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Ariella Brown

More Info in the Name of Better Healthcare

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Ariella
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Re: Cautious Applause
Ariella   11/24/2014 4:58:19 PM
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@Jamescon That's true, though to some extent it has to do with the inclination of the doctor involved. I wasn't present, though at one of the checkups my son had between having had the pneumothorax and the surgery -- while still on a valve as an extra precaution -- one of the doctors in the surgical practice was inclined to take it out the, while the other voted to leave it in until the surgery. One thing he had not foreseen, though, was that when they took out the tube from the surgery, it occasioned another pneumothorax.  But no one said to watch out for it. We weren't told, "if you feel bubbling, that's a bad sign."

However, once burned, twice shy. So when the tube came out on the other side, the surgeon didn't even wait for my son's report and ordered an X-ray to see. And, yes, there was another pneumothorax on that side. So in that case the risk only registered after it had already manifested itself in the patient. That's not the way things usually go, but there really are a lot of surprises in health, and doctors do not strike me as very inclined to expect the unexpected -- only to expect what they are used to seeing. He didn't consider the risk likely in my son's case because he had only had it happen very rarely in his practice, and the last time was seven years before.

Jamescon
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Re: Cautious Applause
Jamescon   11/24/2014 4:36:47 PM
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@Ariella. I think a good portion of what happens in medicine today is that practitioners take the safe route, which is why they focus so much attention on the proven sources of problems. They are afraid of insurance companies, malpractice claims, and disgruntled patients/families.

Ariella
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Re: Cautious Applause
Ariella   11/24/2014 1:30:04 PM
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@Maryam the more I see of medicine, the more reactive it seems to me. How do they know if a person is at risk? Well, they'll go for the obvious things like people in the family with the condition, correlations of weight, blood pressure, and that sort of thing. But not everyone fits that mold, and the usual approach is very unhelpful for them. 

Maryam@Impact
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Re: Cautious Applause
Maryam@Impact   11/24/2014 12:34:02 PM
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Ariella it was voluntary and they provided an incentive for participating. Unfortunately I didn't think the advice was very useful.

Ariella
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Re: Cautious Applause
Ariella   11/21/2014 2:04:10 PM
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@Maryam Was that completely voluntary? I've heard of such screenings being imposed on particular plan members with a threat of higher premiums for those who did not participate. 

Maryam@Impact
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Re: Cautious Applause
Maryam@Impact   11/21/2014 1:12:44 PM
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Ariella, medical analytics is a very interesting area, I recently participated in an analytics effort from my insurance company where they used a questionnaire and a recent blood test to give patients a health score and make recommendations on their health. Sadly, the results were very vanilla and conflicted recommendations were prevalent in the analysis they even used dated criteria such as BMI to indicate fitness. I am intrigued by the power of medical analytics but still have yet to see it fulfill its potential.

Ariella
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Re: Cautious Applause
Ariella   11/21/2014 8:46:23 AM
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@SethBreedlove for the way Caroinas wants to use the data, anonymizing defeats the purpose. They want to know exactly who is at greater risk, where that peson is, and what can be done to improve the odds of that person getting the care needed. For federal data, I suppose there is a general count of how many people are diagnosed with particular illnesses, and that would identify geographic locations. 

SethBreedlove
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Data Doctor
Re: Cautious Applause
SethBreedlove   11/21/2014 2:43:51 AM
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I'm wondering, f the data is anonymized and center to the CDC.  For example, hospitals in the area where experiencing a spike in asthma, cancer and the area happened to have fracking operations going on the area, if these incidences could be reported and and remedied sooner.

 

Ariella
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Re: Cautious Applause
Ariella   11/19/2014 4:17:25 PM
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@Jamescon You hit one aspect of what I think would be solved not by technology but by an empathy exercise.  My modest proposal is this: a span of something like 5 or 6 in which  healthcare workers, which can include residents, PAs, nurses, and patient care technicians put themselves in the patients' position. I was thinking more of the problem of being at their mercy sometimes just to get help to get out of bed or into bed or to get to the bathroom. Whoa to the patient who desires such help when the PCT is going around taking vital signs or blood and doesn't want to stop until done. So being stuck in such a position and having the person assigned to help you keep you waiting for 20-40 minutes (I'm speaking from real experience at two different hospitals here) can make you a bit more sensitive to the need to respond to patient calls promptly. While it's less painful, I suppose that being barraged by the same questions over and over can also get them to realize that it's not so great to be on the receiving end of the questions. 

However, I don't think the intakes themselves have a detrimental effect on the records. Each person isn't updating or even doing something on his/her own. Each member of the team of surgeons, for example, including the anesthesiologist, resident, and nurse in the OR, came in individually, and they all asked for the story, I believe (maybe not the anesthesiologist) They just like to hear about what's going on rather than looking it up. Plus, as I said, some are practicing for when they qualify as full doctors. 

Jamescon
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Re: Cautious Applause
Jamescon   11/19/2014 4:01:18 PM
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@Ariella. I'll second the idea that constantly repeating medical histories -- and doing it orally while perhaps being sick or drugged -- is grossly inefficient and possibly dangerous. It increases the chance for errors to be entered into a record. It also indicates that nobody is reading a centralized file, even when that file is within the same hospital walls.

The time is way past for digital and centralized records. Yes, confirm the accuracy of those records periodically, but they have to be there.

The irony is that if someone comes into a new emergency room unconscious or in great pain, the doctors and nurses are flying blind on that person's history.

Also, I have laugh every time one of those drug commercials shows up on TV and the announcer says, "Be sure to discuss your medical history and conditions with your doctor before taking ..... "  How could I take it without consulting my doctor?

 

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