Comments for Dr. Butler's Blog

Comment on Risky CT scans by Dr. Butler

Dr. Butler — Sun, 04 Jul 2010 15:32:30 +0000

I agree totally.
Regarding CT vs MRI and other imaging, it should be noted that CT scans do offer different information so they may be preferred depending on the body structure to be evaluated. We created decision support in our EMR to guide physicians in this regard. The problem we frequently ran into was a CT being ordered with advice based on the interpretation to do an MRI! - multiple procedures, very expensive.
There was a wave of interest in CT scans as a healthy screening procedure- this as you can imagine was risky business. Very often the problem of radiation was compounded by followup repeat CT scans for small “indeterminate” spots that turned out to be nothing.
Hi resolution electron beam heart scanning to detect coronary artery disease- same problem. This must be used only when the information gathered guides important care decisions.

It is hard to imagine that back in the 1950’s shoe stored used fluoroscopy to measure shoe size! When I was in grade school on a hospital field trip for science class, a girl in my class swallowed barium under fluoro to impress our class!
Yes- we need to inform patients. The suggestion has been made that our electronic medical record should keep track of radiation total exposure- I think that would be useful- in the same way that it can keep track of medication over-dosage.
Thanks for your comments!!
JB

Comment on electronic prescribing reduces medical errors by Ken Brumbaugh

Ken Brumbaugh — Sun, 13 Jun 2010 10:33:24 +0000

Why could not the patient have the option to click their acknowledgment that they understand the dosage and purpose of the prescription - while still in contact with the Doctor?

This might further prevent errors, and could lead to more acceptance of ‘my chart’ and other e-services.

Comment on Congratulations to Regions Hospital by Toby

Toby — Tue, 08 Dec 2009 14:34:56 +0000

Statistics are wonderful but my experience at Regions was not. Following a procedure with anesthesia and while waiting to be escorted to the lobby, I was unamused to watch a party of three point fingers at each other when explaining why my pain medication had not been ordered. Omissions of this sort likely are not included in the numerator but are in the denominator thus skewing the statistics. Had I suspected this would happen, I would have taken great pains to ensure the meds I was promised were delivered.

Comment on Virtual visits with the doctor by D.J. Gimpl

D.J. Gimpl — Fri, 31 Jul 2009 13:40:08 +0000

Dr. I have been following your blog for sometime now. I really think there is value to the virtual evisit. I am wondering if in the future the web cam might be used for a more personal visit. I would guess one might be able to be more accurate is a visual could be included also. i realize there are limitations in just external evidence.
Again I really enjoy your blog and the topics are great.

Comment on Health care costs- if you use healthcare, read Gawande by ghfisher

ghfisher — Sat, 11 Jul 2009 22:06:25 +0000

Dr B,
You have got to include a spell-checker. Sorry.

Comment on Health care costs- if you use healthcare, read Gawande by ghfisher

ghfisher — Sat, 11 Jul 2009 21:33:08 +0000

Thanks for such dishearting reading. No not really. Now we have at least one answer to the question. Know the question — formulate the answer. That is if the answers offered are honest and not profit or ideologially driven.
As I was reading the article I was reminded of an incident that happened around 1980. Wilford Hall, the Air Force’s Walter Reed, in San Antonio got a CAT machine. It was not fully utilized and the AF offered it to the local hospitals for use. All declined and built their own. Result was under utilization of all 4 scanners in town.
So long as there is needless redundancy in services we can be ‘near’ certain that the doctors/hospital administrators will do anything to get maximum utilization.
Recently our local hospital was bought by a major hospital chain and the doctors that used to work for the hospital formed their own for-profit physician’s group. I am blessed with the best health insurance offered in the US and suddenly I found that my doctor wanted to see me 4 times a year rather than twice. There had been no significant change in my medical condition.

Comment on Health care costs- if you use healthcare, read Gawande by Dr. Butler

Dr. Butler — Tue, 16 Jun 2009 03:42:37 +0000

Comment on ePrescribing by Dr. Butler

Dr. Butler — Mon, 15 Jun 2009 03:24:09 +0000

Digital key fobs-??- hmmmm, ok, sounds good, or at least like progress.
Thanks for the comment!!
JB

Comment on ePrescribing by Brad Gordon, MD

Brad Gordon, MD — Sat, 13 Jun 2009 15:08:35 +0000

John - Nice post. I agree, the paper prescription is on the way out. I think this is good, in general. There will be more bumps, as we learn how to do things like cancel prescriptions, modify existing prescriptions, etc. The electronic transmission make make this easier. (e.g. I’d love a message back that indicates when (if!) the patient filled the prescription).

Regarding controlled substances, there will be likely changes there too, but it may be even more bumpy. As you know, there are proposals in the fed sausage machine that are looking at ways of making the electronic process secure and auditable. This probably includes using things like digital key fobs or maybe biometrics (fingerprint, etc) to sign the prescription. Could be cool, but also will likely be a bumpy transition.
For the super interested, the DEA Proposed Rule can be viewed in all its gory detail.

Brad Gordon, MD

Comment on Health care costs- if you use healthcare, read Gawande by Richard Nysse

Richard Nysse — Sat, 06 Jun 2009 17:33:41 +0000

This is an article patients can understand. I am not a health care provider, but the information and contentions of this article were eye-opening. Dr. Gawande’s style is very accessible without watering down the content. Highly informative without the expose tone of much journalism in the 60 Minutes style. It read like a detective story without the “gotcha” part.