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Sunday, March 18, 2018

Understanding signs and symptoms of colon cancer

Good job, Charlie. Dr. Moore is a humble guy with a perpetual youthful constitution. Hey Charlie, what's the role of fecal immunochemical testing (FIT) like Cologuard? Is it used in lieu of colonoscopy or as an adjunct? @CentralTexasEndoscopy
from Rajesh Harrykissoon, MD

Friday, March 9, 2018

Houston Man Convicted in $50 Million Drug Scheme

Sad. Now I wonder if this is just the tip of the iceberg. I also wonder about the confidence in patients actually getting the medication they were prescribed. It's a tremendous safety issue. When a patient reports back that the medication we prescribed is not having a desired effect, our assumption is that the correct medication was dispensed (and not tic-tacs), thus we may change medications or escalate dosage. What if the patient they encounters side effects or overdose because, this time, they were dispensed the true medication? We need to have fidelity and reliability in the pharmacy system for best patient safety.
from Rajesh Harrykissoon, MD

Wednesday, February 28, 2018

Perspective | Problems swallowing are a big killer, but the treatment can be horrible

"The American Geriatrics Society flatly recommends against placing feeding tubes in patients with advanced dementia, and endorses hand-feeding by caregivers as a safer and more humane approach. Placing feeding tubes in these patients does not reduce the likelihood of death or pneumonia, and is instead associated with agitation, pressure ulcers and a bevy of other tube-related complications. A full quarter of dementia patients who get feeding tubes need to be physically restrained, with soft handcuffs pinning them to their hospital bed to prevent them from pulling the tube. Rather than preventing suffering in those with advanced dementia, feeding tubes can cause it."
from Rajesh Harrykissoon, MD

Monday, February 26, 2018

A Time-Motion Study of Primary Care Physicians’ Work in the Electronic Health Record Era

Study finds, "Primary care physicians spent more time working in the EHR than they spent in face-to-face time with patients in clinic visits." Seems about right. I spend on average 3 hours on the EMR at the end of each day apart from the actual patient visit. Due to the EMR burdens, some PCPs have decided to forgo third party insurance contracting and to adopt a cash pay only model (Direct Primary Care, DPC). That model cannot work for all, however, because while a patient may be willing to go off insurance and pay a few dollars out of pocket for a routine PCP visit, it is unlikely they will have deep enough pockets to do so for specialty services like cardiology or orthopedics where a visit may entail orders for a CT scan, echocardiogram, stress testing, cardiac catheterization, joint replacement, rehab, injections and lab work. That would all be too costly to do off insurance. The current system is perfectly designed to perform as it does. The purpose of any for-profit insurance product is to make money. Whether its customers have better health is a secondary issue, not the primary objective. Ideally, an insurer wants to collect premiums and never fulfill a claim. That would maximize profits. However, if the insurer receives a claim then the object becomes to deny the claim or to make it as burdensome as possible to fulfill. If the insurer absolutely cannot avoid paying the claim, then under pay the claim. And, this is exactly what we see in health insurance today. What's the solution?
from Rajesh Harrykissoon, MD

Saturday, February 24, 2018

Wednesday, February 21, 2018

Behaviorally Assessed Sleep and Susceptibility to the Common Cold | Sleep | Oxford Academic

What does the amount of sleep you achieve have to do with getting a cold or your immune response to vaccinations? A 2015 study shows sleep duration of less than six hours was associated with greater susceptibility to the common cold. Short sleep duration in a number of studies has been linked to reduced antibody production after immunization. Thus, you may not be getting the full bang for the buck with your vaccinations if you are not getting sufficient sleep. The Nurses' Health Study of more than 71,000 women followed for ten years also demonstrated higher risk for coronary heart disease in those with short sleep durations. As a rough guide, the average nightly sleep requirements are: -Adults: 7-8 hours -Adolescents: 8-9 hours -Children aged 6-13 years: 9-11 hours Natural variance exist (short sleepers and long sleepers); however, the sleep requirement for variants will be consistent within that individual's life. Sleep for your health. :)
from Rajesh Harrykissoon, MD