Docnotes

pharmacy representative evaluation form

Barbara Supanich, R.S.M., MD - Associate Professor, Michigan State University, Munson Family Practice Residency, Traverse City, Michigan - has developed a great tool for use in residency education.  

The pharmacy representative evaluation form (.doc) (pdf) can be used to help physicians to critically evaluate the information provided to them by pharmaceutical representatives. This is an excellent tool that may even be useful to those who are no longer in training.

Informatics Review

Dean has posted another issue of The Informatics Review.  A great news source of healthcare IT issues.

Smallpox update

I've shared my bias before ... so I won't bore your with it again ... aside from this NY Times link: Panel Urges Shift of Focus in Preparing for Smallpox.   

The vaccine is too dangerous — both to the people receiving it and to those with whom they have close contact — and the risk of an outbreak too small to justify wider use, the panel said.

I agree. 

Medicine, business and technology

Joel on Software is one of the websites that I occasionally read.  Joel writes well about technology and business -- and his foreward to Rick Chapman's new book is compelling, and relevant to medicine.  Joel's argument is that developers should run software companies because the "get it" in ways that non-developers simply wouldn't or couldn't .. and so will avoid the mistakes that the "non-geeks" would make.

I'll make the same statement for medicine -- and even IT in medicine: 

a) Medicine is not "just a business."  As I mentioned last April, there is more to what we do than make money.  If we really are here  to enhance the quality of the lives of others -- then our leaders must have the same core beliefs as we do.   Making money is scondary - providing our services is primary.  Yes, we need to pay the morgage - and the salaries of the nurses, and the phone bill, etc ... so ... yes, we need good business skills.  But good business skills are not enough.  In healthcare, there needs to be a passion.  Yes .. healthcare is not unique .. and there are many professions that share similar qualities: education, some legal services, clergy ... ? journalism? 

 
b) Decisions in healthcare technology can't be made by mainstream IT managers without experience in healthcare.  Why not?  For the same reason that Joel asserts that programmers should run software companies.  One shouldn't have want to have to explain to an IT executive what a CBC is ...  nor should one have to explan the difference between Java and Javascript.  "duh" says the physician/nurse/PA ... "duh" says the geek ... but who knows both?  Sadly, there are rather few. 

My neighbor is a manager for a big company that makes steam turbines for the Navy.  He manages a team of workers, and ... for the most part ... he really understands what the workers are doing.  He tells me that he would have a hard time managing them if he didn't quite get what they were doing.

Managers of software developers have a much tougher time.  They can't always know the details of the work that the workers are doing .. since technology is moving so fast that the workers will nearly alwasy know more about the technology than than the managers do. 

? or do they?  Shouldn't a good manager keep up on this?  Just as a good physician will always keep up on the most recent research?  If web develoeprs start using Flash rather than DHTML .. shouldn't the manager learn about flash too? 

RelayHealth Replacement

We've finally migrated off of Relayhealth.  It was good while it lasted. but overall, I found that we used only 20% of the functions.  I was also frustrated that the system had no way of merging the messages in Relayhealth with our EMR.  This is ironic, of course, since practices "on the cutting edge" would be the ones more likely to be using relayhealth AND using an EMR .. so one would think that Relayhelath would want to give us a method of getting those records into the EMR. 

Nope. 

"Print them" was what their (nice) customer service rep told me last year.  

So ...  as usual .. we built our own.  We call the system the Slingerlands Family Medicine PatientSite ... at .. www.slingerlands.com.  Slingerlands is the name of the small town near Albany, New York where our practice is located.    Yep .. I registered the name back in the bad old days when no one knew what the Internet was.  Thought it would come in handy some day.  If you are interested in how the system works, please send me  a message and I'll e-mail you a test username and password.  It's pretty simple.

Conversions, caluclator in Google

Google Web Search Features holds a function that is hidden yet wonderful.  Convert metric to US .. easy ... type "45 kilograms in pounds" into google's search form and get the answer.

Neat.  Very useful for calculations too.  To Do a BMI, for example .. WT (lbs) / height (inches) squared * 703. So mine is 165 (yes, I need to exercise more) / 70 * 70 *(703) = Google calulates Jacob Reider's BMI.

 

 

BNP Reiveiw

This review of BNP  provides a nice overview of this relatively new assay.  It's sensitive for LV wall stress, but not specific for MI ... so it should not be used for diagnosis of MI .. though it DOES have a good negative predictive value.

What is premature thelarche?

Patient info handout on premature thelarche?

[No Title]

New computer system gives hospitals quick access to patients' records - Thursday, 08/07/03

Nashville health-care entrepreneur Ken Perry says that if hospitals ran more like restaurants, they could make more money and their patients would be happier.

He's right.  But Moving quicky in healthcare IT is tough.  physicians risk adverse .. and our IT Colleagues are even MORE risk adverse ... so moving forward quickly is very tough indeed.

Pediatrics: RSV and risk or Serious Bacterial Infection

Pediatrics -- Abstracts: Titus and Wright 112 (2): 282

The risk of SBI in febrile infants with RSV infection seems to be very low, particularly in comparison with a control group of RSV-negative infants. These data suggest that full septic evaluations are not necessary in nontoxic-appearing infants with a positive RSV test. It seems to be prudent to examine the urine in these infants, as there is a clinically relevant rate of urinary tract infection.

This study confirms that the standard of care for children with RSV is symptomatic.  We needn't chase our tails doing a full septic workup in these kids.