“End of the Line” for medical guidelines

Knowledge is king

That’s the take home message from Professor (of pharmacy) James McCormack’s latest parody video, End of the Line, which takes a whack at healthcare’s increasingly pervasive and rigid medical guidelines.

 

If followed to the letter, these guidelines (often based on research funded by drug companies) would have everyone diagnosed with a disease and taking one or more medications. Medical guidelines may be great for the drug business, but not so much for individualized, patient-centric care and shared decision-making.

Chronic disease state guidelines (blood pressure/lipids/glucose/bone density) do not provide clinicians with

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Rx for health: Community supported agriculture

community supported agricultureA new kind of prescription: fresh vegetables

I’ve always loved the quote by Hippocrates: “Let food be thy medicine and medicine be thy food.”

I’ve said many times in this blog that I’m disturbed by our healthcare system’s increasing dependence on prescription drugs. It’s not only expensive, but long-term use of drugs causes other problems down the road.

So I was pleasantly surprised to see a local news story about a physician who is rejecting the current trend.

Dr. Kris Knox is prescribing community supported agriculture (CSA) in lieu of or in addition to pharmaceuticals for patients with chronic disease

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Can telemedicine save you money?

telemedicineTime is money

Maybe you have affordable health insurance and a doctor you like.

But have you ever had the experience of calling for an appointment for a sore throat, a bladder infection, back pain, or some other minor ailment and being told that the doctor’s next available appointment is in six weeks?

Or you get a same-day appointment, but then have to take time off work, drive to the clinic, perhaps pay for parking, and then wait to be seen by the doctor. For a five-minute appointment.

It’s frustrating, sure, but it’s also costly when you consider the time … Continue reading

Hospital safety tips

hospital safetyHospital safety and medical mistakes

A friend forwarded an email to me. It was from a retirement blog he subscribes to, and this particular post was about what the writer, a doctor as well as a blogger, considers “The deadliest place you’re likely to visit this year…”

He’s talking about hospitals. And he’s not being overly dramatic, either.

He knows what many of us in health care know: hospitals can be dangerous to your health. One of my best friends is a physician. We have a pact that if either one of us has to go into the hospital, the … Continue reading

Be informed – Shared decision-making

Shared decision-making makes better informed patients, and better informed patients use less health care.

…as many as 20% of patients who participate in shared decision making choose less invasive surgical options and more conservative treatment than do patients who do not use decision aids.

Which lowers health care costs.

…a 2012 study…showed that providing decision aids to patients eligible for hip and knee replacements substantially reduced both surgery rates and costs — with up to 38% fewer surgeries and savings of 12 to 21% over 6 months.

[It’s] estimated that implementing shared decision making for just 11 procedures would

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Harken Health – Betting on primary care

I just read about health insurance giant UnitedHealth’s bold but risky new insurance plan, Harken Health:

UnitedHealthcare is betting $65 million that it can profit by making primary care more attractive.

With little fanfare, the nation’s largest health insurer launched an independent subsidiary in January that offers unlimited free doctor visits and 24/7 access by phone. Every member gets a personal health coach to nudge them toward their goals, such as losing weight or exercising more. Mental health counseling is also provided, as are yoga, cooking and acupuncture classes.

At this time, Harken Health is only available in Chicago … Continue reading

Electronic health records and medical mistakes

I just read a funny-not-funny post on the health care blog KevinMD: This doctor orders pregnancy tests on men. You’re probably doing it too

The author, a physician, laments that his hospital’s electronic health records system (EHR or EMR) makes it way too easy to make mistakes, such as ordering pregnancy tests on male patients.

Now this may sound funny to you, and I know the nurses love to read me the riot act when I do it, but truthfully this is no laughing matter.

As easy as it is to order a pregnancy test on a man, it is

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Screening kids for lead poisoning

The high lead levels in Flint, Michigan’s water supply have been news for several months. There’s been a lot of finger pointing and congressional hearings and such, but the bottom line is that because an agency didn’t do its job properly, the health of many kids was put at risk.

Lead poisoning is especially serious in infants and young children, as it interferes with brain development.

Sadly, the situation in Flint is not unique. Washington, DC, had a similar crisis a few years ago, and just last week my home state, Washington, reported that 34 water systems had lead … Continue reading

Decreasing the overuse of antibiotics

Finally some good news!

I’ve posted many times about the problems of over prescribing antibiotics. Not only does it increase health care costs, but patients are at risk of side effects from the antibiotics, and overuse of antibiotics leads to drug-resistant bacteria—a big concern for everybody.

Many times the patient insists on an antibiotic and the doctor complies; sometimes doctors just over prescribe out of habit.

But I just looked at the results of a study that revealed a relatively easy way to encourage physicians to prescribe fewer antibiotics—and it works!

For 18 months, 248 clinicians from 47

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Be informed – PSA screening tests

PSA stands for Prostate-Specific Antigen. It’s a blood test used to screen for prostate cancer.

Doctors used to recommend an annual PSA test for men over 40. But now we know that the PSA is not a good screening tool. It results in a high number of false positives, and not all forms of prostate cancer need to be treated.

Too many men have received unpleasant, expensive treatment they didn’t need.

In an excellent YouTube video, Dr. Mike Evans explains more:

In 2012 the United States Preventive Services Task Force (USPSTF) recommended against Continue reading

A naturopath denounces naturopathy

I’ve never been supportive of alternative health care providers, such as chiropractors and naturopaths, and would never recommend one to friends or family members.

I believe their limited “medical” training is not grounded by evidence-based principles. Also, inconsistent accreditation standards and self-regulation allow for them to provide care well beyond the scope of their training.

That’s my opinion, anyway.

Even so I was rather stunned (but delighted) by a post I read in KevinMD in which a naturopath strikes out at her profession: The shocking confessions of a naturopathic doctor

I quit practicing naturopathic medicine after discovering my former boss,

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The “financial toxicity” of cancer

We’ve all heard the phrase “cancer kills.”

But guess what? So can the high cost of treatment.

I just read about a study that came out of the Fred Hutchison Cancer Research Center here in Seattle.

The results won’t surprise anyone familiar with how much cancer treatment costs (a lot!), but researchers found:

…cancer patients who go bankrupt are nearly 80 percent more likely to die than patients who don’t, and some cancers had significantly higher mortality rates. Prostate cancer patients who filed for bankruptcy were almost twice as likely to die; bankrupt colorectal cancer patients were 2.5 times more

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Tips for the doctor’s office

A pediatrician posted some useful advice to parents on KevinMD: 4 mistakes parents make in the pediatrician’s office

With office visit’s getting shorter, and co-pays getting costlier, it’s more important than ever to make sure each visit counts, and communication is efficient.

What struck me when reading her post was that these tips easily apply to patients of all ages, and any doctor in any specialty.

I encourage you to read the whole post, but in short her tips are:

1. Come prepared.

[W]e aren’t mind readers, and we have a limited amount of time. It’s frustrating when people don’t

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Overuse of CT scans is dangerous and expensive

I read two articles yesterday that complemented each other:

In Kaiser Health News (KHN) Heavy Use Of CT Scans Raises Concerns About Patients’ Exposure To Radiation

And on KevinMD two radiologists posted The financial costs of treating CT-induced cancer

Each underscores the fact that CT scans are significantly overused in American healthcare.

Although CT scans are an essential diagnostic tool, the Food and Drug Administration reports that an estimated 30 to 50 percent of imaging tests are believed to be medically unnecessary.

Considering we spend tens of billions of dollars every year on diagnostic imaging, that’s a lot of wasted … Continue reading

A physician’s own end-of-life story

I’ve always believed that if I were diagnosed with a terminal illness and had a choice between a few months of quality living and a few extra months filled with doctors’ visits, surgeries, lab tests and drug treatments, I would choose quality of life.

Many friends, some of them doctors, have told me, “Oh, you think that now, but when the times comes the will to live is just too strong. You’ll do anything for that extra time.”

Would I? I guess I won’t know for sure until my time comes.

That’s exactly what a hospice physician thought—Will I Continue reading