INteresting post today in Lagniappe on research in psychopharmacology:

"In other words, we're like the drunk looking for his keys under the streetlight, because it's too dark over there where he lost them."

Medscape – weblogs

On the Medscape Technology & Medicine Home Page, there's a list of medical weblogs (scroll to the bottom of the page) .. hmm … are weblogs useful and/or interesting to physicians?  Hard to know.  I've been getting more (mostly positive)feedback about this weblog lately ..

In the midst of a few changes to the structure of the templates I use for Docnotes, I turned off the tracking of my 'hits' for the past month or so.

Just turned them on again last week .. and I'm surprised to see that this site now gets about 200 unique visitors a day.  I don't know how many of these visitors are physicians .. how many are not.   I'll bet medscape would like to know.  Their viability (and the viability of many otehr sites like theirs) relies on consistent traffic.

Let's think about that for a minute.  What do physicians do?

  • See patients
  • Write notes
  • Answer phone calls from patients and other physicians
  • Look up information (patient related)
  • CME
  • Make phone calls to patient and other physicians
  • Take call
  • Go to the hospital

So if I want to capture the physician's eyes .. I want to provide something that the physician wants/needs. 

  • Messaging.   No — not e-mail.  Secure messaging.  Medscape is one of a small number of sites that a majority of physicians have registered for.  If I could securely correspond with patients (perhaps through a WebMD view?) and physicians (through a medscape view) .. I'd be happy.  Yes.  Other companies (relayhealth, mdhub, aboutmyhealth) have developed infrastructure to do this, but they lack the membership.  I had a long talk this week with someone from RelayHealth.  She called me because I'm one of the top users.  (That's odd – I don't use it much.  I probably get two or three messages a day.)  They're thinking about enhancing the service.    It doesn't need enhancement.  It needs focus.  I use 1% of the features – message from patient to me — and back.  That's it.  (more on this later .. off to see patients now) ..


Cedars-Sinai Medical Center suspends CPOE

Hot off the press:

LOS ANGELES (AP) – Cedars-Sinai Medical Center, the largest private hospital in the West, is suspending use of a multimillion-dollar computerized system for doctors' orders because physicians complained it was endangering patient safety and required too much work.

The computer software was designed to reduce medical errors, allow doctors to track orders electronically, and warn them about dangerous drug interactions and redundant laboratory work.

Since it debuted in October, however, the Patient Care Expert program, dubbed PCX, has been plagued with problems, many doctors said.

"The PCX system is presenting too many safety issues in the care of our patients," cardiologist Dr. Mark Urman said. "The only logical, prudent and safe thing to do is to put it on hold until it can be made better."

Interest in computerized physician-order entry software accelerated in 1999 after the Institute of Medicine concluded that up to 98,000 patients die annually in hospitals from avoidable medical errors.

A 2000 California law requires hospitals to implement formal plans, including new technologies, to eliminate or substantially reduce medication-related errors by Jan. 1, 2005.

Most hospitals buy a commercially available product, but Cedars-Sinai decided to create its own, following the example of other major hospitals such as Brigham and Women's Hospital in Boston and Latter-Day Saints Hospital in Salt Lake City.

Estimates of the system's cost have gone as high as $34 million. Hospital officials have said that estimate was too high but they declined to provide a precise figure.

This week, Cedars-Sinai suspended the ordering system after more than 400 physicians confronted hospital administrators during a tense staff meeting Friday. The doctors voted nearly unanimously to urge the hospital to halt the system until the problems are fixed. – Best Practices

More from the Wall Street Journal.  This time, it's an article about the table PC. 

My cousin works for Microsoft, so I got to try one of these things out last November for a few days.

It's not bad.  We may try one for the office in the next few days.   Using the computer in the office is hard — I don't like turning my head away from the patients to enter notes — or even retreive data.

ALLHAT Reactions; Regulatory, Guidelines, and Research News

A nice review on Medscape (Free – login required) of ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial).  Since the press has gotten-hold of the results, I've had several patients ask to be treated with thiazides.  

Some useful Hypertension resources:

ALLHAT slides from

A great article on Secondary Hypertension from American Family Physician

C-Reactive Protein and Ischemia in Users and Nonusers of -Blockers and Statins Published in Circulation this week.  I ordered my frist CRP this week in a man with borderline hypertension, borderline LDL, and is a former smoker.  He really doesn't want to take medications.  I suppose a low CRP would reassure me, and a high one may help me decide to start him on something.  b-blocker?  statin?  thaizide? 

Depression and Mood Management Software

Cheaper than a month of Prozac:

"HealthEngage Depression is designed to help you manage depression, bipolar disorder or a similar condition with ease and flexibility. "

So I downloaded the Windows version just to see what this was.  11MB .. and their server's kinda s-l-o-w.

Speaking of slow.  The  install is slow.  The software is slow .. and I'm not sure that anyone who isn't … um  … slow would ever want to use this software.   It's supposed to remind the user to be positive, take their medications, eat right, etc.

I'd rather have Microsoft 'Bob' around to cheer me up. This software gets two thumbs down.  Depressing