Does Your Doctor Use an Electronic Health Record?

This week's New England Journal of Medicine publishes a health policy report about electronic health records (EHRs).  The article reviews the potential benefits of EHRs to patients and to physicians and laments that as of 2005 only about 23% of physicians used them. The reasons for the slow adoption of EHRs provide an instructive illustration of deep problems in our healthcare marketplace.  EHRs are exp...
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For Severe Sciatica, Back Surgery Can Be Considered Sooner

Sciatica is the common term for lower back pain that radiates down one leg.  It is a very frequent cause of missed work and disability.  Sciatica is almost always caused by a lumbar disk that has been pushed out of its normal location and is impinging on a nerve. The typical treatment for sciatica is anti-inflammatory pain medication and physical therapy.  Most patients recover entirely with this conservative therapy.  For those who continue to have pain, injections to numb the effected nerve f...
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Human Papilomavirus: The Latest Celebrity Pathogen

Recently human papilomavirus (HPV) has been making a lot of news.  The story involves big business, cancer, government policy, and sex.  I'm surprised HBO hasn't made a series about it. HPV is a sexually transmitted virus that causes genital warts, cervical cancer, and has recently been associated with oral cancers.  Merck recently released Gardasil, a vaccine that protects against the strains of HPV that cause most (but not all) of the cas...
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Chondrointin Doesn’t Help Arthritis Pain

I have many patients who swear by alternative therapies that are unproven or, worse, proven not to work.  How should I counsel them?  On the one hand, each individual is unique and it's possible that what applies to thousands of patients in a study shouldn't be generalized to the specific patient sitting in my office right now.  On the other hand, we all (I included) have a staggering capacity for self-delusion, and it's possible that my patient is just engaging in wishful thinking because he si...
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Computer Aided Mammography Interpretation Not Ready for Prime Time

Most of my patients know that I'm a big fan of technology.  From electronic medical records to viewing diagnostic images over the web, I love finding tools that help me take better care of patients.  A study in this week's New England Journal of Medicine is an important cautionary tale that reminds us that new technologies should always be tested rigorously. The study examined the use of a technology ca...
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