Should Patients Be Allowed to Record Doctors?

From Medpage Today:

… the ubiquity of smartphones raises an importunate question: should patients be able to record their doctors? The question raises legal, ethical, and practical considerations. Warning – I’m not a lawyer, so my quick answer on the legal components is, consult local legal counsel. Laws vary from state to state, and my experience and some formal legal study leaves me with the strong impression that privacy is just about the murkiest area of law. States are widely split on the legality of recordings: eleven require all parties to grant consent, while thirty-nine states plus the District of Columbia require only what’s called one-party consent.

Legalities aside, however, my longer, practical answer is … why the heck not? Especially if a patient asks for a doctor’s blessing first and it’s clear the patient’s intent is for her elucidation. To be sure, I can think of some arguments against allowing a patient to record a doctor at work, but stronger ones for it.

Farmers harder hit by opioid crisis than rest of rural U.S.: survey

From Reuters:

The opioid crisis in the United States is impacting farm and ranch families more acutely than their rural neighbors, according to a survey published by the American Farm Bureau Federation (AFBF) and the National Farmers Union on Thursday.

About three-quarters of farmers and ranchers surveyed said a family member, someone they know or they themselves have taken an illegal opioid or are dealing with addiction.

Unconscious Patient With ‘Do Not Resuscitate’ Tattoo Causes Ethical Conundrum at Hospital

From Gizmodo:

When an unresponsive patient arrived at a Florida hospital ER, the medical staff was taken aback upon discovering the words “DO NOT RESUSCITATE” tattooed onto the man’s chest—with the word “NOT” underlined and with his signature beneath it. Confused and alarmed, the medical staff chose to ignore the apparent DNR request—but not without alerting the hospital’s ethics team, who had a different take on the matter.

The doctor will see you now – but often not for long

From Reuters:

For half of the world’s population, primary care doctor visits last less than five minutes, researchers say.

Appointments range from 48 seconds in Bangladesh to 22.5 minutes in Sweden. In the U.S., meetings with doctors average about 20 minutes.

FDA approves first EKG reader for Apple Watch

From The Verge:

The FDA has approved the first medical device accessory for the Apple Watch, made by AliveCor, whose CEO is former Google+ boss Vic Gundotra. The accessory is AliveCor’s KardiaBand electrocardiogram (EKG) reader, a sensor that pairs with an app and can detect abnormal heart rhythm and atrial fibrillation (AFib). The user touches the sensor, which snaps into a slot on the watch’s band, to get an EKG reading in 30 seconds. The recording can then be sent to a doctor.

Using AI, the KardiaBand can predict and analyze someone’s heart rate based on data from both sick and healthy people, Bloomberg notes. “It doesn’t apply a generic range — instead, it determines what’s abnormal for you.” A device like this could play an important role in quickly diagnosing abnormalities and then alerting health-care professionals to life-threatening situations.

Patient satisfaction plummets when doctors say ‘no’ to requests

From Reuters:

Patients may become less satisfied with their care when doctors refuse their requests for things like prescriptions or lab tests, a U.S. study suggests.

Researchers examined data on 1,141 patients with a total of 1,319 doctor visits. Overall, about two-thirds of these visits included at least one patient request for the doctor to provide a particular specialist referral, lab test, pain drug or other prescription medication.

Doctors fulfilled these requests 85% of the time, the study found. When doctors didn’t acquiesce, however, patient satisfaction scores in surveys after the visits were dramatically lower than when requests were fulfilled.

New algorithm can help predict patients’ end-of-life care

From Axios:

The system analyzes a patient’s health records in comparison to data from about 2 million other patients collected over nearly 20 years and then makes a prediction about the patient’s mortality. It also produces a report explaining how the patient’s prescribed medications, their length of hospitalization and the severity of their illness were weighed by the AI in reaching its recommendation. The algorithm is being used in a pilot program at a university hospital.

Is It Time for a New Medical Specialty? The Medical Virtualist

From JAMA (Hat Tip: John Holstein):

We propose the concept of a new specialty representing the medical virtualist. This term could be used to describe physicians who will spend the majority or all of their time caring for patients using a virtual medium. A professional consensus will be needed on a set of core competencies to be further developed over time.

Edible Marijuana Products Pose Risks to Children, Annals of Emergency Medicine Study Finds

Press Release:

As states update marijuana regulations, emergency physicians should be mindful of the likely increase in visits to the emergency room (ER), particularly for children who accidentally ingest edible marijuana or related products, according to a new study in Annals of Emergency MedicineCannabis Intoxication Case Series: The Dangers of Edibles Containing Tetrahydrocannabinol.

Many edible candies or baked products containing tetrahydrocannabinol (THC) look like familiar commercially available products. For example, children are known to inadvertently eat gummies, because they look and taste just like popular candies.

“Children – and even some adults – can have trouble differentiating between candy and marijuana-infused edibles,” said Kathy T. Vo, MD, Assistant Professor of Emergency Medicine at the University of California San Francisco and lead study author. “Child-resistant packaging requirements are getting stronger in some states, but the close resemblance to familiar candies still poses significant risk to children.”

The nonspecific signs of THC intoxication in children, coupled with the potential reluctance of family members to disclose the possibility of marijuana exposure, make it a difficult diagnosis for emergency physicians, the study says. Immunoassays, or drug tests, for THC in children showing signs of intoxication can save time and money in the emergency room —if the results are available in a timely manner.

“Signs and symptoms of THC intoxication can be very similar to other common conditions,” said Dr. Vo. “Emergency physicians should consider ordering tests for THC in pediatric patients with probable cause. This simple step could mean fewer diagnostic tests, enabling faster and more accurate diagnosis and treatment.”

The study findings include analysis from a case series in which children were unintentionally fed THC-infused candy at a birthday party, resulting in 21 pediatric and adult patients treated at six San Francisco hospitals. For adults, high doses of cannabis can be associated with paranoia, reduced motor function and other symptoms. Less is known about the acute effects of THC on children, according to the study. In the cases analyzed, a majority of pediatric patients showed abnormal vision, dizziness and lethargy. Other symptoms included rapid heart rate, abnormally rapid breathing or hypertension.

In one case, gummy candies were sent to a lab and found to contain THC but the results were not available to the physicians during clinical assessment. In other instances, children were admitted to the hospital for observation but THC levels were not confirmed until after discharge.

“The market for edible marijuana products is expanding. More public education about the potential hazards of these products could save a child a trip to the ER,” said Vo.

Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, the national medical society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information, visit www.acep.org.

I spent my first year as a doctor in a rural ER. It was the most exciting job I ever had

From Toronto Life:

My first gig as a full-fledged doctor was in 2002 at a rural hospital in Markdale, Ontario, a town on Highway 10 south of Owen Sound, with a lone set of traffic lights and a population smaller than your average Toronto high school. From the outside, the hospital looked like a garage. The emergency room had two trauma bays, four treatment rooms and one doctor. Me. When I first toured the place, I asked how to activate a Code Blue, should someone be in dire straits. “Just say it in your head and grab the closest nurse,” the chief told me. “You’re the Code Blue team.”

The first few months, I’d wake with a sense of dread—that maybe this was the day that something bad would happen. A head-on car accident. A backyard drowning. There were so many things I hadn’t seen, so many things I wasn’t prepared to deal with. The chief tried to reassure me: “The stuff you’re worried about comes around once in a blue moon. Just do your best.”