Docnotes

AAFP Seeks Partners to Support Open-Source Electronic Health Record Initiative -- American Academy of Family Physicians

AAFP's press release from last week's announcement. 

eMJA: Treatment of sore throat in light of the Cochrane verdict: is the jury still out?

A well written review on the diagnosis and treatment of pharyngitis .. full - text from down-under.

Task Force Recommends Regular Cervical Cancer Screening but Supports Less Frequent Screening for Some Women

"For younger women who have had at least two normal annual screenings, the Task Force found no evidence that annual screening achieves better outcomes than screening every 3 years."

While this isn't really news (the data to support this recommendation has been around for quite a while), it's an 'official' guideline that supports what many of us have been doing for years.  The 37 year old mother-of-two who is monogamous and has no history of abnormal pap smears does not need to be screened annually.  Now I can point to this report when I discuss screening options, since this is always a shared decision anyway.    

A Consumer Guide to Handling

A Consumer Guide to Handling Disputes with Your Employer or Private Health Plan
A new guide from the Kaiser Family Foundation intended to "help you navigate your employer or private health plan's internal grievance procedure, as well as any external review program your state may have. The guide is not applicable, however, for resolving disputes if you have Medicare or Medicaid coverage." The guide is available both as a web document and an Adobe Acrobat file. [PULSE]

Treatment of the Ingrown Toenail

Treatment of the ingrown toenail

Since we're on the topic of writing ... here's a little thing I did with my pal Bob a few years ago.  Submitted and accepted for (paper) publication .. which remains pending.  Who needs paper?  "Published" here today.  Don't tell.  ;-)

Sinusitis Algorithm

A nice Algorithm for the treatment of sinusitis.  Trouble is .. how to diagnose it?

As our friends across the pond remind us:

The clinical bottom line is that we don't have adequate diagnostic methods.

Tonight (this morning) I'm up finishing off a review of the literature for fpin on sinusitis. 

Alas, Medscape's review of sinusitis is written by a specialist - and is nearly 5 years old.  Specialists think differently about things  .. yet in fact the see less of this than we do.  Sinusitis accounts for roughly 1 million office visits a year in this country - most of them to primary care physicians.  We're the experts .. not the "experts."

Physician specialty is associated with differences in the evaluation and management of acute bacterial rhinosinusitis.

Otolaryngologists use more health care resources to diagnose and treat ABRS than primary care physicians despite an absence of evidence that such tests and treatments lead to better outcomes.

Writing the "Clinical Inquiry" has been MUCH harder than I anticipated.  I know the literature well, but it's been quite hard for me to 'find my voice.'  I think I'll stick with the less formal writing on the medlog. 

Docnotes Traffic Watch

The SQLserver worm is now well documented.

This server seems to be holding up just fine.  We do use SQLserver for OnCalls, and the Docnotes website lives on one of the OnCalls servers.

The OnCalls SQLservers were fully patched, but I spent some time today making sure that I had installed the most recent service packs (SP3 just was released three days ago) to all of the servers.  Everything's nicely buttoned down, and we had no downtime aside from a few reboots today for my service pack installations. 

I use sitemeter to track traffic on docnotes.  While I do have the IIS logs, sitemeter is easier.  You can see in the graph above that I had tracking off for a few weeks.  The sitemeter server that tracks docnotes seems to have been down yesterday.  No hits at all on the 25th. 

Second - line antibiotics not better, cost more

This study, published last year, reminds us of something the pharmaceutical representatives are always hoping we'll forget.

CONCLUSIONS: Patients treated with a first-line antibiotic for acute uncomplicated sinusitis did not have clinically significant differences in outcomes vs those treated with a second-line antibiotic. However, cost of care was significantly higher for patients treated with a second-line antibiotic.

Circumcision Opponents Use the Legal System and Legislatures

ARGO, N.D., Jan. 16 — Josiah Flatt, like about 60 percent of other newborn American boys, was circumcised soon after he was born here, in the spring of 1997. Two years later, his parents sued the doctor and the hospital.

They did not contend that the circumcision was botched or deny that Josiah's mother, Anita Flatt, had consented to the procedure in writing. They said, instead, that the doctor had failed to tell them enough about the pain, complications and consequences of circumcision, removing the foreskin of the penis.

It's now well established that circumcision is not medically necessary.  I don't do them.  This causes some trouble for me, as I have to buy my partner lunch sometimes if she has to come in to the hospital to do one for me. 

But if my job as a physician is to do only medically necessary procedures -- I just cant see how performing circumcisions is indicated.   Indeed, one of my concerns is that most parents do not receive adequate information to make the decision.  When I round with the residents in the hospital -- they all anticipate that I'm going to "try to talk the parents out of circumcision."  In fact, that's not my goal.  I do want to make sure that they understand that it's an optional procedure.  Very often, no one has told them that.

The fact that it is also a quick procedure that generates revenue for physicians and hospitals cannot be left out of this equation.  When (not if) insurance begins to curtail the compensation -- I'll bet we'll see the circumcision enthusiasm from both physicians and hospitals wane.