A*******s
发帖数: 9638 | 1 A lot of great points but do you agree all?
I disagree that benzo is unnecessory for delium with dementia. It really
depends.
http://capsules.kaiserhealthnews.org/index.php/2013/02/doctor-g
Don’t use feeding tubes in patients with advanced dementia. Simply
assisting such patients to take food by mouth is better.
Don’t perform EEGs (electroencephalography) on patients with recurrent
headaches. It doesn’t improve diagnosis or outcomes and simply increases
costs.
Don’t perform routine annual Pap tests in women between 30 and 65. Every
three years is enough.
Don’t hold back on providing hospice care to relieve pain and distress just
because a seriously ill patient is getting treatment aimed at alleviating
disease.
Don’t leave an implantable defibrillator turned on if a patient with
incurable disease, or his family decision-makers, have elected to forego
resuscitation. Currently there are no formal policies on this issue, and
implantable defibrillators often fire in the weeks preceding death, causing
pain and distress to dying patients and their families.
Don’t use cough and cold medicines in children under four suffering from
respiratory illness. They offer little benefit, can have serious side
effects and risk accidental overdose.
Don’t do repeat bone scans for osteoporosis more often than every two years
. Healthy women over 67 with normal bone mass can go up to 10 years without
a repeat bone scan.
Don’t prescribe benzodiazepines, such as Valium, or sedatives and sleep
aids to older adults with insomnia, agitation or delirium. They can more
than double the risk of motor vehicle accidents, falls, hip fractures and
death.
Don’t screen patients routinely for vitamin D deficiency. Over the counter
supplements without laboratory testing is sufficient for most otherwise
healthy patients.
Don’t screen for cancer in healthy individuals using CT or PET scans. The
likelihood of finding cancer is around 1 percent, and the scans are likely
to identify harmless findings leading to more tests, biopsies or needless
surgery. | A*******s
发帖数: 9638 | 2 我贴这个帖子是让大家知道， 现在kaiser等等医疗机构开始对医生进行行政指导，这
些指导上了媒体就是大众准则，病人就依赖这些对医生进行监督。 pap smear是年检，
现在说3年一次，做早了就是unnecessory。 所以大家要知道这些媒体的宣传，否则搞
不好就会背上不良医生的恶名。
做不做检查应该是医生的判断，比方说小孩外伤后头疼，这个疼的程度不见得跟病情成
正比，所以如果医生认为必要，即使轻微的头疼也得做CT， 相反，如果没有其他指征
，头疼重一点也不必做CT. | S******9
发帖数: 2837 | | a*********d
发帖数: 2763 | 4 be careful. this is kaiser stuff, their whole purpose it to save money, they
hope you don't order anything so they can make the insurance membership
money.
checking vitamin D is important since most patients we are seeing are at
risk (elderly, DM, overweight, etc)
osteoporosis screening has clear guidelines,not as simple as they list here. |
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