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.

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



Laurence.Bauer@fmec.net

Something New and Exciting

For several years, you have trusted www.mymedicalreports.com as your site for the latest in breaking medical news and trusted health information. In the coming weeks we will be making a transition to a new and exciting site called http://www.123mymd.com/ which will have all you have been used to and even more!

This does not mean www.mymedicalreports.com is going away. It is being transitioned into a resource for physicians who are being faced with the challenge of meeting Meaningful Use and introducing electronic medical records into their practices and care of hospitalized patients. Certainly, non physicians will always be able to access www.mymedicalreports.com, but the new interviews and information will be aimed at practicing physicians.

Take a look at http://www.123mymd.com/ and let me know what you think. The blogs you have been used to reading on this site will be continued on our new site. You won't miss a beat!

Congratulations to President Obama!!

I don't care what your politics are but sometimes you have to say well done. That's the case with our president Barack Obama. Up until recently he was like one in five adults smoking cigarettes. That's 46 million people in the United States who are addicted to nicotine. But now there is news from the First Lady that the president had kicked the habit. This is not the first time he is quit. Mr. Obama says he has tried several times before and returned to cigarettes. However that just makes him more normal. Three out of four smokers who try to kick the habit relapse within six months. But what some may see as a weakness can also be a strength. People often follow the example of public figures. When President Reagan had a colonoscopy the numbers skyrocketed. The hope is that many Americans will try to follow in the president's footsteps and the fact that he has failed before and continues to try maybe the best lesson of all. Back in 1964 the Surgeon General declared tobacco hazardous to your health. Since that time booking rates have dropped but progress has been limited in the past 10 years. Perhaps the president will serve as inspiration for smokers to quit

HPV Vaccine: Is It Tiem To Give It To Boys As Well

The human papilloma virus or HPV vaccine was approved in June of 2006 for use in girls and women for the prevention of cervical cancer. For many years we had known that 70% of cervical cancer cases are associated with HPV. But the question has remained for many years why not give the vaccine to boys as well. According to a new study in the New England Journal of Medicine 4000 boys and men between the ages of 16 and 26 were given either the HPV vaccine or a placebo. After three years the researchers found the vaccine reduced HPV infection by as much as 90% in those who were HPV negative at the start of the testing. Those in favor of vaccinating boys for HPV say that this could dramatically reduce the chances of HPV being spread by sexual activity simply because fewer would have the virus. Those against the idea say they are not certain about the long-term protective effects of the vaccine in question whether it's cost-effective to vaccinate so many people. They also point to the fact that the study was funded by Merck which is the company that produces gardasil, the leading HPV vaccine. Needless to say this is going to raise much debate

Don't Ignore Heartburn

Heartburn is a health issue. It's a health issue that's not going away and that's going to be a problem, but the thing about heartburn that I think is very important is understanding that it can be the sign of a longer-lasting problem. What you have to realize is if you have heartburn and you get over-the-counter treatments, and it's not getting better, you need to get yourself evaluated and looked into so that you get a closer analysis and evaluation of the problem.

Pro Football's Big Secret: A Health Risk

This is a great time of year if you are a football fan. We have two great games this weekend and were heading to the Super Bowl. For those lucky enough to live in cities where there are games many might be heading out to tailgate before the game. When you ask people who tailgate about drinking alcohol and if they're concerned about driving home with a high blood-alcohol level they often say they eat enough food and it is not a big issue. But according to a new report in the journal, Alcoholism: Clinical and Experimental Research, 40% of people tested had detectable alcohol levels after the game eight Percent were legally drunk. What is particularly concerning is that fans under 35 were nine times more likely to be drunk than older ones. Those who tailgate before the games were 14 times more likely to be drunk compared to people who did not wine and dine in the parking lot. So if you think about the average crowd in a typical sports stadium it can be estimated that as many as 5000 people leaving a game could have a blood-alcohol level above the legal limit. The study was conducted at the University of Minnesota and is particularly concerning because the authors of the study believe this is a low estimate. Many people refused to be tested because they thought they might be caught. One other point. Most teams have big business selling alcohol during the game to fans in the stands or in luxury boxes. This is a major public health issue that should not be ignored. Think of all the innocent people driving cars who happened to be in the area after a game. The high percentage of alcohol intoxicated fans leaving games represent a real risk.

Fraud and The Controversy Over Vaccines

The news that one of the biggest studies in the past 50 years may have been an elaborate fraud not only disturbs me but it angers me. The British medical Journal is saying that a man who conducted the study linking autism with the measles vaccine may have not only made a mistake with his research but actually intentionally made mistakes. This has led hundreds of thousands of people to question the importance of having their children immunized. This has led to an increase in the incidence of measles in the population and ultimately it has led to further illness and even death. I can tell you in my own practice it has led to hundreds of conversations with patients about the importance of vaccines and concerns about them. And in the big picture it makes us question the importance of our scientific research and the validity of it. We can't progress in medicine if we don't continue to have these studies. We need to learn what were doing right and what were doing wrong. Medicine is an art based on science. If the science is wrong the artist is stripped of his or her paint brush.

Women have a surprising advantage in the batttle of the sexes

For many years women have complained that it's easier for men to lose weight that is for them to do it. But there may be an advantage for women wanted the war poured in the long run. According to a new study that looked at weight gain over a period of 20 years for more than 3500 men and women it was not surprising to find that people who work out on a regular basis gain less weight than those who are less active. But what was surprising is the fact that women who exercise actually have an easier time keeping off weight than men who exercise. The key is consistency. Women often put on weight during periods of time when there may be less opportunity for exercise such as pregnancy. But with all things being equal and with consistent amount of exercise in either sex with and keep the weight off much easier than men

Are Video Games The Enemy?

Video games can be very effective tools for learning, for education, and for fun. The thing is, as a parent, you need to monitor the video games, not just the games themselves, but how much time the kids are spending on them, whether or not they are learning from them, and whether or not they are violent. Make sure you're part of your child's games and know what's going on. Video games don't have to be an enemy. They can certainly be a part of a constructive life, but you have to realize that it is one aspect and not everything.

New Developments in Detecting Autism..,Perhaps

Autism is a puzzling condition. We're not quite sure of the cause and it is very hard to predict who is at risk. This is why there is a great deal of research design to look at these questions. A new report out of Harvard Medical School looked at the ability of an MRI scan to find differences in brain structure patterns between people with autism and those without. They stand 30 patients all of whom had autism and found this six distinct what they call signatures of autism. The scientists believe they were able to identify people with autism with 94% accuracy. Although this is promising there are several problems with the study. First there were only 30 patients in the scientists knew all of them had autism before the scans were done. That's the downside. The upside is that more work continues to be done and there is no doubt researchers will be following this lead.