The advice of a doctor

The article I read this week was written by a doctor, Peter A. Ubel. In this article he discusses the role of the doctor in the decision making of their patients. "Medical decisions these days are increasingly recognized as being more than simply medical, with the right choice depending in part on the patient's preferences...According to this new paradigm of preference-sensitive decision-making, doctors like me shouldn't tell patients what to do, but rather should educate our patients about the risks and benefits of their options." He goes on to describe an instance in which he disregarded his role as unbiased educator and gave his own personal advice, telling a patient with cancer that he should keep smoking because the cancer is incurable and it will help with the stress. Also, explaining to the patient and his wife that being with each other and the rest of their family is the most important thing for him. 

I believe it is important for a doctor to play the role of educator and let the patient decide. There are so many options available these days that it would difficult for a doctor to determine exactly what works best for each individual. It would be a heavy burden on the doctor if they picked the one that ended up having terrible effects, so it is best to let the patient weigh out there options. I also feel that a doctor can and should step out of this role and offer advice every once in a while. When people have diagnoses that are hard to deal with sometimes a doctor has to be that mediating guide, instead of a medical dictionary. The hard part is knowing when it is right to do so.

Electronic Health Records

In this article in the New York Times the author Walecia Konrad brings up the fact that Obama has put forth a plan to spend 19 billion dollars on electronic medical records. The appeal of having electronic medical records is seamless communication, which would "improve the quality of health care and help reduce dangerous medical errors. And by improving the efficiency of medicine, it might also help curb the nations skyrocketing health care costs." The article states that the intentions are all good, but it will be a while before this idea is able to be fully integrated. If your medical care provider doesn't already provide you with an electronic medical record of yourself, which chances are they don't since only 9% of hospitals, then you are on your own in making it. The author says when he tested out four online health record medical files, Google Health Records, Microsoft Healthvault, RevolutionHealth Health Record, and WebMd Personal Health Record, it proved to be challenging. In order to complete it you would have to do a lot of research and digging in your physicians filing cabinet. Later in the article it also states that personal files done by the patient can be dangerous for doctors to use because their could be errors and omissions. 

With news of the presidents plan, Google and Microsoft have been working on becoming the leaders in the technology, "but progress is being slowed by incompatible technologies, privacy concerns and resistance by many health care providers to installing expensive electronic systems.

I feel that the principles behind the technology are all good and I definitely see the large potential benefit, but in order for this to work properly it will require full cooperation on the part of the patient and medical facilities. It would definitely be great if they could just type in some ones name in the system and get all their past medical history, especially if the person is unconscious or unable to give the proper information needed. For me though, I will sit back and wait until my medical providers take the initiative. 

Real Age

After doing the questionnaire it calculated my real age to be -2.6 which makes my age drop from 20.1 to 17.5. I found this to be a pretty interesting survey. I agree with many of the questions they used to judge age, but I also feel that they need more questions to get a basis. Many of the questions seem like they are designed to find problems, which they can find a prescription for, as the New York Times article suggests. I can't say that I agree with them allowing  pharmaceutical companies use the results as a marketing tool, but overall I feel it is a valuable site. It makes the person taking the survey take inventory of their everyday activities and health choices, and then when it gives the results it informs the individual on what they may be doing incorrectly. It provides them with simple solutions to problems that they may not have noticed, or that they thought were okay. It never hurts to be aware. As far as pharmaceutical companies go, I think the site should protect the members. If an individual is clearly at risk for certain problems, inform the of this and give them the option of receiving the advertisements of pills which could help them. I feel it should be a choice though, not something people are duped  into.

ER assignment

I went to the ER at SOCH today to sit and record notes for the assignment. I figured when I walked in I would tell them why I was there and they would let me stay, this was not the case. The way the ER is set up, there is a window right at the entrance, with the initial nurse who takes down your information, and you have to go down the hall about 10 feet and make a right to get in the waiting room. When the receptionist nurse saw me I told him why I was there, and he told me I couldn't be there because it violates HIPAA laws, but he would ask security. Then a larger woman who was also a nurse came and told me what happens behind those doors is confidential. I told her I wasn't asking to go behind the doors I was just going to sit in the waiting room, but apparently that wasn't allowed either, so I was told I had to leave. I just looked up the HIPAA laws to see why I was made to leave and this is what I found: 

How Is This Information Protected 

• Covered entities must put in place safeguards to protect your health information.
• Covered entities must reasonably limit uses and disclosures to the minimum necessary to accomplish their intended purpose.
• Covered entities must have contracts in place with their contractors and others ensuring that they use and disclose your health information properly and safeguard it appropriately.
• Covered entities must have procedures in place to limit who can view and access your health information as well as implement training programs for employees about how to protect your health information.

Information meaning a patients medical information. So I guess this entity, SOCH, deems it necessary to not allow outside parties into the ER as a method to safeguard the medical information of their patients.

"Study: Triathlons can pose deadly heart risks"

I was listening to the radio this morning and they brought up an article that had been published by the Associated Press entitled "Study: Triathlons can pose a deadly heart risks." After finding it on the internet, I read it, and personally I find it a little funny that they would even do a study on something like this. The premise of the article is that triathlons place added stress on the heart, most specifically the swimming portion which is done in cold lakes or rivers. Many of the people who get involved in triathlons are not frequent swimmers, but are doing the triathlon because it is for a charity. Also, there is the problem that anyone can sign up for a triathlon. The study found that the risk of sudden death during a triathlon is 15 out of a million. I feel that this number is pretty low considering how strenuous a triathlon actual is. People who sign up for a triathlon should know that there is an inherent risk associated with participating and should adequately prepare for the stress that will be placed on their bodies. All this study proves is, if you are going to participate in a triathlon, you should properly prepare for the task.

Treating patients with multiple illnesses

This week in the New York Times I picked an article by Siri Carpenter, which discusses the problem with treating patients with multiple illnesses. In most cases when you are working with an elderly patient and they are coming to you with an ailment, it is more than likely that they have other conditions as well that don't relate to one another. The article sites an example of an 84 year old woman named Mazie Piccolo who has "congestive heart failure, an abnormal heart rhythm, arthritis, osteoporosis, high cholesterol, high blood pressure, gastric reflux, and depression." For a doctor it is very hard to treat a person like this, so what they do is treat just the ailment the patient has come in for. Instead of looking at all of her conditions, they prescribe her medication for the one disease, but this pill could worsen the other conditions. Plus, with every doctor prescribing a medication for the one specific disease, there could be a deadly concoction placed in your body when taking them all. Doctors are not afforded the information needed to treat multiple condition patients because there are no studies done for these individuals. "A 2007 study found that 81 percent of the randomized trials published in the ,most prestigious medical journals excluded patients because of coexisting medical conditions." This means that when a doctor prescribes a medication they know it will fix that problem, but are unaware of how it will interact with coexisting problems. 

Personally, I feel that when a doctor treats a patient they should look at the patient as a whole and not a set of individual illnesses, but if they aren't afforded the tools to do so, I don't know how they can. Testing should be done because a majority of elderly have multiple conditions not just one. The problem with that is, testing a prescriptions effects on multiple conditions is very costly and it would be nearly impossible to account for the hundreds of possible combinations of illnesses out there. So I feel it is almost unrealistic, but companies should not exclude patients with coexisting medical conditions so they can see the different variables at work. Doing so may help give them an idea of different effects that may occur.

Prostate Screenings

The article I found this week online at New York Times was in more of a question and answer format, and I believe it was an interactive piece that people could post questions about and the author would answer them and that is why it is in this format. It is by Tara Parker-Pope and it discusses PSA testing, a blood test, as a means for testing for prostate cancer. I chose this topic because it relates to men, not so directly to myself because I won't have to worry about this test for another 20 some odd years and by then they will probably have new more accurate tests, but my dad is in his mid 40's and will be thinking about these tests sometime in the near future. 

There were two tests done, one in the U.S. and one in Europe, both coming to the conclusion that PSA testing can be very unnecessary. Prostate cancer is very slow developing, so even if you do get the cancer their is always the chance that you live a full healthy life before you feel any full effects of the cancer. Plus the blood test isn't completely effective, just because the test indicates that you have a heightened amount of PSA's in your blood stream does not indicate that you have or will have the cancer it just means that you have a higher risk. This screening is meant as a way to catch cancer before it happens, but if it comes back positive then you could undergo procedures that leave you "impotent and incontinent." The test shows that PSA screening is effective in detecting the cancer, but "finding those cancers early doesn't reduce your risk of dying from the disease." The worst part in my opinion is that they found many people received unnecessary treatment due to the screening, which means they probably became sterile from the treatment that they didn't even need to begin with. In conclusion, doctors say that even though the test shows that this screening is not necessarily accurate it doesn't mean people should not get the test because it is effective at finding the cancer. Instead, doctors say that you should still discuss it with your physician and make the decision yourself.