Medical

Patients who bring in labs from other providers

imemod — Wed, 30 Mar 2011 18:55:30 GMT

We are seeing more patients who obtain lab work through their work place or employer health clinic, which is fine. However, it they come to our office with these results - sometimes for their annual preventive-care exam and sometimes for an unrelated problem visit.

I would be interested in knowing how others handle this. My general opinion is that if someone is knows enough to request labs, they ought to interpret and inform or discuss them with the patient, but I wanted to hear what others think.

Telemedicine...the future of medicine?

david2 — Thu, 03 Mar 2011 17:15:42 GMT

Telemedicine encompasses the use of technology to monitor patients remotely, store clinical data, or facilitate real-time communication between patients and providers. According to Greg Billings, director of the center for telehealth and e-health law, telemedicine will play a huge part in the future of medicine.

See the entire telemedcine podast here.

Severe Acne, not Accutane, May Cause Increased Suicide Risk

dagmar — Wed, 24 Nov 2010 13:16:09 GMT

http://www.medscape.com/viewarticle/732442?src=mp&spon=33&uac=117747ER

Findings Support Previous Research That Disease Severity, and Not Drug Treatment, Increases Suicidal Behavior

Caroline Cassels

November 12, 2010 — A large retrospective study appears to confirm a recent previous study that suicidal behavior in individuals with severe acne is linked to the disease, and not to treatment with isotretinoin.

The study also shows that an additional risk may be present during and up to 1 year after treatment with isotretinoin. However, investigators stress that this additional risk is most likely a result of the acne itself, rather than treatment with the drug.

"Severe acne is not a trivial condition; in the absence of treatment with isotretinoin, it is associated with an increased risk of attempted suicide," write investigators led by Anders Sundstrom, a pharmacoepidemiologist from the Karolinska Institute, Sweden.

The study was published online November 12 in BMJ.

Isotretinoin has been used to treat acne since the 1980s, with effective results. Although the study authors note that there has been research linking the drug to depression and suicidal behavior, the findings have been conflicting.

"The association between acne, psychiatric morbidity, and suicide attempts has been described, and some authors have observed that isotretinoin actually lead to an improvement in anxiety and depression because of the clearing of disfiguring acne," they write.

The investigators hypothesized that those with acne are at higher risk for suicide regardless of whether they are taking isotretinoin. They analyzed data from 5756 individuals aged 15 to 49 years who were prescribed isotretinoin for severe acne between 1980 and 1989. These data were then linked to data from hospital discharge and cause-of-death registers from 1980 to 2001.

Of the total cohort, 3613 were men. The average age of the patients when they were first prescribed isotretinoin was 22 years for men and 27 years for women.

The main outcome measure was the standardized incidence ratio, which was the observed number of suicides divided by the expected number of suicide attempts calculated up to 3 years before, during, and up to 15 years after the end of treatment.

A total of 128 patients were admitted to the hospital for attempted suicide. During the year before treatment, the standardized incidence ratio for attempted suicide was raised by 1.57 (95% confidence interval [CI], 0.86 - 2.63) for all suicide attempts, including repeat attempts, and 1.36 for first attempts only (95% CI, 0.65 - 2.50).

The standardized incidence ratio during and up to 6 months after treatment was 1.78 (95% CI, 1.04 - 2.85) for all attempts and 1.93 (95% CI, 1.08 - 3.18) for first attempts.

The investigators report that 3 years after treatment stopped, the observed number of attempts was close to the expected number and remained so during 15 years of follow-up, with a standardized incidence ratio of 1.04 (95% CI, 0.74 - 1.43) for all attempts and 0.97 (95% CI, 0.64 - 1.40) for first attempts.

The study authors speculate that the finding that the risk for attempted suicide was highest within 6 months after treatment ended may be because patients whose acne and physical appearance improved after treatment were distraught if there was no improvement in their social life.

"We must stress that we cannot exclude the possibility that the raised risk of suicide attempts during treatment and 6 months after treatment is due to the exposure to isotretinoin. However, a more probable interpretation is that the underlying severe acne may best explain the raised risk," the study authors write.

These findings appear to support results of a recent study published September 16 in the Journal of Investigative Dermatology and reported by Medscape Medical News at that time, which suggested that suicidal ideation in this population may reflect the burden of the disease, rather than treatment with isotretinoin.

"Physicians prescribing isotretinoin should be aware that a history of psychiatric problems, such as suicide, need not constitute a decisive factor when considering treatment with isotretinoin.

"Much more important is the fact that suicide attempts can occur quite a long time after treatment has stopped. For this reason, close monitoring of the mental status of patients receiving isotretinoin, as well as those with severe acne, should be a part of the treatment process and should continue for at least a year after the end of treatment."

In an accompanying editorial, Parker Magin, MD, PhD, from the University of Newcastle, in Callaghan, Australia, and John Sullivan, MD, from the University of New South Wales, in Sydney, Australia, acknowledge that "it is difficult to tease out the relationship between mental health and isotretinoin because acne itself is associated with psychiatric morbidity, including depression.

"Clinicians can draw important practical conclusions from this study, which are relevant whether isotretinoin is or is not, directly or indirectly, causally implicated in suicide. During and after treatment with isotretinoin (perhaps, especially, unsuccessful treatment), patients should be carefully monitored for depression and suicidal thoughts. Patients probably have an increased risk before treatment, however, so all patients with acne of a severity for which isotretinoin is indicated should have psychosocial factors and suicidal intent monitored," they write.

Skin Cancer vs. Vitamin D Deficiency

dagmar — Tue, 02 Nov 2010 23:33:10 GMT

Maybe we can overdo it with the sunscreen...

From Medscape Medical News

Skin Cancer Patients at Risk for Vitamin D Deficiency

Janis C. Kelly

Authors and Disclosures

October 22, 2010 — Patients with basal cell nevus syndrome (BCNS) who carefully avoid sun exposure might be trading one form of risk for another, according to American researchers.

Of the 41 patients with BCNS participating in a 2-year celecoxib chemoprevention trial, 23 (56%) were deficient in vitamin D, report lead author Jean Y. Tang, MD, PhD, and colleagues in the October issue of the Archives of Dermatology. Vitamin D levels are partly determined by a person's sun exposure; in the study, a deficiency was defined as a 25-hydroxyvitamin D (25[OH]D) level of 20 ng/mL or below.

Vitamin D deficiency has been linked to an increased risk for breast and colon cancer, autoimmune disease, fractures, and cardiovascular disease.

Dr. Tang, who is assistant professor of dermatology at Stanford University School of Medicine, Redwood City, California, told Medscape Medical News that the data have immediate clinical implications. "I think that dermatologists should monitor vitamin D levels, especially if they have skin cancer patients who are really good about sun avoidance/protection," Dr. Tang said.

Patients with BCNS are genetically predisposed to develop basal cell carcinomas, and usually develop multiple basal cell carcinomas in young adulthood. In contrast, most cases of sporadic basal cell carcinoma occur in the sixth to seventh decades of life. People with BCNS generally try to prevent skin cancer by using sunscreen and avoiding the sun during peak hours.

Patients had blood drawn an average of 3 times during the 2-year study of celecoxib (which is not known to affect vitamin D levels). Compared with the general population, patients with BCNS had lower average vitamin D levels and were 3 times more likely to be deficient.

Surprise: Seasonal Variation in Both Groups

Dr. Tang and her colleagues improved on previous studies by matching the data from each BCNS patient with data from a control population of people of comparable age, sex, body mass index, geographic residence, and Fitzpatrick skin type (a measure of melanin pigmentation, or skin color). The data for the control population came from the 2007 Nutritional & Health Examination Survey, conducted by the US Centers for Disease Control and Prevention.

Blood vitamin D levels were lower in patients with BCNS who were overweight, and in those who had blood collected in the winter, as opposed to the summer.

"I was surprised that among BCNS patients, there was a seasonal variation in serum vitamin D levels that was similar to that in the general non-BCNS population; in other words, BCNS patients have higher vitamin D levels in the summer than in the winter," Dr. Tang said.

"That means that these patients with so many skin cancers are still getting more sun exposure in the summer than in the winter. They are not good about listening to their dermatologist's warnings about not going out to the sun. I guess the BCNS patients are similar to most of our skin cancer patients; they probably try to use sunscreen, wear long sleeves, avoid noon-time sun, but they are not perfect," she added.

Of 35 patients with BCNS who completed a survey, 28 (80%) reported using sunscreen daily and most reported avoiding sunshine during the hours of 10 a.m. and 2 p.m. "It may not be surprising that patients with a genetic predisposition to sun-induced cancers report a high frequency of photoprotection and may be vitamin D deficient," the authors write. "However, the magnitude of this deficiency and the possible additive effect of obesity, which is common in these patients, make individuals with [BCNS] optimal candidates for cholecalciferol supplementation."

"Furthermore, if the mechanism for the association between low 25(OH)D levels in patients with [BCNS] is indeed photoprotection, these results may be applicable to patients without [BCNS] who have sporadic basal cell carcinomas and for whom photoprotection is currently recommended," they conclude. "Given that sporadic basal cell carcinoma is the most common cancer worldwide, with more than 1 million cases reported annually in the United States, and that most patients with basal cell carcinoma survive for many years after their diagnosis, screening for vitamin D deficiency may become an important part of the care of this population," they add.

Dr. Tang told Medscape Medical News that the data also raise new questions. "I would like to see if skin cancer patients (without BCNS) also have low vitamin D levels. I would expect so," she said.

Dr. Tang noted that the Institute of Medicine will be conducting a review of vitamin D requirements; new recommendations are expected in November 2010.

Dr. Tang has disclosed no relevant financial relationships.

Arch Dermatol. 2010;146:1105-1110. Abstract

Memories... My Xray Collection!

alborg — Fri, 29 Oct 2010 11:44:40 GMT

Remember my "rectal toys" collection? A new one just came out in the NEJM, where a guy somehow ended up with a beer bottle up his rear end! Incredible...

I didn't know this, but the NEJM is an aficionado of foreign bodies: http://www.google.com/images?um=1&hl=en&rls=com.microsoft%3Aen-us%3AIE-SearchBox&biw=1379&bih=874&tbs=isch%3A1&sa=1&q=a+foreign+body+nejm&btnG=Search&aq=f&aqi=&aql=&oq=&gs_rfai= , both top and bottom. Check out the swallowed spoon:

Avandia in news re: MI risk

joseph — Mon, 21 May 2007 22:55:50 GMT

We knew it can cause edema and macular edema.

We knew if patient on avandia developed CHF, we had to stop avandia.

This is new news --

http://www.nytimes.com/2007/05/22/business/21drug-web.html?_r=1&hp&oref=slogin

First principle is not to harm patient.

Workplace Violence in Healthcare

david2 — Mon, 04 Oct 2010 19:47:19 GMT

This isn't really something nice to think or hear about, but data from the Bureau of Labor Statistics shows that healthcare workers are more than four times likely than professionals in other work settings to be victims of a violent act. This podcast can help educate medical practice staff about the common warning signs and types of workplace violence, and review strategies for assessment and prevention. See bio of speaker below:

Bio: Eugene A. Rugala is a former profiler/supervisory special agent with the Federal Bureau of Investigation's (FBI) Critical Incident Response Group (CIRG), at the National Center for the Analysis of Violent Crime (NCAVC), FBI Academy, in Quantico, Virginia. He has participated in ongoing research regarding stalking behavior; serial rape; and domestic, workplace and school violence; and has contributed to a number of publications dealing with workplace violence, school violence and stalking.

An international authority on workplace violence, Rugala has testified before Congress, and has collaborated with multiple government and trade associations to further workplace violence prevention initiatives. He currently consults with Fortune 500 companies on the implementation of workplace violence education and prevention programs.

Everyone needs Special K for breakfast

DrMurdoch — Wed, 09 Aug 2006 20:11:15 GMT

http://www.boston.com/yourlife/health/mental/articles/2006/08/08/drug_may_quickly_lift_depression_study_says/

Drug may quickly lift depression, study says

By Carey Goldberg, Globe Staff | August 8, 2006

Ketamine, an anesthetic also used illegally as the club drug Special K, has the power to lift stubborn depression within hours, instead of the weeks it typically takes prescription antidepressants to kick in, a new federal study suggested yesterday.

....

``It's not ready for prime time yet," said Insel, whose agency funded the research. But if the quick antidepressant effect of ketamine is borne out in future studies, ``it would be just terrific," he said.

The study found that patients given a single intravenous infusion of ketamine began to feel their depression lift within two hours and that after a day, 71 percent reported a major improvement in mood. A control group that received an infusion containing only a placebo showed no improvement.

....

Interesting stuff. Funny. One of the most depressed hackers on the internet i've stumbled upon had a "off the shelf" problem with Special K.

Psychiatric EHR EMR Wish List

cyberpsych — Tue, 17 Aug 2010 14:14:33 GMT

What has your experience been using current psychiatric electronic medical records? What works, what doesn’t? What would be an “ideal wish-list” of feature sets for a stand-alone Psychiatric EHR/EMR?

I am a psychiatrist in private practice and have been looking at the current options available for EMR/EHR. Most programs are full software suites focused on general medicine with good practice management/billing options, but the psychiatric EHR portion is merely added on as an after thought (for instance, rudimentary word document templates, etc) and do not address the needs for specialty EHR/workflow of a psychiatric medical record.

I am evaluating the need to develop a stand alone web based psychiatric EHR, focused primarily on psychiatric/behavioral health medical records without the extra bells and whistles for extensive practice management add-ons. (One other reason for honing in on the medical record aspect is that most private practice offices are leery to give up their practice management software which keeps the billing/revenue generating stream up and running, and hence end up compromising on hanging on to the watered down medical record portion that is tacked on to it). The purpose is not to reinvent the wheel, but rather, focus on a core product that does what it needs to do well, instead of trying to be the jack of all trades.

As a disclaimer, I will also be posting this in other forums (AATP, Sermo, Medscape, etc) for maximum feedback from colleagues, so advance apologies if this is against any cross-posting rules.

Thank you in advance for your feedback.

Canada reassessing healthcare model?

JamesNT — Wed, 07 Jul 2010 13:37:36 GMT

From Reuters:

Soaring costs force Canada to reassess health model

Mon, May 31 2010

By Claire Sibonney - Analysis

TORONTO (Reuters) - Pressured by an aging population and the need to rein in budget deficits, Canada's provinces are taking tough measures to curb healthcare costs, a trend that could erode the principles of the popular state-funded system.

Ontario, Canada's most populous province, kicked off a fierce battle with drug companies and pharmacies when it said earlier this year it would halve generic drug prices and eliminate "incentive fees" to generic drug manufacturers.

British Columbia is replacing block grants to hospitals with fee-for-procedure payments and Quebec has a new flat health tax and a proposal for payments on each medical visit -- an idea that critics say is an illegal user fee.

And a few provinces are also experimenting with private funding for procedures such as hip, knee and cataract surgery.

It's likely just a start as the provinces, responsible for delivering healthcare, cope with the demands of a retiring baby-boom generation. Official figures show that senior citizens will make up 25 percent of the population by 2036.

"There's got to be some change to the status quo whether it happens in three years or 10 years," said Derek Burleton, senior economist at Toronto-Dominion Bank.

"We can't continually see health spending growing above and beyond the growth rate in the economy because, at some point, it means crowding out of all the other government services.

"At some stage we're going to hit a breaking point."

MIRROR IMAGE DEBATE

In some ways the Canadian debate is the mirror image of discussions going on in the United States.

Canada, fretting over budget strains, wants to prune its system, while the United States, worrying about an army of uninsured, aims to create a state-backed safety net.

Healthcare in Canada is delivered through a publicly funded system, which covers all "medically necessary" hospital and physician care and curbs the role of private medicine. It ate up about 40 percent of provincial budgets, or some C$183 billion ($174 billion) last year.

Spending has been rising 6 percent a year under a deal that added C$41.3 billion of federal funding over 10 years.

But that deal ends in 2013, and the federal government is unlikely to be as generous in future, especially for one-off projects.

"As Ottawa looks to repair its budget balance ... one could see these one-time allocations to specific health projects might be curtailed," said Mary Webb, senior economist at Scotia Capital.

Brian Golden, a professor at University of Toronto's Rotman School of Business, said provinces are weighing new sources of funding, including "means-testing" and moving toward evidence-based and pay-for-performance models.

"Why are we paying more or the same for cataract surgery when it costs substantially less today than it did 10 years ago? There's going to be a finer look at what we're paying for and, more importantly, what we're getting for it," he said.

Other problems include trying to control independently set salaries for top hospital executives and doctors and rein in spiraling costs for new medical technologies and drugs.

Ontario says healthcare could eat up 70 percent of its budget in 12 years, if all these costs are left unchecked.

"Our objective is to preserve the quality healthcare system we have and indeed to enhance it. But there are difficult decisions ahead and we will continue to make them," Ontario Finance Minister Dwight Duncan told Reuters.

The province has introduced legislation that ties hospital chief executive pay with the quality of patient care and says it wants to put more physicians on salary to save money.

In a report released last week, TD Bank said Ontario should consider other proposals to help cut costs, including scaling back drug coverage for affluent seniors and paying doctors according to quality and efficiency of care.

WINNERS AND LOSERS

The losers could be drug companies and pharmacies, both of which are getting increasingly nervous.

"Many of the advances in healthcare and life expectancy are due to the pharmaceutical industry so we should never demonize them," said U of T's Golden. "We need to ensure that they maintain a profitable business but our ability to make it very very profitable is constrained right now."

Scotia Capital's Webb said one cost-saving idea may be to make patients aware of how much it costs each time they visit a healthcare professional. "(The public) will use the services more wisely if they know how much it's costing," she said.

"If it's absolutely free with no information on the cost and the information of an alternative that would be have been more practical, then how can we expect the public to wisely use the service?"

But change may come slowly. Universal healthcare is central to Canada's national identity, and decisions are made as much on politics as economics.

"It's an area that Canadians don't want to see touched," said TD's Burleton. "Essentially it boils down the wishes of the population. But I think, from an economist's standpoint, we point to the fact that sometimes Canadians in the short term may not realize the cost."

($1=$1.05 Canadian)

(Reporting by Claire Sibonney; editing by Janet Guttsman and Peter Galloway)

JamesNT

CMS Offer to Participate in Medicare

elidan — Mon, 28 Jun 2010 23:06:57 GMT

http://www.aafp.org/online/en/home/publications/news/news-now/government-medicine/20100628cmsparticipation.html

Any non pars considering participation in Medicare at this time?

Omega 3 supplements for depression - might work if you are not anxious ?

DrMurdoch — Tue, 22 Jun 2010 12:47:14 GMT

The Efficacy of Omega-3 Supplementation for Major Depression: A Randomized Controlled Trial

François Lespérance, MD; Nancy Frasure-Smith, PhD; Elise St-André, MD; Gustavo Turecki, MD, PhD; Paul Lespérance, MD, MSc; and Stephen R. Wisniewski, PhD
J Clin Psychiatry 10.4088/JCP.10m05966blu © Copyright 2010 Physicians Postgraduate Press, Inc.

Objective: To document the short-term efficacy of omega-3 supplementation in reducing depressive symptoms in patients experiencing a major depressive episode (MDE).

Method: Inclusive, double-blind, randomized, controlled, 8-week, parallel-group trial, conducted October 17, 2005 through January 30, 2009 in 8 Canadian academic and psychiatric clinics. Adult outpatients (N = 432) with MDE (Mini-International Neuropsychiatric Interview, version 5.0.0, criteria) lasting at least 4 weeks, including 40.3% taking antidepressants at baseline, were randomly assigned to 8 weeks of 1,050 mg/d of eicosapentaenoic acid (EPA) and 150 mg/d of docosahexaenoic acid (DHA) or matched sunflower oil placebo (2% fish oil). The primary outcome was the self-report Inventory of Depressive Symptomatology (IDS-SR30); the secondary outcome was the clinician-rated Montgomery-Åsberg Depression Rating Scale (MADRS).

Results: The adjusted mean difference between treatment and placebo was 1.32 points (95% CI, –0.20 to 2.84; P = .088) on the IDS-SR30 and 0.97 points (95% CI, –0.012 to 1.95; P = .053) on the MADRS. Planned subgroup analyses revealed a significant interaction of comorbid anxiety disorders and study group (P = .035). For patients without comorbid anxiety disorders (n = 204), omega-3 supplementation was superior to placebo, with an adjusted mean difference of 3.17 points on the IDS-SR30 (95% CI, 0.89 to 5.45; P = .007) and 1.93 points (95% CI, 0.50 to 3.36; P = .008) on the MADRS.

Conclusions: In this heterogeneous sample of patients with MDE, there was only a trend toward superiority of omega-3 supplementation over placebo in reducing depressive symptoms. However, there was a clear benefit of omega-3 supplementation among patients with MDE without comorbid anxiety disorders.

source: http://article.psychiatrist.com/dao_1-login.asp?ID=10006935&RSID=7754587027462

http://www.cbc.ca/canada/montreal/story/2010/06/21/mtl-omega-3-depression.html

Anyone have a copy of the original article ?

The study was funded by the Omega 3 maker.

A simple approach to Dizziness

DrMurdoch — Mon, 26 Apr 2010 13:25:21 GMT

I had a patient on Friday that was dizzier than I'd expect.

She's 85.

Nothing jumped out at me as to why she was dizzy. My thoughts were either Stress or Chronic Disease. I wanted to expand the differential into more rare things .. so I reviewed "Approaches to dizziness". I found this.

I guess it's a "First Approach" to dizziness.

Anyone like it ?

Trying to do no harm to Medicare

imemod — Wed, 31 Mar 2010 22:04:21 GMT

Until Congress decides to fix the 21% Medicare reimbursement problem, I have decided to limit the Medicare services i will provide. As a gynecologist, I do not want to see harm come to these patients so I still feel it appropriate to see those with complaints requiring assessment for malignancy, such as post-menopausal bleeding. However, I do not want to see new patients with quality-of-life concerns such as prolapse until this issue is resolved satisfactorily.

I have been told this may not be an option. I always understood that I do not have to provide services, but that if I have agreed to accept assignment (and I have) that I must charge accordingly. Am I correct??

DERM spot diagnosis case: painful heel, especially when running.

DrMurdoch — Wed, 10 Mar 2010 22:48:01 GMT

almost 50 yo male

here to review his hearing.

as i was leaving he asked me to look at his foot.

been sore for a few years, especially when running.

Diagnosis please !

ObamaCare-Social MalMed

digital-doc — Wed, 17 Mar 2010 23:16:53 GMT

Senator Bayh, "As a practicing physician I have major concerns with the health care bill before Congress. I actually have read the bill and am shocked by the brazenness of the government's proposed involvement in the patient-physician relationship. The very idea that the government will dictate and ration patient care is dangerous and certainly not helpful in designing a health care system that works for all. Every physician I work with agrees that we need to fix our health care system, but the proposed bills currently making their way through congress will be a disaster if passed. I ask you respectfully and as a patriotic American to look at the following troubling lines that I have read in the bill. You cannot possibly believe that these proposals are in the best interests of the country and our fellow citizens."

Page 22 of the HC Bill: Mandates that the Govt will audit books of all employers that self-insure!!
Page 30 Sec 123 of HC bill: THERE WILL BE A GOVT COMMITTEE that decides what treatments/benefits you get.
Page 29 lines 4-16 in the HC bill: YOUR HEALTH CARE IS RATIONED!!!

Page 42 of HC Bill: The Health Choices Commissioner will choose your HC benefits for you. You have no choice!
Page 50 Section 152 in HC bill: HC will be provided to ALL non-US citizens, illegal or otherwise.
Page 58 HC Bill: Govt will have real-time access to individuals' finances & a 'National ID Health card' will be issued! (Papers please!)

Page 59 HC Bill lines 21-24: Govt will have direct access to your bank accounts for elective funds transfer. (Time for more cash and carry)

Page 65 Sec 164: Is a payoff subsidized plan for retirees and their families in unions & community organizations: (ACORN).
Page 84 Sec 203 HC bill: Govt mandates ALL benefit packages for private HC plans in the 'Exchange.'

Page 85 Line 7 HC Bill: Specifications of Benefit Levels for Plans -- The Govt will ration your health care!

Page 91 Lines 4-7 HC Bill: Govt mandates linguistic appropriate services. (Translation: illegal aliens.)

Page 95 HC Bill Lines 8-18: The Govt will use groups (i.e. ACORN & Americorps to sign up individuals for Govt HC plan.
Page 85 Line 7 HC Bill: Specifications of Benefit Levels for Plans. (AARP members - your health care WILL be rationed!)
Page 102 Lines 12-18 HC Bill: Medicaid eligible individuals will be automatically enrolled in Medicaid. (No choice.)
Page 12 4 lines 24-25 HC: No company can sue GOVT on price fixing. No "judicial review" against Govt monopoly.
Page 127 Lines 1-16 HC Bill: Doctors/ American Medical Association - The Govt will tell YOU what salary you can make.
Page 145 Line 15-17: An Employer MUST auto-enroll employees into public option plan. (NO choice!)
Page 126 Lines 22-25: Employers MUST pay for HC for part-time employees ANDtheir families. (Employees shouldn't get excited about this as employers will be forced to reduce its work force, benefits, and wages/salaries to cover such a huge expense.)
Page 149 Lines 16-24: ANY Employer with payroll 401k & above who does not provide public option will pay 8% tax on all payroll! (See the last comment in parenthesis.)

Page 150 Lines 9-13: A business with payroll between $251K & $401K who doesn't provide public option will pay 2-6% tax on all payroll.

Page 167 Lines 18-23: ANY individual who doesn't have acceptable HC according to Govt will be taxed 2.5% of income.
Page 170 Lines 1-3 HC Bill: Any NONRESIDENT Alien is exempt from individual taxes. (Americans will pay.) (Like always)
Page 195 HC Bill: Officers & employees of the GOVT HC Admin.. will have access to ALL Americans' finances and personal records. (I guess so they can 'deduct' their fees)

Page 203 Line 14-15 HC: "The tax imposed under this section shall not be treated as tax." (Yes, it really says that!) ( a 'fee' instead)
Page 239 Line 14-24 HC Bill: Govt will reduce physician services for Medicaid Seniors. (Low-income and the poor are affected.)
Page 241 Line 6-8 HC Bill: Doctors: It doesn't matter what specialty you have trained yourself in -- you will all be paid the same! (Just TRY to tell me that's not Socialism!)

Page 253 Line 10-18: The Govt sets the value of a doctor's time, profession, judgment, etc. (Literally-- the value of humans.)
Page 265 Sec 1131: The Govt mandates and controls productivity for "private" HC industries.

Page 268 Sec 1141: The federal Govt regulates the rental and purchase of power driven wheelchairs.

Page 272 SEC. 1145: TREATMENT OF CERTAIN CANCER HOSPITALS - Cancer patients - welcome to rationing!

Page 280 Sec 1151: The Govt will penalize hospitals for whatever the Govt deems preventable (i.e...re-admissions).
Page 298 Lines 9-11: Doctors: If you treat a patient during initial admission that results in a re-admission -- the Govt will penalize you.

Page 317 L 13-20: PROHIBITION on ownership/investment. (The Govt tells doctors what and how much they can own!)

Page 317-318 lines 21-25, 1-3: PROHIBITION on expansion. (The Govt is mandating that hospitals cannot expand.)
Page 321 2-13: Hospitals have the opportunity to apply for exception BUT community input is required. (Can you say ACORN?)

Page 335 L 16-25 Pg 336-339: The Govt mandates establishment of=2 outcome-based measures. (HC the way they want -- rationing.)
Page 341 Lines 3-9: The Govt has authority to disqualify Medicare Advance Plans, HMOs, etc. (Forcing people into the Govt plan)

Page 354 Sec 1177: The Govt will RESTRICT enrollment of 'special needs people!' Unbelievable!

Page 379 Sec 1191: The Govt creates more bureaucracy via a "Tele-Health Advisory Committee." (Can you say HC by phone?)

Page 425 Lines 4-12: The Govt mandates "Advance-Care Planning Consult." (Think senior citizens end-of-life patients.)

Page 425 Lines 17-19: The Govt will instruct and consult regarding living wills, durable powers of attorney, etc. (And it's mandatory!)
Page 425 Lines 22-25, 426 Lines 1-3: The Govt provides an "approved" list of end-of-life resources; guiding you in death. (Also called 'assisted suicide.')(Sounds like Soylent Green to me.)

Page 427 Lines 15-24: The Govt mandates a program for orders on "end-of-life." (The Govt has a say in how your life ends!)

Page 429 Lines 1-9: An "advanced-care planning consultant" will be used frequently as a patient's health deteriorates.

Page 429 Lines 10-12: An "advanced care consultation" may include an ORDER for end-of-life plans.. (AN ORDER TO DIE FROM THE GOVERNMENT?!?)
Page 429 Lines 13-25: The GOVT will specify which doctors can write an end-of-life order.. (I wouldn't want to stand before God after getting paid for THAT job!)
Page 430 Lines 11-15: The Govt will decide what level of treatment you will have at end-of-life! (Again -- no choice!)

Page 469: Community-Based Home Medical Services = Non-Profit Organizations. (Hello? ACORN Medical Services here!?!)

Page 489 Sec 1308: The Govt will cover marriage and family therapy. (Which means Govt will insert itself into your marriage even.)
Page 494-498: Govt will cover Mental Health Services including defining, creating, and rationing those services.

Senator, I guarantee that I personally will do everything possible to inform patients and my fellow physicians about the dangers of the proposed bills you and your colleagues are debating.

Furthermore, if you vote for a bill that enforces socialized medicine on the country and destroys the doctor-patient relationship, I will do everything in my power to make sure you lose your job in the next election.

Respectfully,

Stephen E. Fraser, MD

Dear Reader,
I urge you to use the power that you were born with (and the power that may soon be taken away) and circulate this email to as many people as you can reach. The Power of the People can stop this from happening to us, our parents, our grandparents, our children, and to following generations

Why won't my hospital allow me to access the secure wireless environment?

Rogerven — Fri, 19 Feb 2010 01:47:31 GMT

I was informed that I can only use the GUEST wifi and not the secure wifi on the ACE floor that I direct. I was told for "security" and "virus" issues.

My solution was to risk it and go thru the guest wi fi, remotedesktop to my computer in the office and then vpn to the Cerner system. But it does not make sense to me, plus it will risk my clinics server.

I was told I can go to the President of the hospital but the IT of the hospital would not care anyways. It was suggested that I request for a lap top that is issued by their IT. Wow why would I do that when I have my own lap top. Does not make any sense at all. Any suggestions or comments are appreciated.

Thanks

Medicare Audit

imemod — Fri, 19 Feb 2010 23:30:39 GMT

Our office had a "Medicare Audit" done through Medical Staff SOS to give us a idea of how we would survive the real deal. One of the crtitiques I received was that my assessment and plan were first on myh notes. I set them this way in the EMR because it is so !@#$%%^ frustrating to scroll through notes. This way I can sort of "page through" them if I am looking for a specific visit. My question is: Is there a Medicare rule that requires the note to be constructed in a specific order? I am not aware of one and I am aware of other providers/practices who construct their notes as I do, for the reasons noted. Thanks

The medical milkshake for Alzheimer's (it's easy to dupe people with dementia)

DrMurdoch — Sat, 09 Jan 2010 15:13:36 GMT

Dear Makers of Cholinesterase Inhibitors .....

I thought you made the world's most laughable placebos.

I was wrong.

But I do have good news ... someone for you to sue !

Cue: The medical milkshake for Alzheimer's.

Sad note: Alzheimer's is a terrible disease. Scamming these patients and their caregivers is cruel. I think now I can safely say, all reasonableness in the world is gone.

Scientists have developed a drink called Souvenaid that is a "medical food," meaning it's taken under the guidance of a physician to manage a specific condition. The drink has three components -- uridine, choline, and the omega-3 fatty acid DHA -- that, working together, help restore synapses, said Dr. Richard Wurtman, professor at the Massachusetts Institute of Technology and co-author of the study. Uridine is a molecule used in the genetic coding for RNA, choline is in the vitamin B family, and DHA is found in certain fish and fish oils.

These nutrients are already found in the human body and have been shown to be safe, he said. But taking a supplement of any one of them will not have the same beneficial effect, he said. Together in the right proportions, the cocktail increases the production of fatty constituents and proteins needed for synapses.

The study looked at 225 patients who had mild Alzheimer's, according to an examination. Some took Souvenaid, and the control group participants received a non-medical drink, once a day for 12 weeks.

They found that patients showed significant improvement in the delayed verbal recall task, in which participants were asked to remember what they had been told earlier. The idea is that the formation of synapses delays the symptoms of Alzheimer's, but it is not a cure, experts said.

"There was a clear difference. The difference was greatest in people with very mild but quite real Alzheimer's," he said.

source: http://www.cnn.com/2010/HEALTH/01/08/alzheimer.drink.scan/index.html

scam, scam, scam.

shame on you CNN.

The medical info on CNN is deteriorating.

FDR Died From Melanoma Complications

dagmar — Sun, 03 Jan 2010 17:52:42 GMT

http://www.nypost.com/p/news/national/fdr_kept_deadly_disease_hidden_for_5EQDNU3uhriRo1HQRdmTrN

If melanoma was strong eonugh to bring down the greatest Democrat in history, then the next step is obvious: The Democrat-controlled House and Senate should immediately triple skin cancer related reimbursements.

This message has been approved by The American Academy of Dermatology.

ps - hey, does the smileyface insert work with firefox???

EMRs don't save lives, Health Insurance does.

DrMurdoch — Sun, 27 Dec 2009 19:53:15 GMT

Study links 45,000 U.S. deaths to lack of insurance

http://www.reuters.com/article/idUSTRE58G6W520090917

WASHINGTON (Reuters) - Nearly 45,000 people die in the United States each year -- one every 12 minutes -- in large part because they lack health insurance and can not get good care, Harvard Medical School researchers found in an analysis released on Thursday.

"We're losing more Americans every day because of inaction ... than drunk driving and homicide combined," Dr. David Himmelstein, a co-author of the study and an associate professor of medicine at Harvard, said in an interview with Reuters.

Ouch

Washington Post report on Smoking Vaccine: NicVax

Nick Harrington — Tue, 24 Nov 2009 16:40:35 GMT

Article here.

Nabi's experimental vaccine, a decade in the works, tries a more direct approach: It shuts down nicotine's access to the brain. Smokers may light up a cigarette while on NicVax, but if the drug works as intended, they won't feel any of the stimulating effects they crave from nicotine.

NicVax causes the immune system to create antibodies that bond with the nicotine molecule if it enters the bloodstream. The result is a molecule too large to pass along to the brain. In short, the vaccine seeks to make the body immune to nicotine.

Sounds awfully similar to the Shot developed by Dr. Kirk Voelker.

I'm just saying, that's all. Don't know what all the fuss is about. All smokers quit in the end.

Nick

More on ENHANCE

Rogerven — Tue, 04 Mar 2008 23:51:36 GMT

"For one thing, ENHANCE was not a clinical-end-point trial, as was reported in the media, nor were the results "negative," said Greenland. They were not statistically significant, a big difference lost among some in the media. Moreover, the end point was not "fatty plaque," as reported by others, but intima-media thickness. More concerning, however, was the fact that ENHANCE "mushroomed" to the point where almost 50 years of "serious and logical research has been damaged and defamed for no good purpose," write Greenland and Lloyd-Jones."

http://www.theheart.org/viewArticle.do?primaryKey=845925&nl_id=tho04mar08

Upset cardiologists

joseph — Wed, 21 Nov 2007 18:44:46 GMT

Cardiologist getting upset about unpublished data seems to be unusual. But they are upset.

http://www.nytimes.com/2007/11/21/business/21drug.html?_r=1&hp&oref=slogin

So will they see the data earlier, now that pharmaceuticals know they are upset?

Ezetrol is not good - not that you didn't know.

DrMurdoch — Fri, 04 Feb 2005 16:30:05 GMT

The height of reductionist medicine with almost no demonstrated value to patients is Ezetrol. The lack of any meaningful endpoint data on this product should be disturbing. From an economic viewpoint, it is a horrifically ridiculous drug.

And it's not benign.

http://www.hc-sc.gc.ca/hpfb-dgpsa/tpd-dpt/ezetrol_hpc_e.html

Subject: Association of Ezetrol® (ezetimibe) with myalgia, rhabdomyolysis, hepatitis, pancreatitis, and thrombocytopenia