Do you mean government interference in general? This wouldn't explain why universal, single-payer health care in nearly every other industrialized democracy ends up being significantly more efficient than the US system - providing better outcomes for a lower cost.
Do you mean government interference in the United States? This wouldn't explain why Medicare provides lower cost (in terms of overhead - about 5%) care than commercial insurance in the United States.
Medicare's rules and regulations are byzantine, but in my medical practice most of my paperwork is courtesy of private insurers, typically asking me to fill out 3 pages of paperwork when a patient comes in for a sprained ankle to see if I can help them figure out if coverage should be denied as part of a pre-existing condition.
The most impressively expensive cases in my experience as a primary care physician are the uninsured patients suffering without care for years - say for lack of a prescription for $4/month diabetes medicine, ending up in the ICU for 2 months getting their legs amputated and their kidneys blown to pieces, then ending up on disability and in an inevitable, medically complicated, expensive, taxpayer-financed decline.
Last spring, when cases started turning up in Mexico, it was reported that H1N1 was striking young adults and bypassing the usual 'high risk' groups (children and old people).
Now, its killing kids (according to press releases).
Novel H1N1 flu has a predilection for killing people with robust immune systems; it hijacks the inflammatory response and happens to kill people in the process, likely attributing for the higher mortality among young adults. Kids (especially under 2) tend to be more vulnerable too (to both novel H1N1 and seasonal flu) than adults.
The first batches of vaccine are being reserved for two groups, kids and health care workers. Because they are at higher risk for complications, or because they pose a higher risk of transmitting virus to others?
Ever heard of Google? Please check your own county's public health site where you will note that kids are indeed at higher risk for complications, and health care workers come into a lot of contact with sick people.
Where health care workers have traditionally partaken of the usual annual flue vaccines, they are not doing so at rates acceptable to the CDC for H1N1. A few hospitals have announced policies wherein workers who refuse the vaccine will be fired, or otherwise disciplined.
I can't any hard data about rate of novel H1N1 influenza inoculation of health care personnel. I can find a local news stories denoting that cafeteria workers and phlebotomists in some places expressed skepticism. I can anecdotally tell you that every physician I know here in Multnomah County (the Portland metropolitan area) is planning on or has gotten vaccinated, and plans on getting their families vaccinated too. I include myself, the 12 other physicians in my practice, my wife, the 12 other physicians in her practice, and all of our socially inbred doctor friends and acquaintances. Cafeteria workers declining the vaccine makes for a good story. People taking care of sick people, however, I suspect are going to have a high vaccination rate for themselves.
A few doctors are hesitant to get involved in the current vaccination program. One I heard on a radio talk show was expressing concerns about the unusual agreements he would have to sign to get involved with the distribution program. He's staying on the sidelines for now.
One doctor you heard on talk radio is staying on the sidelines. Noted.
There was a suggestion that homeless people in my city (Seattle) be prioritized for the vaccine. Why? They don't make a particularly good vector for flue transmission to the general population. But, since they won't be missed, they make great guinea pigs.
Citation please; this isn't noted on the King County Public Health website, though they do note that the homeless population has a high prevalence of chronic diseases known to increase risk of morbidity for influenza (asthma, COPD/emphysema, heart disease, diabetes, poor access to care, hanging out in shelters).
I'm beginning to think there's something really wrong with this vaccine. And that the CDC is prioritizing stopping the spread of the virus above the health of the afflicted people.
I'm beginning to think that intellectual laziness and being prone to rumors and half-truths is more prevalent than I expected, despite the fact that all sorts of information is available at your fingertips.
Yes, knocking on wood will really help. When you or someone you love ends up catching H1N1 flu from a health care worker in a medical office or a hospital who "never gets the flu" you can spend some time comparing their individual rights to your right not to be placed at serious risk of injury and death in a health care facility.
Not that I'm advocating all health care workers be compelled to get an H1N1 or any other vaccine. But for those who decline, I'm perfectly comfortable advocating that they not be permitted to come into contact with unsuspecting patients.
That's because you don't know what you're talking about.
Most people recover from H1N1 flu fine. As in the summary, those who don't recover fine tend to get very sick, get stuck in the ICU, and a fair amount die.
On the other hand, the risks of the vaccine include (in a minority of patients) redness and pain at the vaccination site. The typical reaction is... nothing.
Dear Commodore-64 -
Your new albuterol-HFA inhaler is available for $9 at Walmart, which is cheaper than any of my patients every found old CFC-propelled abuterol for ($12 at Costco).
That's because the parent is misinformed. Acetaminophen is added to narcotics, like oxycodone or hydrocodone, not to discourage abuse but to augment the effect of the narcotic and make it more effective. (The fact that it's controversial how much it helps is another topic.) Acetaminophen toxicity is often clinically mild until it's too late to do anything about it.
Taken as directed and without combining with other medicines, hydrocodone-acetaminophen and oxyocodone-acetaminophen are relatively safe. Combine it with Tylenol or Dayquil and maybe a drinking habit, and you can run into trouble. The proposed ban on combination drugs is to help avoid accidental overdoses due to patients not knowing that Vicodin and Nyquil and Tylenol taken together can potentially lead to liver failure.
I had an interesting experience, volunteering in a clinic in a slum in Kampala Uganda a few years ago. Medical records were kept on 5 x 8 index cards the patients would bring in with them. Unless, of course, the records fell in a pile of goat crap on the way there, or the arthritic patient with homemade crutches slipped and the card landed in the open sewer, or the card was simply lost altogether in the chaos of the patient's life.
This was troublesome enough in Uganda where blood pressure management consisted of prescribing enough Valium to use for headaches as needed when the patient's blood pressure exceeded 200 systolic or so, but imaging this model in use with, say, USB keys or even patient-passworded files living in a cloud somewhere gives me tremors. Emergency call in the middle of the night from someone bleeding profusely from some orifice? Patient temporarily psychotic when they mess up their thyroid meds? Patient is 4 years old with the third foster parent of the week?
Thank you, but I guess this is one instance where I prefer my overpriced, non-interopable, mediocre centralized EMR.
Re:one word: protectionism
on
IT and Health Care
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· Score: 5, Informative
Parent either is full of it or lives in a parallel universe.
1. Cost is not a barrier? Our EMR costs each physician many tens of thousands a dollar a year in application support, licensing, databases, and for a phalanx of IS personnel in various departments (local, regional, EMR, hospital IS).
2. MD's have a monopoly? What planet are you on? DO's have had precisely equivalent standing for decades in medical practice in the United States, and NP's are far from being "wiggled in." As a primary care physician, when I send a patient to the cardiologist or pulmonologist, half the time the entire consult is done by a PA or NP.
3. Please direct me to the land you describe where I can have control over my care environment and take home most of the money. I can't get a contracting pregnant lady into labor and delivery without asking for permission from two nurses, and I'm not aware that the balance of power in any health system I've worked in has been any different before and after transition from paper records. Medical care in most locales in the US has long been collaborative, team-based system, even if you've met a few physicians who are jerks or drive nice cars. (I am looking forward to upgrading my '94 Corolla by 2014.)
EMR systems have poor market penetration, in my direct experience over the last 9 years, because:
1. Many, if not most, suck in a medium to large way;
2. They are incredibly expensive;
3. They can often be hard to use, and are typically more labor-intensive than paper charts for most physicians in the US;
4. They don't inter-operate. (When I request old records from other physicians with electronic charts, I enter the pertinent data into my electronic chart by typing it in.)
If any skilled group of software engineers were to write a decent, usable EMR that was extensible, and didn't cost an arm and a leg, with an eye to being excellent first and profitable as a consequence, they could be up for a Nobel prize.
TFA refers to cardiac CT to prevent heart attacks. The author, too, lives in a dream world - contrary to her thesis, this test has been shown to help with the boat payments of radiologists and equipment manufacturers, but there is no evidence it helps prevent heart attacks.
I'm a physician who's been on Slashdot for a long time, and I have no idea what you're talking about, and I couldn't find it on Google either. Could you be more specific?
My polite mouthing off to drug reps and on surveys promising them I'll never prescribe their new expensive brand-name me-too drug without head-to-head trials showing superiority over cheaper, older generic agents does not seem to have landed me in hot water, and I fail to see how it could.
The abstracts are available free online - but if you aren't a subscriber you have to pay to read about the methodology and details of the statistical analysis.
Nevertheless, my expectations are low that most patients would bother to search the primary literature (speaking from experience - IAAMD).
Me and everyone I know in practice keeps up with the literature quite regularly, thank you. In order to keep our licenses and board certification, we submit for continuing education credit evidence of such reading, or conference-going.
And while I'm happy you were able to use Google to find out that lithium can be used as an adjunct third-line for depression (though in regular doses according to my reading and chats with psychiatrists, not low doses - J Clin Psychopharmacol 1999 Oct;19(5):427-34.) we'd rather you tried standard therapy first so we don't have to go through the expense and toil of regular monitoring so we don't accidentally kill you or fry your thyroid, thank you. Looks like studies of low dose lithium (as in J Clin Psychopharmacol - 01-APR-1988; 8(2): 120-4) are either admittedly underpowered or on naturopathic web sites with no published methodology.
Research is indeed ongoing. We call that science, and we do keep up with it. We doctor couples even talk over we what we read about over dinner.
Unless your primary care doctor own his or own CT scanner or MRI machine or reference lab, they do not get a cut of the money from these tests, and incentive payments from labs or radiology providers to them would be considered illegal kickbacks (in the United States).
And, if you figure out a way to fairly reward doctors for "good care," developing metrics that account for riskier patients while preventing doctors from ridding their practices of complicated, cranky patients who don't like to follow advice, there may be a Nobel Prize in it for you.
People withholding information from their physicians is already a problem. Forbidding me from maintaining any medical records is likely to make this worse. Why, just recently, in my own clinic:
Mentally ill patient willing to see me, but declining to see a psychiatrist or allow me access to their old psychiatrist's records. Talks to bicycles and believes dogs are reporting his/her extrasensory perception abilities to FBI. History of threatening people on public transit, but hasn't actually done anything violent yet, so not eligible for the thoughtful intervention of law enforcement.
Pregnant patient likely addicted to mind-altering substances but prefers not to get CPS involved in imminent childbirth; cagey about previous diagnoses and treatments.
Odd hypothyroid patient thinks they really may have an astrological problem and not a malfunctioning gland, takes medication only at certain times, seeing alternative providers but prefers they don't share information so we don't get pre-conceived notions. As the thyroid gets more out of whack, the patient's clarity and judgment worsen.
You will note in 2 out of 3 cases, these people aren't only endangering their own health but that of innocents around them. The 3rd is just reinforcing his/her own downward spiral.
This would be a fascinating study of evolution in action. As a physician, barring me from storing medical records would result in a host of epiphenomena: people purposefully withholding histories of mental illness, drug and alcohol addiction, and even high blood pressure diagnoses they didn't agree with. Moreover, population control could be augmented while untangling how we'd implement getting ahold of critical information in emergencies, or when people forgot their passwords or access keys.
For what it's worth, in the developing world, where I worked for a while, people do carry their own medical records - typically on index cards or other scraps of paper they would bring to their appointments, as clinics could not be expected to bear the expense or trouble of maintaining them. This went for immunization records, logs of taking your TB medicine, and records of diagnosis and treatment of chronic diseases.
Notwithstanding medical records being lost in open sewers when my disabled patients lost their balance on their crutches, the system didn't work very well. The sicker people tend to be, the more difficult it is for them to manage basic affairs.
This strikes me as a solution looking for a problem. Just how often do people truly find their medical records being used against them?
Breastfeeding's benefits extend far beyond 6 months (less asthma and overweight later on, for example), but this has nothing to do with why the MMR vaccine is given at a year. That seems to be when the child's immune system can mount a sufficient response to the vaccines components so that it has a lasting effect.
And, it's not too late to give your daughter the varicella (chicken pox) vaccine. Your opinion may be that's it's irritating, but with the infinitesimally low rate of complications of the vaccine compared to the not so infrequent complications from the virus (see http://www.immunize.org/reports/chickenpox.asp) as well as likely reduction in the risk of shingles (from lingering effects of the same virus) later on in life, your daughter will thank you.
When parents of my pediatric patients say they're skipping vaccines, they talk more about what they read on the Internet than what they see on television or read in the newspaper. The second most common source of information cited about how vaccines are dangerous is "people [they've] talked to."
Only a small percentage make a distinction about specific vaccines; most who refuse the MMR refuse everything. So, do I have to wait until we prove another negative - autism isn't caused by DTaP - to prevent common (and sometimes fatal) whooping cough? Proving that the MMR vaccine doesn't cause autism (NEJM 347:1477-1482) hasn't been enough for my vaccine refusers so far.
This is a parental issue. I think the solution is basic education in the scientific method and statistics for everyone, beginning in elementary school.
This has got to be the dumbest reason for requiring organic chemistry - simply because it's a lot of material. Medicine is already a lot of material. If we're going to cram you with a lot of facts, why not make it clinically relevant ones you actually have some hope of using to help someone? Speaking as an actual, practicing physician (who passed orgo just fine, thanks, and even enjoyed it).
Uggh. Organic chemistry might be essential to understanding how organic molecules interact in the body, but it just isn't used in the day-to-day practice of clinical medicine. A semester of the fundamentals would probably do fine, instead of the whole year.
I can think of a slew of subjects that would be more helpful in my daily practice as a primary care physician - statistics (I think this should be taught in high school instead of calculus), basic psychology, nutrition... Spanish! Biochem, as it's currently taught in many medical schools (opaquely and with little clinical reference) hasn't proven to be too useful either.
While many (though hardly all) of the compounds I prescribe daily are organic, I am not aware of anyone who routinely refers to their structural formulae.
In our hospitals (Portland, Oregon) the fetal heart monitor is a dedicated box connected to a Windows server that in turn displays fetal heart tracings on a PC screen above the monitor itself. (It runs an overpriced, difficult to use software package made by GE.) Sure, the server goes down now now and then. But, the actual tracing can still be seen on the thermal paper output, and the heart rate on the display on the dedicated monitor itself.
For what it's worth, continuous fetal heart tracing has never been shown to improve outcomes anyway - the idea caught on well before it was adequately studied.
Oy vey, you folks need to take a step back. The above guidelines refer to other service providers that users can opt in to and share their history with. Google is simply limiting their ability to annoy you, should you choose to opt in.
And, Google isn't protecting your information via HIPAA because it can't - it's not a "covered entity" under the definition outlined in the law. (That is, they aren't a health provider, billing clearinghouse, or health plan.) Instead, they provide the Google Health Privacy Policy, which seems pretty reasonable. Like HIPAA, it allows them to disclose information when it seems like the government (US, in this case, as that's where the service is limited to) compels it. Before you get hot and bothered, HIPAA allows this too - it's how we tell get to CPS about abused children, for example.
I'm not new here, but I'm used to Slashdot readers being somewhat more informed before having a fit. As a covered entity myself (I'm a physician), I look forward to the day when the patients who come in saying they doubled the pink pills but lost the yellow ones they took for that surgery to remove that thigamajig have a hope of a secure information repository to clarify their history, and potentially save their bacon.
If you want to look up my licensing status and any restrictions, as well as board certification, go right ahead - http://www.docboard.org/docfinder.html. If you want to know if I'm a good match for you, you'll have to do the same thing as you would for your dentist, plumber, or lawyer - try me and see if it works out.
If you want to figure out how much I'm charging, good luck: each different plan with each distinct insurance company charges different prices for different procedures or visit types, which is often considered proprietary information so I'm not allowed to know or publicize what it is anyway, lest I collude with other physicians to get better a payment schedule.
And while some doctors may be competing for your business, as a primary care physician, I'm not - our practice (like many) limits new patients. I take Medicaid and uninsured patients along with commercial insurance, and my panel is overflowing. I'm happy to say I love my job, but the long hours, mountains of paperwork, and 13 year old car are typical of my colleagues - we're not exactly living high off the hog, or running our hands through a mountain of gold coins.
By law in the United States, no hospital with an emergency room can turn away anyone for needed care, but I can see why the folks doing elective surgeries might want to be sure you can pay your bill. This is America after all, and we are apparently a long way off from figuring out what virtually every other industrialized democracy has: private insurers are in it for the money, and are not necessarily aligned with your best interests.
1. I don't get the article summary. Are my STD results somehow more vulnerable to theft if they are in a proprietary database format rather than an open one? 2. In my practice, we use an EHR (electronic health record) because I'm an employee of a big enough group that has the resources to purchase one of these expensive, bloated, not very well-maintained systems. (They're still working on making cut and paste work, and the group has to pay a bucket of money every month for ongoing support.) When I was a medical student in Ireland, I marveled how the GP I worked with in West Clare had a simple system he paid something like $300 which did everything he needed it to do, like track progress notes and lists, and keep track of drugs. That amount here covers about 30 seconds of use of our current software. Which is barely interoperable even with itself - if we see a patient from an affiliated private group using the same software, interoperability means they can email us a progress note, and then I can spend my afternoon hand-entering the medications and problems from their chart into my state of the art software's database to make sure grandpa doesn't crump over the holiday from a drug interaction with the cardiologist's new pills.
There isn't much incentive to make this software as easy to use as iTunes - the players seem to make plenty of money already with their proprietary storage formats and circa 1991 interface. There is no viable open source alternative (http://oemr.org/ doesn't look quite ready for prime time) - though I think there's an opportunity here for some enterprising Linux loving propellerheads.
If you use McKesson's software every day like I do, you would be amazed at its expense, sluggishness, and irritability. Lab systems that insist on running on Internet Explorer 6 and resizing to fit your whole screen aren't a big surprise - however mediocre. But mission critical systems that routinely crash with Java errors, can't run reliably remotely, require large IT departments to maintain, are slower and more difficult to use than the tty-based systems they replaced, can't trend labs, can't reliably wildcard search patient names, and die miserably if the wind blows more than 5 miles an hour or the moon is waxing - this is truly sad.
I wish our hospital system could dig its way out of it. I don't think running on top of Linux will help much. See if you can get a screenshot of their software on their website - I can't - they don't promote this stuff to the physicians and nurses who use it - it gets sold to the suits. There's a goldmine out their awaiting some entrepreneur who could really take pride in writing good software of this sort, and though I love Linux, I don't really care what it runs on top of.
* We'd be better off if physicians weren't certified, and patients would do their own research as to the qualifications of their practitioner.
* When you have a throat infection, you can somehow tell without access to a medical lab whether or not you have viral pharyngitis, a Group A strep infection, some other bacterial infection, or a developing peritonsillar abscess.
* People who are poor enough to have to choose between rent and food and have enough chronic illnesses that they see a physician every month should not have health insurance available to them for "routine" visits
Do you really want to shop around for the right emergency department? Do you really want anyone graduating from Brand X medical school to hang out a shingle and never take board certification exams? (These days, most primary care physicians take certifying exams every 6-10 years.)
As a physician, I have enough trouble when people take leftover antibiotics, guessing at the frequency and duration of treatment, and making subsequent bacterial culture testing impossible. When I've practiced overseas, I've seen children die when their kids mistakenly get dosed with the wrong amount of "routine" anti-malarial medicine.
1. Most MRSA infections occur in hospitalized patients who are already really sick from something else (bad diabetes, vascular disease, or anything else keeping them in a hospital bed and on a lot of antibiotics already). MRSA pretty much comes from hospitals: all of the sick patients + all of their antibiotics breeds resistant bacteria.
2. There are already antibiotics that work for MRSA infections, but not many of them, and they're often quite expensive. The new agent noted above would add to this arsenal, not constitute it.
3. Patients with MRSA infections tend to have chronic medical problems, so they tend to be elderly (i.e. on Medicare), poor (down and out alcoholics and drug abusers, on Medicaid) or with major pre-existing conditions (paralysis, congenital defects, and otherwise debilitated -- on Medicare for disability).
That means that these expensive antibiotics aren't paid for by the patients; YOU pay for them, through your taxes. Does this make anyone feel any differently about paying a fair price for the hard work of pharmaceutical companies?
The way the health care system is set up in the United States, preventive care for poor and old people is harder to come by, but we do not yet let our poor or debilitated citizens drop in the streets. So, patients in Oregon (for example) this month facing funding setbacks to the Medicaid system can no longer pay for their insulin -- it's not covered for many of them -- but when their limbs start rotting as a result or they go into a hyperosmolar coma, they still get admitted to the hospital for $2000 a night. We discharge them -- without insulin, as it's not covered -- and wish them the best. They do get the very finest antibiotics while they're in the hospital, however; the system still pays for that.
Why is health care so expensive these days?
The most quickly expanding piece of the expanding pie is pharmaceutical costs. Even generic drugs have increased in price up to 800% (because that's what the market will bear). Pharma says this is fair, because drugs are better than ever, so they deserve a bigger piece of the pie.
The economics of the system are deeply distorted; I bet few of the readers above pay for most of their own medicines; rather, they're covered through commercial insurance, which benefits from deeply discounted costs. This is great for those of us with insurance, but torques my patients with a $630 social security income and $390 a month in prescription costs with no drug coverage at all. They don't want to land in the hospital either, which is when you start to foot the bill in a large way.
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Do you mean government interference in the United States? This wouldn't explain why Medicare provides lower cost (in terms of overhead - about 5%) care than commercial insurance in the United States.
Medicare's rules and regulations are byzantine, but in my medical practice most of my paperwork is courtesy of private insurers, typically asking me to fill out 3 pages of paperwork when a patient comes in for a sprained ankle to see if I can help them figure out if coverage should be denied as part of a pre-existing condition.
The most impressively expensive cases in my experience as a primary care physician are the uninsured patients suffering without care for years - say for lack of a prescription for $4/month diabetes medicine, ending up in the ICU for 2 months getting their legs amputated and their kidneys blown to pieces, then ending up on disability and in an inevitable, medically complicated, expensive, taxpayer-financed decline.
So far, this is what I've heard about H1N1:
Novel H1N1 flu has a predilection for killing people with robust immune systems; it hijacks the inflammatory response and happens to kill people in the process, likely attributing for the higher mortality among young adults. Kids (especially under 2) tend to be more vulnerable too (to both novel H1N1 and seasonal flu) than adults.
The first batches of vaccine are being reserved for two groups, kids and health care workers. Because they are at higher risk for complications, or because they pose a higher risk of transmitting virus to others?
Ever heard of Google? Please check your own county's public health site where you will note that kids are indeed at higher risk for complications, and health care workers come into a lot of contact with sick people.
Where health care workers have traditionally partaken of the usual annual flue vaccines, they are not doing so at rates acceptable to the CDC for H1N1. A few hospitals have announced policies wherein workers who refuse the vaccine will be fired, or otherwise disciplined.
I can't any hard data about rate of novel H1N1 influenza inoculation of health care personnel. I can find a local news stories denoting that cafeteria workers and phlebotomists in some places expressed skepticism. I can anecdotally tell you that every physician I know here in Multnomah County (the Portland metropolitan area) is planning on or has gotten vaccinated, and plans on getting their families vaccinated too. I include myself, the 12 other physicians in my practice, my wife, the 12 other physicians in her practice, and all of our socially inbred doctor friends and acquaintances. Cafeteria workers declining the vaccine makes for a good story. People taking care of sick people, however, I suspect are going to have a high vaccination rate for themselves.
A few doctors are hesitant to get involved in the current vaccination program. One I heard on a radio talk show was expressing concerns about the unusual agreements he would have to sign to get involved with the distribution program. He's staying on the sidelines for now.
One doctor you heard on talk radio is staying on the sidelines. Noted.
There was a suggestion that homeless people in my city (Seattle) be prioritized for the vaccine. Why? They don't make a particularly good vector for flue transmission to the general population. But, since they won't be missed, they make great guinea pigs.
Citation please; this isn't noted on the King County Public Health website, though they do note that the homeless population has a high prevalence of chronic diseases known to increase risk of morbidity for influenza (asthma, COPD/emphysema, heart disease, diabetes, poor access to care, hanging out in shelters).
I'm beginning to think there's something really wrong with this vaccine. And that the CDC is prioritizing stopping the spread of the virus above the health of the afflicted people.
I'm beginning to think that intellectual laziness and being prone to rumors and half-truths is more prevalent than I expected, despite the fact that all sorts of information is available at your fingertips.
Not that I'm advocating all health care workers be compelled to get an H1N1 or any other vaccine. But for those who decline, I'm perfectly comfortable advocating that they not be permitted to come into contact with unsuspecting patients.
Most people recover from H1N1 flu fine. As in the summary, those who don't recover fine tend to get very sick, get stuck in the ICU, and a fair amount die.
On the other hand, the risks of the vaccine include (in a minority of patients) redness and pain at the vaccination site. The typical reaction is... nothing.
Dear Commodore-64 - Your new albuterol-HFA inhaler is available for $9 at Walmart, which is cheaper than any of my patients every found old CFC-propelled abuterol for ($12 at Costco).
Taken as directed and without combining with other medicines, hydrocodone-acetaminophen and oxyocodone-acetaminophen are relatively safe. Combine it with Tylenol or Dayquil and maybe a drinking habit, and you can run into trouble. The proposed ban on combination drugs is to help avoid accidental overdoses due to patients not knowing that Vicodin and Nyquil and Tylenol taken together can potentially lead to liver failure.
I had an interesting experience, volunteering in a clinic in a slum in Kampala Uganda a few years ago. Medical records were kept on 5 x 8 index cards the patients would bring in with them. Unless, of course, the records fell in a pile of goat crap on the way there, or the arthritic patient with homemade crutches slipped and the card landed in the open sewer, or the card was simply lost altogether in the chaos of the patient's life.
This was troublesome enough in Uganda where blood pressure management consisted of prescribing enough Valium to use for headaches as needed when the patient's blood pressure exceeded 200 systolic or so, but imaging this model in use with, say, USB keys or even patient-passworded files living in a cloud somewhere gives me tremors. Emergency call in the middle of the night from someone bleeding profusely from some orifice? Patient temporarily psychotic when they mess up their thyroid meds? Patient is 4 years old with the third foster parent of the week?
Thank you, but I guess this is one instance where I prefer my overpriced, non-interopable, mediocre centralized EMR.
Parent either is full of it or lives in a parallel universe.
1. Cost is not a barrier? Our EMR costs each physician many tens of thousands a dollar a year in application support, licensing, databases, and for a phalanx of IS personnel in various departments (local, regional, EMR, hospital IS).
2. MD's have a monopoly? What planet are you on? DO's have had precisely equivalent standing for decades in medical practice in the United States, and NP's are far from being "wiggled in." As a primary care physician, when I send a patient to the cardiologist or pulmonologist, half the time the entire consult is done by a PA or NP.
3. Please direct me to the land you describe where I can have control over my care environment and take home most of the money. I can't get a contracting pregnant lady into labor and delivery without asking for permission from two nurses, and I'm not aware that the balance of power in any health system I've worked in has been any different before and after transition from paper records. Medical care in most locales in the US has long been collaborative, team-based system, even if you've met a few physicians who are jerks or drive nice cars. (I am looking forward to upgrading my '94 Corolla by 2014.)
EMR systems have poor market penetration, in my direct experience over the last 9 years, because:
1. Many, if not most, suck in a medium to large way;
2. They are incredibly expensive;
3. They can often be hard to use, and are typically more labor-intensive than paper charts for most physicians in the US;
4. They don't inter-operate. (When I request old records from other physicians with electronic charts, I enter the pertinent data into my electronic chart by typing it in.)
If any skilled group of software engineers were to write a decent, usable EMR that was extensible, and didn't cost an arm and a leg, with an eye to being excellent first and profitable as a consequence, they could be up for a Nobel prize.
TFA refers to cardiac CT to prevent heart attacks. The author, too, lives in a dream world - contrary to her thesis, this test has been shown to help with the boat payments of radiologists and equipment manufacturers, but there is no evidence it helps prevent heart attacks.
My polite mouthing off to drug reps and on surveys promising them I'll never prescribe their new expensive brand-name me-too drug without head-to-head trials showing superiority over cheaper, older generic agents does not seem to have landed me in hot water, and I fail to see how it could.
Nevertheless, my expectations are low that most patients would bother to search the primary literature (speaking from experience - IAAMD).
Me and everyone I know in practice keeps up with the literature quite regularly, thank you. In order to keep our licenses and board certification, we submit for continuing education credit evidence of such reading, or conference-going.
And while I'm happy you were able to use Google to find out that lithium can be used as an adjunct third-line for depression (though in regular doses according to my reading and chats with psychiatrists, not low doses - J Clin Psychopharmacol 1999 Oct;19(5):427-34.) we'd rather you tried standard therapy first so we don't have to go through the expense and toil of regular monitoring so we don't accidentally kill you or fry your thyroid, thank you. Looks like studies of low dose lithium (as in J Clin Psychopharmacol - 01-APR-1988; 8(2): 120-4) are either admittedly underpowered or on naturopathic web sites with no published methodology.
Research is indeed ongoing. We call that science, and we do keep up with it. We doctor couples even talk over we what we read about over dinner.
Unless your primary care doctor own his or own CT scanner or MRI machine or reference lab, they do not get a cut of the money from these tests, and incentive payments from labs or radiology providers to them would be considered illegal kickbacks (in the United States). And, if you figure out a way to fairly reward doctors for "good care," developing metrics that account for riskier patients while preventing doctors from ridding their practices of complicated, cranky patients who don't like to follow advice, there may be a Nobel Prize in it for you.
You will note in 2 out of 3 cases, these people aren't only endangering their own health but that of innocents around them. The 3rd is just reinforcing his/her own downward spiral.
This would be a fascinating study of evolution in action. As a physician, barring me from storing medical records would result in a host of epiphenomena: people purposefully withholding histories of mental illness, drug and alcohol addiction, and even high blood pressure diagnoses they didn't agree with. Moreover, population control could be augmented while untangling how we'd implement getting ahold of critical information in emergencies, or when people forgot their passwords or access keys. For what it's worth, in the developing world, where I worked for a while, people do carry their own medical records - typically on index cards or other scraps of paper they would bring to their appointments, as clinics could not be expected to bear the expense or trouble of maintaining them. This went for immunization records, logs of taking your TB medicine, and records of diagnosis and treatment of chronic diseases. Notwithstanding medical records being lost in open sewers when my disabled patients lost their balance on their crutches, the system didn't work very well. The sicker people tend to be, the more difficult it is for them to manage basic affairs. This strikes me as a solution looking for a problem. Just how often do people truly find their medical records being used against them?
And, it's not too late to give your daughter the varicella (chicken pox) vaccine. Your opinion may be that's it's irritating, but with the infinitesimally low rate of complications of the vaccine compared to the not so infrequent complications from the virus (see http://www.immunize.org/reports/chickenpox.asp) as well as likely reduction in the risk of shingles (from lingering effects of the same virus) later on in life, your daughter will thank you.
When parents of my pediatric patients say they're skipping vaccines, they talk more about what they read on the Internet than what they see on television or read in the newspaper. The second most common source of information cited about how vaccines are dangerous is "people [they've] talked to." Only a small percentage make a distinction about specific vaccines; most who refuse the MMR refuse everything. So, do I have to wait until we prove another negative - autism isn't caused by DTaP - to prevent common (and sometimes fatal) whooping cough? Proving that the MMR vaccine doesn't cause autism (NEJM 347:1477-1482) hasn't been enough for my vaccine refusers so far. This is a parental issue. I think the solution is basic education in the scientific method and statistics for everyone, beginning in elementary school.
This has got to be the dumbest reason for requiring organic chemistry - simply because it's a lot of material. Medicine is already a lot of material. If we're going to cram you with a lot of facts, why not make it clinically relevant ones you actually have some hope of using to help someone? Speaking as an actual, practicing physician (who passed orgo just fine, thanks, and even enjoyed it).
Uggh. Organic chemistry might be essential to understanding how organic molecules interact in the body, but it just isn't used in the day-to-day practice of clinical medicine. A semester of the fundamentals would probably do fine, instead of the whole year. I can think of a slew of subjects that would be more helpful in my daily practice as a primary care physician - statistics (I think this should be taught in high school instead of calculus), basic psychology, nutrition... Spanish! Biochem, as it's currently taught in many medical schools (opaquely and with little clinical reference) hasn't proven to be too useful either. While many (though hardly all) of the compounds I prescribe daily are organic, I am not aware of anyone who routinely refers to their structural formulae.
In our hospitals (Portland, Oregon) the fetal heart monitor is a dedicated box connected to a Windows server that in turn displays fetal heart tracings on a PC screen above the monitor itself. (It runs an overpriced, difficult to use software package made by GE.) Sure, the server goes down now now and then. But, the actual tracing can still be seen on the thermal paper output, and the heart rate on the display on the dedicated monitor itself. For what it's worth, continuous fetal heart tracing has never been shown to improve outcomes anyway - the idea caught on well before it was adequately studied.
And, Google isn't protecting your information via HIPAA because it can't - it's not a "covered entity" under the definition outlined in the law. (That is, they aren't a health provider, billing clearinghouse, or health plan.) Instead, they provide the Google Health Privacy Policy, which seems pretty reasonable. Like HIPAA, it allows them to disclose information when it seems like the government (US, in this case, as that's where the service is limited to) compels it. Before you get hot and bothered, HIPAA allows this too - it's how we tell get to CPS about abused children, for example.
I'm not new here, but I'm used to Slashdot readers being somewhat more informed before having a fit. As a covered entity myself (I'm a physician), I look forward to the day when the patients who come in saying they doubled the pink pills but lost the yellow ones they took for that surgery to remove that thigamajig have a hope of a secure information repository to clarify their history, and potentially save their bacon.
If you want to look up my licensing status and any restrictions, as well as board certification, go right ahead - http://www.docboard.org/docfinder.html. If you want to know if I'm a good match for you, you'll have to do the same thing as you would for your dentist, plumber, or lawyer - try me and see if it works out.
If you want to figure out how much I'm charging, good luck: each different plan with each distinct insurance company charges different prices for different procedures or visit types, which is often considered proprietary information so I'm not allowed to know or publicize what it is anyway, lest I collude with other physicians to get better a payment schedule.
And while some doctors may be competing for your business, as a primary care physician, I'm not - our practice (like many) limits new patients. I take Medicaid and uninsured patients along with commercial insurance, and my panel is overflowing. I'm happy to say I love my job, but the long hours, mountains of paperwork, and 13 year old car are typical of my colleagues - we're not exactly living high off the hog, or running our hands through a mountain of gold coins.
By law in the United States, no hospital with an emergency room can turn away anyone for needed care, but I can see why the folks doing elective surgeries might want to be sure you can pay your bill. This is America after all, and we are apparently a long way off from figuring out what virtually every other industrialized democracy has: private insurers are in it for the money, and are not necessarily aligned with your best interests.
1. I don't get the article summary. Are my STD results somehow more vulnerable to theft if they are in a proprietary database format rather than an open one?
2. In my practice, we use an EHR (electronic health record) because I'm an employee of a big enough group that has the resources to purchase one of these expensive, bloated, not very well-maintained systems. (They're still working on making cut and paste work, and the group has to pay a bucket of money every month for ongoing support.) When I was a medical student in Ireland, I marveled how the GP I worked with in West Clare had a simple system he paid something like $300 which did everything he needed it to do, like track progress notes and lists, and keep track of drugs. That amount here covers about 30 seconds of use of our current software. Which is barely interoperable even with itself - if we see a patient from an affiliated private group using the same software, interoperability means they can email us a progress note, and then I can spend my afternoon hand-entering the medications and problems from their chart into my state of the art software's database to make sure grandpa doesn't crump over the holiday from a drug interaction with the cardiologist's new pills.
There isn't much incentive to make this software as easy to use as iTunes - the players seem to make plenty of money already with their proprietary storage formats and circa 1991 interface. There is no viable open source alternative (http://oemr.org/ doesn't look quite ready for prime time) - though I think there's an opportunity here for some enterprising Linux loving propellerheads.
If you use McKesson's software every day like I do, you would be amazed at its expense, sluggishness, and irritability. Lab systems that insist on running on Internet Explorer 6 and resizing to fit your whole screen aren't a big surprise - however mediocre. But mission critical systems that routinely crash with Java errors, can't run reliably remotely, require large IT departments to maintain, are slower and more difficult to use than the tty-based systems they replaced, can't trend labs, can't reliably wildcard search patient names, and die miserably if the wind blows more than 5 miles an hour or the moon is waxing - this is truly sad.
I wish our hospital system could dig its way out of it. I don't think running on top of Linux will help much. See if you can get a screenshot of their software on their website - I can't - they don't promote this stuff to the physicians and nurses who use it - it gets sold to the suits. There's a goldmine out their awaiting some entrepreneur who could really take pride in writing good software of this sort, and though I love Linux, I don't really care what it runs on top of.
So, if I understand you correctly, you claim:
* We'd be better off if physicians weren't certified, and patients would do their own research as to the qualifications of their practitioner.
* When you have a throat infection, you can somehow tell without access to a medical lab whether or not you have viral pharyngitis, a Group A strep infection, some other bacterial infection, or a developing peritonsillar abscess.
* People who are poor enough to have to choose between rent and food and have enough chronic illnesses that they see a physician every month should not have health insurance available to them for "routine" visits
Do you really want to shop around for the right emergency department? Do you really want anyone graduating from Brand X medical school to hang out a shingle and never take board certification exams? (These days, most primary care physicians take certifying exams every 6-10 years.)
As a physician, I have enough trouble when people take leftover antibiotics, guessing at the frequency and duration of treatment, and making subsequent bacterial culture testing impossible. When I've practiced overseas, I've seen children die when their kids mistakenly get dosed with the wrong amount of "routine" anti-malarial medicine.
Can we talk about MRSA here a second?
1. Most MRSA infections occur in hospitalized patients who are already really sick from something else (bad diabetes, vascular disease, or anything else keeping them in a hospital bed and on a lot of antibiotics already). MRSA pretty much comes from hospitals: all of the sick patients + all of their antibiotics breeds resistant bacteria.
2. There are already antibiotics that work for MRSA infections, but not many of them, and they're often quite expensive. The new agent noted above would add to this arsenal, not constitute it.
3. Patients with MRSA infections tend to have chronic medical problems, so they tend to be elderly (i.e. on Medicare), poor (down and out alcoholics and drug abusers, on Medicaid) or with major pre-existing conditions (paralysis, congenital defects, and otherwise debilitated -- on Medicare for disability).
That means that these expensive antibiotics aren't paid for by the patients; YOU pay for them, through your taxes. Does this make anyone feel any differently about paying a fair price for the hard work of pharmaceutical companies?
The way the health care system is set up in the United States, preventive care for poor and old people is harder to come by, but we do not yet let our poor or debilitated citizens drop in the streets. So, patients in Oregon (for example) this month facing funding setbacks to the Medicaid system can no longer pay for their insulin -- it's not covered for many of them -- but when their limbs start rotting as a result or they go into a hyperosmolar coma, they still get admitted to the hospital for $2000 a night. We discharge them -- without insulin, as it's not covered -- and wish them the best. They do get the very finest antibiotics while they're in the hospital, however; the system still pays for that.
Why is health care so expensive these days?
The most quickly expanding piece of the expanding pie is pharmaceutical costs. Even generic drugs have increased in price up to 800% (because that's what the market will bear). Pharma says this is fair, because drugs are better than ever, so they deserve a bigger piece of the pie.
The economics of the system are deeply distorted; I bet few of the readers above pay for most of their own medicines; rather, they're covered through commercial insurance, which benefits from deeply discounted costs. This is great for those of us with insurance, but torques my patients with a $630 social security income and $390 a month in prescription costs with no drug coverage at all. They don't want to land in the hospital either, which is when you start to foot the bill in a large way.