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Diabetes Prevention Starts With Your Doctor
Tweet Share on Facebook September 15, 2011 Comment (1)The first time I ever used an electronic medical record was 12 years ago, during my neurology rotation in medical school. Students were responsible for writing daily progress notes on each hospitalized patient that updated his or her treatment plan and list of ailments. A helpful senior doctor let me in on a time-saver: cut and paste. I could insert sections of the previous day's progress note into the current day's note, which I could then modify to account for any changes that had occurred.
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The Promise and Pitfalls of Medical Apps for Doctors
Tweet Share on Facebook August 26, 2011 Comment (2)Doctors of my generation have experienced dramatic changes in the way we access the information we need to care for patients. As a medical student 15 years ago, my "peripheral brain" consisted of fat textbooks sitting on office bookshelves or smaller, spiral-bound references stuffed into the bulging pockets of my lab coat. As a doctor-in-training, I replaced those bulky references with programs loaded onto PDAs. Today, smartphone apps allow health professionals at all levels to access the most up-to-date medical resources such as drug references, disease-risk calculators, and clinical guidelines—anytime, anywhere.
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Headed to the Hospital? 4 Key Questions to Ask Your Doctor
Tweet Share on Facebook August 2, 2011 Comment (1)Doctors do the best they can to keep patients healthy and out of the hospital. Sometimes, though, hospitalization is necessary despite the best possible care. At the first private practice I joined after residency training, my colleagues and I admitted patients to a local hospital and took turns caring for those who needed inpatient treatment. This system ensured we'd have easy access to their previous medical records and often know them on a personal level. Arranging office appointments after discharge was almost never a problem, and we were guaranteed knowledge of what had happened to our patients in the hospital.
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Decoding Doctor-Speak: Translations of Common Medical Terms
Tweet Share on Facebook July 25, 2011 Comment (8)"Mr. Smith, let's review the results of your blood tests. Your CBC, BMP, and LFTs were basically negative. You have prediabetes and a slightly elevated LDL, and since your BMI is 28, you should watch your diet and exercise more to prevent metabolic syndrome. Oh, and it's OK to keep taking an occasional NSAID with food for your idiopathic knee pain."
Huh? Although I hope I've never said anything resembling the above to a real patient, doctors routinely use so many medical terms and abbreviations that it can sometimes sound as if we're speaking gibberish. What's worse, many patients may feel pressure to simply pretend they understand what the doctor is saying. Unfortunately, that approach often leads to misunderstandings and poor health choices. A report published last week in the Annals of Internal Medicine found that patients with low health literacy (the ability to read and interpret medical information) were more likely to be hospitalized, use medications inappropriately, and receive fewer recommended vaccines and screening tests. While the report only covered written materials, it stands to reason that patients also make worse health-related decisions when they don't understand medical jargon spoken in the doctor's office.
So let's demystify the terms I just used with my imaginary patient—terms family and friends told me they wished doctors would explain.
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How Politically Unpopular Research Helps Us Make Better Medical Decisions
Tweet Share on Facebook July 7, 2011 Comment (1)When a new drug goes on the market for, say, diabetes, doctors are typically bombarded by advertising messages that promote it. Patients may see television commercials touting the new drug's advantages over older ones and advising them to "talk to your doctor" about obtaining a prescription. But since the U.S. Food and Drug Administration only requires drug companies to prove that new drugs work better than placebos (sugar pills), there's often little or no reliable information about whether a new drug is actually an improvement over existing therapies.
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How to See a Doctor—Stat
Tweet Share on Facebook June 23, 2011 Comment (2)A few weeks ago, while at an out-of-state wedding reception, I began having chest pain that didn't immediately go away with rest and antacids. Although it was unlikely to be an early symptom of a heart attack (I'm relatively young, have good cholesterol levels, and have no relatives with early heart disease), I felt uncomfortable enough to want another physician to confirm that it was only a bad episode of heartburn. But with my family doctor's office hundreds of miles away, the only medical option seemed to be the nearest hospital emergency room. And like most people, I avoid emergency rooms unless I have a broken bone or life-threatening medical emergency.
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How to Find Good Health Information Online
Tweet Share on Facebook June 10, 2011 Comment (9)A recent survey found that 60 percent of adults have gone online at least once to look up health information. Unfortunately, finding high-quality health websites is a challenge. Several years ago, a review of 79 studies published in the Journal of the American Medical Association concluded that online health information for consumers is frequently flawed, inaccurate, or biased. Based on my experience, the situation isn't any better today.
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To Fix Your Health Habits, Do It All at Once
Tweet Share on Facebook May 6, 2011 Comment (1)As a physician, I have mixed feelings about the popular reality television show "The Biggest Loser." On one hand, some of my patients are surely inspired by seeing severely overweight people, many of them suffering chronic weight-related health problems, make various positive lifestyle changes and rapidly lose weight. Unfortunately, others may assume that eating meals prepared by professional nutritionists and getting one-on-one coaching from a celebrity personal trainer are fundamental to the contestants' successes. Since most people don't have access to such help, they may conclude that it's not worth trying to fix all their unhealthy habits.
That, however, would be the wrong conclusion to draw.
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Dangers of the Incidentaloma: Why to Think Twice Before Getting a CT Scan
Tweet Share on Facebook April 18, 2011 Comment (6)Mrs. Smith (not her real name) fidgeted in her chair in my examination room as I scanned the radiology report she had given me. She had visited the emergency room the previous evening with severe abdominal pain that had eventually been diagnosed as gastritis, or swelling of the stomach lining due to a virus. During her evaluation, the ER physician had ordered a CT scan of her abdomen and pelvis. Although Mrs. Smith's liver and intestines appeared normal, the radiologist had noted a tiny mass on one of her kidneys.
The report stated that the mass was consistent with a harmless cyst, but concluded with a statement that was all too familiar to me: "Cannot rule out malignancy. Clinical correlation required." Translation: it was almost certainly nothing serious, but there was a very small chance that it might be cancer, and now it was my job to make sure it wasn't. But further investigation of this incidental finding, which had no relationship to Mrs. Smith's original symptoms, would involve a painful biopsy, and if the biopsy was inconclusive, surgery to remove her kidney. In similar situations with other patients, I had suggested the alternative of regular monitoring with additional scans to make sure that the mass wasn't growing; however, this option requires that a patient live each day with the anxiety of not knowing if she has cancer.
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A Doctor's Practical Guide to Prescription Drugs
Tweet Share on Facebook March 30, 2011 Comment (1)When I was in residency training, one of my more challenging patients was a woman in her sixties who ended up in the hospital again and again with complications from heart failure and diabetes. I and her other physicians prescribed a dozen powerful medications to keep her conditions under control, but nothing seemed to work. Her blood sugar level was always too high or too low, and, despite our repeated instructions and reminders, it wasn't clear that she understood what each of her medications was for or how to take them on schedule.
