As I mentioned previously on The Doctor Anonymous Show, there will be no show for May 8, 2008 since I will be out of town. Where am I going? Well, I will be in Vegas Baby! (see video post above) In case anyone is interested, here is the current forecast for Vegas (They say it's a dry heat, right?)
I'm going out there with people from the hospital for a conference. I haven't even looked at the schedule yet, but I hope that it's not an all day thing. What's the time difference out there, anyway? I guess I'll find out. With me being on call last weekend, I'm still catching up on things and haven't been able to think ahead that much.
Our flight leaves this afternoon and we'll be arriving there in the early evening tonight. I hope to be shooting some video out there and posting it here. Wouldn't that be nice? It's been a few years since I've been out there. As with my previous trip this year, make sure to keep track of My Twitter Feed to see what I'm doing. I may even check out this Brightkite account that I just got. Anyway, any suggestions on what I should do when I'm out there in Vegas?
Grand Rounds 4.33 is now up and running over at Suture For A Living. (apologies for the late posting of this today). There is no theme this week. But in addition to the great posts, there are some great pics! Thanks to Dr. Ramona for including my post this week:
Dr Anonymous asks a simple, yet, controversial question: If someone has used marijuana - even if used for medical reasons - should this prohibit him or her from being considered to be on a transplant list? Hospitals throughout this great nation struggle with this question every day.
If you don't know what Grand Rounds is, it is a weekly compilation of the best posts from the medical blogosphere that moves to different sites each week. And, who doesn't like reading about medicine and science? Next week, Grand Rounds moves to the site called Health Business Blog.
You've probably seen this your morning news stories, but doctors are being blamed (imagine that) for overmedicating kids (again). In fact, according to a study reported by the Associated Press, American children are taking what are called "anti-psychotic" drugs at a rate six times higher than children in the UK.
Does it mean U.S. kids are being over-treated? Or that U.K. children are being under-treated? Experts say that's almost beside the point, because use is rising on both sides of the Atlantic. And with scant long-term safety data, it's likely the drugs are being over-prescribed for both U.S. and U.K. children, research suggests.
What are "anti-psychotic" drugs? Well, according to the article, the most commonly prescribed drugs in the UK in this study have the names of risperdal and thioridazine. Now, I have to tell you that these are medications that I hardly use in adults. And, I have never used these drugs in children.
The new U.K. study, involving 1992-2005 health records of more than 16,000 children, is the first large examination of these drugs in U.K. children. It found the increase was mostly in medicines that haven't been officially approved for kids. They were most commonly prescribed for behavior and conduct disorders, which include attention deficit disorder.
Ah, HA! Here we go. The issue of attention deficit disorder is so divisive among the parents, teachers, and docs that I talk to - that this article will continue to fuel the fire. There are some who debate whether this diagnosis even exists. There are others who believe that docs do not medicate these kids enough. So, why do US docs medicate kids more?
A recent report in The Lancet suggested that the U.K.'s universal health care system limits prescribing practices there. The report also said direct-to-consumer ads are more common in the United States. These ads raise consumer awareness and demand for medication.
While drug company ties with doctors are common in both the U.S. and U.K., Vanderbilt University researcher Wayne Ray said U.K. physicians generally are more conservative about prescribing psychiatric drugs. Ray co-authored the U.S. study, published in 2004.
So, again, it's the doctors fault that American kids are overmedicated for attention deficit disorder. What is new about that? It'll be interesting to see how the parents, teachers, and medical blogs will react to this report today. We'll see.
Finally, if you haven't seen this already, the American Heart Association made a statement last month that kids who will be receiving attention deficit disorder drugs - these kids should receive a heart test (ECG/EKG) before start of these medicines. The American Academy of Pediatrics has not taken a position on this recommendation as of yet. But, this recommendation could have a huge impact. Here is what's on the AAP website:
The American Heart Association is now recommending children with attention deficit hyperactivity disorder (ADHD) should have heart tests - including an electrocardiogram (ECG) - before starting treatment with stimulant drugs. The AAP is evaluating the science behind these recommendations and will offer its guidance in the near future. Meanwhile, parents with questions or concerns about the AHA statement should consult their child's pediatrician.
By the way, just to clarify, family docs also take care of kids. Why couldn't they say "consult their child's physician." Sheesh.
Thanks so much to my guest Dr. John Halamka for being on The Doctor Anonymous Show. Very knowledgeable guy. So much so that I have to admit that I was a little intimidated after doing research for this interview. But, to my pleasant surprise, not only is he a knowledgeable guy, a very nice guy - and funny.
We talked about his early love for medicine and technology. He is the first physician in his family and talked about how he built his first computer. Then, the talked about how he used this passion for technology in medical school and in residency. Following his emergency medicine residency, the pursued a fellowship in Health Informatics and then eventually ended up in his position right now which is Chief Information Officer at Boston's Beth Israel Deaconess Medical Center.
How do you incorporate technology in a health setting? We talked about when he started in Boston and when Paul Levy became CEO of the hospital there. Since it's my show, I talked about my situation being a physician leader at my hospital and how sometimes physicians can be resistant to change - particularly technology change.
Close to the end of the show, we talked about the partnership between Google Health and Cleveland Clinic in the area of health information. He informed me that his hospital has also partnered with Google for a similar program. Sarebear called into the show and discussed topic as well.
Finally, on a lighter note, John discussed his personal weight loss story which included a shift toward vegan life. The weight loss has opened the doors for him to do things like rock climbing and ice climbing. He also has a love for the Japanese flute (music included in the video post above). And, we talked about his association with Blackberry. Can you believe this guy gets 600-700 e-mails a day? Sheesh! Don't forget to rate the show here after listening to it. Have a great weekend!
Join us tonight for The Doctor Anonymous Show . Our guest will be Dr. John Halamka who is Chief Information Officer of Beth Israel Deaconess Medical Center in Boston. He is author of the blog called Life as a Healthcare CIO. He is also an emergency physician, and apparently, a Blackberry guy. I'll have to ask him some iPhone questions just to be funny.
You can even take part in the chat room. It is truly "The show within the show." You can even call in and say hello. A great opportunity to interact with medbloggers you've only read about. See you for the show!
For first time Blog Talk Radio listeners: *Although it is not required to listen to the show, I encourage you to register on the BlogTalkRadio site prior to the show. I think it will make the process easier.
*To get to my show site, click here. As show time gets closer, keep hitting "refresh" on your browser until you see the "Click to Listen" button. Then, of course, press the "Click to Listen" button.
*You can also participate in the live chat room before, during, and after the show. Look for the "Chat Available" button in the upper right hand corner of the page. If you are registered with the BTR site, your registered name and picture will appear in the chat room.
*You can also call into the show. The number is on my show site. I'll be taking calls beginning at around the bottom of the hour. Hope these tips are helpful!
I did want to share a couple of excerpts from his blog - The first of which I call the "Geek Doctor" portion from a post entitled "Designing the Ideal Electronic Health Record:"
I was posed a simple question - If I had infinite resources, infinite time, and no legacy compatibility issues, how would I design the electronic health record of the future?
The web is the way. Given the 24x7 nature of healthcare, the need for physicians to be in many physical locations, and the multitude of clinician computing devices, the ideal EHR should be web-based, browser neutral and run flawlessly on every operating system. I highly recommend the use of AJAX techniques to give physicians a more real time interactive experience. Client/Server may have some user interface advantages, but it's just too challenging to install thick clients on every clinician computing device. Citrix is an expensive and sometimes slow remote access solution. Native web works.
For the non-geek part of the blog, I reference a post simply called "Go Climb A Rock:"
It's Thursday, so it's time for a personal introspection blog. At times I get quizzical looks for being vegan, playing the Japanese flute, or wearing black. However, the most unusual looks from my peers occur when they see photos like this one of Dark Shadows on Mescalito North in Red Rocks, Nevada.
Winter mountaineering is a good way to get away from your cell phone (the battery life is 2 minutes at -40F), but why climb a rock? Think of climbing a mountain as a giant Rubik's cube - a wonderful mental exercise. Climbing requires a well orchestrated combination of gear, route finding, movement, and teamwork to make it to the top.
So, needless to say, this is interesting stuff. So, tune in Thursday, May 1st at 9pm Eastern Time where we will be talking about his blog and a whole lot more. You can also join us in the live chat room or even call into the show to ask us a question. Check back here tomorrow for details!
You may remember this story from last month. An 11 year-old girl died following the complications of untreated diabetic ketoacidosis (DKA). Now, DKA is a serious condition and strikes fear in anyone who has diabetes. However, if recognized early, this is a treatable. And, for the most part, DKA has a good recovery rate.
The parents of this child did not see it necessary to seek medical attention for their daughter. Instead, they felt that faith alone along with prayer would be enough to heal their daughter. This Associated Press story continues:
Madeline Neumann died March 23 -- Easter Sunday -- at her family's rural Weston home. Her parents were told the body would be taken to Madison for an autopsy the next day. "They responded, 'You won't need to do that. She will be alive by then,"' the medical examiner wrote in a report.
Family and friends had urged Dale and Leilani Neumann to get help for their daughter, but the father considered the illness "a test of faith" and the mother never considered taking the girl to the doctor because she thought her daughter was under a "spiritual attack," the criminal complaint said.
The story states that each parent may face as many as 25 years in prison. What's unfortunate is that I don't think that these people really care about that. They probably still feel (and will always feel) that they did the right thing in not seeking medical attention. I do not see any remorse in these parent's future.
Now, I consider myself a spiritual-type person. But, as I read story after story after story of what people do in the name of some higher power somewhere - it really frightens me. For the most part, I still believe that there is more good in this world. But, even my faith gets tested sometimes. And, this story is one of those times....
Here is a simple, yet, controversial question: If someone has used marijuana - even if used for medical reasons - should this prohibit him or her from being considered to be on a transplant list? Hospitals throughout this great nation struggle with this question every day.
Timothy Garon (pictured above) is a patient at the University of Washington Medical Center. He has end stage Hepatitis C and, according to this Associated Press story, may be in his final days without a liver transplant.
But Garon's been refused a spot on the transplant list, largely because he has used marijuana, even though it was legally approved for medical reasons. "I'm not angry, I'm not mad, I'm just confused," said Garon, lying in his hospital bed a few minutes after a doctor told him the hospital transplant committee's decision Thursday.
With the scarcity of donated organs, transplant committees like the one at the University of Washington Medical Center use tough standards, including whether the candidate has other serious health problems or is likely to drink or do drugs. And with cases like Garon's, they also have to consider — as a dozen states now have medical marijuana laws — if using dope with a doctor's blessing should be held against a dying patient in need of a transplant.
Now, according to the American Liver Foundation, in 2005, approximately 6500 liver transplants were performed in the United States. Also, according to the site, it states that about 17000 Americans are on the liver transplant list. Interestingly enough, the CDC website states that the number of new infections with Hepatitis C has decreased from 240000 in the 1980s to about 19000 in 2006.
The issue of who should and who should not receive a transplant is always controversial. I think the issue of use of marijuana is interesting as I have blogged about it before here,here, and here.
Even though this gentleman's story is very compelling, I'm going to have to side with the hospital on this one. I agree with what was said by Dr. Robert Sade, director of the Institute of Human Values in Health Care at the Medical University of South Carolina. "Marijuana, unlike alcohol, has no direct effect on the liver. It is however a concern ... in that it's a potential indicator of an addictive personality." (And in my book, not a good candidate for a transplant.)
Thanks so much to my guests Kevin MD and Dr. Val for coming on the show. (See video post above) Not only did Kevin talk about his recent USA Today Op-Ed piece, but also why physicians should write opinion pieces for blogs, for newspapers, and other media sources.
Dr. Val talked about her great week which included her interview with the former surgeon general of the United States, her Grand Rounds hosting experience, her running of a conference call celebrating the first year anniversary of Revolution Health, and her quote in the Wall Street Journal.
I was only able to schedule 60 minutes live time and we went another 30 minutes over. In this last 30 minutes, we talked about personal health information out there on the internet. Great conversation and springboard for our guest next week who is John Halamka from GeekDoctor.
Thanks also to my callers MexicoMedStudent and Dr. Rob. I appreciate you contributing to the conversation. Thanks to those who were able to join us in the live chat room. And, thanks to all of you for listening to the show either live and/or on the archives. I really appreciate everyone's continued support of the show. Have a great weekend! (Don't forget to rate the show right here!)
Join us tonight for The Doctor Anonymous Show . Isn't it great how things come together? Two days ago, I had zero scheduled guests. But, how things change almost overnight... (See video post above)
I'm very happy to announce that Kevin MD will be back on the show to talk about his 4/23/08 USA Today Op-Ed piece entitled "Wasted Medical Dollars" talking about the reality of the practice of defensive medicine. As of this posting, there are already about 30 total comments on Kevin's site and on the USA Today site. Interesting discussion.
Normally, that would be enough for one show. But, wait, there's more! Dr. Val will also be joining the show at some point to discuss a bunch of things. First, Revolution Health is celebrating their one year anniversary and she was part of the festivities on that. Second, last week, she interviewed the former US surgeon general and that interview will be going up on her site soon. Finally, she hosted Grand Rounds this week. Sheesh! I'm tired just reading this. So, hopefully, she'll be updating us on how here week has been going.
You can even take part in the chat room. It is truly "The show within the show." You can even call in and say hello. A great opportunity to interact with medbloggers you've only read about. See you later!
For first time Blog Talk Radio listeners: *Although it is not required to listen to the show, I encourage you to register on the BlogTalkRadio site prior to the show. I think it will make the process easier.
*To get to my show site, click here. As show time gets closer, keep hitting "refresh" on your browser until you see the "Click to Listen" button. Then, of course, press the "Click to Listen" button.
*You can also participate in the live chat room before, during, and after the show. Look for the "Chat Available" button in the upper right hand corner of the page. If you are registered with the BTR site, your registered name and picture will appear in the chat room.
*You can also call into the show. The number is on my show site. I'll be taking calls beginning at around the bottom of the hour. Hope these tips are helpful!
