Healing Heat

Some of my most pleasant memories growing up in Japan were trundling across the street with my family to go to the neighborhood public bath or sento. That’s where many of learned to swim and the underwater trip from the 39° soaking tub to the 41° tub was an adventure. Later on our high school basketball coach would reward the team by walking to the nearby ofuroba where the team would soak away the soreness and then saunter back to the dorm wearing only yukatas with the steam rising into the frosty winter air. The spas and saunas in southern Germany rivaled the Japanese onsens for providing relaxing sweaty conversations with locals and vacationers.  Rounds of golf in Korea are completed with a hot soaking bath or you can go to the local Jjimjilbang to bathe. Around the world there are many countries that have a rich public bathing tradition and whenever I’ve been fortunate to travel have felt they play a very large role in promoting physical and psychological health.

Looking back I think there are two very important health promoting forces in play. First, and foremost, is the power of heat (whether dry or moist) in washing away or killing harmful disease promoting viruses and bacteria as well as reducing allergy causing antigens. Time spent in these cleansing environments reduce the chance of subsequent infections and allergies. Second, is the social health that improves when you shed your clothes and interact with other people. The baths, steams, saunas and spas taken with others is much healthier for the psyche than those taken alone. I’m convinced these two factors, when combined, boost the immunity, relax the mind and stave off diseases.

I wonder if there would be less obesity if every day we knew we were going to be spending time naked with our friends and neighbors? Maybe it is entirely anecdotal but it seems that in countries with a public bathing tradition people spend less time watching TV and more time in conversation with each other. This carries over to how they eat as well. It seemed we spent more time around the table communing instead of the table being a place to wolf down the food and leave to watch TV or do something else. It was a place to spend time and enjoy the food and the companionship.

As a physician I’ve been advocating to my patients with a variety of ailments to invest time in going to the local Y where there is an excellent steam room and sauna. Alternatively they should invest in steam generators and convert one of their showers to a steam shower. Unfortunately very few of them follow that advice and I see them all too often in the clinic with one physical or psychological problem after another. For the cost of many prescriptions they could be experiencing the healing power of heat and begin to enjoy life.

Testing Livewriter

Am beginning to see a trend where applications, even those that are competing share the same information.  This short blog is being written in the new Windows Live Writer and ostensibly will automatically post this to my Blogspot.com page and Windows Live Spaces.

I’m wondering how long it will be before this interaction translates into the healthcare electronic records?  Right now there are a number of Personal Health Records enabling individuals to enter and have access to their health data from anywhere.  The problem with most of these is that the data their doctor enters in their offices doesn’t automatically flow into their PHRs.  There are some organizations, like Cleveland Clinic, who have formed relationships with Google Health and Microsoft’s HealthVault  but most of us don’t go to Cleveland Clinic. We need to figure out how all EMRs being used in physician’s offices can be configured to automatically exchange data with each of the patients’ PHRs.

Recently gave a presentation about the importance of social media in health care.  We’re a ways away from social media tools being integrated into EMRs but blogging, twitter, Facebook and other social media tools are laying the groundwork for the interoperability that we’re all wanting.

Playing around with what’s available and waiting for the plug-in that will allow me as an individual physician using a integrated EMR from Cerner along with other 100+ physicians and a hospital to concentrate on what I’m doing and seamlessly update my patients’ PHRs.

Littman 3200 BT Stethoscope & Zargis Cardioscan - Is the PC the problem?

Am midway through testing the Littman 3200 BT Stethoscope and accompanying Zargis Cardioscan and StethAssist software. First, the scope and software do work as advertised.  User interface on the scope was relatively simple and didn't really require much training.  Similarly the software (both the StethAssist which ships with the stethoscope) and the $395 Cardioscan software do work reasonably well.  The problem is in the logistics.

Most of us physicians practice out of several exam rooms and usually are under significant time constraints.  In my clinic we have wireless desktop PC's with large 21" swivel monitors that are primarily for the patient to view along with the physician our digital records, radiologic images and patient information.  The EMR software (Cerner's PowerChart) is running on Citrix servers. Each of these devices is networked autologon device that is rigidly controlled for security purposes (limiting SD, BT local CD connections).

The Cardioscan software runs on a PC and after inputing the patient information and wirelessly connecting with the stethoscope guides the physician through the steps of collecting heart tones from the 4 standard chest locations (takes nearly 2 minutes to collect all of the information). When finished the softare analyzes the data and produces a graphical and sound output that highlights any murmurs that might be present.

So far so good. The problem is when I move from one exam room to another it's not easy to manage both the PC softare, the scope, the patient and the EMR that is collecting information at the point of care.  Installing the software on each of the exam room machines is possible but in our clinic that would entail loading it on 32 devices.  More limiting is that each of us with one of these stethoscopes would need to carry around the BT dongle and plugging it in to the networked devices would entail security changes that would compromise the network.  Right now we have to carry our own tablets or notebooks into the room along with the scope in order to use it effectively.  Even so, the logistics would quickly prevent the effective and timely use of this. The extra time would convert to lost appointments and revenue.

What's needed is for the software to reside on the scope itself allowing us to record a complete sequence.  The scope is able to record data but only short segments that can't be paired with specific locations for the Cardioscan software. Unfortunately the small user interface prevents a challenge.  What I'd really like to see is the Cardioscan software be published as an iPhone App.  This would allow us the flexibility and freedom to move quickly in the exam rooms, on the floor and other locations and collect heart tones needed for downstream analysis and documentation.

There's another problem.  The stethoscope costs around $400.  It ships with a virtually useless SethAssist software that does not provide any analytical tools and has very limited functionality.  Zargis then hits the user with another $400 for the more useful CardioScan software (and also nails you for $17 shipping and handling!).  Spending $800 for an 80% solution sticks in my craw as a primary care physician and especially for medical students and residents who would find this most useful.

Recommendations to Littman and Zargis: 

1. Make sure the BT is BT2 allowing pairing with multiple devices.
2. Enable the software to be easily installed on multiple devices.
3. Lower the price of the software with residents and PCPs in mind
4. Dump StethAssist and ship the system with CardioScan
5. Create an iPhone, Pre and other BT enabled device App and enable pairing of the scope to all of these smart phones

Oh, the same advice goes to Welch-Allyn who also manufacture digital otoscopes and ophthalmoscopes.  The problem to effective use is all in the logistics. It's not possible for a physician to control these devices AND click or manipulate an accompanying software on a PC or video screen in order to capture images to place in the EMR.  The controls have to be on the device and the connection has to be wireless to a very mobile device that can be carried on rounds, into many different exam rooms, nursing homes and wherever the patient being examined happens to be. 

It takes an comedian to make sense of the healthcare debate

Twitterworld has bounced Al Franken's interaction with the Tea Party confontists. I watched in fascination how deference, respect and acknowledgement of other's points of view (no matter how idiotic) carried the day.

The more I watch this video the more humbled I am and vow to spend more time listening to others, making sure that I don't insult them (either on purpose or inadvertently).

We need more leaders like Mr. Franken.