EMR(electronic medical record)=Medical texting while "driving"

It is clearly evident that the push for EMR(electronic medical records)continues. The national healthcare community fueled by goverment incentives continues to drive this trend. We are enamored by this technology whether we like it or not. As I walk down the corridors of a major New Jersey medical center, I cannot help but notice rows of medical professionals transfixed to computer screens as if they were seduced by the data before them. It consumes their attention. The patients are awaiting to be seen or have recently been evaluated. The professionals peruse the data and robotically configure the information into a medical "note". We cannot deny that this is a laborious process even for the most adept typists. I often thank God that I paid attention in Ms. McGillicutty's high school typing class not knowing then how important this skill would prove to be at this stage in my career! In all seriousness, I can reasonably understand the rationale and motivation to adopt this technology. The consolidation of data would certainly avoid the duplication of unnecessary services which could have astronomical savings in the context of an exorbitant and escalating national healthcare bill. But, let us not forget, first and foremost, the PATIENT. The number of hours in the day is unchanged and the additional computer tasks certainly extracts time from the traditional doctor-patient encounter. Futhermore, It's unfortunate that many physicians have resigned themselves to enter data using computer tablets during the patient encounter and avoiding any direct eye contact with the patient. It's very easy for the patient to feel distant and ignored from such an encounter leading to further erosion of the doctor-patient relationship. There was a time not too long ago when texting while driving was not regarded as hazardous. That was soon to change and the penalties are currently steep for those committing this act. For that matter, any distraction while driving is dangerous. EMR, can easily be equated to medical texting while "driving". While not recognized now, it may not be very long before we realize the detrimental effects on the quality of patient care and the doctor-patient relationship. Only time will tell whether this technology has irreparable damages.

Study questions value of prostate cancer surgery

Today's New York Times article about the PIVOT study(Prostate Cancer Intervention Versus Observation Trial)presents important data and once again reiterates the role of watchful waiting in early prostate cancer. The role of PSA testing and intense counseling of early newly diagnosed prostate is of the utmost importance. The need for surgical management needs to be individualized.

ZYTIGA(abiraterone acetate)

An exciting new oral agent has recently become available to treat patients with metastatic castration-resistant prostate cancer (mCRPC) who have received prior chemotherapy containing docetaxel.

Abiraterone is an androgen biosynthesis inhibitor which acts at 3 sources of testosterone production: the testes, adrenal glands and prostate tumor tissue.

Hopefully, the indications for this once daily 250mg tablet will be expanded to include other patients who never received chemotherapy.

We're moving

We are looking forward to moving our office just 1 mile down Northfield to the Atkin's Building at 1500 Pleasant Valley Way in West Orange. The office will be ready for occupancy in early 2012!!

IMMUNOTHERAPY for prostate cancer

A number of articles in the NYT and WSJ have addressed the treatment of prostate cancer using immunotherapy. Provenge (Dendreon Corp) has recently received the most publicity particularly in reference to Medicare's decision to cover this costly drug.


How does immunotherapy work?

Certain immune cells are collected from a patient's blood in a procedure known as leukapheresis. The immune cells are processed to combine with a protein found in most prostate cancers and another compound that stimulates the immune system to make Provenge. When given intravenously, the drug is believed to activate other immune cells to see the cancer as a threat and attack it.

Several companies are exploring this modality for the treatment of other solid tumors. More to come.

AVODART warning

As with Proscar (finasteride), new warnings have been released regarding the incidence of high grade prostate cancers in men taking Avodart and the combination drug Jalyn (avodart +flomax). The incidence is 1% with avodart versus placebo of 0.5%. This data was presented in the 4 year REDUCE (reduction by dutasteride of prostate cancer events study). The data for for proscar was slightly higher at 1.8% versus placebo of 1.1%).

Therefore, close monitoring of PSA is important in this group of patients taking Avodart as well as Proscar in those patients who require these medications for the treatment of symptomatic benign prostatic hyperplasia (BPH).

DIET, HEALTH AND FITNESS

I was saddened to hear of the death of Jack LaLanne at the age of 96. I vividly remember his black and white television shows during my childhood. Although, he was fanatical and regimental in his daily exercise routines and obviously had a good genetic make-up, there is a lot to learn from his habits. In his obituary in the New York Times 1/24/2011, he outlined his eating habits..."he ate two meals a day and shunned snacks. Breakfast, following his morning workout, usually included several hard-boiled egg whites, a cup of broth, oatmeal with soy milk and seasonal fruit. For dinner he took his wife, Elaine, to restaurants that knew what he wanted: a salad with raw vegetables and egg whites along with fish-often salmon-and a mixture of red and white wine. He sometimes allowed himself a roast turkey sandwich, but never a cup of coffee." He was definitely a forward thinker way ahead of his time.
He would famously like to say. "I can't die, it would ruin my image."
He was a true icon.