Monday, May 2, 2011

PTSD and Risk Factors

Posttraumatic stress disorder or PTSD is a major complication for soldiers fighting wars. There are obvious reasons for this. Stress, the concern over life or death, and fear of the unknown often contribute. But when soldiers witness death and destruction directly they can have long-term effects. But what soldiers are at greater risk to develop PTSD. Are there certain characteristics? Are there certain ways to find out? According to a new study in the archives of Gen. Psychiatry, military service members who screened positive for signs of PTSD before they were deployed were five times more likely to develop the condition. There were other risk factors. Those who took psychiatric drugs before deployment were to two and a half more times more likely. Experts say that early intervention is necessary for people at risk

Thursday, April 21, 2011

A Look at Meaningful Use

The term is meaningful use. The vast majority of people words the meaningful use don't really mean all that much, but in medical circles these two words will dramatically affect the way you receive care. Meaningful use is the way the government has chosen to describe a series of rules and regulations that will help determine how computers and technology will affect the care you are given. The good news is that there are all sorts of regulations put in place that will be used to measure the quality of your care and the way records are kept. The bad news is that many of these regulations were written by politicians or people who have very little to do with the practice of medicine. Overall I believe we are definitely heading into a time where care will be improved especially from an organizational standpoint and consistency of decision-making. My fear is that a great deal of the art of medicine may be left behind with the clicks on a keyboard. The best way to achieve success and we can accept nothing but success is to involve healthcare providers and patients in the process

Sunday, April 17, 2011

Do You Want To Know The Future This Much????

There have been many tremendous breakthroughs in the field of genetic research. As a result of greater understanding of the genetic code we understand the origin of many illnesses and conditions some of which can be life-threatening. But a new report in the Journal Pediatrics takes a look and a very interesting study which is based on the information we have learned from genetic research. Do the majority of parents who have young children want to know what conditions their children may develop when they are older. In other words would you as a parent wants to know if your young child was someday going to suffer from a certain form of cancer or genetic disease. According to the new study a majority of parents would want their children to be tested and know the results. The American Academy of pediatrics advises against this type of testing. This is an interesting study that at one time would have been a hypothetical discussion. But it is becoming more realistic everyday.

Thursday, April 14, 2011

The battle over the medical chart!

There is a battle going on in medicine these days and as patients it is very important that you know what is happening. I don’t know if you saw the Seinfeld episode where Elaine wants to see what is on her doctor’s chart. It is actually very entertaining to watch the comedy surrounding what Elaine sees as her doctor’s ability to write anything he wants seemingly without her control. Fortunately, patients have access to their charts and have control. But the battle I am talking about has to do with hospital charts. Each day doctors, nurse and anyone involved with an in patient’s care writes notes as a way to communicate information to other healthcare providers –information that is crucial for your healthcare. But, long after discharge the government and other payers for care look at the notes and determine what they will pay for your hospitalization. The battle is that the notes are potentially being used to generate payments. We need to return to a time when the charts were used to help people get better ..not justify fees.

Tuesday, April 12, 2011

Herpes Lasts Forever

There is a concerning new study dealing with the herpes virus. According to a report in the Journal of the American Medical Association people with genital herpes can be contagious even when they don't have symptoms. We have known for many years that herpes is spread through sexual contact when people have source or what is called prodromal period in the days before the soars appear. Worldwide more than 530 million people at the herpes virus and according to this report people who harbor the virus can be shedding it as much as 10% of the time. This means they could infect sexual partners. Although  use of condoms can reduce the spread of genital herpes, it does not provide 100% percent protection.

A very interesting Blog

Shifting the bell curve

The nurse at my doctor's office was checking my blood pressure last week when the following conversation ensued:

Nurse: (trying not to look worried) Um, have you ever had low blood pressure before?

Me: No. I've always had normal blood pressure.

Nurse: (now not hiding worry) Well, I'm getting 100/70 for you.

Me: Yep. Perfectly normal.

One of the residents today was telling me about a code he attended in the hospital yesterday. The code was called for hypotension (dangerously low blood pressure). The resident rushed into the room to find the patient sitting calmly, eating his breakfast. The nurse informed the resident that the patient's blood pressure was 90/60.

My intention here is not to lambaste nurses. They are merely following their protocols and experience. The larger question, I think, is when did reasonable blood pressures become "low"? Is it just because most of the blood pressures that nurses (and docs, for that matter) see are elevated?

I can't separate the word "normal" from the picture of a bell curve in my head. And I have to wonder if the bell curve for "normal" blood pressures isn't starting to shift toward the right.

I don't like the complacency toward a new norm that these events portend. How can we convince our patients that their blood pressures are too high when the bell curve of normalcy has shifted? I have started using the word "healthy" to describe desirable blood pressures instead of "normal."

Because, sadly, normal doesn't seem to be healthy anymore.

Laurence Bauer, MSW, MEd

Chief Executive Officer

Family Medicine Education Consortium

Wednesday, April 6, 2011

EMR and Catching Hospital Errors

One of the major things that hospitals can do to ensure your safety as a patient is to keep careful track of possible errors. No one wants to make an error especially in a hospital setting when patient lives are on the line but if these errors can be measured and people can learn from them,similar mistakes can be prevented. But according to a study from the University of Utah in the journal Health Affairs ,current tracking measures including a self reporting system are not catching the majority of errors. The University of Utah uses a technique called the global trigger tool which measures errors. Their system was able to identify 354 errors compared to only 39 with the other systems that are more traditional. This means that 90% of mistakes were missed. A review of the study shows that many of these mistakes were not major errors nor did they necessarily cause patients significant harm but the point is we need better ways to monitor errors across the board. It is hoped that as electronic medical records become more part of patient care many of these errors to be picked up earlier.