone survey of 180,000 doctors, 19 percent of U.S. office-based physicians refuse to see sales representatives from the drug and device industry at any time, according to the recent study by SK&A Information Services, Inc. Another 22.7 percent of doctors require the reps to set an appointment. These findings underscore the increasing limitations that physicians are imposing on visits from the medical industry. 'The old days of walking into an office and bumping into the doctor are waning,' said Dave Escalante, President of SK&A."

I see reps only once - when they have a new product they want to tell me about.

Improving your bedside manner - doc.com Learning Management System

Improving your bedside manner - doc.com Learning Management System: "This unique resource provides its users with knowledge, skills review, and opportunities for reflection. It also fosters learning about complex communication and relationship challenges. Each of 40 learning modules presents key principles, evidence-based recommendations, and a skills checklist. Authors demonstrate key skills in video encounters with standardized patients and provide video and text commentary on the interview. The interview challenges help learners develop sensitivity to differing communication styles and difficult situations, and the flexibility to respond respectfully and skillfully."

The great thing about the internet is that every once in a while, you come across a gem. This is one of those websites ! I think every medical student, resident and doctor should go through this carefully. It will help them to improve their EQ ( what used to be called the bedside manner, in the good old days !) All of us need polishing in this department - and helpful reminders can never hurt !

They should translate these videos into many other languages - this is a marvellous teaching resource !

Happy patients make for happy doctors !

We always ask our patients for feedbacks - and both complaints and compliments are welcome.
Here's what a patient just sent us by email...

My husband and I had been married for three years before we decided we were ready to have a baby. We were still in our late 20s and thought we had all the time in the world to start a family. But when 6 months and then a year went by and I was still not pregnant, we grew worried and consulted my Ob/ Gyn who recommended a series of tests for me and my husband. Gathering all the test results took nearly 6 months as she would wait for the result of one test before ordering the next. Everything appeared fine, except possibly a problem with the semen analysis. We decided at this point to consult infertility specialists at a leading medical institution in the US. We considered ourselves lucky as we lived close to such a good medical facility and chose the director of the IVF program as our physician. We were recommended to undergo intrauterine insemination. We had three unsuccessful cycles with clomid. During this time, we were considering the possibility of needing IVF and examining our options. We were extremely unhappy with the interactions we had with our physician. We only saw him at our first consultation and then at the follow up after the failed IUIs. During treatment visits, we saw other physicians in the practice or this being a leading medical school, we often were seen by residents/ fellows. While we didn’t mind this (after all doctors are humans and can’t be in the clinic all the time: weekends and holidays!), what concerned us was that questions & concerns during the treatment cycles were dealt with by nurses or fellows and very often I had to call 2-3 times before we got any answer at all! I expressed my concern to the physician following our failed IUIs and he as much as said that patients receiving IVFs received better treatment and got their attention. Rather than making us feel better (as IVF was the next step for us), this helped seal our decision not to pursue IVF at this facility where patients receiving different treatment options were given different kinds of attention. This was an intensely emotional time for us and to be told that we were any less deserving of attention than a couple undergoing IVF made us angry. We tried one other practice closer to our home and decided that we did not like them either.

In the meantime, we started researching options in India and my husband found Dr. Malpani’s web-site. I am originally from Bombay and had heard of them and seen their name in magazines and newspapers in India. We decided to contact them and were very pleased with the prompt responses we received from Dr. Malpani. He told us in no uncertain terms that what would be best for us was ICSI and that IUIs would be a waste of our time. We made a trip to Bombay in March 2006 especially for the IVF cycle and were very happy with the warm environment of the clinic combined with the professional attitude of Drs. Anjali and Aniruddha Malpani. I had already started the medications in the US and was responding well to the ovarian stimulation. Several good eggs were retrieved and we had 15 good embryos. We transferred 4 embryos and froze the remaining. We returned back to the US in a few days. Unfortunately, I did not get pregnant. But we still had enough good embryos to try a frozen cycle. Due to a family emergency we returned to India in July 2006. We considered doing the frozen transfer then, but were discouraged by Dr. Anjali Malpani. She felt that we would stand a much better chance of success if we did the transfer when we were stronger emotionally. This was great advice. In Nov 2006, we returned back to the clinic. We had 5 good embryos after the thaw and we transferred them all. This time I stayed in Bombay longer and two weeks later we got the wonderful news we had been waiting three years for! I was pregnant!! Dr. Anjali Malpani did an ultrasound a few days later and confirmed the pregnancy.

We returned back to the US to the care of a wonderful new Ob/ Gyn. In Aug 2007 I gave birth to a precious baby boy. We feel truly blessed and are convinced that we would not have been able to become parents without the help of Drs. Malpani and their staff. We thank them for the wonderful care we received. We would recommend them readily to anyone seeking infertility treatment. You not only get high quality state of the art medical treatment, but are also received with warmth, care and compassion which we felt were sorely lacking in the experiences we had in the US.

We will be happy to discuss our experiences further. Feel free to contact us at vkm_ivf@yahoo.com"

It's feedback like this which makes a doctor's job so worthwhile ! There is lots of stress - but the smile on a happy patient's face and a heartfelt thanks gives pleasure which cannot be matched by anything else. Unfortunately , some doctors are too busy to stop and accept the thanks - or don't take the trouble to savour it !

And if a picture is worth a thousand words, this photo says it all !

Thursday, January 24, 2008

Five commonly misdiagnosed diseases - CNN.com

Five commonly misdiagnosed diseases - CNN.com: "Don't assume no news is good news.
Another source of misdiagnosis: Lab results get lost or forgotten. A study by Dr. Tejal Gandhi at Harvard Medical School found that up to 33 percent of physicians did not always notify patients about abnormal test results. 'No news is not good news,' says Dr. Saul Weingart, vice president for patient safety at Dana Farber Cancer Institute. 'It might be that the report fell down behind someone's desk.'"

Initiative Tackles Chronic Disease Management

Initiative Tackles Chronic Disease Management : "'Experience has shown that if you do everything in the planned-care model but don't include self management, you're only going to get so far. Patient self-management is the critical piece, and this initiative gives us tools to incorporate true patient self-management -- such as patient goal-setting -- into a typical busy family medicine practice. That's one of the reasons it's so exciting,' said Safford.

'Self-management support is the most important intervention physicians can do to improve patient outcomes,' said FP David Swieskowski, M.D., M.B.A., vice president of Mercy Clinics Inc. in Des Moines, Iowa. 'The New Health Partnerships pilot collaborative provided both the knowledge and the motivation to implement (self-management support) in Mercy Clinics,' he added."

Mistake-Proofing the Design of Health Care Processes

Mistake-Proofing the Design of Health Care Processes " Dr. Grout has been working for many years to disseminate information about the use of mistake-proofing devices in health care. This volume represents a compendium of information and ideas to broaden our understanding of mistake-proofing and its emerging role in health care and patient safety. Our hope is that the information and resources presented in this publication will lead to more and better error-prevention in healthcare."

The DUN Factor: How Communication Complicates the Patient Safety Movement

The DUN Factor: How Communication Complicates the Patient Safety Movement: "The patient safety movement is an incredibly important effort yet sits precariously poised at the edge of the same logic-driven chasm as the rest of medicine, obsessed by a nearly exclusive focus on defining processes as the key to enhancing safety. The movement is on the brink of making the same mistakes as the medical malpractice insurance industry, and the medical profession itself, by ignoring incredibly important aspects of the human relationship as related to patient safety and liability. The patient safety movement, in its current state, is in danger of over-promising and under-delivering unless it includes a focus on the relationship between the caregiver and the patient as a core and critical piece of the puzzle.

Enter the DUN Factor. DUN is my mnemonic for 'Dynamic, Unpredictable, and Non-linear,' and it reflects how life really 'is.' In brief, life is DUN. The DUN Factor is responsible for the majority of patient safety breaches and accounts for the terrible medical malpractice environment.

Perhaps nowhere in our daily experience is the DUN Factor more evident than in the communication between two (or more) people. Who would argue that conversation between two or more individuals is not dynamic, often unpredictable and non-linear, especially in emotionally charged situations, as is often the case in healthcare."

Wednesday, January 23, 2008

Understanding and Curing the Healthcare Crisis:

Understanding and Curing the Healthcare Crisis: A Wise Way to Better Outcomes and Lower Costs: "
By Stephen E. Beller, Ph.D. and Sabatini J. Monatesti. The Wellness Wiki helps to clarify the complex problems plaguing the U.S. healthcare system and develop sustainable ways to improve the health and well-being of all people. This ever-evolving virtual encyclopedia of the healthcare crisis and potential remedies is updated continually. The various topics include updated links to external blogs and wikis containing relevant discussions."

This is a treasure-trove of updated information ! It takes an exceptionally broad view of the healthcare system; and prescribes clever ways of fixing the many problems which plague it.

The Evolution of Evidence-Based Medicine

The Evolution of Evidence-Based Medicine: "Health information that is incomplete, inaccurate, or misleading can be harmful. If patients act on it, they might harm themselves or delay seeking medical attention until a treatable problem has become life threatening. Of the estimated 21 million people who seek health information on the Internet, 70% said the information influenced their decision about how to treat an illness or condition, and 28% said it influenced their decision about whether or not to see a doctor (Fox & Rainie, 2000)."

MedCommons Home

MedCommons Home: "A Health URL is a patient-centered portfolio of private health information on the Internet. Each Health URL points to an individual person's account that stores and delivers health records assembled from hospitals and other health care providers, important documents such as advance directives and diagnostic imaging such as CT and MRI studies. Health URL accounts are used collaboratively by physicians and other clinical practitioners as well as by interested patients and their authorized caregivers. Access to the Health URL account is via over 30 standard Web services and legacy enterprise interfaces. Strict, HIPAA-compliant privacy and security safeguards are integral to the Appliance. A hospital, practice or service provider hosts Health URL accounts on behalf of their patients by licensing software for installation on-site or in a hosting center. The MedCommons Health URL Appliance is a convenient, integrated and HIPAA-compliant way for a provider to add Internet collaboration for telemedicine, referrals, secure messaging, paperless health information management, night call coverage, home care devices, interaction with retail clinics as well as new consumer-centered Web sites. A RESTful API is ready for Web 2.0 integration in health care."

PHR and the Health URL

PHR and the Health URL : "The Health URL is emerging as the essential concept of a patient-centered health information revolution. Any member of the care team can offer a Health URL to the patient or request access to a patient's existing Health URL. Once the Health URL is established, the patient is, by definition, fundamentally associated with his or her Health URL. As with bank accounts and personal email domains, patients can choose to move their Health URL accounts to a different hosting agent and their private health records will remain intact together with its connections to specified healthcare providers.

Clinicians and other collaborators on a patient's healthcare team can gain access to diagnostic quality and digitally authenticated images and reports in the Health URL with permission of the patient or his or her designated agents. Practice management systems and EHRs interact with the Health URL by coding relevant patient information into CCR format with DICOM and PDF references and implementing Web services and federated identity protocols already deployed in government and corporate networks. A new generation of Internet commerce and collaboration technologies allows healthcare providers to leverage their customers' trust by combining their internal practice management systems with a patient-centered, independent private health record.

Four Health URL Basics

Glenn Beck: Put the 'care' back in health care - CNN.com

Glenn Beck: Put the 'care' back in health care - CNN.com: "I've now seen our system at its very best and I've also experienced it at its very worst. But in each case, the difference had nothing to do with whether the hospital had the latest equipment or whether it looked like the Taj Mahal. It had to do with compassion. It had to do with respect. It had to do with treating people the way you'd want to be treated when going through something unfamiliar and frightening.

That's why I don't want to hear anymore about universal health care or HMOs or the evils of insurance companies until each and every hospital in this country can look me in the eye and tell me that they their staff is full of truly compassionate people who treat their visitors like patients, not products. Hire and train the right people, and then and only then come talk to me about everything else you need.

Our politicians are right; we do have a health care crisis in this country. But it's not going to be fixed by them, it's not going to be fixed by some government agency, and it's certainly not going to be fixed by throwing more money around. No, if you really want to fix our healthcare system then look no further than the word 'healthcare' itself because the secret is right there.

The secret is 'care.' "

Yes - putting care into healthcare is simple - but not easy !

Products - MediKiosk™ Software - Check-In

Products - MediKiosk™ Software - Check-In: "Patient Check-in features uniquely enable patients to sign-in for appointments without waiting in long lines, filling out forms on clipboards or giving the same information over and over again.

By swiping a membership card, credit card or driver's license at the kiosk, patients can be automatically checked-in, presented with their appointments, given the opportunity to sign consent forms and even prompted for their co-pay. Once the patient is checked in, the kiosks can display patient education, collect medical history information and provide way-finding directions. Registration or front desk personnel can then view and manage patient checked-in lists, monitor patient flow through the organization and much more."

Medic Alert Tools - Medical Information - Medical Informatics

Medic Alert Tools - Medical Information - Medical Informatics: "Recalling the details of your medication cabinet doesn't come easily during a medical emergency. But that information is vital to the professionals taking care of you. Emergencies happen when we least expect it, so it's important to prepare ahead of time.

Here are some products and services designed to help prepare you for the unexpected. Regardless which one you use, be sure to update medical information regularly. Outdated information may be more dangerous than none at all."

HAVIDOL® - YOU, HAVIDOL & YOUR HEALTHCARE PROVIDER.

HAVIDOL®: "YOU, HAVIDOL & YOUR HEALTHCARE PROVIDER. Your healthcare provider may not be aware of DSACDAD. You can use our ZING SELF ASSESSMENT TOOL to determine if HAVIDOL may be right for you. Print out your results and take it with you on your next visit. Refer your treating healthcare provider to our website for more information."

This is a hilarious spoof on Big Pharma websites which use DTC ( direct to consumer advertising ) to sell their drugs. After looking at this site, you'll never get fooled by Big Pharma marketing whizkids again ! I didn't know whether to laugh - or to cry !

Mystery Meat Macrophotography

Mystery Meat Macrophotography : "Here's a 2x magnification photo of the Jimmy Dean sausage showing more detail of the fat blobs and the slightly stringy texture of the sausage in general. (You can actually see some stringy elements in this photo if you look closely.)"

If you look at these photos, you'll stop eating processed foods bought at the supermarket ( and improve your health in the bargain) !

Tuesday, January 22, 2008

Introducing nine new made-up diseases for drug companies to exploit with mind-altering drugs (satire)

Introducing nine new made-up diseases for drug companies to exploit with mind-altering drugs (satire): "Language Obfuscation Disorder (LOD). Striking mostly doctors, surgeons and oncologists, Language Obfuscation Disorder causes its victims to speak in unintelligible medi-babble while imagining their words make perfect sense. People afflicted with this disease literally speak in Greek, substituting normal-sounding English words (like 'liver' and 'inflamed') with words made of Greek elements ('hepato' and 'itis' or just hepatitis.) Interestingly, two or more victims of LOD seem to be able to understand each other perfectly well, although no one else has any idea what they're saying."

The top ten reasons why the U.S. needs more pharmaceutical companies (satire)

The top ten reasons why the U.S. needs more pharmaceutical companies (satire): "Cures: We need drug companies to keep finding cures for major diseases. Look at all the cures they've found so far like... well... okay, they haven't actually found any cures yet. But maybe they can at least cure all the bogus diseases they made up like 'social anxiety disorder' and 'attention deficit hyperactivity disorder.'"

If the auto industry operated like Big Pharma: fifteen things you might notice

If the auto industry operated like Big Pharma: fifteen things you might notice: "Companies would make up new reasons why you need more automobiles, hoping to convince you to buy a dozen or more. They might say you need one car to make you feel happy, another for basic transportation, a third to match the color of your house, and so on. Explanation: drug companies frequently invent new, fictitious diseases, and then try to sell you drugs to treat those made-up afflictions. Examples include ADHD, FSD (female sexual dysfunction), General Anxiety Disorder, and other made-up diseases that have no purpose other than selling drugs. Essentially, Big Pharma wants to define everyone as diseased in some way, and then convince people they need a lifetime of prescription drugs to 'manage' those diseases. From the moment you're born, the drug companies say, you're already diseased."

Hilarious !

Disease mongering Restless Legs Syndrome: A case study of how the media helps make people sick (PLoS Medicine)

Disease mongering Restless Legs Syndrome: A case study of how the media helps make people sick (PLoS Medicine): "“Disease mongering” is the effort by pharmaceutical companies (or others with similar financial interests) to enlarge the market for a treatment by convincing people that they are sick and need medical intervention . Typically, the disease is vague, with nonspecific symptoms spanning a broad spectrum of severity—from everyday experiences many people would not even call “symptoms,” to profound suffering. The market for treatment gets enlarged in two ways: by narrowing the definition of health so normal experiences get labeled as pathologic, and by expanding the definition of disease to include earlier, milder, and presymptomatic forms (e.g., regarding a risk factor such as high cholesterol as a disease in itself).

Discussions about disease mongering usually focus on the role of pharmaceutical companies—how they promote disease and their products through “disease awareness” campaigns and direct-to-consumer drug advertising, and by funding disease advocacy groups. But diseases also get promoted in another way: through the news media. News reports are a major source of health information for people . Unless journalists approach stories about new diseases skeptically and look out for disease mongering by the pharmaceutical industry, pharmaceutical consultants, and advocacy groups, journalists too, may end up selling sickness."

KitchenMedicineBook.com Complete book on Kitchen Medicine

KitchenMedicineBook.com Complete book on Kitchen Medicine: " Discover the healing power of everyday kitchen foods like honey in this healing foods exploration written by Kelly Joyce Neff. In this free online book, you'll learn the healing secrets of salt, garlic, cayenne and a number of culinary herbs."

Read the entire book free online !

HealthRanger.org - Health Through Education

HealthRanger.org - Health Through Education: "Because our system of modern medicine thrives on sick people. Drug companies, doctors, surgeons and hospitals are all pocketing a fortune by financially exploiting sickness and disease across our population. They gain power, money and control by treating sickness, not by making people healthy. And that's why all the talk you hear about health care reform never mentions making people any healthier. It's only about shifting the responsibility of who pays for disease."

The great direct-to-consumer prescription drug advertising con: how patients and doctors alike are easily influenced to demand dangerous drugs

The great direct-to-consumer prescription drug advertising con: how patients and doctors alike are easily influenced to demand dangerous drugs: "Doctors are easy to manipulate, drug companies discover
You may be wondering why doctors base their prescriptions on the requests of their patients, who usually have no medical training whatsoever. That's a good question with a simple answer. The pharmaceutical-advertising machine seduces doctors, too.

According to Burton Goldberg's book, Alternative Medicine, paid pharmaceutical advertisements are the main source of the Journal of the American Medical Association's revenues. The American Psychological Association is equally under the pharmaceutical companies' spell, as 15 to 20 percent of the American Psychological Association's (APA) income comes from pharmaceutical advertisements in its journals."

'Politics has absolutely no business in reproductive rights.'

'Politics has absolutely no business in reproductive rights.' : "You write about how legal and political distractions take up a huge amount of time in your work. In an election year, is there a way you'd like to see the discussion on abortion and reproductive rights framed?

In my opinion, a candidate should get up and say, 'Politics has absolutely no business in reproductive rights.' A politician should say, 'This is not even something I'm willing to discuss. It is a woman's right. It's not my decision.' Unfortunately, that's not the way it's happening."

Unfortunately, politicians and bureaucrats want to meddle in our lives and take away our reproductive rights - one by one. Most of us are blissfully unaware that this is happening , and we are powerless to prevent this.

When the Doctor Is in, but You Wish He Weren't - New York Times

When the Doctor Is in, but You Wish He Weren't - New York Times: "Ms. Wong had come across a bane of the medical profession: the difficult doctor. These doctors may be arrogant or rude, highhanded or dismissive. They drive away patients who need help, and some have been magnets for malpractice claims.

And while such doctors have always been part of medicine, medical organizations say they fear that they are increasingly common - doctors, under pressure to see more patients, are spending less and less time with each one and are replacing long discussions with laboratory tests and scans - and that most problem doctors apparently have no idea of their patients' opinions of them.

Patients usually do not confront doctors. Instead, most rant to friends or family members about their experiences or simply change doctors. But in most areas of the country, there is an abundance of patients. If a few patients leave a medical practice, plenty more can take their place, so doctors may never even know what their patients think."

Physicians and bribery: a closer look at this common medical industry practice

Physicians and bribery: a closer look at this common medical industry practice: "How does your doctor decide which medications to prescribe? Is the decision based on the first-hand testimonies of other patients? Is the decision made after a careful and thorough research of medical journals? Usually not. As Michael T. Murray explains in Natural Alternatives to Drugs, your doctor's decision has nothing to do with medicine: 'Most physicians do not make decisions about which drug to use on the basis of scientific research or cost. They base their decision almost entirely on which drug is the most popular choice of their colleagues.

What determines popularity? The effectiveness of the drug company's marketing and advertising efforts. In essence, doctors are often bribed or lied to so that they will prescribe certain medications.' Bribery is a danger in any business sector. In medicine, bribes can prove downright deadly; nevertheless, they are shockingly common.

How would you like a bonus of $100,000 per year on top of your already outrageously high salary? Wow, that sounds like a dream, doesn't it? Well, for many doctors, obtaining a bonus of that amount is a reality. These days, the majority of doctors have dived right into the 'deep waters of entrepreneurship, where there is always the danger of conflict of interest between patient care and making a buck,' as Martin. L. Gross phrases it ".

Online health sites | Salon Life

Online health sites | Salon Life: "The medical establishment, in fact, has taken way too much time to understand that the Internet is a disruptive innovation that has overturned the status quo. It has leveled the playing field between expert and novice -- in this case, doctor and patient. While some doctors like Haig may find that challenge threatening to their status as an expert, the Web is now providing the kind of information doctors need to be aware of if we want to continue to be good at our job, and the kind of trends that can help patients be smarter and healthier.

According to a 2006 study of online health searches by the Pew Research Center, eight of 10 Internet users, up to 113 million Americans, have gone online looking for health information on behalf of themselves or a loved one. For those with a chronic problem, like Susan, that number rises. People with chronic medical problems are more avid users of the Web and state that their online searches affect treatment decisions, their interactions with doctors, and their ability to cope with their condition. That's not something that any doctor can dismiss."

Why Doctors are Idiots: 150 Years of Disatrous Advice on Children's Health (satire)

Why Doctors are Idiots: 150 Years of Disatrous Advice on Children's Health (satire): I think all doctors should read this ! We think we are wise and know much more than our patients - but this historical perspective will remind us that the medical profession has often been wrong . We meed to remember to keep an open mind - and be willing to listen to our patients.

Sunday, January 20, 2008

BREAST CANCER:

BREAST CANCER:: "Early detection techniques such as breast self exam (BSEs) or mammograms don't necessarily extend a woman's life; they may just lengthen the period of time she knows she's sick, as well as the time during which she receives treatment. As Dr. McDougall puts it: 'The real beneficiaries of early detection are the providers of health care, who now have a longer time in which to treat the victims before they die.'"

Ouch - sometimes the truth can hurt !

I am sure we'll all continue advising breast self-exams and mammography, even though they do not help ( and can actually harm) because

1. It makes sense . After all, if you pick it up early, isn't it common-sense that treatment will help ? Unfortunately, we refuse to let ugly facts slay a beautiful hypothesis !
2. We've been brainwashed into believing it helps . Repeating something ad nauseam will do this very effectively !
3. It's become a billion dollar industry !
4. We want to believe that we can prevent and treat cancer - it's a helpful delusion to have.
5. We don't want to accept the fact that everything we've done for the last 30 years has been wrong and unhelpful !

BMJ BestTreatments :: Decision support :: Shared decisions

BMJ BestTreatments :: Decision support :: Shared decisions: "Many people find it hard to ask their doctor questions. Sometimes their doctor doesn't encourage them. Doctors always seem so busy. You may worry you will look stupid if you use the wrong words. Or you may worry that you will annoy your doctor by asking questions. Sometimes you may feel too ill to take an active role in making decisions. And some people are happy just to do what their doctor tells them.

You may feel more comfortable talking things over with your doctor if you do some of the following things:

* Write down a list of questions to take with you when you go to see your doctor
* Have a family member or friend come with you to the appointment
* Make notes of what your doctor says during your visit"

BMJ BestTreatments :: Decision support index

BMJ BestTreatments :: Decision support index: " It can be hard to know which medical research to believe. One day you may hear that drinking alcohol is good for your heart. The next day you may hear that alcohol makes it more likely that you'll get breast cancer. And your friend may swear that a treatment you've never heard of saved his mother's life.

Not all medical research is good. Some studies are more reliable than others. So we've put together some guides to help you weigh up the evidence and work with your doctor to choose the treatment that is best for you."

RediClinic: Services

RediClinic: Services: "RediClinic’s nurse practitioners provide a broad range of preventive services, including screenings and blood tests, immunizations, and basic physical exams. At RediClinic, you can receive most common blood tests. Our tests include, but are not limited to, screenings for high cholesterol, diabetes, heart disease, liver and kidney function, thyroid disease, allergies, prostatic specific antigen (PSA), and osteoporosis. Our packages combine our most popular exams at a discounted price to give you an even better value for your money!"

Now family physicians have one more problem to worry about - competition from these clinics.

Testing, Testing

Testing, Testing: "A seldom-discussed aspect of medical costs and hazards is medical testing . Testing is a sacred cow. Many who reject allopathic medicine's slash/poison/bum treatment style subscribe to the 'better safe than sorry'' logic that sustains one of the industry's most lucrative branches.

The extensiveness of medical testing is stunning. Speaking of the early 1980s-- and since then greater numbers have assuredly been achieved--Dr. Edward R. Pinckney noted: 'When all direct and related costs for medical testing are added together--including office visits and hospital charges--the annual bill for medical testing, in 1983, came to about 160 billion dollars, or about half of the entire cost of all medical care' ('The Accuracy of Medical Testing,' in Dissent in Medicine: Nine Doctors Speak Out.)

Doctors often excuse their obvious over-exuberance in ordering tests by saying that much 'defensive' testing is necessary to protect them from lawyers. This is no doubt true. But the 'better safe than sorry' philosophy has been very successfully promoted in an effort to make testing a synonym of prevention in the popular mind. This is, without doubt, one of the Church of Medicine's most lucrative beliefs."

However, over-testing can cause a lot of harm - including the Ulysses syndrome and over-treatment !

Medical myths -- Vreeman and Carroll 335 (7633): 1288 -- BMJ

Medical myths -- Vreeman and Carroll 335 (7633): 1288 -- BMJ: " Even physicians sometimes believe medical myths contradicted by scientific evidence. The prevalence and endorsement of simple medical myths point to the need to continue to question what other falsehoods physicians endorse
Examining why we believe myths and using evidence to dispel false beliefs can move us closer to evidence based practice.

Physicians would do well to understand the evidence supporting their medical decision making. They should at least recognise when their practice is based on tradition, anecdote, or art. While belief in the described myths is unlikely to cause harm, recommending medical treatment for which there is little evidence certainly can. Speaking from a position of authority, as physicians do, requires constant evaluation of the validity of our knowledge."

Physicians are human too - and both they and their patients need to be reminded of this fact !

Ulysses syndrome

Ulysses syndrome : "What are the two hardest things to do in medicine? To say nothing (or 'I don't know') and to do nothing. We have all felt parents' disappointment at the end of a consultation. So, rather than discharge their child, we offer a follow-up appointment, hoping that by then the parents will be more accepting of the situation or that they will be seen by a different doctor. However well meaning our action may be, it medicalises the child's condition: the parents may well feel that their child must have a serious problem because he or she is 'under' a specialist.

We might also request another test, and risk inducing 'Ulysses syndrome.' Ulysses fought in the Trojan war but afterwards took 10 years, with many dangerous and often pointless adventures, before he got back to where he had started. Patients with Ulysses syndrome find themselves caught in a web of further investigations, referrals, and sometimes treatment before finally being recognised as healthy, which they were in the first place. Ulysses syndrome is a side effect of unnecessary and inappropriate investigations or wrong interpretation of results. It was first described 30 years ago,1 and the number of tests available is now much greater. With greater choice comes greater responsibility and the need for greater discernment. Otherwise we may condemn our patients to a similar ordeal."

I just wish more doctors ( and their patients) became aware of what they are potentially subjecting their patients to when they order tests. Tests are meant to reassure - but they often end up as a "wild-goose chase" - and cause more distress and anguish ! Masterly inactivity is sometimes the best course of action.

Our unhealthy obsession with sickness

Our unhealthy obsession with sickness: "Essentially, the term medicalisation means that problems we encounter in everyday life are reinterpreted as medical ones. So problems that might traditionally have been defined as existential - that is, the problems of existence - have a medical label attached to them. Today, it is difficult to think of any kind of human experience that doesn't come with a health warning or some kind of medical explanation."

It can be very comforting to believe that if we want relief from our miseries, all we need to do is turn to our doctor and let him fix all our problems with a pill !

The invisible computer revolution

The invisible computer revolution: "Consider just one application: continuing education for clinical health workers. Many developing country health providers get trained once, at the start of their career, and never get any additional training at all.

This is because transporting these workers to a training conference is hugely difficult in countries where roads are inadequate, or don't exist, or fuel is scarce -- and sending paper-based materials to workers is either expensive, or more likely impossible given a poorly-functioning postal mail system.

But imagine a system that lets managers at a national level, who probably do have access to the internet on a desktop computer, coordinate and transmit SMS-based continuing education messages to the computers - sorry, to the cell phones - of those health professionals. What a difference would that make to the level of up-to-date knowledge available to a clinic worker? And how would that impact the quality of care?"

Friday, January 18, 2008

Surgeon General's Workshop on Improving Health Literacy

Surgeon General's Workshop on Improving Health Literacy: "Improving the Communication Skills of Health Care Providers

A representative from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) raised the issue of changing the communication practices of healthcare providers, noting that good communication practices need to be introduced in provider education and training. An audience member from the American Medical Association (AMA) echoed these concerns and announced that the AMA would be launching an initiative linking health communication and patient safety. Dr. Schillinger pointed out that nursing, medical, and pharmacy students are very receptive to learning these skills, but noted that skills training needs to continue into the residency phase/clinical context. The positive effects of communication skills training can be displaced by the demands of residency. He commented that medical student associations can often drive curricular change, making them excellent points of intervention.

Dr. Pignone noted that system changes such as team-based care, information technology infrastructure, and reimbursement practices can also improve patient-provider communication."

Surgeon General's Workshop on Improving Health Literacy

Surgeon General's Workshop on Improving Health Literacy: "Patient activation refers to the ability to manage one's own health and health care. The Patient Activation Measure (PAM) is a 22-item measure that assesses patient knowledge, skill, and confidence for self-management.

Empirical evidence suggests that there are four stages of activation that patients go through in the process of becoming fully competent managers of their health:

1. The patient does not yet believe that they have an active and important role in their health;
2. The patient lacks the confidence and knowledge to take action;
3. The patient begins to take action; and
4. The patient maintains behaviors over time"

Thursday, January 17, 2008

Wednesday, January 16, 2008

Laughter Medicine :

Laughter Medicine : "Laugh yourself healthy We all know that laughter makes us feel good. A regular 20 minute laughter session can have a profound impact on our health and wellbeing. Laughter is gentle exercise. It fill your lungs and body with oxygen, deep-clears your breathing passages and exercises your lungs. This is really important for people who don't get regular aerobic exercise.

When we laugh our bodies release a cocktail of hormones & chemicals that have startling positive effects on our system. Stress is reduced, blood pressure drops, depression is lifted, your immune system is boosted & more. Western science is just starting to discover the great effects of laughter.

Why Laughter Yoga? Eleven years ago Dr Madan Kataria, an Indian doctor and student of Yoga was writing a paper for a medical journal titled 'Laughter is the best medicine'.

Convinced of the medical benefits of laughter and Yogic breathing exercises, Doctor Kataria was searching for a way to bring these benefits to modern man. You can't prescribe 20 minutes of laughter a day, and for best effect a range of different types of laughter should be combined.

In a flash of inspiration Laughter Yoga was born. Thanks to Doctor Kataria, countless people all over the world today enjoy the benefits of a daily dose of laughter."

I prefer watching Laurel and Hardy; or reading comic strips such as Sherman or Zits :)

Tuesday, January 15, 2008

Online Clinic To Help Nova Scotia Patients Manage Their Health - iHealthBeat

Online Clinic To Help Nova Scotia Patients Manage Their Health - iHealthBeat: "A new online clinic scheduled to launch Wednesday aims to let patients in Nova Scotia, Canada, track their health records from various sources and ask health-related questions, the Halifax Chronicle-Herald reports.

The online clinic, called Connecting People for Health Co-operative, will charge users $9.95 Canadian, or about $9.77, per month. Users will be able to enter their health data and update their profiles with test results and other information received from their family physicians."

Stressing the other

Stressing the other : "The experience was excruciating, an needless act of emotional abuse where kindness would have required little effort. It was also, I suppose, no more and no less cruel than thousands of such encounters that occur every day in the health service, not just with technicians, but with doctors, clerks, or just about anyone with degree of power to exercise and who lacks insight—whether for a passing moment or a whole lifetime—into what it feels like to be the other. We all have our explanations for such behaviour. They include multiple failings at the collective level: in the department, the hospital, the health service, and the nation. We also have our own preferred prescriptions for the problem, such as better pay and conditions, improved team morale, enhanced training, attractive incentives, consumer choice, becoming a more compassionate society, and so on and so forth.

The philosopher Martin Buber taught that we all live with a two-fold attitude, which he called the ‘I-It’ attitude and the ‘I-Thou’ attitude. ‘If I face a human being as my Thou’ he argued, ‘he is not a thing among things, and does not consist of things’. In the same corridor as the ECG technician, there is a secretary who is outstandingly helpful, although presumably she shares many of the same work conditions as the technician. I know her name, her direct line and her email address. She always remembers my name, what I do, who I am seeing and why. When I contact her, she seems to operate from the premise that my request is going to be reasonable and that she will try her utmost to make sure it is met. I believe she treats everyone else in the same way. Without the active will, and the moral choice, of people like her, I suspect that all the well-meant interventions of politicians, managers and educators to improve the way patients are treated will subside into mere noise. Or to put it in Buber's words: ‘All true living is meeting.

Nurses and paramedical workers play such a key role in humanising the medical care patients receive. How can we teach them to be more empathetic ?

Doing the rounds

Doing the rounds : "The list of hospital visiting times, in particular, is heartbreaking. It makes me go hot and cold with anger, misery and a retrospective sense of helplessness. The emotional effects of such institutionalized brutality are too painful to hold in the imagination. How on earth can it have happened? How can people have believed that it was a good thing? How could doctors and nurses have been so blind to the distress they were causing, and so uncritical of themselves?

The answer, of course, is that the rules were familiar, and familiarity breeds conformism. As Robertson found, protests against convention can invite ridicule, particularly from the medical profession. We also need to remind ourselves of innumerable other examples of social practices that were considered humane for considerable periods of time, but that now fill us with horror—including slavery, workhouses, and large mental asylums in remote rural locations.

Which brings us, somewhat uncomfortably, to the question of whether there are any current practices that doctors now accept with complacency, but ought to regard as similarly grotesque. My own nomination for such a practice would be the ward round."

One of the sacred cows of medicine we should consider sacrificing ?

Keeping quiet can get you into hot water

Keeping quiet can get you into hot water : "Everything else was going very smoothly ... none of us wanted to upset anybody by making a fuss ... you can't change something that's generally accepted ... no actual proof of a link ... no definite scientific evidence of a raised incidence of morbidity ... it probably would all have happened anyway ... none of the other doctors seemed very bothered ... it was easier to forget about the problem. Does any of this sound familiar? Of course it does. It is the miserable and unconvincing chorus of self-exculpation that attends every single health service scandal that ever occurs. What I and my colleagues had enacted on our holidays, with characteristic professional insouciance and automatism, was classic medical bystander behaviour. We had played our traditional parts in a simulation of the prologue to systemic disaster, the sort of disaster that befalls people like us in our workplaces time and again, year after year.

It did not feel like that at the time. It felt, of course, like normality. Better than normality, positively hunky-dory. But that precisely is the problem. Apathy is a retrospective diagnosis. Had there been a serious epidemic of gastroenteritis ending in hospitalizations and a catastrophic end to people's summer break, I am sure that we would have reframed the experience very differently. What seemed at first like an idyllic holiday would have been recollected as a nightmare, and our inaction would have become a cause of deep guilt and shame. Next time, I have promised myself, I will make a fuss."

This explains why doctors turn a blind eye when they see another doctor doing something wrong. This is also the reason why most patients never complain about incompetent doctors. How will things ever improve ? If you are not part of the solution, you are part of the problem !

Sunday, January 13, 2008

IMPACT OF PREVENTIVE HEALTH CARE

IMPACT OF PREVENTIVE HEALTH CARE ON INDIAN INDUSTRY AND ECONOMY This study, being the first of its kind in India, makes an important contribution to preventive healthcare practise in the corporate sector by examining the linkage between corporate preventive health care programmes and profitability. In order to assess the impact of preventive health care on the Indian Industry, a survey of some of the best performing companies and a sample of employees from the manufacturing and service sector was undertaken. Finally, based on the findings from our surveys, certain policy recommendations have been made to promote preventive healthcare practise in India’s corporate sector and ensure productivity and competitiveness of the Indian Industry.

Annual Physical Exam: Unneeded Expense? - Disease Prevention and Wellness Information to Improve Your Health on MedicineNet.com

Annual Physical Exam: Unneeded Expense? - Disease Prevention and Wellness Information to Improve Your Health on MedicineNet.com: "An annual physical exam is a tradition for many U.S. adults, but it is not always necessary, according to a new study. 'I'm not advocating we should get rid of these visits,' says researcher Ateev Mehrotra, MD, MPH, assistant professor of medicine at the University of Pittsburgh School of Medicine and a policy analyst at RAND Corp.

Rather, the preventive services and tests ordered at these exams that are actually necessary often can be received -- and often already are -- at other visits and times, says Mehrotra. The study is published in the Sept. 24 issue of the Archives of Internal Medicine."

India Inc losing working days due to staff sickness: Study-India Business-Business-The Times of India

India Inc losing working days due to staff sickness: Study-India Business-Business-The Times of India: "Suggesting a positive correlation between preventive health care and profits of companies, the ICRIER study said, 'In an era where competitiveness and profitability are determined by intellectual capital, promotion of employee health is crucial for the organisation.' The survey covered 81 companies in 15 states and covering a wide range of sectors. The companies included Maruti, Bajaj Auto, Alcatel, TCS, Citibank and Genpact among others.

Almost 82 per cent of the respondents (including many of those who do not provide preventive health care facilities at present) agreed that such measures increase firm productivity and profitability.
Employee wellness demonstrates a real contribution to company bottom lines since promoting employee health is a means to controlling health care costs, the study said. As regards the financing of health care, the ICRIER study found that more than half of the respondents supported the idea of vouchers as an effective delivery tool to encourage preventive health care measures."

While I agree that corporates should be investing in the health of their employees and that preventive healthcare offers a great ROI, I am not sure that providing them with health vouchers is the right way to implement this suggestion. All it will lead to is a greater utilisation of "healthcare" services. This usually just means over-testing and over-diagnosing medical problems, and while this may be good for the bottomline of the hospitals which provide this service, the impact on the worker's health is far more doubtful. We'll just end up seeing an epidemic of "testitis" and an increased population of the "worried well" because of an abuse of "executive health checkup" schemes !

Saturday, January 12, 2008

How to make your doctor your friend !

» New Jersey to mandate electronic health records | ZDNet Healthcare | ZDNet.com

» New Jersey to mandate electronic health records | ZDNet Healthcare | ZDNet.com: "New Jersey will become the first state to mandate a move toward electronic health records under a bill now before Gov. Jon Corzine. A. 4044 establishes a 19-member commission to oversee the transition from paper.
The commission’s job will be to promote the use of national standards in “security, privacy, data content, format, vocabulary and information transfer standards.”

This is a big step forward - and a big opportunity for companies who provide EHRs !

Do What You Love

Do What You Love "No one wants to die. Even people who want to go to heaven don't want to die to get there. And yet death is the destination we all share. No one has ever escaped it. And that is as it should be, because Death is very likely the single best invention of Life. It is Life's change agent. It clears out the old to make way for the new. Right now the new is you, but someday not too long from now, you will gradually become the old and be cleared away. Sorry to be so dramatic, but it is quite true. "

Can you guess whose wise words these are ? You will be surprised !

Thursday, January 10, 2008

Consumer Bill of Rights & Responsibilities

Consumer Bill of Rights & Responsibilities: "In a health care system that protects consumers' rights, it is reasonable to expect and encourage consumers to assume reasonable responsibilities. Greater individual involvement by consumers in their care increases the likelihood of achieving the best outcomes and helps support a quality improvement, cost-conscious environment. Such responsibilities include:

* Take responsibility for maximizing healthy habits, such as exercising, not smoking, and eating a healthy diet.
* Work collaboratively with health care providers in developing and carrying out agreed-upon treatment plans.
* Disclose relevant information and clearly communicate wants and needs.
* Use the health plan's internal complaint and appeal processes to address concerns that may arise.
* Avoid knowingly spreading disease.
* Recognize the reality of risks and limits of the science of medical care and the human fallibility of the health care professional.
* Be aware of a health care provider's obligation to be reasonably efficient and equitable in providing care to other patients and the community.
* Become knowledgeable about their health plan coverage and health plan options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules"

Why Can't We Get Health Care Right?

Why Can't We Get Health Care Right? : "First of all we don’t really have a health care system. Indeed, where we spend the largest portion of this amount on sick care, not health care. In fact, virtually our entire fragmented system is focused on sick care. Many researchers have shown that doing simple things in the wellness universe – broad application of immunizations, annual screenings for early detection of cancers, diabetes, cardiovascular risk factors, etc. – remarkably improves outcomes, and decreases sick care.

Secondly, our entire system focuses on costs; not on outcomes. It is disappointing that of the health reform plans advanced by all of the presidential candidates, every one of them mentions controlling costs as the primary goal of their proposals. Care models in the US that have shown success, most notably the Community Care of North Carolina model that creates a “medical home” for all NC Medicaid recipients, have shown conclusively that focusing on maintaining health and putting quality outcomes first not only can achieve those goals, but they also save dollars!"

Net-savvy doctors - the new generation !

Net-savvy doctors - the new generation !: "Did you ever wonder why you can do almost everything on-line these days except 'see' your doctor? Wouldn't it be great if healthcare professionals, hospitals, and clinics were as net-savvy as other service industries? Well friends, there is hope.

I want to share an interview I did a few weeks ago with someone who I believe is setting the bar for a new generation of healthcare professionals and the patients they care for. Someone who isn't afraid to buck the system. Someone who says, 'why not?' instead of 'why?'. Someone who just plain understands how to leverage the power of the Net in healthcare. He's not the only one out there. He may not have perfected the business model. But he is doing exactly what needs to be done to better serve his patients. He is leading by example, and I have nothing but admiration for what he is doing."

This is such a sensible model !

Lifespan Health Planning

Lifespan Health Planning: "The Lifespan Planning Record offers an exciting vision of how radically different our health care future could be. Born today, the newborn child’s LPR would already be inhabited with a great deal of data – ranging from some reasonable compilation of the records of parents, grandparents and siblings to future diagnostic and preventive therapeutic measures, based on familial information. Print, video and graphic information from other accessible intelligence databases would be seamlessly interwoven. As time passes, this “living record” would flexibly grow and adjust to assist informed decision making, preventive behavior and full and complete human development.

But what does this have to do with Google and cell phones?

The answer is that the LPR can only be realized through significant advances in our technology infrastructure. And Google’s most recent action begins to address several hurdles that stand in the way of the LPR. One is the problem of bandwidth and transporting information – a curve Google is clearly ahead of. Second, people -- especially those with a high burden of chronic disease and those challenged by socioeconomic factors -- often don’t own computers or have trouble using them. But cell phones are everywhere. Third, the development of new applications is a must – to help people manage complex medical knowledge and to store vast amounts of data. And Google has already started down this road."

Wednesday, January 09, 2008

Patient Follow-ups Reduce Adverse Events

Patient Follow-ups Reduce Adverse Events: " Approximately 1 in 5 patients will experience some form of adverse event after discharge from hospital. Due to lack of available staff, budget, or other concerns, post-discharge patient monitoring through telephone follow-up can be costly and impractical. CallAssure makes it possible by automating post-discharge telephone interviews. The system is designed to work with live nurse follow-up as patients who are experiencing adverse affect are able to quickly transfer to a live nurse where resources exist. In some cases, this can actually save lives.

*Is able to establish a 100% success rate in contacting patients—also 90% quicker than a person dialing
* Enables healthcare providers to deliver 100% consistent quality of care
* Has shown that many patients prefer IVR – patients were more honest and therefore received more accurate care
* Is “easy to use” – over 90% of patients who used it, liked the IVR"

Maybe a SMS could be sent to all patients after discharge automatically, to confirm that they are fine ?

Archetypes for PHRs

Archetypes for PHRs Medicine is one of the oldest professions in our civilization dealing with human life which deeply affects our individual and societal wellbeing. It should be expected that such an important field has to be backed up with every possible science and technology. Information and communications technology (ICT) is no exception with a good track of success in many fields such as finance and tourism. However it is
obvious that this is not the case in healthcare in spite of the vast amount of literature on the proven benefits of ICT for tackling the fundamental problems of healthcare. The identified reasons for this paradox are many fold but they mainly focus on added difficulty to IS development due to the complexity and volatility of medical concepts. Another important reason roots from the inherent subjective or non-deterministic
nature of medicine. Not only is the body of knowledge highly variable but also the practice changes from time to time and place to place. This means a particular instance of a medical situation may not be valid at all times. The consequences of this during HIS development are disastrous. Medical authorities concentrate on establishing a standardized or at least core medical curriculum in medical education and also try to realize a common medical terminology for practicing physicians to alleviate these problems. Considering the dynamic and fast track advance in ICT, we believe it will be more efficient to attack the former problem while hoping the latter one to progress over time. This is the general motivation for this study.

Death By Medicine

Death By Medicine A definitive review and close reading of medical peer-review journals, and government health statistics shows that American medicine frequently causes more harm than good. The number of people having in-hospital, adverse drug reactions (ADR) to prescribed medicine is 2.2 million.1 Dr. Richard Besser, of the CDC, in 1995, said the number of unnecessary antibiotics prescribed annually for viral infections was 20 million. Dr. Besser, in 2003, now refers to tens of millions of unnecessary antibiotics.2,2a The number of unnecessary medical and surgical procedures performed annually is 7.5 million.3 The number of people exposed to unnecessary hospitalization annually is 8.9 million.4 The total number of iatrogenic deaths shown in the following table is 783,936. It is evident that the American medical system is the leading cause of death and injury in the United States.

Tuesday, January 08, 2008

The 3rd Annual Employer Health & Human Capital Congress

The 3rd Annual Employer Health & Human Capital Congress: "The business case for effective management of corporate health programs has never been clearer. The Mission of the Annual Employer Health & Human Capital Congress is to help our executive delegation of large employers maximize bottom-line corporate performance, improve overall employee health and productivity and achieve cost containment targets. Topics addressed by the EHHC Congress will encourage our executive delegation to make strategic and specific actions to improve the management of employee benefits, health & wellness programs and the delivery of effective economic incentives for better employee health."

Indian companies still lag behind in taking a proactive approach towards helping their employees remain healthy. This is a shame because it's a big opportunity which is being wasted. The most valuable resource for any company is its human capital - why don't they invest more in keeping it in good shape ?

ADVANCE for Health Information Executives

ADVANCE for Health Information Executives: "In a recent Wall Street Journal poll, 83 percent of respondents to a survey about Web-based interaction with their physician's office said they thought there was room for improvement in how they communicated with their doctor and their doctor's communications with them.

'There is a large gap between what the patient population expects and demands. That's an important trend to note, because people are now asking hospitals and health care providers where their treatment results will be stored,' Martin Pellinat, president and founder of VisionTree Software, based in San Diego, said during an interview."

This is actually a big opportunity for hospitals ! Giving their patients a PHR will help them to empower their patients with information - and also make life easier for their doctors, as they won't need to hunt for medical records ( since patients will keep these carefully )

Monday, January 07, 2008

The ART of making babies

The ART of making babies : "Making babies is increasingly becoming an ART — in this case, Assisted Reproductive Therapy — thanks to lifestyle-induced infertility and late marriages. So much so that ART is today a Rs 3 billion industry in India, with over 300 clinics all over the country. “If you take the 30-40 age group of couples in India, you will find that the commonest medical problem is infertility,” says Dr Aniruddha Malpani, the renowned infertility specialist in Mumbai. “It’s a chronic illness.” One in six couples are diagnosed as infertile."

WiserWiki

WiserWiki: "WiserWiki is a wiki that will allow accredited physicians to comment, collaborate and update medical information online and is viewable by everyone. The site was originally seeded with content from John Noble’s “Textbook of Primary Care Medicine” (3rd Edition). We hope to provide a trusted forum for physicians to collaborate and contribute professional-level medical content that can be viewable by everyone. WiserWiki is one example of our commitment to explore innovative tools to help medical professionals access the most up-to-date medical information available. As of now, the site is still in “Beta mode” as we test new ways to make it better for you as a user!"

This is a great idea ! Since the text book is already available in the wiki, many more doctors will be able to edit and contribute to it, to make it better and more reliable and upto-date. Is this the way all text books will be published in the future ?

Sunday, January 06, 2008

Facts about Miscarriage

Facts about Miscarriage: " At this site you will find information and a place to come in your dark and frightened hours. The special features of the site are listed in the next column, as well as topics ranging from causes of miscarriage, to prevention, to when to try again for a new pregnancy."

This is one of the wisest websites I have seen. It deals with a very touchy topic - miscarriages - and does so in a very well-informed and comforting manner. I think the reason it's so good is because it's been done as a labour of love by a mother who has suffered miscarriages herself - and her empathy comes through clearly on each page. I recommend this site to my patients who have had a miscarriage - and this is a great model of what a great job an "expert patient" can do !

Saturday, January 05, 2008

Lawyers are better than doctors in protecting their clients

Lawyers are better than doctors in protecting their clients : "Many physicians find themselves envious of the unbending resolve with which lawyers are able to embrace their most basic role of advocacy. Lawyers retain this luxury because society recognizes the legal system to be a morass of rules and regulations which ordinary citizens cannot hope to navigate on their own. Any citizen who becomes embroiled in this morass is universally acknowledged to have the right to a lawyer who is expected to hold that citizen’s interests above all others (within, of course, the constraints of the law). Even those accused of the most heinous of crimes are entitled to legal representation, and even if the evidence against them seems overwhelming, their lawyers are expected to jealously guard their rights.Doctors are expected to fill for their patients the very same advocacy role that lawyers fill for their clients. This role is necessary, because sick people are no more capable of navigating the complex health care system than are accused felons the complex legal system, and are no less in peril if they run afoul of that system. And a patient’s need of an advocate, a professional whose job it is to protect the patient’s own best interests, is no less vital than that of the felon."

This is an interesting point of view. Lawyers do a better job at protecting their client's interests than a doctor does !

guthealthcare.com - Personal healthcare advocates - PHCA

guthealthcare.com - Personal healthcare advocates - PHCA: "PHCAs would provide individual patients with an opportunity to retain their own personal advocates - professionals who work for them and them alone, and who place their interests above all others on matters related to their healthcare - just as they might retain an attorney on legal matters. In fact, on the simple premise that patients have just as much right to a strong advocate as do accused felons, PHCAs would model themselves not after the medical profession, but after the legal profession.

Accordingly, PHCAs would not practice medicine. Instead, they would practice medical advocacy, doing whatever is necessary to guard the rights and welfare of their clients in all their interactions with a hostile healthcare system.

Their mission statement might read something like this: As PHCAs, we will perform the same service within the healthcare system that attorneys perform within the legal system. We will become our clients' advocates and advisors, assuring that a dedicated and knowledgeable professional is representing them, protecting them, and advancing their rights and welfare within the healthcare system. Our relationships with our clients will be built on trust; we will hold their confidences in private, will assiduously avoid conflicts of interest, and will work directly for them"

The Center for Patient Partnerships

The Center for Patient Partnerships: "What is patient advocacy? Patient advocates work alongside patients to help them make informed medical decisions, get the health care they need, and build strong partnerships with providers. Advocates also provide support to assist patients as they deal with medical, legal or financial uncertainty. Advocacy on behalf of patients has been practiced in some form by nurses, social workers, physicians, lawyers and others throughout the history of medicine."

Getting what you need from your doctor

Getting what you need from your doctor: "The effective patient understands all this, and nurtures her relationship with her doctor accordingly. She tailors the relationship in such a way that, when the chips are down, she is likely to be one of those her doctor will go to the wall for. To be such an effective patient, consider following these three general strategies:

Strategy 1 - Be empathetic. Show that you understand the constraints under which your doctor is laboring, and adjust your expectations accordingly. Don't be too demanding, especially regarding the small stuff. Show that you respect your doctor's skills, and that having his skills working for you is worth a few minor inconveniences. After all, you make clear, you know how hard it is to be a good doctor these days, and you're thankful he's there for you despite everything."

Strategy 2 - Align your interests with those of your doctor. Remember: you and your doctor are in this together. He feels your pain, and you feel his. You both want the same things. You both want the patient (you) to get good health care; and you both want the doctor's practice - and professional integrity - to thrive. So while you fully expect to get the care you need from your doctor, you will help him to deliver that care as efficiently and as cheaply as possible.

You will not bother him needlessly, or thoughtlessly. You will make the most efficient use of your time with him. You will learn how his office operates, and cooperate with his office staff in minimizing interruptions and special requests. (For instance, inquire as to the best time to call the office with questions, or to speak with the doctor.) The main idea is: you are interested in making the doctor's job as easy for him as possible, while still having your own vital needs served.

Strategy 3 - Become engaged in your own good health. Nothing makes doctors crazier than patients who completely neglect their own health, then expect their doctors to pull out all the stops for them when they get into medical difficulties. The fact is, your doctor simply cannot afford to vigorously advocate for every problem for every patient. This being the case, which patient is your doctor more likely to fight for when they get sick - the obese smoker who has made no visible effort to take care of himself, or the diabetic who has carefully tried to follow her difficult diet and drug regimens?

Maybe it isn't fair, but it's nonetheless true. If a doctor is considering stepping out of line and jeopardizing his own security to fight for his patient's best outcome, you can be sure he's more likely to reserve that action for a patient who's fighting right at his side for the very same thing."



This is great advice !

Tuesday, January 01, 2008

Patient education libraries in hospitals

Every hospital should have a patient education library ! It could just be a simple 100 square foot structure as pictured above, with books, TV and an internet terminal, staffed by a librarian or nurse, to help patients ( and their family members) get answers to their questions ! Not only will this save the doctors' time ( because they can "refer" them for "information therapy" to the librarian; it will help to create a lot of goodwill in the community !
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