Image via WikipediaAn article in JAMA suggests that radiofrequency identification devices (RFIDs -- pronounced "AR-phids," like a type of insect) can create hazardous electromagnetic interference. And RFIDs were touted widely as device that improve patient safety. Whoops. More coverage in the Wall Street Journal and the New York Times.
“Care delivery in the U.S. is uncoordinated, unfocused, inconsistent, unmeasured, extremely inefficient, perversely incented, excessively expensive and sometimes dangerous…Health care delivery is, however, the fastest growing and most profitable segment of the whole U.S. economy…Healthcare is full of smart people. Smart people do not kill the geese who lay lots of golden eggs. Health care is awash in both golden eggs and very smart people…We need to remember that the people who depend on a cash flow of fees to stay in business and serve patients will not, voluntarily, take independent steps to reduce the flow of those fees…In today’s world, more efficient and effective caregivers simply deprive themselves of income. Asthma: $200 to prevent, $10,000 to treat…Health care reform needs to be a “product”—purchased and paid for by high leverage buyers in a well designed, sophisticated and carefully targeted purchasing strategy.”
The method is known as a micropractice, and it defies the conventional wisdom of practice management experts who urge doctors to boost their productivity by delegating nonphysician chores. A micropractice doctor typically works without employees in a space that's drastically smaller than what the average soloist has. Such austerity reduces the customary overhead by 40 to 50 percent, thereby lowering the break-even point and enabling micropractitioners to spend more time with fewer patients
The New 3G iPhone, Doctors, The App Store, and Medicine
Saturday, June 21, 2008
Joshua Schwimmer, MD, FACP, FASN
I've taken a long break from writing about the iPhone, and you might be sick of hearing about it. But be prepared — in less than a month, things are about to get very interesting.
Why? Not only will the new faster & cheaper 3G iPhone be released, but more importantly, the iPhone will now be open to third party software — that is, programs created by developers other than Apple. And why is this important? In the words of David Pogue, technology columnist for the New York Times, this means there will now be three major operating systems: the Mac, Windows, and the iPhone. (My apologies to Linux.)
This is only a small exaggeration. The iPhone has huge potential as a mobile computing platform, especially for physicians.
Sure, other mobile platforms exist — the Treo, Windows Mobile devices, tablet computers — but none have the graphics capability, the memory, the computing power, the form factor, and the ease of use of the iPhone.
What follows is the result of a brief brainstorming session about potential applications of the iPhone for doctors. Some have already been announced for the iPhone, are available on other platforms, or are currently in development. Let's see how many of these applications are eventually released and sold in the App store. My guess? All of them.
Drug database
Anatomical atlas
Medical calculator
Interface for electronic health record
Viewer of radiologic images
Interface for laboratory results
An expert system to help with differential diagnoses
Messaging system for laboratory alerts and hospital pages
Interface for medical devices (like ultrasounds and EKG machines)
Dictation recorder
Device for electronic prescribing
Device for directly receiving and reading medical journals and podcasts
Medical book reader
Reminder system for patient visits and meetings synced remotely with the office through Mobile Me
Display for patient education videos
Medical simulator (ACLS, for example)
Telemedicine device (pending the eventual release of iChat and a videoconferencing system)
Interface for medical literature searches (Pubmed, Google Scholar)
Word processing device for papers (I'm still waiting for a bluetooth keyboard)
Communication device for hospital teams (Using Twitter or another system)
Secure system for messaging/emailing patients
CME course viewer (with text and/or video)
What other application ideas can you come up with?
Your Next Stethoscope Should be Electronic. Here's Why. (Littmann Electronic Stethoscope Model 3000 Review)
Thursday, June 12, 2008
Joshua Schwimmer, MD, FACP, FASN
Last month, I reluctantly entered the market for a new stethoscope. (My old one broke. Don't ask.)
For doctors, choosing a stethoscope is not a decision made lightly: it requires laying out a significant amount of cash for a device you might carry in your pocket for years. So, after researching stethoscopes online for a few days, I surprised myself by buying an electronic model — the 3M Littmann Electronic Stethoscope Model 3000 — and I couldn't be happier.
"Why an electronic stethoscope?" is a reasonable question, but a better one might be: "What prevented you from buying one before?" Here are the most common objections:
Electronic stethoscopes are expensive.
Unless you have a hearing problem, you should be able to hear just fine without one.
Physicians have gone without electronic stethoscopes for almost two hundred years — why switch now?
The price of electronic stethoscopes has fallen dramatically in recent years. As of this writing, the Littmann Model 3000 is $287 on Amazon. Compare this with the price of the Littmann Cardiology II, which is $156. What does this $131 difference get you? The amplification of the Model 3000, according to the website, is "up to 18 times greater than the best non-electronic stethoscope." And the ambient noise reduction technology cancels out "an average of 75% of distracting room noise."
That sounds great, but does it actually make a difference? To test the performance of the Model 3000, an internal medicine resident and I listened to the heart of a patient with hypertrophic obstructive cardiomyopathy. We each auscultated the patient's murmur with both a conventional acoustic stethoscope and the Model 3000 — but to level the playing field, we placed the electronic stethoscope on the patient's hospital gown and placed the acoustic stethoscope directly on the patient's skin. We heard the patient's murmur better with the electronic stethoscope on the patient's clothes than we did with the acoustic stethoscope on bare skin.
In an ideal situation, could you pick up all the murmurs you might hear with the electronic Model 3000 with a conventional acoustic stethoscope? Sure — but there are no ideal situations. Hospitals are noisy, it's sometimes difficult to position patients properly to listen to their heart and lungs, and doctors are often rushed. At the very least, the electronic stethoscope provides an added level of assurance that you haven't missed any significant findings. If you view the physical exam as a test, then the electronic stethoscope significantly increases the test's sensitivity without decreasing its specificity.
If you see 20 patients a day, 5 days a week, for 48 weeks a year, in 2 years you will have used your stethoscope on patients 9600 times. For the Littman Model 3000, that is the equivalent of an extra 2 cents per physical exam. Is this worth it? If the average physician makes $50 per hour — and feel free to check my math, here — 2 cents is worth about a second of their time.So if an electronic stethoscope saves you more than a second per patient — and I would argue that it does — it's worth buying.
Even so, I wasn't fully convinced the Model 3000 was worth it until I showed it to another resident. She placed the chestpiece on her heart — over her clothes, mind you — and listened. Her eyes widened. "Oh my god," she said, "I have mitral valve prolapse. I was never able to hear it before." And I listened too. She was right. Even through her clothes, you could clearly hear the mid-systolic click.
What do you think? Has anyone else had positive or negative experiences with electronic stethoscopes? Are there compelling reasons not to get one?
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Image via WikipediaAn article in JAMA suggests that radiofrequency identification devices (RFIDs -- pronounced "AR-phids," like a type of insect) can create hazardous electromagnetic interference. And RFIDs were touted widely as device that improve patient safety. Whoops. More coverage in the Wall Street Journal and the New York Times.
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