December 19th, 2011 by Trudy Lieberman in Opinion, Research
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Who doesn’t think preventive health care is important? Probably nobody if you ask this question abstractly. But when it comes to getting it–well that’s a different matter. Medicare stats show that too few people are getting preventive services even when they are free. It’s darn difficult, it seems, to get people to take good care of themselves.
By mid-November, of the four million or so new beneficiaries who signed up for Medicare this year, only 3.6 percent had had their “Welcome to Medicare” exam. Only 1.7 million of the more than 40 million seniors, most of whom were already on Medicare, had had their “Annual Wellness Visit.” A poor showing indeed given all the hoopla and hype surrounding the preventive benefits that health reform was supposed to bring to seniors.
To review: All new Medicare beneficiaries are entitled to a free physical exam within the first twelve months that their medical, or Part B, coverage becomes effective. It’s a one-time benefit, and Medicare says that seniors are told about the benefit when they sign up. A Medicare spokesperson added that Read more »
*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*
October 18th, 2011 by Bryan Vartabedian, M.D. in Opinion
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I suffer with herniated lumbar disks. L4-L5 bulges and ruptures on occasion. If you catch me on the wrong day I have a little curvature to my back representing the spasm that makes me miserable.
I saw an extremely well-referenced orthopedic surgeon in consultation recently. But through the course of my visit he never touched me. We spent an extraordinary amount of time examining my MRI. Together in front of a large monitor we looked at every angle of my spine with me asking questions. I could see first hand what had been keeping me up at night. I could understand why certain positions make me comfortable. What we drew from those images could never be determined with human hands. In my experience as a patient, I consider it Read more »
*This blog post was originally published at 33 Charts*
August 28th, 2011 by RyanDuBosar in Better Health Network
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Four out of five doctors agree that they don’t need scans to make the right diagnosis.
It’s an old-fashioned concept frequently discussed among ACP members, but the history and physical combined with basic tests is way more important to diagnosis than ordering scans and advanced tests. A recent research letter in the Archives of Internal Medicine makes the case.
In the letter, Israeli researchers described a prospective study of 442 consecutive patients admitted from the emergency department in 53 days.
A senior resident examined all patients within 24 hours of admission (mean=14), including a history, physical, and review of ancillary test findings done at the emergency department, such as blood and urine tests, electrocardiography, and chest radiography. The resident also reviewed additional tests such as Read more »
*This blog post was originally published at ACP Hospitalist*
July 4th, 2011 by ChristopherChangMD in Health Tips
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One June 20, 2011, NPR aired a great story about how a person may not “see” a person getting beat up on the side of a jogging path when they are focused on a task (pursuing another jogger)… even if they pass RIGHT BY THE FIGHT!!!
In fact, only a third of the subjects reported seeing this mock fight when the experiment was conducted at night. Even more surprisingly, broad daylight didn’t improve the statistics (only 40% noticed the fight).
Though the situation and circumstances do not exactly correspond, there is a lesson to be learned here that applies to a medical visit.
As an ENT, I often see patients for a very specific complaint…
“My right ear hurts.”
“I have a bad cough.”
No matter what the complaint, unless it is for a specific task (there is earwax… can you remove it), I most always still do a complete ear, nose, and throat exam no matter the complaint.
Why??? Read more »
*This blog post was originally published at Fauquier ENT Blog*
June 28th, 2011 by Dr. Val Jones in Opinion
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I’ve often heard physicians say that “the history is 90% of the diagnosis.” In other words, they can usually determine the underlying cause of a patient’s problem just by listening to their account of how it evolved. The physical exam is merely to confirm the diagnosis, and is often cursory, limited, or ignored.
I believe that the physical exam is far more important than it seems – and I learned this during my recent oral medical specialty board examination. Although I have been sworn to secrecy regarding the content of the test questions, I will share an epiphany that I had during the exam.
The examiners’ job is to describe a patient and then ask the examinee what else she’d like to know and what she’d do next. With each description, I found myself struggling to visualize the patient – wishing I could see their face and hear their tone of their voice as they described their condition. I hadn’t realized that so much of my clinical judgement was based on laying eyes on a patient – I needed to see if they were in pain, if they were straining to breathe, if their skin was pasty or pale, if they were disconnected and potentially drug-seeking, if they were fidgety, if they were articulate, forgetful, or well-groomed. All of these subtle cues were gone. I was left staring at the examiner – who himself couldn’t describe the patient more fully because he was to stick to the script, reading verbatim from a prepared list of signs and symptoms. Read more »
