Family Medicine Notes

How Perils Can Await the 'Worried Wealthy'. Hordes of consumers are flocking to centers around the country to have their bodies scanned by three-dimensional computerized X-rays. By Jane E. Brody. [New York Times: Health]

This is a compelling article that I'll print out for the office.  Too much testing CAN be a bad thing.  The article clarifies how false positives on screening tests can lead to serious problems .. and great expense and hardship. 

Today I saw a 53 year old man for a "annual physicial."  Unfortunately, the common misperception is that a physicial examination is the conerstone of this annual visit.  It's not.  As a primary care physician, my job is to assess risk, and prevent disease.  I always ask patients if they wear seatbelts, since automobile accidents are more likely to contribite to their death or illness than anything I hear when I listen to their lungs.   Testing always comes up too.  "Do the all of the bloodwork" I often hear ...  "I want to be sure everything is OK"  Hmm ... How do I respond?

Of course, I can't do "all of the bloodwork."  Doing so would be both impossible and irresponsible.  I need to help my patients make careful, informed decisions about which screening tests are appropriate and indicated.  I often make use of the USPSTF screening guidelines to guide the disucssion.  To some, "It's just a blood test" and the risk of a false positive or ambiguous result isn't appreciated.  I don't want to talk my patients OUT of getting a PSA.  ? or do I?

Posted by Jacob Reider, MD at 11:37 PM | Permalink

It's interesting to look at the access and referrer logs for the docnotes website.  Rererrer logs tell me who has linked to docnotes .. access logs tell me who has visited .. and often .. from where.

Where do people come from?
Most often ... it's either "unknown" meaning they typed in the link or used a bookmark on in the browser ... or from a search engine.
Other referrers are the medical weblogs .. or weblogs.com
Where are people logged in from?
It's usually possible to determine the domain from which a user is coming from.  So if a user is on AOL .. I can tell .. or AT&T .. or MSN.   More interesting is when the domain is from a health related webiste.  Today's interesing login is from Medfusion.  It's a company that offers several services to physician practices. They do their programming in ColdFusion, which is good .. and they seem to offer services to practices including online lab result reporting, online scheduling (for patient appointments) and online bill payment.  It's not clear, though, how they interact with the myriad practice management systems.  There is no mention of interfaces on the website.  This is important to know.  INdeed, the reason that we're moving out of relayhelath is because we don't want to have several separate data repositories.  We want out patient information to live in ONE place.  So we're building our own simple (yeh .. coldfusion, of course) replacement for RelayHealth.  It's going to run as a webservice on our external server.  The internal server will poll the exteral server every few minutes.  If there are new messages, The external server responds with the (encrypted) data, and the internal server will post the messages to our internal messaging system.

So it's not clear to me what the role of Medfusion will be.  No mention on their website of pricing.  Id be surprised if it's cheap.  Build vs buy?  I'll continue to build.

Posted by Jacob Reider, MD at 09:00 PM | Permalink