January 5th, 2012 by DavidHarlow in Health Policy, Opinion
Tags: ACP, Avastin, CMS, FDA, Guidelines, Health Reform, Mammography, Medical Ethics, NPR, Physicians, Policy, PSA, Reform, Shared Resources, Tragedy of the Common
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There are at least two conversations going on in the health care marketplace today, each focused on one of two key questions. One is: How can we achieve the Triple Aim? The other is: Why do they get to do that? (It’s not fair! I want more!)
Until we stop asking the second question, we can’t answer the first question. Why? Because all too often the answer to the second question is the equivalent of: It’s OK, Timmy, I’ll buy you TWO lollipops; pick whichever ones you want.
It’s the tragedy of the commons, transposed to the health care marketplace.
Recent cases in point:
- Avastin
- Tufts Medical Center – Blue Cross Blue Shield of Massachusetts grudge match
- Mammography and PSA guidelines
1. Avastin. Late last year, Read more »
*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*
January 4th, 2012 by KerriSparling in Opinion, True Stories
Tags: Blood Sugar, Bolus, Dexcom, Diabetes, Glucose Monitors, Highs, Hydration, Injection, Insulin Pump, Ketones, symptoms, Thirsty, Type 1
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High blood sugars come in three different tiers for me: No Big Deal (NBD), Tricky Little Sucker (TLS), and What The Eff (WTE).
No Big Deal (NBD) highs are the ones I see when I first hear the Dexcom BEEEEEEEP!ing. They are the 180 – 240 mg/dL highs, where I’m cruising out of range, but not so far outside that it takes hours to correct. The NBD highs are usually mild in their symptoms (kind of thirsty, sort of tired, maybe wouldn’t have noticed if the Dex hadn’t hollered) are thankfully short in their duration, so long as I’m on the ball about keeping tabs on my blood sugars.
Tricky Little Sucker (TLS) highs are obnoxious pieces of garbage that hang on for hours. These highs are the ones where you hit anything over 200 mg/dL and just ride there for hours. HOURS. Like you can undecorate the Christmas tree and pack up all the holiday nonsense back into the attic and STILL find yourself rolling outside the threshold. They’re the ones that Read more »
*This blog post was originally published at Six Until Me.*
January 3rd, 2012 by DrWes in Opinion, True Stories
Tags: Call, Concerned Patients, Life, Medicine, Operator, Rule-Breaker, Rules
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The call never should have been made.
It broke every proscribed rule.
After all, I was not on call. Thanks to the wonders of computer technology, it was very clear that I was being covered by my colleague. And yet, despite this, it came.
“Dr. Fisher, I’m so sorry for calling you at home, but I received a call from Ms. X, the wife of your patient Mr. Y. who said she really needed to speak to you about her husband… she seemed quite concerned and insisted I call you…. I told her I’d see if I could reach you at home… I’m so sorry, but it sounded urgent… I have her number, could I connect you?” Read more »
*This blog post was originally published at Dr. Wes*
January 3rd, 2012 by Lucy Hornstein, M.D. in Opinion
Tags: Celebrex, COX2 inhibitors, Dangers, Elderly, Fatal, Medical, Perception, Primary Care, Quality of Life, Red Flags, Risk, Risk Factors, warnings
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Why is it easier to talk about quality of life with patients who are dying? Why don’t we factor these considerations into the decision-making for patients with conditions that aren’t fatal?
The presence of a terminal illness serves to focus everyone’s attentions. Widespread cancer metastases? Concerns about tight blood glucose control fade away. End-stage liver disease? Blood pressure control doesn’t matter so much any more. Bony pain from prostate cancer? Narcotic and sleeping pill addiction doesn’t even occur to anyone. I find it far more problematic to deal with patients with debilitating but non-fatal conditions when treatment options are perceived as limited because of co-existing diseases that produce so-called contraindications to certain medications.
I have a patient in his mid-70s with severe pain from osteoarthritis. Several fractures and a couple of unsuccessful joint replacement surgeries haven’t helped matters. Several years ago he found that a little drug called Vioxx worked extremely well for him, reducing his pain considerably and allowing him to do pretty much watever he wanted. As we all know, however, that drug was pulled from the market because of an unacceptable increased risk of heart attacks and other untoward cardiovascular events. Interestingly, Read more »
*This blog post was originally published at Musings of a Dinosaur*
January 3rd, 2012 by Nicholas Genes, M.D., Ph.D. in Opinion
Tags: Alerts, Apple, Apps, Bacterial Colonization, Cloud, Design, Devices, EHR, Electronic Health Record, Emergency Medicine, ER, Impact Resistance, iOS 5, iPad, Save feature, Technology
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I’ve been using my iPad in the ED, with my white coat’s sewn-in iPad-sized pocket, for some time now — mostly for patient and resident education, and to look up dosages or rashes. Hitting up my Evernote database or Dropbox documents is also useful. Occasionally I’ll use my iPhone, for its LED light (when the otoscope can’t reach to where I need to see) or rarely, its camera (in compliance with my hospital and department photo policy, naturally).
Our ED’s EHR isn’t quite accessible enough via iPad for me to quickly check results or place orders at the bedside — right now it’s just too cumbersome. But there’s been progress — enough so that I start to wonder about the flip side: instead of reviewing iOS medical apps and pining for an optimized EHR experience on the iPad, what if there are features of the iPad that could limit the utility of medical apps?
Well, there are some product design issues, like impact resistance and bacterial colonization, that have been discussed. But the operating system, iOS 5, has some quirks, too. Some have received a lot of attention. Some are maddening in their capriciousness. Read more »
*This blog post was originally published at Blogborygmi*
