Tuesday, December 22, 2015

Kids and Concussions

From MIT Technology Review: "Are Young Athletes Risking Brain Damage?"

And with the increasing awareness of concussion injuries, comes a rise in bogus (or marginal) services.

Monday, December 21, 2015

Friday, December 18, 2015

Politics and Health

This New York Times column by Dr. Aaron Carroll acknowledges an important truth: "Even in Basic Health Decisions, You Can’t Screen Out Politics".

Whenever people expect "somebody else" to pay for their health care, then inevitably "somebody else" will decide what care they will (or will not) receive.

This is also why I support health reforms that allow patients to control as much of their own health spending as possible (such as Health Savings Accounts, direct pay primary care, and catastrophic-only insurance with as few mandated benefits as possible.)

Tuesday, December 15, 2015

Hsieh Forbes Column: Are Mandatory Electronic Medical Records Causing Doctor Burnout?

I've expanded my latest blog post into a new Forbes column: "Are Mandatory Electronic Medical Records Causing Doctor Burnout?"

In this piece, I discuss why both doctors and patients are frustrated with electronic medical records (EMRs), drawing upon good reporting from the Chicago Tribune and the Wall Street Journal. I also discuss some ways patients can act to protect the quality of their health care, despite the problems caused by the EMRs.

Thanks to Dr. Matthew Bowdish for alerting me to the WSJ piece.

Bonus: I managed to violate Betteridge's Law of Headlines!

Mandatory Electronic Records and Doctor Burnout

Detailed piece in the 12/12/2015 Chicago Tribune: "Beleaguered by electronic record mandates, some doctors burning out".

One excerpt:
There are so many boxes to click through, she [Dr. Niva Lubin-Johnson] wonders whether she spends more time with her patients or with her computer. She's had to cut back from seeing four patients an hour to three so she doesn't feel overwhelmed. When she does examine patients, she also spends much of her time on her laptop, filling out dozens of electronic forms mandated by law.

"Is this really helping us with patient care? The answer is no. We're just checking off boxes, sending in a report," said Lubin-Johnson, 58.

It's getting to the point where she is looking forward to retiring. It's a thought she rarely entertained before the federal government began requiring physicians to use an elaborate — or maddening and onerous — system of electronic health records four years ago or face penalties worth tens of thousands of dollars in lower Medicare reimbursements.
The concept of electronic medical records is good. But these were never adopted in an organic fashion by physicians and hospitals choosing in a free market which systems to purchase, based the feature sets that helped them and their patients.  Rather, they were rammed down doctors' throats via government carrots-and-sticks. Vendors essentially had a captive audience.

Imagine if the government mandated electronic accounting software for all small businesses for billing and inventory, regardless of whether or not a particular business found it worthwhile. Or if the government mandated universal smartphone ownership, whether or not an individual needed those capabilities. Such mandates would have a hugely distorting effect on the quality and usability of the product.

Image below from the article: "Dr. Niva Lubin-Johnson, an internist, walks with her laptop to see a patient Dec. 8, 2015, at her practice in Chicago's Chatham neighborhood. She is unhappy with federal requirements for electronic health records. (Zbigniew Bzdak / Chicago Tribune)"

Thursday, December 3, 2015

They Did WHAT To Revive People In The 18th Century ?!?

From Neatorama: "This Emergency Enema Kit Was the Defibrillator of the 18th Century".

I am so very, very, very, thankful that we've progressed past this point:
According to Eighteenth Century British medicine, that it was possible to revive a person who had stopped breathing by blowing tobacco smoke up his rectum. Emergency enema kits like these were the defibrillators of the day: essential lifesaving tools designed by medical professionals. Ella Morton of Atlas Obscura writes:
Cardiopulmonary resuscitation, or CPR, was still centuries away from common usage. Instead of pumping the chest or giving mouth-to-mouth to a drowning victim—a practice that prominent British doctor William Hunter called "vulgar" in 1776—rescuers employed a variety of other dubious methods when attempting to revive those with waterlogged lungs. Rubbing the skin, inflating the lungs via a tube inserted into the trachea, and bloodletting were among the approaches. The most creative technique, however, was rectal tobacco insufflation—piping smoke into the unconscious person’s intestines via a bellows inserted in the anus.
Occasionally the process worked. The medical journal The Lancet repeats a story from 1746:
A man's wife was pulled from the water apparently dead. Amid much conflicting advice, a passing sailor proffered his pipe and instructed the husband to insert the stem into his wife's rectum, cover the bowl with a piece of perforated paper, and ‘blow hard.’ Miraculously, the woman revived.
I'm surprised this hasn't been on an episode of House, MD.

Wednesday, December 2, 2015

Your Doctor Doesn't Want to Hear About Your Fitness-Tracker Data

Basically, it's the medical version of TMI -- "Your Doctor Doesn't Want to Hear About Your Fitness-Tracker Data":
Wearable producers such as Apple, Fitbit, and Pebble will ship more than 76 million of the devices by the end of the year, according to market research firm IDC. Some doctors and researchers, however, remain unimpressed, They question the value of the particular metrics tracked, as well as the validity of the deluge of data these gadgets produce...