Electronic medical records

The passage of the American Recovery and Reinvestment Act, spearheaded by Obama, required that healthcare providers adopt electronic medical records by January 1, 2014. Adoption was mandatory if providers wanted to maintain their existing Medicare and Medicare reimbursement levels.

Digital records were expected to improve accuracy, support clinical decision-making and make a patient’s records easily accessible to multiple providers and organizations. These benefits may have come to pass, but by now, most of us know that the technology has undermined face-to-face patient care. In their limited time with you, docs are looking at their screens, not at you. (Abraham Verghese calls this the “iPatient” phenomenon.)

Electronic medical records have also contributed to physician burnout. A report from the National Academy of Medicine revealed that, on an average, nurses and doctors spend 50 percent of their workday treating the screen, not the patient. A study of emergency room doctors revealed that putting information into the computer consumed more of their time than any other activity. A doctor needed to make six clicks of the computer mouse to order an aspirin, eight clicks to get a chest x-ray, 15 clicks to provide a prescription, and so forth. All in all, a ten-hour emergency room shift included 4,000 clicks of the mouse.

One solution is to hire medical scribes—people who enter patient information into the computer. The physician then reviews the notes, makes corrections, and signs off on them. Some scribes work remotely (I’m not sure how that works). Anyway, it’s estimated that in 2021, 100,000 scribes were working in medical practices around the country. In fact, medical scribing is the fastest growing healthcare profession in the nation.

In 2011, I had some experience dealing with electronic medical records. I was hired to write a user guide by one of the companies vying to get their product into the marketplace. I don’t think they succeeded. Their product was quite complex and rather unwieldy,  I still have my drafts and a few images. Here’s one I found:

Electronic medical records are here to stay, of course. I recently had my knees x-rayed at a radiology lab. When I showed up, all they asked for was my name and birthdate because all my info was in their system. Pretty nifty.

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Getting a good deal on drugs from Mark Cuban

Those of you who watch Shark Tank know that Mark Cuban is one of the “sharks” on that reality show. He’s also the owner of the Dallas Mavericks, among other businesses. I’d never heard of him. But I recently learned, from Bob Sutherland, relative-in-law, that Cuban started a business selling affordable generic drugs.

Cuban got into the business after being contacted by Dr. Alex Oshmyansky, a radiologist, asking if he (Cuban) would consider investing in a company that sells generic medications for roughly the cost of production. Cuban would and he did. He and Oshmayansky started Cost Plus Drugs in January, 2022, offering around 1,000 medications in the U.S.

Cost Plus cuts out middlemen and keeps the cost close to the manufacturer’s price, selling generic medications for the cost of manufacturing, plus a 15% markup and shipping fees. (Hospitals can sell cancer drugs at a 600% markup.)

Here’s an example of their pricing for a 30-count supply of 400 mg Imatnib:

Cost to produce: $27.90
Cost Plus markup: $4.20 (15%)
Pharmacists’ time: $3.00
Shipping:. $.48 (plus carrier’s costs)

Total: $35.10, compared with $9,657.30 retail price for the same drug.

One customer reported saving more than $600 for a three-month supply of his diabetes and blood pressure meds. A study by the Journal of Clinical Oncology reports that the U.S. government could save taxpayers between $228 million and $2.15 billion a year if insurers who operate its Medicare Part D plans purchased seven generic oncology drugs at the same prices obtained by Cuban’s outfit.

The idea, according to Cuban is to “disrupt the drug industry.” Cuban’s Web site is worth a visit: https://costplusdrugs.com/  

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Strengthen your pelvic floor muscles

Pelvic floor muscles sit at the base of your pelvis. Here are a couple of illustrations showing these muscles. Note that the top photo shows a woman's innards, but the musculature is the same for men.

These are important muscles. They contribute to overall core strength and hold multiple organs in place, including the bladder and bowel, insuring they work properly. They are vital for everything from basic bathroom functions to sitting and standing. As one professional states, the pelvic floor is “just as important in your daily life as your Achilles is for running, because we use it for everything.” Historically, there’s been some prudishness about the area. (The pudendal nerve, that runs through the pelvic floor, comes from a Latin word that means “to be ashamed.”)

When the pelvic floor muscles aren’t working well, you can have urinary incontinence, pelvic pain, pelvic organ prolapse, or a combination of both. Symptoms of a weak pelvic floor are leaking pee or poop, or feeling the need to pee when you don’t have to. Both men and women can experience these issues.

You can strengthen these muscles with exercises, commonly known as Kegel exercises. Kegel exercises can give you better control over your bladder and bowels and prevent your pelvic muscles from getting weak. It’s tricky to feel these muscles. You can get a feel for them by trying to stop peeing after you’ve started, or imagine you’re trying to prevent yourself from passing gas. (Women tend to know about Kegel exercises, but they are just as valuable for men.) I don’t want to include the exercises here, but you’ll have no trouble finding them on Google.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Whole milk is political

Whole milk was yanked from public schools in 2010, thanks to Michelle Obama’s campaign to save children from obesity. Big mistake: 45 years ago, less than 5 percent of children ages 2 to 17 had obesity. In 2020, that number had quadrupled to nearly 20 percent. The problem with eliminating whole milk is that kids drink juice instead. Apple juice, for example, contains 30 grams of sugar (fructose) per cup, compared to 12 grams of sugar (lactose) in whole milk. What’s more, milk contains protein and is a naturally rich source of calcium Vitamin B2, Vitamin B12, potassium, phosphorous, and is supplemented with Vitamins A and D. Many vitamins are fat soluble, meaning fat is needed to fully absorb these nutrients.

(A word about lactose intolerance: we're born with the ability to digest lactose, but as we get older, many of us stop producing lactase, the enzyme that digests lactose. In such cases eating dairy products may cause gastric discomfort.)  

Anyway, Glenn Thompson, a Republican Congressman from Pennsylvania has been trying to get whole milk back in schools, His “Whole Milk for Healthy Kids Act” was approved by the Education and Workforce Committee in a 26-13 vote along partisan lines, with Republicans in the majority. (For the record, I’m a Democrat.) The Republicans have it right this time. His bill is headed for a vote in the full House, but its passage is uncertain.

Some democrats view the Republicans’ stance as an effort to “roll back” or “unravel” Michelle Obama’s efforts. Some liberals are more concerned with animal rights and climate changes. Jamaal Bowman, a Democrat from New York, comments that schools needed a more “climate friendly” beverage. Because cows emit lots of methane gas and eat water-grabbing alfalfa, I can sort of get behind that one.  

The saturated fat in whole milk is not bad for you. After all, would Mother Nature include plenty of it in human breast milk if it were dangerous? We old people grew up drinking whole milk (remember those little cartons?) So did our kids, who are now in their 60s. We even drank whole unpasteurized milk from our cow for a few years. We are not obese or ill with cardiovascular problems. The same goes for our kids.

I’m with Democratic Congresswoman Jahana Hayes, from Connecticut: “I drink whole milk. My kids drink whole milk. We like it.”  

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

More on noise pollution

A couple of weeks after I posted a blog on noise pollution (pet peeve of mine), The New York Times published the latest research on the effects of noise on health. According to the detailed studies by more than 25 researchers, here is a bit of what they discovered:

• Unpleasant noise goes from your ears to the amygdala part of your brain—essentially a stress detection center. If the amygdala is chronically overactivated by noise, the reactions begin to produce harmful effects:
• Your endocrine system can overact, causing too much cortisol, adrenaline, and other chemicals to course through your body.
• Your sympathetic nervous system can become hyperactivated, quickening the heart rate, raising blood pressure, and triggering the production of inflammatory cells.

Over time, the above changes can lead to inflammation, hypertension, and plaque buildup in arteries, increasing the risk of heart disease, heart attacks and stroke. After analyzing the brain scans and health records of hundreds of people at Massachusetts General Hospital, researchers found that those who lived in areas with high levels of transportation noise were more likely to have highly activated amygdalae (plural form of amygdala), arterial inflammation and—within five years—major cardiac events.

The decibel scale of noise is logarithmic, not linear: with every 10-decibel increase, the sense of loudness to your ear generally doubles. Thus, while a quiet room has a decibel level of 27, and that of a hair dryer is 87, to your ear, the sound of the hair drier is 66 times that of the quiet room.

The noises mentioned in the article tended to be those made from jets, trains, cars, leaf blowers, and similar noise-making machines. Reader comments complained about restaurant noise, loud music, and barking dogs. I never thought about barking dogs. Those in our neighborhood don’t bother me. In fact, it’s about the only sound we hear, and it’s not nearby.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.