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The continuing battle between the emergency department and radiology Print E-mail
Written by Cory Michael, MD | KevinMD   
Tuesday, 31 December 2019 13:31

I overheard a disappointing phone call while supervising a radiology resident recently. I could tell that the resident was struggling in a conversation with an emergency department physician, so I asked him to switch over to speakerphone. Eventually, I heard the emergency physician say, “Listen. This is how it works. A patient points to what hurts. Then I have that part scanned, and you tell me what is wrong.”

Disheartening as it sounds, patterns like these have worsened in recent years. I try to teach radiology residents and ordering providers alike what the most important imaging tests are given clinical concerns, yet the amount of information given to the radiologist declines, and the number of scans continues to grow while the payment for these studies has leveled off or decreased in some cases. I even find out that providers are sometimes dishonest in the history provided just to get a study performed. The county hospital I am affiliated with has a large number of patients who can’t pay. Not only does the system eat the cost, but many of these studies involve potentially harmful radiation.

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Dollar General isn't doing enough to bring healthy food to low-income Americans Print E-mail
Written by FHI's Week in Review   
Monday, 23 December 2019 00:00

Darya Minovi reports for CNN Business on December 20, 2019
75% of Dollar General stores are located in communities of 20,000 or fewer people. What's more, these locations are typically at least 15 miles away from a full-service grocery store, leaving families with limited options for food... Dollar stores are able to sell products at unbeatable prices because of their simple business model. Operating costs are kept low by employing only a handful of people to stock aisles and limiting the amount of cold storage, which is necessary for fresh food. This is a business model that promotes nutritionally poor food and beverages to low-income customers. Dollar General opens stores in communities that grapple with gaps in food access that need to be addressed. But the retailers' approach to growth is rapid saturation, effectively boxing out the competition... <Meanwhile> People with low incomes face a significantly higher burden of diet-related diseases, like type 2 diabetes and high blood pressure, than those with higher incomes and tend to have less access to quality medical care to prevent or address those health conditions.
Read more in the current issue of Week in Review>>

Last Updated on Tuesday, 24 December 2019 15:17
 
A perk of Medicare for all: More time for doctors and patients Print E-mail
Written by FHI's Week in Review   
Monday, 09 December 2019 18:01

Rani Marx, MD and James G. Kahn, PhD offer an interesting commentary in KevinMD on Dec. 6:
...discussions of health care financing miss one critical issue that patients and providers desperately care about: sufficient time to communicate with each other. Presidential candidates focus on cost, policies, and logistics of implementation. But no one talks about how proposed plans will fix a big problem in the doctor's office: the amount of time doctors must spend attending to the computer - the electronic health record (EHR) - rather than the patient.
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Last Updated on Monday, 09 December 2019 18:17
 
Changing EMR - Seamless Continuation, Dreaded Chore or Fresh Start? Print E-mail
Written by A Country Doctor Writes   
Friday, 29 November 2019 18:08

At the end of the year my patients and I will start over. That is what changing EMRs does to us. I have mixed feelings about data migration, if it even happens. I will move into a new virtual environment and my patients will take on slightly different appearances, maybe even alter their medical histories. Some will perhaps be asking me to edit diagnoses that have haunted them since we went from paper to computer records almost a decade ago. With our first EMR, we scanned in a few things from patients' paper records - sometimes only a few pages from years or decades of first handwritten and later typed notes. Much got lost, because we were doing something we never really had thought through, and we had to do it with a clock ticking: "Hurry, before the Federal incentives go away." The Feds wanted EMRs because the vision was that more data would help research and population health and also reduce medical errors. This time, another factor is pushing us forward...

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Last Updated on Saturday, 30 November 2019 15:53
 
A tiny pharmacy is identifying big problems with common drugs, including Zantac Print E-mail
Written by FHI's Week in Review   
Monday, 11 November 2019 18:19

Carolyn Y. Johnson, Science Reporter for the Washington Post delivers this interesting story on November 8, 2019.

NEW HAVEN, Conn. - The escalating global recall of Zantac, the heartburn pill that once ranked as the world's best-selling drug, has its roots not in government oversight or a high-profile lawsuit, but in a tiny online pharmacy here whose founders feared that U.S. drugs might not be as safe as people think. The pharmacy, Valisure, is a start-up with only 14 full-time employees. But since its scientists alerted American regulators that Zantac and its generic form, ranitidine, contained a chemical thought to cause cancer, more than 40 countries from Australia to Vietnam have either stopped sales, launched investigations or otherwise stepped in to protect consumers from possible health risks. In the United States, the Food and Drug Administration this month confirmed unacceptable levels of the chemical, N-nitrosodimethylamine (NDMA), in some ranitidine products.

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Last Updated on Monday, 11 November 2019 18:26
 
Letting go when people let go of their lives Print E-mail
Written by John Dodson, MD | KevinMD   
Tuesday, 05 November 2019 18:46

My 83-year-old patient had outlived peoples' expectations on several occasions. Faced with a critical illness three years ago, she underwent emergency surgery and spent several months in the hospital with a series of complications, including septic shock, renal failure, and hospital-acquired pneumonia. I'd seen her in the office for a new visit soon after she was discharged. It took nearly 20 minutes to go through her history before walking into the exam room. Notes from several doctors during that hospitalization said that she might never become well enough to be discharged home. When I finally walked into the room, I expected to see someone frail, debilitated, with a caregiver answering most of my inquiries. Instead, she appeared robust, completely alert, and cheerfully answered my questions herself. "You look better than your chart," I told her, truthfully. Given the extent of her recent workup, we agreed to keep further testing and medication changes to a minimum. I established that we'd touch base in the office every three to four months - a typical interval at her age.

Last Updated on Friday, 20 December 2019 17:39
 
What does cable news do to your brain? A neurosurgeon explains Print E-mail
Written by FHI's Week in Review   
Monday, 28 October 2019 12:35

Marc Arginteanu, MD writes in a KevinMD post on 10.25.19:
 
The availability of up to the minute information, presented 24/7/365, could assist a democratic society in making the best choices in determining its future. That was the promise of cable news. Unfortunately, cable news has fallen short of its potential and has led to the further polarization of America. More than that, it has changed the way your brain works. Not for the better...Brain science supports the notion that intellectual bubbles, such as those created by cable news, are bad for society. Citizens are intellectually impoverished by the absence of input from those with different life experiences and different perspectives. 

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