FuN LivINg Lifestyle

Here are the top posts from this past week, based on the number of times they were viewed.

1) Does your cardiologist deserve his salary?

2) What doctors do when they don’t know the answer

3) Why Medicare and health care should be deregulated

4) How the ER is now used to triage every patient

5) How pediatricians should handle families who refuse vaccines

• How pediatricians should handle families who refuse vaccines
• Ten top medical blog posts, October 2009
• 10 most read health blog posts, January 2010
• Ten top medical blog posts, May 2009
• 10 top medical blog posts, September 2009

Posted at KevinMD.com. Stay updated and subscribe, follow me on Twitter, or connect on Facebook.

by Dr. Charles

“I’ll be back in a little while, Hon’. Will you be okay without me?” the frail old woman asked of her husband. She was standing at the front door and breathing heavily.

“I’ll be fine,” her husband replied from his wheelchair. His voice sounded as weak as his body looked – emaciated, scaly, and full of cancer. “I’m sorry I can’t come with you.”

The woman opened the front door. A gust of cold winter air scattered dried leaves into the foyer and chilled her lungs. The lone tree in their small yard looked tired and skeletal. She coughed against the wind, but pushed on. The walk down the stairs and across the driveway was exhausting. She wrested the car door open and plopped down into the bucket seat. Her breaths came fast, and she thought of calling the ambulance instead of driving herself to the doctor. But after a few minutes of rest she felt better. Her husband had wheeled himself to the front window and was watching her with concern. A nasal cannula graced his elfin face, and the woman thought how marvelous it would be to take a deep drag of his oxygen. But she felt good enough to proceed, and waved to her husband. He blew her a small kiss from his dried lips as she backed out of the driveway.

The woman drove cautiously to the doctor’s office. Other cars swerved aggressively around her. The impatience of youth and the hostility of the middle-aged were very unsettling. A black car behind her was flashing its high beams, signaling for her to speed up or die. At the next stoplight the black car pulled up next to her, riding the right hand shoulder of the road. The driver was a man with a goatee, and he looked over her with all the dramatic scorn his face could muster.

The journey to the doctor’s office took a harrowing thirty minutes. All the parking spots close to the entrance were filled with rugged SUV’s and bright family cars. The closest spot she could find was dauntingly far, and she worried her lungs would not carry her. Like a diver she stored up a few deep breaths, and then embarked across the macadam.

She made it to the front desk, huffing as she signed in. Other patients in the waiting room watched her surreptitiously, wondering if they should spring up to catch her if she began to fall. Fortunately the woman made it to a chair and began recharging her lungs once more..

When she was eventually called back to see the doctor she asked for the closest room. The medical assistant obliged, taking her pulse and blood pressure. The doctor breezed into the room. “How are you today?” he asked.

“Not good, doctor,” she said with a shaky, breathless voice. “Over the past week I’ve gotten to the point where I can’t walk across my house without getting out of breath. My ankles are swollen, my chest is tight, and I’m really worried because there is no one else to take care of my sick husband. You remember he has cancer, right?”

The doctor looked uneasy. He scribbled notes, asked more questions, and then took a deep breath himself. He examined her, but it seemed he had already made a diagnosis given his furrowed brow. “Well, I’m definitely concerned about you. I’d like to do an EKG to take a look at your heart rhythm. Do you think you can make it up to this examining table?”

The woman looked up from her chair at the examining table, plush with institutional green plastic upholstery. It looked like some high altitude mesa, but she agreed to climb up. The doctor held her arm as she moved arthritically. She felt her heart racing again, and her lungs felt as if she were sprinting at full speed. The air in the room became thinner and thinner as she climbed, until suddenly there was a faint feeling and darkness advancing from all sides.

When she next opened her eyes she was looking at the ceiling panels of the exam room. There was a dead bug of some sort in the fluorescent light overhead. The doctor was kneeling beside her, supporting her head and taking her pulse. Someone had placed a nasal cannula into her nose, and it was blowing sweet oxygen into her being. In her confusion and alarm she thought immediately of her husband back home, and how quenching his oxygen supply had seemed. How ironic it all was. How pitifully powerless they had become. Everything was happening quickly and in a blur of movements. A few young men, presumably from an ambulance, lifted her onto a stretcher. She was wheeled out of the office in an embarrassing parade, passing other frightened patients who were no longer reading in the waiting room. She asked the doctor to please call her husband at home, and to tell him not to worry. He would need someone to take care of him, and she would set this up just as soon as she could from the hospital. The doctor nodded and wished her well as he patted her sorrowfully on the shoulder.

Several hours later, having endured blood, radiological, and cardiac testing the woman found herself in a quiet room on the 4th floor of the hospital. It was determined that she had congestive heart failure, and the doctors and nurses would be working to fix her up over the next several days. She had started calling her home from the emergency room, but her husband wasn’t answering. The anxiety she felt for him far outweighed any breathlessness she felt in her own body. Upon arriving in her own room the first thing she asked for was a telephone. Still there was no answer. She called her neighbor, who went next door while on the phone to check for her husband. No one answered the door, and the neighbor could not see anyone in the house.

It had been about 5 hours since she had begun her voyage away from home, and she mulled calling the police to go check on her husband. But it was possible he was just napping. His hearing was shot, and the fright of seeing a policeman at the front door might kill him. The woman held back tears as she fiddled nervously with her watch.

She barely looked up as the nurse appeared in the doorway. She was pushing another patient in a wheelchair into the room. “Looks like you have a roommate, Ma’am.” The woman forced an anxious smile as she looked at her new roommate, a frail and bony silhouette in the light spilling from the hallway. When she realized it was her husband smiling back at her, with a boyish grin she recognized from fifty years ago, her heart began pounding even harder than before. “How did you get here?” she exclaimed. “You should be at home resting! I was worried sick! You didn’t answer the phone!”

“You shouldn’t be here alone,” her husband replied. “I called a cab after the doctor phoned me. The hospital doesn’t know this yet, but I’m staying here with you tonight.”

The woman took her husband’s hand, shaking her head. “You are in no shape to be chasing after me,” she scolded him. But her eyes betrayed happiness that he had made the brave odyssey through the frigid world, especially in his condition. “Look at us. We’re not doing so well, are we?”

They sat together precariously, silently content in one another’s presence. Despite the IV poles, oxygen tanks, and beeping monitors they felt at home.

They were, as always, two lovers still journeying together into the uncertain night.

Dr. Charles is a family physician who blogs at The Examining Room of Dr. Charles.

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Originally published in HCPLive.com

by Owen Dahl and Altamash Rahman

“Her MA is very rude, uncompassionate. Dr. ABCD doesn’t return phone calls. They’re not helpful and not good with following up with the care plan for patients. We’re new seeing this doctor, but will never go back. I would not recommend this practice at all!!!!!!”

How would you handle a comment like this when found on your patient satisfaction surveys?

What if, even worse, this comment was found about you on the Internet. This is an actual comment about a physician found on a website that rates physicians. So, what is doctor grading, how have things changed recently, and what can you do about it?

Doctor grades
Rating physicians has been part of the “business” for years. In the past, the grading was done formally by utilization review or quality assurance committees at the hospital. It has also been “controlled” by lawsuits and by the various state medical boards. This type of information was maintained “internally” to the medical community.

The other method of rating was via word of mouth. This has been the most effective way to market a practice, but it also has been equally effective in losing patients. It has often been stated that one bad experience will be heard by 10 others, whereas one good experience will only be heard by one.

As we move into the new decade, the era of public rankings is moving full speed ahead, and the real issue is the online rating sites and what they can do for, or against, you.

Online
A recent survey in New York returned results from physicians who said 27% of their patients find their providers online, that 46% of them use a health plan website to do so, and that 31% of them are commercial. Making matters worse is that Americans can now go to any of at least 10 websites to find out how well you are doing in taking care of your patients. These sites use questionnaires or allow for posting comments. You may find yourself with stars by your name, a smile or sad face, or a numerical score. If you do a survey and 95% of your patients are satisfied, what are the other 5% doing? They could be writing poor reviews on such sites. In any event, consumers are being encouraged to forgo what their neighbors have to say and instead check you out on the Web. Let’s look at a few sites:

• With 7 million visitors to its site each month, Healthgrades.com is probably the most utilized and sophisticated site. It offers free reports, but more often than not, interested parties must pay a fee of $12.95 per physician to get a complete report.

• Angieslist.com: Yes you, along with the local plumber and painter, can now be found on Angie’s list. This site allows for posting of comments about you from anyone and rates you based on beside manor. There is a membership fee to join, but comments can be posted without membership on selected items. The patient is required to sign their name, giving you an opportunity to respond or follow up with him or her.

• RateMDs.com uses patient comments and marks with a smile, neutral, or sad face in measuring four categories: punctuality, helpfulness, knowledge, and a five-point quality scale.

• Additional sites, such as physicianreports.com, vitals.com, bookofdoctors.com, mydochub.com, drscore.com, healthcarereivews.com, and doctorscorecard.com, provide rating information as well.

• Patients can also find “grades” posted on managed care-sponsored websites.

These sites do not offer sophisticated opportunities to review actual medical outcomes or quality measures. They are measuring the importance of bedside manner, wait times, and other non-quality measures.

What happens on these sites, and why
There are several options from which you may choose to reactively, proactively, realistically, or unrealistically deal with physician rating sites.

First, it is important to recognize the role of the patient in this digital era and what you can do with the information that is discovered. The Google search engine folks indicate that they get 60,000 hits per second on health- and healthcare-related topics [need reference]. So, from where do these 60,000 hits come? They’re from people who:

• Search sites like HealthGrades.com to find out about you. Search results can reveal your education, training, and in some cases, your malpractice history.

• Report on their doctor’s office visits, which more often than not represent the extremes; either they are very happy or very unhappy. Of these, most are unhappy and can be related to delays in being seen or unfriendly staff.

• Search the Web for information on their symptoms and come prepared with a diagnosis and treatment plan for you to endorse.

• Go to their insurance carrier website to either find you or to find out about you and their insurance company’s ranking.

How do you deal with the Internet?
The time and effort put in by you or your staff is significant in dealing with this issue. Following is what one practice chose to post on a website in response to negative comments:

“We at the [Doctors office] would like to make it clear that the poor reviews listed on this site over the last several weeks are written by a single woman who is logging on under “shadow” alias’ which are easily obtained through yahoo and leaving slanderous emails. Please note the use of capitalized letters in all e-mails and the truly disparaging remarks which are a common theme in all of the emails. They should not be interpreted as being legitimate in any way. We have reported her to the correct department at yahoo and an investigation is underway. We encourage anyone to talk to a legitimate patient or family member at our clinics if one takes her comments seriously. Please feel free to call our clinic and ask for a patient or patients’ family to discuss options with. Many have volunteered after seeing these statements. They do not reflect our clinic or our clinic’s goals.”

Others have asked patients to pledge that they would not post anything on a website, even going so far as asking patients to sign a document. But could this make it appear that they are hiding something?

Several key approaches should be considered when dealing with Internet grading or “gossiping” sites, all of which should be done in a realistic and proactive manner. Reaction to a negative comment on a website will be taken as defensive and will not have the desired outcome.

Instead, we recommend that you do several things:
1. Be aware. Simply being aware of these sites is a key step. The best way to find out what is on the Internet about you and your practice is to search online for your name and/or the name of the practice. You will likely find sites with comments and rankings that you were not aware of. In some cases, it may be beneficial to pay the fee to join these sites in order to be able to continuously monitor what is being said, so that your patients don’t start dropping off and you don’t know why. This activity should be assigned to a staff member.

2. Understand what each site is measuring and how they are determining the rankings. Often, there may be only one comment posted, which results in a low grade. While this may not be statistically significant, to the reader, it will not make any difference. Understanding the metrics and measurement formula will be important. If you find a site that has a negative rating based upon one report, you may choose to print and post it in your reception area (we don’t have waiting rooms) as an educational tool for your patients.

3. Take action. Once you are aware and understand what is behind the grading systems, it is time to act, similarly to how you (hopefully) do with your patient satisfaction information, when you discover the findings. It is not bad to hear negative comments if you learn from them and use them to improve the practice. If you choose a defensive response and do not recognize that what is being said may be a legitimate response, you are missing the boat. A thoughtful and truthful analysis of your practice will yield positive results for your patients and for you.

4. Develop a practice website, or update the one you have had for three years. If patients are searching for you online, it helps for your website to be one of the first page options they see. You control the information and can send positive messages about who you really are, what services you offer, and key policies that affect the patient. And, you can offer secure logins for appointment and patient registration, links to other key websites, and more.

It is important that at your next practice board or management meeting that you review how you can and will respond to the Internet grading and gossip system. We believe a positive, thoughtful plan will bring more benefit than a defensive, negative response that may be your first reaction to the perceived negativity that is on the Web.

• Can a doctor sue a patient for a negative online review?
• Poll: What should doctors do if patients give a negative online review?
• How doctors should deal with physician rating sites
• How Google Sidewiki will impact drug company websites
• Why doctors should care about search engine optimization, and why SEO can make or break your practice

Posted at KevinMD.com. Stay updated and subscribe, follow me on Twitter, or connect on Facebook.

Here is a very useful tool which I had meant to use for a long time and also had meant to tell you about it, but keep procrastinating. Well, finally here it is, the Xenu’s Link Sleuth which you can download here.

Most of you probably already knows that search engines don’t like dead links (Definition: A dead link (also called a broken link or dangling link) is a link on the World Wide Web that

 … and her babies Zipper and Velcro.

Check out the feed!

In the Age of Technology, I think that nothing really “dates” you as much as your tech savvy skills. I can never get over how fast my niece and nephews are with their web expertise, or how much I learn from them. I remember being in middle school when news about email was going around as a rumor! It is fascinating how fast kids make technology their own quite simply because in some form or another, technology is their life. While this has advantages galore, it also puts children in a kind of risk we cannot even imagine. But we have to.

When I was in college, we had just started texting, sending friends small “notes” during the day, maybe coordinate skipping a class here or there. These days, young kids have taken texting to a whole other level and it is called “sexting”: sending naked or sexually explicit images of yourself on text. As shocking as it may sound the first time you hear of it, when you think about the amount of sex being bombarded to kids, the worship of celebrity culture in their lives, sending nude images of themselves to their boyfriends would only seem natural.

As recently as last month, pop icon Rihanna stated that if you did not send naked pictures of yourself to your boyfriend, aka sexting, she felt bad for him. The singer’s statement is a serious reflection of how common and popular sexting has become.

But what is really scary about this kind of technology use is that it creates excellent breeding grounds for child predators, such pedophiles and sex offenders, to prey on kids. Just think about how dangerous the internet is even for adults. We have to constantly be on guard about identity theft, bank fraud etc.

Think about how easy the internet is to find anything, especially things sexual in nature. Then think about how easy it is to find a child on the internet. All you really need is a screen name and you can start to create a whole new identity online. The whole “cyberbullying” and “sexting” culture is so new that there is not even clear legislation to safeguard kids. If you are feeling scared, you should be.

Last year, my friend’s boss had a nephew who had an abnormally high cell phone bill. His father did the math and figured that his kid pretty much had to be on the phone all day and all night. Turns out the kid pretty much was. But who was he spending all this time talking on the phone to? A sexual predator in another State. Imagine that. In his home, under the watchful eyes of his parents.

While businesses around the country are crashing and closing, entrepreneurs are making a business out of safeguarding kids from online child predators. Netnanny and Mobile Watchdog both provide some degree of online monitoring for your kids, but nothing is as comprehensive as this new company called KidSafe.

KidSafe is a mobile phone service that gives parents a “bird’s eye view of what is going on in their child’s digital world, with a focus on social networks and the mobile phone.” The company also uses data mining to specifically “identify for parents the things that they are most concerned with- risky activities, risky connections and developing threats to their child’s safety.”

If it sounds a bit like stalking, well it kind of is. Every time suspicious language or behavior is picked up by the phone application, parents are notified. For instance, if your child gets a text that contains words like “sex” or “drugs,” the parent is alerted.

The KidSafe application also includes a “Text Lingo” dictionary which defines words teenagers may use that parents may not know the meaning of such as “LMIRL” (let’s meet in real life), or “hook up.”

This may sound like a major invasion of your kid’s privacy, but how else can parents really know who their kids are talking to, or worse yet, who is trying to talk to their kids? I think a few years ago something like this would have been out of the question. But the truth now is that we cannot afford to take any chances.

When I was in fourth grade, I had a teacher that I really did not care much for. But my closest friend at the time had a detestation for him that was so strong, it was baffling for my nine year old mind. I never understood where her anger towards him came from. By the time I graduated from high school, that teacher had been accused of child molestation by a slew of his young female students.

I think about what technology like KidSafe would have done in preventing a man like that be able to prey on little girls. It makes me think that any clue, any hint we can provide parents that there may be someone trying to harm their child is worth the invasion of privacy. The internet is too big and too wide to control. You have to do what you can on your end because seriously, what is the alternative?

Check out the KidSafe product at www.KidSafe.me and discover the latest challenge in parenting.

More on Parenting

The “Move Your Money” campaign was featured on CBS Sunday Morning this week. Arianna appeared on the show to talk about why moving money out of big banks and into smaller banks is important:

“JP Morgan, Citi, Bank of America, Wells Fargo — these banks, that have received taxpayer money, that have been bailed out by the taxpayer, have not done their job at helping small businesses, at lending, so that the economy can start again, and start producing jobs.”

WATCH:

Watch CBS News Videos Online

More on Move Your Money

SYDNEY — Thousands of people in lavish costumes and various states of undress danced and partied their way through Sydney’s streets on Saturday, in Australia’s annual Gay and Lesbian Mardi Gras Parade.

The parade – one of the world’s largest and most flamboyant gay pride events – had 9,400 participants and 135 floats and featured the theme, “History of the World” – a look at gay history.

Hundreds of thousands of cheering spectators watched the procession, led this year by famed transsexual model Amanda Lepore. Her sparse attire, festooned with precision-cut crystals, left little to the imagination as she perched on an open-top Mercedes.

One reveler dressed as Osama bin Laden led a group of dancing “Binlettes,” who sported pink sequins and improvised “mini-burkas,” which only covered the head. Osama’s right-hand man, who identified himself as “Greenie,” said the bearded leader was here to terrorize the intolerant.

“It’s about bringing back the gayness for Osama: Express the flesh!” Greenie said. “He’s been in a cave for a long time. Bill Clinton couldn’t do it, George Bush couldn’t do it, Barack Obama doesn’t want to do it … but he’s come out today for the Gay and Lesbian Mardi Gras here in Sydney.”

“Michael Jackson’s Thriller Zombie Marching Group” followed a hearse through the streets, which the director and producer of the float, Gareth Ernst, said was a parody of the celebrity death cult.

“Celebrities are like zombies,” said Ernst, who was dressed as Joey Stefano, a 1980s porn star. “They die and come back stronger, more powerful and more popular.”

Other dancers were decked out in full Lycra bodysuits, red devil halos and peacock feathers.

“I actually came out on a float,” Ernst said. “My parents saw me kissing my boyfriend on television. Ten days later I had a call from my mum, who only said to me, ‘We saw you on TV.’”

Spectators crowded the route of the parade through Australia’s largest city. They held rainbow banners and Aussie flags aloft in the hot night air. Jewelry-covered dancers flaunted their frills for the crowd and twirled LED hula hoops with mesmeric variation.

One spectator, Emma Rule, drove more than 600 miles (1,000 kilometers) from Melbourne to watch the parade for the first time, and spent more than six hours waiting on the sidelines for the festivities to begin.

“We’ve been here since 1:30 p.m.,” she said excitedly. “But it was worth it … we were looking forward to the Dykes on Bikes – they are always awesome.”

Rule was referring to the famed Australian lesbian motorcycling group, which rode up and down the parade route on their bikes clad in leather, revving their engines and honking horns.

The parade began as a protest march in 1978 by homosexual and transsexual men and women.

Katrina Marton, head of events at Mardi Gras, said the parade had taken on special importance after a same-sex marriage bill was voted down in the Senate earlier this week.

“Under the glitz and glamour it’s still a political march,” she said.

More on Australia