Docnotes

2002 immunization schedule - AAP & AAFP

Seems like this is updated every year.  Notable changes for 2002:  Catchup sequences are clearly depicted, emphasis for Hep B in hospital is added, and consideration of influenza is added for all childern -- not only high risk patients. 

But schedules are subject to availability, and there is a website provided by the CDC that provides information on which vaccines are in short supply, and what the timeframe is.

Onychomycosis: Terbinafine vs Itraconazole

Looks like terbinafine is much better at treating onychomycosis than itraconazole.  I'm surprised that nearly 1/2 of patients retain cure at 5 years.  I may alter my prescribing habits based on this one ... as I usually refuse to treat onycomycosis based on other studies that suggest much lower long term "cure." rates.

I've imported all of the

I've imported all of the old Docnotes postings from blogger.  They go back to Novermber, 1999! ...  I'm not sure how to get the Conversant posts into Radio.  I really want to get searching to work next.

Lab Tests Online

Written for the layperson, this website provides a great overview of what most lab tests are, and how results can be interpreted.  For those of us who use electronic means to communicate lab results, this may be a great adjunct:

Dear Bob:

Your Total Cholesterol result was 250.  Take a look at the FAQ for high cholesterol and I'll call you tomorrow so that we can discuss what our next steps will be.

From BMJ: "Tribal people do

From BMJ: "Tribal people do not like lying on the ground in the recovery position while wearing no clothes as the penis dangles in the dust and can get bitten by insects."  This is actually a very interesting article about how we humans are actually quite well engineered, yet the habits of Western Culture have changed our posture, sleeping position, etc ... so that we are much more prone to physical injury, back pain, etc. 

Diabetes is so commin ..

Diabetes is so commin .. not a week goes by that I don't diagnose a patient with type 2 diabetes.  Some great education material is out there.  I found this on the Diabetes and footcare weblog. 

Going Solo: Making the Leap:

Going Solo: Making the Leap: "Why one family physician left the security of salaried practice to pursue ideal patient care completely on his own"  Thsi two-part series appeared lat month and this month in Family Practice Management It's a compelling story of what's wrong with medicine these days, and what could be right.

Not unlike Gordon Moore, I left what was a safe job, and wne out on my own in the last year.  Our motives were in fact quite similar to his, yet our method was quite different.

The explanation is too long for today's weblog.

As technology commentators discuss the

As technology commentators discuss the hollings bill, the Bush administration has proposed big changes to the health information privacy rules that were promulgated by the Clinton administration.

I'm not sure how to respond to all of this.  The origianl privacy rules were rather onerous in many ways, and if taken literally, would have altered the practice of medicine in many ways.  

Nonethelss, privacy is imporatnt, and there are many ways that patient privacy is compromised in the name of convenience, marketing, research or simple careleness. 

On the topic of privacy ... I often read the Diary from a week in practice published every month in American Family Physician.  It's often instructive .. and our medical students find it an ejoyable snapshot of the "real life" of a family physician.  I preferred the writing of Walt Larimore to the current authors.  In these short notes about their patient encounters, we see the humanity of physicians as many people may not traditionally encounter.

Last week, as I was just finishing a visit with a patient, she reflected to me how she was so appreciative of the way that I treated her "like a real human."   Somehow patients have come to expect the "meet-em, treat 'em and street 'em" interactions.    Too bad that patients are so pleased and surprised when we treat them with respect.  This is the bare minimum of good care.  As Joe Scherger says:  Your patients don't care how much you know until they know how much you care."

 

 

On Bandolier this month: Evidence

On Bandolier this month:

Evidence and migraine trials

"Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients."

Bandolier is a wonderful resource for good evidence-based clinical information.  The writing is clear and light -- without the self-importance of many medical infromation resources. 

This month's American Family Physician has

This month's American Family Physician has an excellent review on smoking cessation.  There's a patient handout too.  I often print these handouts in the office and give to patients, but I don't like the HTML views when printed.  Especially the otherwise excellent handouts that are available on familydoctor.org.  Doesn't seem like it would be so hard to make pdf's out of these.