Saturday, September 27, 2008

Oregon hospital tells grandfather he's pregnant

PORTLAND, Ore. (AP) -- A patient treated for agonizing abdominal pain received this surprising news in the hospital's paperwork: "Based on your visit today, we know you are pregnant." Surprising indeed for 71-year-old John Grady Pippen.

The staff at Curry General Hospital in Gold Beach gave the retired mechanic and logger the ridiculously happy news this month, along with some pain pills.

Hospital administrator William McMillan says an errant keystroke caused the hospital's computer to spit out the wrong discharge instructions for the grandfather.

Friday, September 26, 2008

Does Clothing Play a Role in the Spread of Infection? -

Many hospitals have stepped up efforts to encourage regular hand washing by doctors. But what about their clothes?

Amid growing concerns about hospital infections and a rise in drug-resistant bacteria, the attire of doctors, nurses and other health care workers — worn both inside and outside the hospital — is getting more attention. While infection control experts have published extensive research on the benefits of hand washing and equipment sterilization in hospitals, little is known about the role that ties, white coats, long sleeves and soiled scrubs play in the spread of bacteria.

The discussion was reignited this year when the British National Health Service imposed a "bare below the elbows" rule barring doctors from wearing ties and long sleeves, both of which are known to accumulate germs as doctors move from patient to patient.

(In the United States, hospitals generally require doctors to wear "professional" dress but have no specific edicts about ties and long sleeves.)

But while some data suggest that doctors' garments are crawling with germs, there's no evidence that clothing plays a role in the spread of hospital infections. And some researchers report that patients have less confidence in a doctor whose attire is casual. This month, the medical journal BJU International cited the lack of data in questioning the validity of the new British dress code.

Still, experts say the absence of evidence doesn't mean there is no risk — it just means there is no good research. A handful of reports do suggest that the clothing of health workers can be a reservoir for risky germs.

In 2004, a study from the New York Hospital Medical Center of Queens compared the ties of 40 doctors and medical students with those of 10 security guards. It found that about half the ties worn by medical personnel were a reservoir for germs, compared with just 1 in 10 of the ties taken from the security guards. The doctors' ties harbored several pathogens, including those that can lead to staph infections or pneumonia.

Another study at a Connecticut hospital sought to gauge the role that clothing plays in the spread of methicillin-resistant Staphylococcus aureus, or MRSA. The study found that if a worker entered a room where the patient had MRSA, the bacteria would end up on the worker's clothes about 70 percent of the time, even if the person never actually touched the patient.

"We know it can live for long periods of time on fabrics," said Marcia Patrick, an infection control expert in Tacoma, Wash., and co-author of the Association of Professionals in Infection Control and Epidemiology guidelines for eliminating MRSA in hospitals.

Hospital rules typically encourage workers to change out of soiled scrubs before leaving, but infection control experts say enforcement can be lax. Doctors and nurses can often be seen wearing scrubs on subways and in grocery stores.

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Thursday, September 25, 2008

Playing the doctor card - Salon

I was aggravated by the treatment my mother was receiving in the hospital -- until I spoke up.

By Rahul K. Parikh, M.D.

The nurse had a way of talking to my mother -- the pedantic tone of a crusty grade-school teacher. It grated on me like fingers across a chalkboard.

My mother lay in a hospital bed, tired, uncomfortable from abdominal pain, attached to I.V. lines. A couple of nights previous, while my family and I were relaxing on vacation in Los Cabos, Mexico, my brother had sent me an e-mail:

Mom's in the hospital with stomach pain. Give them a call to see what's going on.

She had started having gradually escalating stomach pain the night before to a point where her doctor sent her to the emergency room. We cut our trip short when we found out that a CT scan showed swelling in her intestine, possibly indicating colon cancer. They would have to operate and remove a piece of her large intestine to figure it out.

I arrived at the hospital the night before the operation. I was exhausted from the chaos of prematurely checking out of our hotel, rushing to the airport without a ticket, sneaking onto an evening flight, and eating no more than chips and candy along the way. None of that fatigue could compare with the looks of fatigue, uncertainty and pain on my parents' faces. My mother was tearful. She is 62 years and has the looks and energy of someone decades younger. Most people have trouble guessing her age. But that evening she looked older, and her voice trembled. It was late and all we could do was sit and wait for tomorrow.

I came back to the hospital in the morning to wait with my mom. I intended to request and review all of her test results, and obtain opinions from friends of mine who were gastroenterologists. Her doctors, with a surgeon in the lead, had agreed that given the situation, waiting for her pain and swelling to subside on antibiotics wasn't a good option. On the other hand, it's not a secret that surgeons look at the world from behind the handle of a scalpel. I was afraid they were being too aggressive.

My mother told me she had requested to have a look at her test results. So when I arrived, we called her nurse, who was young and stout, with a cherubic face. My mother asked nicely about getting her results. The nurse stopped, turned and looked at my mom with an annoyed, matter-of-fact countenance. "Now, didn't we already talk about that last night, love?" Her voice had more than a tinge of condescension. "When I get around to it, I'll bring the form for you to sign so you can get your records." Then, more loudly (my mother isn't hard of hearing), "OK?" She marched out of the room and on to other tasks.

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NeuroLogica Blog

The NeuroLogicaBlog covers news and issues in neuroscience, but also general science, scientific skepticism, philosophy of science, critical thinking, and the intersection of science with the media and society

Science-Based Medicine

Exploring issues and controversies in the relationship between science and medicine

Pallimed: A Hospice & Palliative Medicine Blog

Our target audience is the professionals (MD, DO, RN, LPN, LVN, Home Health Aide, ARNP, SW, Chaplain, Administrators, PT, OT, Speech, Pharmacy, etc.) working in hospice & palliative medicine, but we welcome all readers to this blog, including patients, families and other medical professionals outside of this field.

Our goal is to review current palliative medicine, hospice, end-of-life research with a particular focus on publications not from the major palliative care journals. We also highlight important events in end-of-life care from the news media and entertainment arenas. Pallimed is not intended to replace the patient-physician relationship.

Retooling for an Aging America: Building the Health Care Workforce - Institute of Medicine Report (download)

The nation faces an impending health care crisis as the number of older patients with more complex health needs increasingly outpaces the number of health care providers with the knowledge and skills to adequately care for them. As the nation's baby boomers turn 65 and older and are living longer lives, fundamental changes in the health care system need to take place, and greater financial resources need to be committed to ensure they can receive high-quality care. Right now, the nation is not prepared to meet the social and health care needs of elderly people.

The Institute of Medicine charged the ad hoc Committee on the Future Health Care Workforce for Older Americans to determine the health care needs of Americans over 65 years of age and to assess those needs through an analysis of the forces that shape the health care workforce, including education and training, models of care, and public and private programs.

The resulting report, Retooling for an Aging America: Building the Health Care Workforce, says that as the population of seniors grows to comprise approximately 20 percent of the U.S. population, they will face a health care workforce that is too small and critically unprepared to meet their health needs. The committee concluded that if our aging family members and friends are to continue to live robustly and in the best possible health, we need bold initiatives designed to

  • explore ways to broaden the duties and responsibilities of workers at various levels of training;
  • better prepare informal caregivers to tend to the needs of aging family members and friends; and
  • develop new models of health care delivery and payment as old ways sponsored by federal programs such as Medicare prove to be ineffective and inefficient.

Angioplasty for chest pain is no bargain - Reuters

People who get surgery to ease chest pain from a blocked heart artery pay $10,000 more for about the same level of relief they can get from taking a combination of pills, U.S. researchers said on Wednesday.

The finding comes from a large study that compared standard drug therapy with angioplasty to open up blockages in the heart.

"It costs about $10,000 more and you are not getting any more value," said Dr. William Weintraub of Christiana Care Health System in Newark, Delaware, whose research appears in the journal Cardiovascular Quality and Outcomes.

"We don't have to reflexively do angioplasty on every blockage there is in an artery of the heart," Weintraub said in a telephone interview.

The surgery, known as PCI for percutaneous coronary intervention, involves threading a balloon-tipped catheter through the arteries and opening up the clog. A tiny wire-mesh coil called a stent is often inserted to prop open the artery.

More than 800,000 of these procedures are performed each year and they represent big business for medical device makers including Medtronic Inc, Boston Scientific Corp, Johnson & Johnson and Abbott Laboratories Inc.

But studies increasingly suggest that many patients can opt for a less invasive approach and still get relief from their chest pain, although it may take more time.

Initial results from the same study last year found balloon angioplasty to restore blood flow to clogged heart arteries plus drug therapy was no better than drugs alone at reducing deaths or heart attacks after 4.6 years, although some people who had the surgery did experience a better quality of life.

Weintraub's team reported in the New England Journal of Medicine that any immediate advantages that angioplasty or stent surgery offered over drugs went away after about three years.

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Wednesday, September 24, 2008

A tale of 2 sickbeds: Health care in U.K. vs. U.S. - Health care -

A journalist's treatment for same condition in two countries is worlds apart

LONDON - A few weeks ago I found myself curled up in a hospital here in London, my feverish body shaking violently back and forth. The pain in my side and back made it hard to straighten my torso, and I'd thrown up in a friend's car on the way to the hospital.

The hospital couldn't find an extra hospital bed, so I spent my first night hooked up to an IV on a gurney in the middle of a row of men and women, my sweaty skin sticking to the plastic. A shriveled woman in the bed to my right issued loud and largely unintelligible commands to nobody in particular. A steady flow of patients visited the bathroom right in front of my bed. A shouting match broke out between some of the nurses and nurses aides until a man at the other end of the room yelled, "Could you please take it outside? I'm trying to rest."

Sometime in the midst of this I was diagnosed with pyelonephritis, a severe urinary tract infection that had spread to a kidney, and ended up in the hospital for three nights. I had already been on two courses of antibiotics, but that hadn't cleared up the initial infection. Finding myself sick and alone thousands of miles away from my mom was bad enough, but scarier still was just how familiar the illness felt.

I'd been sick with the same thing almost 10 years ago when I was in my 20s and still living in the United States, where I'm from. In both cases, my side and back hurt and fever shot up. And each time, I recovered after serious doses of antibiotics and lots of bed rest. But apart from that, my experiences were a world apart.

The biggest difference: Money. Getting sick in New York City decimated my bank account. In London, I didn't pay a penny. I should note, however, that a full 9 percent of my gross pay goes towards the equivalent of a health tax. (For comparison's sake, according to the Commonwealth Fund, in 2007 about half of working-age Americans spent 5 percent or more of their income on out-of-pocket medical costs and premiums.)

And while I recovered fully in both cases, the care I received felt quite different. In New York, I never feared that I would be overlooked. At my doctor's office in upscale Gramercy Park, he and his nurses took their time seeing me, and were always at pains to reassure me. On my first visit, the receptionist let me sit in an empty consulting room so that I wouldn't have to weep in the waiting room. She checked in on me and brought me water.

But unlike the personal care I received in the U.S., in London, I felt like I was on a vast and often creaking conveyor belt, and there was a big risk of falling through the cracks. British care is socialized — and feels that way.

Affordable, but at what cost?

Amid the fever and pain, and the crushing boredom of my London hospital beds (I spent each of my three nights in different wards of the huge Royal Free Hospital), I couldn't help but compare my two experiences and think about the presidential campaign happening back home and the growing impetus for health care reform in the United States.

Would the elderly woman in my ward in London who repeatedly pleaded "Can someone help me please?" after being left on her dirty bedpan for almost an hour, recommend a version of the National Health Service to Americans? What would British patients who are denied certain drugs because of funding constraints or because they're deemed too experimental say about it?

And how about Professor Paul Goddard, one of the England's senior doctors, who said recently that thousands of hospital patients are "starving" because over-burdened nurses don't have time to feed them?

I saw what he was talking about. In the third ward, I spent a day next to an ancient-looking woman who refused to touch her food. A few times the harried nurse tried unsuccessfully to get her to eat. Mostly my neighbor sat with her eyes closed, her chin resting on her chest.

Being mouthy and mobile, I felt confident that I could cajole the hospital workers into paying attention to me. As it turned out, I had to be very, very patient. Nurses paced the corridors all the time and we could call them from our beds, but doctors were a bit harder to come by — unless there was a real emergency everyone had to wait their turn. And about twice a day a pack of lean and well-dressed physicians clutching clipboards would lope into the ward, pull the flimsy green curtains around our beds and ask us to share intimate information within earshot of the other patients. Being shameless and forthright, I got along OK — I pressed the doctors for answers and they sent me for a battery of tests to make sure that there wasn't anything else wrong with me.

But I wasn't so confident for some of my companions. One of my three roommates in the second ward was a woman who said she had a dislodged stent in her chest and was waiting for urgent heart surgery. She gasped for breath when hobbling across the room to the bathroom, and rarely spoke to the doctors except to say "thank you." She confessed to me through tears that she had tried to kill herself a few weeks earlier. At one point the nurses left her in a corner in a wheelchair for about two hours as they looked for a bed for her on the cardiac ward.

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Hot Tip: Have Your Heart Attack In Seattle -

A new study finds dramatic regional differences in cardiac-arrest survival rates. Why some places are better than others when it comes to saving lives.

What are your chances of surviving cardiac arrest outside a hospital setting? In a word, remote. But some doctors are turning that around, boosting survival rates to previously unthinkable levels. That's great news, right? Now for the bad news: your likelihood of being in that lucky group of survivors depends a great deal on where you live. "It's like real estate—location, location, location," says Dr. Arthur Sanders, a professor of emergency medicine at the University of Arizona's Sarver Heart Center.

That is the upshot of a study appearing this week in the Journal of the American Medical Association. Dr. Graham Nichol, director of the University of Washington's Center for Prehospital Emergency Care, surveyed the outcomes of cardiac arrest in 10 North American cities and states. Though outcomes for most medical procedures vary with factors like socioeconomic status, the differences in this study were even more pronounced than usual. Survival from site to site varied as much as fivefold. Patients in Seattle who were treated by emergency medical technicians (EMTs) pulled through in 16 percent of cases. In Alabama, they survived just 3 percent of the time.

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Drug maker plans to disclose payments to doctors

In an industry first, Eli Lilly and Co. says it will begin disclosing how much money it paid to individual doctors nationally for advice, speeches and other services.

The drug company's move comes as members of Congress push a disclosure bill in an effort to prevent such payments from improperly influencing medical decisions.

Beginning next year, Eli Lilly will disclose payments of more than $500 to doctors for their roles as advisers and for speaking at educational seminars. In later years, the company will expand the types of payments disclosed to include such things as travel, entertainment and gifts.

Some have voiced concerns that doctors are influenced by these payments in their treatment decisions and that this in turn can drive up medical bills. Although most physicians believe that free lunches or trips have no effect on their medical judgment, research has shown that these type of payments can affect how people act.

"The ethical handwriting is on the wall. Disclosure is coming. States are pushing for it, and once a few states do, it's hard to imagine the federal government won't line up behind," said Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania in Philadelphia. "I think that's a good thing because we have a great deal of empirical evidence that gift giving can influence behavior in terms of prescriptions, publishing positive findings but suppressing negative findings, and generating enthusiasm for new drugs."

Eli Lilly was also the first drug company to publicly report its educational grants for medical conferences. Dr. John Lechleiter, president and CEO of the company, said that made good business sense for the drug industry.

"We've learned that letting people see for themselves what we're doing is a good way to restore trust," Lechleiter said.

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Monday, September 22, 2008

Study: Doctors Don’t Always Respond with Empathy - Psych Central News

If you're facing a life-threatening cancer, you'd think your doctor might respond with a healthy dose of empathy for your diagnosis. However, new research published today suggests that most physicians rarely respond to their patients with empathy to patient concerns, even when they were directly related to their diagnosis or treatment options.

The new research examined twenty recorded and transcribed consultations between physicians and their patients. It found that doctors often missed opportunities to recognize and ease the concerns of their patients. The research also discovered that doctors routinely provided virtually no emotional support to their patients.

"When patients are struggling and bring up important issues, doctors don't have to take a lot of time to address them, but they do need to respond. Showing that they understand and giving their patients more of what they need is not that difficult," said Diane Morse, M.D., assistant professor of psychiatry and of medicine at the University of Rochester Medical Center.

The study sheds light on the types of situations and remarks that physicians should recognize as opportunities to express understanding and support, she said. The research also showed that empathic responses can be brief and do not make consultations longer.

Morse and her researchers examined 20 representative transcripts from recordings of 137 consultations between physicians at a Veterans Affairs hospital in the southern United States and patients with lung cancer or a pulmonary mass requiring surgical diagnosis.

Empathy — the identification with and understanding of another person's situation and feelings — is considered an important element of communication between patients and physicians and is associated with improved patient satisfaction and compliance with recommended treatment.

In the transcribed consultations, the researchers identified 384 moments or "empathic opportunities" when patients stated or alluded to concerns, emotions or stressors. These included statements about the impact of cancer, diagnosis, treatment or health care system barriers to care. They found that physicians responded empathically to only 39 of those moments (10 percent of the total opportunities available).

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The Merck Manuals Online Medical Library

Merck is committed to bringing out the best in medicine. As part of that effort, Merck has created The Merck Manuals, a series of healthcare books for medical professionals and consumers. As a service to the community, the content of The Manuals is now available in enhanced online versions as part of The Merck Manuals Online Medical Library. The Online Medical Library is updated periodically with new information, and contains photographs, and audio and video material not present in the print versions.


PubMed Central Journals — Full List

PubMed Central is a digital archive of life sciences journal literature at the U.S. National Institutes of Health (NIH), developed and managed by NIH's National Center for Biotechnology Information (NCBI) in the National Library of Medicine (NLM). 

With PubMed Central, NLM is taking the lead in preserving and maintaining unrestricted access to the electronic literature, just as it has done for decades with the printed biomedical literature. 

PubMed Central aims to fill the role of a world class library in the digital age. It is not a journal publisher. 

NLM believes that giving all users free and unrestricted access to the material in PubMed Central is the best way to ensure the durability and utility of the archive as technology changes over time.

National Center for Biotech Information: Bookshelf

The Bookshelf is a growing collection of biomedical books that can be searched directly by typing a concept into the textbox and selecting "Go"

Medical Books - FreeBooks4Doctors

Free Medical Books - Over the next few years, many important medical textbooks will be available online, free and in full-text. The unrestricted access to scientific knowledge will have a major impact on medical practice. FreeBooks4Doctors! is dedicated to the promotion of free access to medical books over the Internet.

White Coat, Black Art | CBC Radio

Dr. Brian Goldman takes listeners through the swinging doors of hospitals and doctors' offices, behind the curtain where the gurney lies.

It's a biting, original and provocative show that will demystify the world of medicine.

We'll explore the tension between hope and reality: between what patients want, and what doctors can deliver. Doctors, nurses and other healthcare professionals will explain how the system works, and why, with a refreshing and unprecedented level of honesty.

■ Mondays at 11:30 am and Saturdays at 4:30 pm on CBC Radio One

■ Mondays at 4:30 pm and Saturdays at 2:30 pm on Sirius Satellite 137

■ Weekly podcasts available Sunday at midnight

Sunday, September 21, 2008

They Know What's in Your Medicine Cabinet - Business Week

That prescription you just picked up at the drugstore could hurt your chances of getting health insurance.

An untold number of people have been rejected for medical coverage for a reason they never could have guessed: Insurance companies are using huge, commercially available prescription databases to screen out applicants based on their drug purchases.

Privacy and consumer advocates warn that the information can easily be misinterpreted or knowingly misused. At a minimum, the practice is adding another layer of anxiety to a marketplace that many consumers already find baffling. "It's making it harder to find insurance for people," says Jay Horowitz, an independent insurance agent in Overland Park, Kan.

The obstacle primarily confronts people seeking individual health insurance, not those covered under an employer's plan. Walter and Paula Shelton of Gilbert, La., applied to Humana (HUM) in February. They were rejected by the large Louisville insurer after a company representative pulled their drug profiles and questioned them over the telephone about prescriptions from Wal-Mart Stores (WMT) and Randalls, part of the Safeway grocery chain, for blood-pressure and anti-depressant medications.


Walter Shelton, a 57-year-old safety consultant in the oil and gas industry, says he tried to explain that the medications weren't for serious ailments. The blood-pressure prescription related to a minor problem his wife, Paula, had with swelling of her ankles. The antidepressant was prescribed to help her sleep—a common "off-label" treatment doctors advise for some menopausal women. But drugs for depression and other mental health conditions are often red flags to insurers.

Despite his efforts to reassure Humana, the phone interview with the company representative "just went south," Walter recounts. He and his wife remain uninsured.

"I want to know what's in there if there's a black mark against us," Walter says. Paula, 51, adds: "We can't get health insurance because we're taking medications that were prescribed by our doctors. I don't think that's right."

A spokesman for Humana says the company uses "data regarding pharmacy history as part of our assessment process." But he adds that the insurer has a policy of not commenting on particular cases, such as the Sheltons' failed application.

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The Moral Hazard Myth - Malcolm Gladwell, New Yorker

The U.  S.  health-care system, according to "Uninsured in America," has created a group of people who increasingly look different from others and suffer in ways that others do not.  The leading cause of personal bankruptcy in the United States is unpaid medical bills.  

Half of the uninsured owe money to hospitals, and a third are being pursued by collection agencies.  Children without health insurance are less likely to receive medical attention for serious injuries, for recurrent ear infections, or for asthma.  Lung-cancer patients without insurance are less likely to receive surgery, chemotherapy, or radiation treatment.  Heart-attack victims without health insurance are less likely to receive angioplasty.  People with pneumonia who don't have health insurance are less likely to receive X rays or consultations.  The death rate in any given year for someone without health insurance is twenty-five per cent higher than for someone with insurance.  

Because the uninsured are sicker than the rest of us, they can't get better jobs, and because they can't get better jobs they can't afford health insurance, and because they can't afford health insurance they get even sicker.  John, the manager of a bar in Idaho, tells Sered and Fernandopulle that as a result of various workplace injuries over the years he takes eight ibuprofen, waits two hours, then takes eight more—and tries to cadge as much prescription pain medication as he can from friends.  "There are times when I should've gone to the doctor, but I couldn't afford to go because I don't have insurance," he says.  "Like when my back messed up, I should've gone.  If I had insurance, I would've went, because I know I could get treatment, but when you can't afford it you don't go.  Because the harder the hole you get into in terms of bills, then you'll never get out.  So you just say, 'I can deal with the pain.' "

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