On Electronic Health Records and Meaningful Use Incentives

Many medical students, particularly pre-clinical medical students, do not understand the utter insanity and horror that is electronic health records/electronic medical records (EHRs/EMRs).  Instead, you will find many that endorse such programs as the be-all end-all and cure to the terrible days of handwritten records.  In such EMRs, we are promised, is the potential for limitless medical discovery and efficiency.  This ethos is shared by many in healthcare administration and others who are not clinicians.  The Federal government has bought this hook, line, and sinker and is poised to impose financial penalties upon any healthcare provider who does not use EMRs.  As an aside, this is not attributable to the ACA/Obamacare- the EHR companies have their tendrils into US Department of Health and Human Services, and it was under Bush that the first meaningful use incentives began to come out if I recall correctly.  However, Obama has continued this trend with his ACA, and his recently announced initiative to use large scale data collection from EMRs combined with genetic data- which he is calling Precision Medicine.

I fully support the use of big data, but I think EHR incentives/penalties are a terrible idea.

I support vaccines- but I am somewhat surprised that more parents don't

As a medical student, I strongly support vaccination. It works, it's safe, and it doesn't cause autism. But I also understand why many parents don't believe me and the medical community when we beg them to vaccinate their kids.

Medicine has come a long way from "Do No Harm". Now we talk about risks and benefits: and none of our tests, medicines, or procedures are without risks. Increasingly, pharmaceutical companies have been caught concealing those risks from doctors and the public.

A Medical Perspective on the Negligent Homicide of Eric Garner

I am not going to get into the larger sociopolitical issues surrounding the death of Eric Garner.  I don't want anything to distract from sharing one observation that has not been widely reported, and which may lead to at least one change that every police department in the country should implement.

Is Obesity more like Crime, Cigarettes, or Sex?

Obesity is a massive problem.  35℅ of America is obese.  Democrats are worried that their prized social welfare programs will collapse under the weight of the problem.  Republicans are worried that they will only be able to invade 1 country every 8 years, as the military finds itself forced to accept increasingly sluggish recruits.  Regardless of how you look at it (and how many puns I can make), this is a serious issue.  But how to frame it makes a massive difference in what tactics and tools it makes sense to pursue.

The Lost Glory Days of General Practice, and a Vision of it's Resurrection

I'm on my family medicine rotation right now.  One of my preceptors is ~80 years old, and went through medical school in the 1960s.  He is still sharp as a tack, and quite possibly the most BAMF-ing family practitioner of all time.  He used to do c-sections, hernia repairs, appendectomies, fracture repairs, and get this- emergency burr holes for subdural hematomas (aka neurosurgery).  He stopped ~1997, mostly because he got tired of his morning cases getting bumped constantly for overnight emergencies and throwing off his schedule for the rest of the day when he had clinic in the afternoon.  He has since moved out to Palm Springs, where he still sees more patients than any of his fellow physicians in the group, still does all his own trigger finger release surgeries and SCC/BCC excisions, and still administers the group.  In addition to all this, he is one of the nicest people I've ever met, beloved by his patients.  He truly epitomizes the fading glory days of family medicine, the ideal of the General Practitioner who could truly do it all.

Ebola, Texas Health Presbyterian Hospital, and Medical Errors

Ebola is in the United States!  Everybody (please don't...) panic!  Quarantine all Texans!  Though that might be a good idea anyway (just kidding).  More on Ebola in general in another post if I have time.

First off though, we've found out more information about the sequence of events leading to the hospitalization of the patient, Thomas Duncan.  Apparently, he came to the hospital, told people he'd come back from Liberia, and was still discharged home.  He was only admitted 2 days later when his nephew called the CDC.  The tale reveals a fascinating story of medical quality and system error.

Informed Consent is a Chimera

This post by Paul Levy got me thinking about informed consent, and a case I saw recently got me to take a little time and write about an issue frequently ignored in medical school.

A bit of background for non-medical readers: Informed Consent is a term in medicine for when doctors get the agreement of the patient to do something to said patient.  For example, before a patient is cut open for surgery, the patient has to say "yes I want to be cut open and have _____ happen".  Less extreme examples abound- the patient has to consent to anything from a blood draw for a lab test to a CT scan.  Part of informed consent is that the patient has to be "informed".  It is acceptable for a patient to say "tell me nothing, just do it", but the patient has to be offered information regarding their disease as well as the risks and benefits of the procedure they are consenting to.  For example, "This x-ray will tell us whether or not you have pneumonia or something else, but may slightly increase your risk of cancer in the long run.  I recommend you get it.  Do you agree?"