medpundit is opening a new practice.  I hope that she does well.  One of my favorite readers commented the other day that Docnotes doesn't have much of the personal thoughts of a family physician anymore .. and as I read the last few weeks/months .. she's right. 

Here goes:

1) Our practice is going well, but I'm finding it harder and harder to keep up.  My efficiency in the office leaves something to be desired.   The nurses say that I'm too slow … but the patients, of course, disagree.  Nonetheless, this is the perpetual stuggle of primary care.  Spending time with patients does not pay the rent as well as not spending time with patients.    I enjoy the diversity of family medicine, but this diversity also creates complexities of relationships and temporal demands that can pull me in 8 directions at once.

2) Electronic Medical Records.   Our practice is part of a larger group that is in the proccess of making a decision on am EMR vendor.  It's very tough.  when the group started – about 5 years ago – chey chose the practice management system over others because of the promise that the EMR would provide an integrated PM/EMR system.

It's well known that our EMR is weak.  In our office, we've been using it for two years, and while I would agree that there have been incremental improvements, it remains a very difficult system to use on a daily basis.  While the family physicians and pediatricians seem to agree that this is the case, our internist colleagues disagree.  They feel that this product is just fine.

We're looking carefully at Practice Partner as an alternative to the system.

Family physicians and pediatricians seem to prefer Practice Partner.  Internists seem to prefer the other one. 

Hence our challenge in making a decision.  It's clearly more expensive to implement Practice Partner – as we would need two servers and the pricing of our current product – since it's bundled with the practice management system – would be much less.

But a less expensive option is not always better — especially if it's not usable.

While usability may seem to be less important to some ("it's a training issue") .. I consider usability to be one of the most important features of a system.  If I can't use it, any money spent at all would be wasted. 

Final decision comes from our elected board of nine physicians: three FP, three peds and three IM.

I'm so fed up with the Misys product that I think I'll have to go back to dictation if Practice Partner isn't selected.  ugh.

A new article on Bandolier: Pneumococcal vaccination update

These results are broadly consistent with results of several meta-analyses of randomised trials, none of which showed any effect of pneumococcal vaccination on pneumonia

  AHRQ doesn't say much about pneumoccal vaccine.   From the study cited in Bandolier, it looks like there was no reduction in pneumonia or hospital admissions, but there was a reduction in pneumococcal bacteremia.

Like Celiac disease – hemochromatosis is more common than we learned in medical school.  "Hereditary hemochromatosis–early diagnosis can lead to cure" is a good short overview of the disease. 

According to this POEM … we shouldn't have our patients waste money on pillow covers for asthma.

In the last week, I've tied three umbilical granulomas .. more than the last 6 months. I wonder why?

Amazon.com: Books: How to Good-Bye Depression: If You Constrict Anus 100 Times Everyday. Malarkey? or Effective Way?

And a comment from a reader: "I am afraid I must chime in and say that I didn't find this book very helpful. It was  recommended by my doctor, whom I now regard as somewhat of a quack."

OK .. so I won't be suggesting that anyone buy this book any time soon ;-) 

Steve remains a great motivator.  I've posted a first draft of a Medical Weblog discussion description on Dave's BloggerCon discussion forum.