Drugstores embrace E-prescription system

Drugstores embrace E-prescription system – Computerworld

Half of the 55,000 pharmacies in the U.S. are due to be connected to an electronic prescription system by year's end as part of a nationwide rollout announced Monday by SureScripts, a technology company founded by two drugstore industry associations.

I think it's good that someone's forging ahead with this – but the technical and legal bumps in this road are significant.  I'll see what else I can learn …

Dr Robot

Dr. Robot Tested at Hopkins

It lacks the warm bedside manner of Marcus Welby or Dr. Kildare, but a high-tech robot being tested at The Johns Hopkins Hospital could be used to link patients with their physicians in a whole new way.

Yeh — I'm  a geek — but I don't see adding one of these to my practice any time soon.

Diabetes prevalence

The IDF's e-Atlas  shows some sobering data on diabetes – and reminds us that this is a worldwide problem that is getting worse.

This image (from the home page of the IDF) tells the story well:

OBesity image from IDF

Diabetes – one of the most challenging health problems in the 21st century Diabetes mellitus can now be found in almost every population in the world and epidemiological evidence suggests that, without effective prevention and control programmes, diabetes will likely continue to increase globally. Diabetes is now one of the most common non-communicable diseases globally. It is the fourth or fifth leading cause of death in most developed countries and there is substantial evidence that it is epidemic in many developing and newly industrialized nations.

Today I discharged a 500 lb patient from the hospital.  He wanted me to tell him why he was so fat.  "I must have a gland problem" he says.

Yes he does.  And it's taken him many years to get to where he is. 

In the context of the Atkins fad – and all of the other low-carb plans – I do think that we – as a species – are predisposed to overeating in the context of overabundance.  Here's how it goes:

2000 years ago (ok — even 200 years ago!), when we were cavemen and cavewomen, our ancestors would eat whatever they could get their hands on.  IN the fall – when there were more ample supplies – especially carbohydrates – they ate more.  Eating lots of carbs caused insulin secretion – which made their blood sugars fall … and made them hungry (recall that insulin makes people hungry) … so they ate more – which was good.  Fat people in November would survive until March.  People who didn't get fat in the Fall would die in February.

So we've evolved with a great mechanism to eat more when there are abundant supplies.

Our overweight patients are not "weak" or inferior – indeed, they have evolved well.  They're Darwin's success stories!

'cept now it's always harvest time.

 

 

Soccer Mouthguards

Asked tonight at the Soccer parents meeting if we should require the kids to wear them.

 

Here's the 1st part:  They won't wear them unless they really fit well

There are several papers on the use of mouthguards – but I can't find anything that is specific to this question:  What is the incidence of dental injuries in soccer (Football in non-US papers) players – and is that number significantly reduced in players who wear mouthguards?

 

Family Physicians Make a Substantial Contribution to Maternity Care

From the Graham Center – this month's "one-pager:"   Family Physicians Make a Substantial Contribution to Maternity Care

I still meet new patients who are amazed that I deliver babies .. um .. well .. I assist in the delivery of babies .. um .. well .. perhaps it is better said that I attend deliveries .. since the mothers are the ones doing the deliveries .. and (one hopes) the fathers/partners/significant others are assisting … yes .. attend is a good word for the for the physician's role.

Ideally, there is rather little for a physician attending a delivery to do aside from making sure the little one doesn't hit the floor on the way out.   

Otitis Media (again)

This study reminds us that at least 30% of diagnoses of AOM .. are not AOM.

This review also reminds us that the standard course of treatment if one chooses to use antibiotics (and you all know that I do not as 1st line treatment) is 5 days rather than 10.

I remain surprised (as I have in the past) that so few physicians are using the acoustic reflectometer.  This devide is much cheaper and much easier to use than the tympanometer – and gives very good results.