Electronic Records

Posted: March 26, 2012 in Electronic records Uncategorized

Electronic Records

An article in the New York Times business section on Tuesday, March 6th quotes a study done by the the National Center for Health Statistics which was published in the Journal of Health Affairs the day before which found that electronic medical records increased the cost of health care in the population studied. A significant portion of the cost was an increase in the use of expensive diagnostic x-ray studies. This finding contradicts the speculative projections from think tanks that the electronic record would save billions of health care dollars. Those projections for cost savings were the rationale behind the government’s mandate for implementation of the electronic records.

The article did not discuss the other problems with the electronic medical records:

1] doctors aand other providers using the electronic records commonly are slower and able to care for fewer patients in the same time period

2] the providers often appear to be more focused on the computer screen rather than on the patient

3] information may be present in the record but more difficult to find and more easily missed

4] today the electronic records from one institution may not communicate with another institution or with a doctor’s office or even within a single hospital as there are often multiple systems in different departments

5] the cost of the hardware and software required, which is likely to be outdated in the near future

6] the much greater potential for loss of privacy when your private health information is electronic, particularly when it can be accessible from the outside.

What is Board Certification in St. Louis

Posted: March 16, 2012 in Board Certified Plastic Surgeon Board Certified Plastic Surgery

“Board Certification”

House Bill 1622 has been introduced into the Missouri legislature in order to provide consumers with useful information regarding board certification. This is an important issue because many individuals do not understand the meaning of board certification for a physician and can be confused by the number of different names.

A license to practice medicine in a state is just that. It denotes that the minimal requirements have been met for a license. It does not attempt to represent the individual physician as having experience or training in any particular area. That function is provided primarily by the 24 specialty boards [and more subspecialty boards] that are members of the American Board of Medical Specialties [ABMS]. For example I am certified by the American Board of Plastic Surgery which is one of those 24 recognized boards.

Today you may see an advertisement for a cosmetic medical service that has only the name of the facility. This does not provide you with even an actual doctor’s name. If there is a name of a physician it may not include information regarding board certification, or it may state only “board certified” without naming the board, or it may give a name of an organization that may sound impressive but is not one of the 24 ABMS recognized boards. One can be a more informed consumer of health care if you know the name of the physician, whether he or she is board certified, and which ABMS recognized board has provided that certification. That is, if you are having a baby you may prefer to have care provided by a physician who is certified by the American Board of Obstetrics and Gynecology, rather than someone certified in some other specialty or not certified at all.

In the past one could reasonably rely upon the hospital to oversee this. That is the hospital has a duty to make sure that medical professionals working in their facility do have appropriate qualifications for the type of care that is being provided. To the extent that some procedures today may be performed within a doctor’s office, a medical spa, or an outpatient surgical center, there may not be anyone providing the same level of oversight over the physician. Similarly the operating room in every hospital is evaluated as part of the accreditation process for that hospital. People may assume that a procedure room in an office or medical spa is similarly accredited and has the same equipment available and meets the same standards, but this may not be true. One should not hesitate to ask about the accreditation of the facility when scheduling a procedure in any non-hospital location. Any professional who has done the work to obtain that accreditation for their facility won’t be insulted, instead they will be proud to tell you about it.

St. Louis Abdominoplasty Procedure In Combination with Other Surgery

Posted: March 9, 2012 in Abdominoplasty Procedure Board Certified Plastic Surgeon Tummy Tuck

Women often ask about having an abdominoplasty combined with another surgical procedure. This is appealing since there would be a single anesthetic, a single recovery period, and a single period off work rather than two. It is commonly done, particularly along with gynecological procedures such as hysterectomy. It requires the cooperation of the other surgeon and coordination in scheduling. The addition of abdominoplasty may make it easier for the other surgeon if they are performing an open procedure [not endoscopic] since they don’t have to limit the length of their incision or need to spend time closing the skin. There may be a medical reason not to combine the procedures in some cases, such as a history of deep venous thrombosis or if the other procedure has a significant risk of infection. Insurers typically require the operating room and anesthesia times to be clearly separated if there is a combination of a covered procedure with a cosmetic procedure, since they don’t want to pay for the cosmetic portion.

Please feel free to contact our office.

St. Louis Increase in Mastectomies

Posted: March 2, 2012 in Before and After Photos Board Certified Plastic Surgeon Breast Procedures Breast-Reconstruction Procedures

It has been reported that there is an increasing number of mastectomies being performed in the United States today. Some commentators appear to be attaching a negative slant to this trend. However there are multiple valid reasons behind this increase.

1] Compared to the not so distant past we now have the availability of genetic testing. This allows women who are found to have significant risk for the development of breast cancer to consider prophylactic mastectomy before they develop cancer or to have prophylactic mastectomy on the opposite side along with treatment for their breast cancer on the original side.

2] The advent of digital mammography and particularly MRI has greatly improved our ability to image the breast. There may be increased detection of a second primary cancer by MRI leading to a recommendation for mastectomy rather than lumpectomy.

3] The changes in the methods for both mastectomy and breast reconstruction produce better and more consistent cosmetic results than were available previously. In the appropriate candidate nipple-sparing mastectomy can leave a more natural appearing breast. Breast reconstruction can be performed more reliably and reproducibly than in the past. There is therefore less downside for mastectomy compared to the alternative treatments for breast cancer today.

4] Mastectomy for some women will eliminate the need for radiation therapy, or chemotherapy, or anti-estrogen medication for treatment of their breast cancer. This may be preferable for some women.
5] After undergoing x-rays and biopsy and treatment for breast cancer some women find it worrisome considering the future need for performing self-exam monthly and having mammograms and not knowing if another tumor may develop. They may more comfortable electing to undergo mastectomy instead..

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