Medical Student Tries to Attack Family with Meat Cleaver

I read Dave's post on when he quit smoking to a patient in the office tonight. I was trying to break through the iron wall of denial. No dice. "Doc, I'm not gonna quit .. I like smoking." How many physicians does it take to change a lightbulb? (answer)

Childless couple told to try sex

A clinic spokesman said: "When we asked them how often they had had sex, they looked blank, and said: "What do you mean?".
"We are not talking retarded people here, but a couple who were brought up in a religious environment who were simply unaware, after eight years of marriage, of the physical requirements necessary to procreate."

Delfini

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This is an interesting endeavor – it will be interesting to see if they can make a living by providing EBM consulting.  The problem wityh excellent healthcare practices is that there is no clear ROI for the people who would pay for it.  For example – in my few years with medremote, we developed WONDERFUL prototypes proptotypes for bayesian algorithms that would extract salient items from free text notes.  This has enormous protential for improving the quality and potentially the quality of care.

Huh?

ok .. here's how it goes:  The progres note says "Marge has a hx of hypercholesterolemia, hypertension and type 2 diabetes.  She's not allergic to anything but her mom had hives when she took Bactrim."

ITEA would be able to make this:

• Hypercholesterolemia
• HTN
• Diabetes – Type 2
• Allergies: NKDA

(notice that it isn't fooled by the mom's Bactrim Allergy).

Now we can use the computer to prompt the physician to check A1c, treat or monitor the cholesterol, etc … and this is all WITHOUT an EMR.  That is the cool part. 

But it's hard to get anyone to invest in this component of the services .. and I'll be surprised if people become instantly motivated to push EBM either.   EBM is a religion (of which I am a faithful congregant) yet it's hard to convert the masses.  As CMS devises methods of reimbursing better practices .. perhaps this will fall into place.  Then again .. maybe not.  Time for Matthew Holt to chime in.  I feel like we're getting into his terrritory.

Kent e-mailed me a few days ago .. and now I'm finally getting to updating my reference to Shots 2004 - which remains available for free from the STFM group on immunization resources.

He's updated this Palm-OS immunization reference.  It's excellent.  A true must-have for anyone who cares for kids.

The best part is that his weblog now has an RSS feed. 

From the Cleveland Clinic: Prostate Cancer: Screening Guidelines

Short, unbiased and to the point. 

I struggle with this subject daily.  When I'm pressed for time, I find that I order the PSA, do the DRE and discuss it far less than I should.  These are generally patients who have had annual PSA tests done int he past – and have been told by someone that she "need to have a PSA."  When I'm not so pressed for time (or in denial) … I engage my patients and provide true informed consent.  All-in-all, a good discussion of PSA pro & con takes at least 10 minutes, and usually involves a quick review of this paper and its implications.

I'll usually bring in data that most men have some prostate cancer by the time we turn 60 .. and nearly half have some by age 50.

.. an interesting picture of an Italian perspecitve:

"Screening should be banned from current practice until its efficacy is demonstrated"

.. and here's the most recent news tidbit:  Inuit are protected against prostate cancer.

From American Medical News: Doctor redefines visits with phone, e-mail … American Medical News

It's an interesting story about a physician who has set up a practice based largely on cash payments (he accepts no insurance) for visits, phone calls, and e-mail communication.

Dr. Dappen charges $20 for a five-minute block spent on the phone and $25 if that time is spent in the office. However, he reduces his fees — $15 for a five-minute phone visit, $22 in person — if the patient sets up a prepaid account that allows Dr. Dappen to withdraw funds as services are provided. He said he doesn't charge for time spent doing the "back-end work," like faxing information or ordering a test after the conversation is completed.

It's an interesting concept.  I would agree that the current method of reimbursment isn't working very well.  Capitation didn't work so well either.  Most days, I would say that I spend 60 – 70 minutes talking with patients by e-mail or on the phone.  E-mail certainly speeds this up a bit, and it does provide a useful method of communicating quickly.    The fees for office visits seem inflated — until one considers the "free" care that goes on between office visits.  Perhaps it all comes out in the wash.  Hmmm.

PDA versions of many practice guidelines are available from Guidelines.gov