Is My Cancer in the Wrong Body Part?

Elaine Waples

Recently, our city hosted the fifth annual national marathon to fight breast cancer. This is not part of the Komen “race for the cure” but rather a grassroots effort that mushroomed from its inception five years ago into the impressive event it is today. Thousands of people participate as runners, volunteers, and cheerleaders clad in the signature color. I must admit, seeing some grown men run twenty six miles wearing pink tu-tus is both awe inspiring and a testament to dedication over self-image.

It’s supporters include corporate sponsors, vendors, and exhibitors, and (no surprise) pharmaceutical companies. Its originators are a local TV celebrity breast cancer survivor and a cancer physician at Mayo clinic. It promises to donate 100% of the money to breast cancer research or care. To date, the event has raised millions of dollars and has met its contribution promise. It’s all very worthy, noble and heartwarming.

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Fewer Than 10% of People Manage Health via Mobile: a HIMSS Reality Check on Remote Health Monitoring

Jane Sarasohn-Kahn

Posted 2/28/12 on Health Populi

With mobile health consumer market projections for ranging from $7 billion to $43 billion, according to PricewaterhouseCoopers, a casual reader might think that a plethora of health citizens are tracking their health, weight, food intake, exercise, and other observations of daily living by smartphones and tablets.

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How Many Referrals Is Too Many?

Kenneth Lin

Posted 2/1/12 on The American Family Physician Community Blog

Most AFP review articles about conditions that may require co-management of specialists contain a short section or Table titled “Indications for Referral.” For example, the January 1st article on prevention and care of outpatient burns includes a list of criteria from the American Burn Association for considering the transfer of a patient to a burn center. This and other lists generally represent expert consensus on appropriate reasons to refer a patient in a typical primary care setting; obviously, availability and accessibility of specialists has a large influence on a family physician’s practice with regard to management of “referable” conditions. Clinicians’ training and expertise also affect their comfort levels in caring for patients with complex problems and, as previous studies have shown, these factors lead to variations in referral rates.

Despite variations in referral rates among individual physicians, there is a clear trend in the U.S. toward more referrals. An analysis of ambulatory care survey data from 1999 to 2009 recently published in the Archives of Internal Medicine found that the probability that an office visit resulted in a referral nearly doubled during this time period, from 4.8% to 9.3%. It isn’t clear why this is happening, or what percentage of those referrals are appropriate. Medicine may be becoming more complex, or patients may be presenting with more problems that cannot be effectively dealt with in an office visit that is the same length as it was 10 years ago. What is clear is that at a time when a coalition of national primary and specialty care organizations is leading a campaign to reduce overuse of health care resources, the impact of this dramatic increase in referrals cannot be ignored. But in the absence of evidence-based standards for when to refer, how many referrals is too many? Is this even an answerable question? And if it is, what can be done about it?

The National Nurse Act of 2011

Brian Klepper

On December 15, Rep. Eddie Bernice Johnson (TX-30) introduced HR 3679, The National Nurse Act of 2011.

The legislation, co-led by Rep. Peter King (NY-3), would elevate the existing Chief Nurse Officer of the US Public Health Service to the National Nurse for Public Health, a new full time leadership position that can focus nationally on health promotion and disease prevention priorities.

Teri Mills, a Certified Nurse Educator at Portland Community College in Oregon and President of the National Nursing Network Organization (NNNO), introduced the idea of a National Nurse in a 2005 NY Times op/ed. Here is an excerpt from that article.

…Nurses are considered the most honest and ethical professionals, according to a recent Gallup poll. It’s the nurse whom the patient trusts to explain the treatment ordered by a doctor. It is the nurse who teaches new parents how to care for their newborn. It is the nurse who explains to the family how to comfort a dying loved one.

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6 Big HealthTech Ideas That Will Change Medicine in 2012

Josh Constine

Posted 1/1/12 on TechCrunch

“In the future we might not prescribe drugs all the time, we might prescribe apps.” Singularity University‘s executive director of FutureMed Daniel Kraft M.D. sat down with me to discuss the biggest emerging trends in HealthTech. Here we’ll look at how A.I, big data, 3D printing, social health networks and other new technologies will help you get better medical care. Kraft believes that by analyzing where the field is going, we have the ability to reinvent medicine and build important new business models.

For background, Daniel Kraft studied medicine at Stanford and did his residency at Harvard. He’s the founder of StemCore systems and inventor of the MarrowMiner, a minimally invasive bone marrow stem cell harvesting device. The following is rough transcript of the 6 big ideas Kraft outlined for me at the Practice Fusion conference.

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Consumer Engagement in Health: Greater Cost-Consciousness and Demand for Cost/Quality Information

Jane Sarasohn-Kahn

Posted 12/14/11 on Health Populi

People enrolled in consumer-directed health plans (CDHPs) are more likely than enrollees in traditional health insurance products to be cost-conscious. In particular, CDHP members check prices before they receive health care services, ask for generic drugs versus branded Rx’s, talk to doctors about treatment options and their costs, and use online cost-tracking tools.

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The Vital Role of Guideline Narratives

Kenneth Lin

Posted 12/1/11 on Common Sense Family Doctor

A few weeks ago, I presented Family Medicine Grand Rounds at Georgetown University School of Medicine on resolving conflicts between screening guidelines. During the question and answer session, Department Chair James Welsh, MD asked how evidence from carefully conducted clinical trials can possibly overcome powerful emotional stories of “saved lives.” I answered that evidence-based medicine’s supporters must fight anecdotes with anecdotes. For every person who believes his or her life was extended by a PSA test or a mammogram, statistics show that many more are temporarily or permanently injured as a result – and their stories matter too. As blogger Kevin Pho, MD wrote about the USPSTF’s recent prostate cancer guideline, “Task Force advocates will need to put a human face on the complications stemming from prostate cancer screening” in order to convince physicians and patients that it’s okay to stop. Indeed, news stories about PSA test-related complications such as this one by Associated Press writer Marilynn Marchione will go a long way in balancing the scales.

An insightful commentary published in JAMA last month took this point one step further by asserting that narratives deployed to support evidence-based guidelines should include not only patients’ stories, but the story of the guideline developers themselves:

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Half of Americans Don’t Realize There’s No-Cost Preventive Care in the Affordable Care Act

Jane Sarasohn-Kahn

Posted 11/30/11 on Health Populi

The U.S. public’s views on health reform — remain fairly negative, although the percent of people feeling favorably toward it increased from 34% to 37% between October and November. Still, that represents a low from the 50% who favored the law back in July 2010. It’s quite possible that American health citizens’ views on health reform are largely reflective of their more general feelings about the direction of the country and what’s going on in Washington right now, versus what’s specifically embodied in the health care law, according to the November 2011 Kaiser Health Tracking Poll from the Kaiser Family Foundation.

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Primary Care Everywhere – How the Shortage of PCPs is Driving Innovation: Especially for Patients’ Participation in Their Own Care

Jane Sarasohn-Kahn

Posted 11/04/11 on Health Populi

The signs of the primary care crisis in America are visible:

A growing number of visits to the emergency room for treating commonplace ailments
Waiting lists for signing up with and queuing lines to see primary care doctors
Fewer med students entering primary care disciplines
Maldistribution of primary care practitioners (PCPs) in underserved areas, rural, exurban and urban.

The implementation of the Affordable Care Act will (try to) enroll at least 30 million newly-insured health citizens into the U.S. health system. That’s the objective: whether being insured will actually provide people access to needed primary care is a big question given the current supply of internists, general medicine specialists, family physicians, pediatricians, and OB/GYNs.

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