Monday, June 30, 2014

Technological Age Appropiate Software

Modern communication has evolved exponentially in the last few years.  The  new technology does incredible things and dramatically changed behaviors.  It is rare to see a young person today walking down the street without a "smartphone" held in an outstretched arm.

When people of my era got a "new toy", we may have read the directions.  My children say, "play with it and figure it out".  This is not an easy solution to people who think, "if I press the wrong button, I will destroy the software and or hardware".

Software and hardware developers should remember that they should provide a product that is appropriate to the technological level of the user.

My smartphone has a multitude of tasks that it can accomplish, but I will never even look at or explore by myself.  The manufacturers should remember to develop a tiered approach to their products.

Certain companies have accomplished this.  Dragon voice activated technology can be used by the most and least sophisticated user.  When utilizing Dragon in an electronic health(care) record, you can use all the widgets or just dictate correcting mistakes with the mouse and or keyboard.  Just using the old-fashioned non-video games technique only costs a few more seconds without fat-finger syndrome!

When creating a software product or website, do not assume that everybody understands programming convention or standards.  Provide simple guides and avoid the right-click solution.  Most people over 50 do not know what a right click is.

At my age, I would welcome the dreaded chip in the brain, so I could keep up.  Until that becomes a reality, realize that the only people that can afford most of these toys are chronologically old, but technologically young.

Wednesday, June 25, 2014

Monopolizing Physician Time is NOT Meaningful!

Guest blogger Dr. Donald Kamens, MD discusses the definition of meaningful use- Enjoy!

Taking Physicians away from their patients is anything but meaningful.  I saw a urologist yesterday, and while he was unable to look me in the eyes because he was fixed on the screen, he was also saying, "see, I cannot even see you, judge your reactions, assess your status...the screen takes it all away from what was once the doctor-patient relationship."

He further said, "that every day (every day!) he has to stay late to complete his MU requirements, and most often winds up taking the work home.  It is destroying his family life as well.  Patient care is being undermined.  He said that the issue was not only the MU criteria itself (which he said will have to be relaxed), but also the implementations, and was complaining about their current system- one of the big 3, but learned that most all other products have the same or worse issues.  A big (HUGE) push back is coming!

Fortunately, there are products out there that have been designed with thought of physician time, efficiency, and making clinical work easier.  Unlike some of the other products for EDs, UCs and clinics, a physician can work at a relaxed, but speedy pace without being overwhelmed by the screen.  Allowing for more time to see what is going on with the patient...

Tuesday, June 17, 2014

Why Fitness Matters to the "AARP" Crowd!

As one ages, it is obvious that the body suffers from acute on chronic inertia and soon deteriorates.  One of the leading causes of death is the "DREADED FALL".  The 'AARP' fall (anyone 50 or over) leads to multiple deaths and morbidity.  The CDC reports that each year, one in every three adults age 65 and older falls.  Falls can cause moderate to severe injuries, such as hip fractures and head traumas, and can increase the risk of early death.  One out of three older adults 65 and older falls each year, but less than half talk to their healthcare providers about it.  Among older adults, falls are the leading cause of both fatal and no-fatal injuries.  In 2010, 2.3 million non-fatal fall injuries among older adults were treated in emergency departments and more than 662,000 of these patients were hospitalized.  In 2010, the direct medical costs of fall, adjusted for inflation, was $30 billion.

It is imperative that one is not only concerned with their lipids, cholesterol, ad blood pressure, but their flexibility, mobility, balance, and strength.  Being a member of a health club with a high % of healthy seniors, it became apparent that regular fitness works.  The joke among our co-workers is that at work we are lean, mean fighting machines compared to everyone else, but at the health club we would be classified as overweight, out-of-shape, and a potential medical disaster.

The balance, flexibility go first that leads to a decrease in mobility ad strength.  Avoid 'face plants' - the act of landing face first as a result of an accident or error- by getting involved.

We recommend any continuous- life-long- exercise program that one likes, but it must include cardiovascular and strength/flexibility training.  Yoga, Pilates, personal training, TRX, group workouts, or any of the number of fitness plans work.  Do not be embarrassed y the inability to perform easy exercises in the beginning.  You will and can catch up- you will surprise yourself!

Monday, June 9, 2014

Is Coffee, Aspirin & a Statin the "Breakfast of Champions"?

The FDA (Federal Drug Administration) recently announced as a result of their ongoing disagreement with Bayer Aspirin over the prophylactic benefit of Aspirin to avoid heart attacks and strokes even if the patient has a positive family history of heart disease.  The recent FDA article, Can an Aspirin a Day Help Prevent a Heart Attack?, states "Since the 1990s, clinical data has shown that in people who have experienced a heart attack, stroke or who have a disease of the blood vessels in the heart, a daily low dose of aspirin can help prevent a reoccurrence, Temple says." (A dose ranges from the 80 milligrams (mg) in a low-dose tablet to the 325 mg in a regular strength tablet.  This use is known as secondary prevention.

However, after carefully examining scientific data from major studies, the FDA has concluded that the data does not support the use of aspirin as a preventive medication by people who have not had a heart attack, stroke or cardiovascular problems- a use that is called primary prevention.  In such people, the benefit has not been established but risks such as dangerous bleeding into the brain or stomach are still present.

The number needed to treat website ( concurs with this data.  In summary, Aspirin to Prevent Cardiovascular Disease in Patients with Known Heart Disease or Strokes, 98% saw no benefit.  0.3% were helped by preventing a fatal heart attack, 1.3% were helped by preventing a non-fatal heart attack and 0.5% in preventing a non-fatal stroke.  For those who took aspirin daily for a year, Aspirin to Prevent a First Heat Attack or Stroke, 99.94% saw no benefit, 0% helped by avoiding a fatal heart attack or stroke, 0.05% helped by preventing a non-fatal heart attack and 0.01 were helped by preventing a non-fatal stroke.

So then we have coffee- Coffee is bad for us or is it??  The Mayo clinic published a consumer article- Coffee and health:  Is coffee good or bad for me?, The recommendation is that Coffee has a long history of being blamed for many ills from stunting your growth to claims that it causes heart disease and cancer.  But recent research indicates that coffee may not be so bad after all. 

So which is it- good, bad, ugly??  The best answer may be that for most people the health benefits outweigh the risks.

In a prior blog, I analyzed the virtues of statins with the following data.  Statins Given for 5 Years for Heart Disease Prevention With Known Heart Disease, 96% saw no benefit, 1.2% helped being saved from death, 2.6% helped by preventing a repeat heart attack, 0.8% helped by preventing a stroke.  For patient with no known heart disease, Statin Drugs Given for 5 Years for Heart Disease Prevention, 98% saw no benefit, 0% were saved from death, 1.6% helped prevent a heart attack and 0.4% helped prevent a stroke.
The bottom line is that coffee in moderation is OK.   In the view that my daily aspirin makes me, "less creaky".   All these studies seem to change all the time with inconsistent results.  My non-scientific analysis allows me to continue my aspirin regimen without guilt.

Tuesday, June 3, 2014

Should Baby Boomers Retire Already?

Baby boomers are defined as people born during the demographic post-WW II baby boom between the years 1946 and 1964.  As a group, they were the wealthiest, most active, and most physically fit generation up to that time.  They were a generation that received peak levels of income, so they could reap the benefits of abundant levels of food, apparel, retirement programs, and sometimes even "midlife crisis" products. 

Being a member of that group, it is time to think of retirement and all of its trappings. 
When I was 50, my requirement for retirement was a Dow of 20,000, and S&P of 2,000, an end to supporting various universities, winning the lottery, and finally controlling my chronic disease of fixed monthly expenses. 

Time has changed these criteria, but even with a 20% net reduction in the value of the dollar since the "crash" I '08-'09, the stock market has recovered significantly.  This has given more people a chance to consider retirement despite the fear of "running out of money".

Of course, this is all monetary.  The real substance of the issue is within the word retire.  How can I re-tire, when I an not even tired, yet?  Other than finances, then, a more important question is "what am I going to do with myself"?  This is a real issue for hard-working type A personalities who daily have a large number of people under their beck and call.  Another facet of this issue is the concept, long purposed in many corporation, of mandatory retirement.  Have many of us worked alongside a long-time partner who is "slowing down" and whose apparent clinical productivity is not what it use to be?  What should happen to him, if he loves practicing medicine, and wants to work into his 70's?

Start thinking about this, when you are 50.  If your life expectancy is 80 or 90, you probably will have at lease 20 years of retirement. 

Retirement does not mean intellectual, spiritual, and physical death.  It should be viewed as an opportunity.  After all, there are many youths out there that world love to have your job!!  Give the "kids a chance".