Link roundup

I’m going to start a periodic roundup of things from the internets that I’ve found interesting.  Typically this will flow from the twitter feed. Follow me there to get these as they happen! @ihaterashes

First one gets no comments from me, just sharing the news…. Overmedicating AL veterans at the VA http://blog.al.com/wire/2013/11/overmedicating_alabama_veteran.html

Nice discussion here about mistakes in medicine. We all make them, might as well learn from them.  “You can’t take them back, you can only pay them forward.” http://www.princegeorgecitizen.com/article/20131104/PRINCEGEORGE0101/311049990/-1/princegeorge0101/many-a-slip

So it turns out, things aren’t always what they seem.  It seems that, when analyzed, things that were labeled as one herb, actually contained something else.  My favorite finding:  echinacea supplements that contained ground up bitter weed, Parthenium hysterophorus, “an invasive plant found in India and Australia that has been linked to rashes, nausea and flatulence.”.nyti.ms/1azMdaO

Here’s a really cool webtool for use at the point of care.  ACP’s Smart Medicine.  Up To Date or Medscape-esque, with content from ACP, In the Clinic, and Guidelines.  Free for ACP members. 

Finally, a link inspired by our recent UAB Women in Medicine discussion.  You can in fact, “have it all.”  But realize that what “all” is changes with time, and achieving it all is a transient thing.  You can’t have it all, but you can have cake

Minimally Disruptive Medicine

So, this is a thing…

Also known as “Goldilocks” care, proponents of Minimally Disruptive Medicine aim to line up medical interventions with patient’s own goals, so as not to offer duplicate or confusing treatments.

we paradoxically add more and more to the work of being a patient when the patient is least able to manage that work.

There is a lot of discussion about the “workload” of being a patient with chronic illness, and the “capacity” to manage that workload.  We add to the workload with medicines, dietary restrictions,  multiple specialty visits. The capacity to deal with that is diminished by the illness itself so we paradoxically add more and more to the work of being a patient when the patient is least able to manage that work.

Minimally disruptive care tries to match workload and capacity. There are four principles at work (from BMJ 2009)

  • Establish the weight of burden: ideally with some set of tools or metrics that could help us define and follow this.
  • coordinate care: rather than reimbursement targeted to “one size fits all” HbA1c or LDL targets, actually use incentives to prioritize care and help patients navigate the health system
  • Acknowledge comorbidity in clinical evidence: develop guidelines that deal explicitly with managing multiple chronic conditions. Help us figure out what to prioritize for the typical veteran with DM, CAD, and COPD.
  • Prioritize from the patient perspective: the patient should be equally invested in which conditions to go after next, based on their own goals and the treatment burden. We do this already when we hold off on starting insulin (a treatment with a relatively high workload) and focus on blood pressure instead.

I came across this info via twitter and this you tube video (also below), and I like the concept. Some have called it Geriatrics for the Young, or Palliative care for those far from the end of life.   Read more here or here.

What do you think?