Sean Khozin, MD, MPH

The Journal of the American Medical Association (JAMA) recently published a case about a 66 year-old man with heart disease and an enlarging abdominal aortic aneurysm (AAA). Once these aneurysms grow beyond a certain size, they may rupture and place one at the risk of bleeding to death. What I found unique about this case was not the story about the AAA but the patient’s own account of his situation, published in the same article. As the physicians taking care of this patient closely monitored the size of the AAA and aggressively managed his heart disease risk factors, the patient gradually came to accept his disease as a reality of life:

I was first diagnosed with my aneurysm about 4 or 5 years ago. My doctors found it accidentally when they were looking for problems with my esophagus. After the tests, my doctor called me and said, “I need to see you . . . now.” So I went in and she told me about the aneurysm and I went, “Oh,” feeling as if there wasn’t much else to say. I backed up, relaxed a little bit, and tried to grasp what was going on. She referred me to a cardiovascular specialist who follows me. We’ve been following the aneurysm now for about 4 years. I see my cardiovascular surgeon about every 6 months and so far it hasn’t gotten big enough for me to worry about.

I know the aneurysm can break or rupture and have dire consequences. It took about a year to let that information settle. But when it did, I realized that we have winter too, and I don’t like it either.

I came to terms with my aneurysm on an intellectual basis. There’s nothing I or anybody else can do. At some point I’m going to die, so all I can do is enjoy what I’ve got. I can’t spend my life worrying about an inevitability. That’s a waste of my time and a misdirection of my efforts.

An interesting study recently published in the Journal of Pediatrics shows that sending text message reminders may be an effective way to make young liver transplant recipients take their immunosuppressive medications regularly and on time. This was a small one-year study of 41 patients with a median age of 15.  The study investigators saw a significant improvement in medication compliance after a year of sending regular text messages to patients or their caregivers. They measured adherence to tacrolimus (Prograf) and/or sirolimus (Rapamune).

The increase in adherence to medications was followed by a drop in the number of “histologically proven acute cellular rejection episodes,” from 12 in the year before the study to two after one year of receiving the reminders.

Small study but I’ve also noticed a trend towards better compliance in my patients using secure email, instant messaging, and video chat to communicate with them between–and in appropriate cases instead of–office visits.

Last year I was introduced to Nancy Pando, the producer of a new documentary that is taking a bold look at the frustrations of practicing physicians in the country:

Being a physician today carries a complexity and responsibility, known only to those whom are expected to tend to the ills of society. But when doctors are suffering themselves – who really cares? We are all patients and come the day that we allow for money to supersede humanity, we all become collateral damage. Crash Cart Productions.

The documentary is being pre-screened for one day in NYC::

Sunday, October 25th at 4:10PM

Village East Cinema
181 2nd Avenue at 12th Street Manhattan, New York

I’m looking forward to seeing the documentary. It’s certainly a timely topic. Let’s hope that the hippocratic oath is not really vanishing.

Left to Right: Sean Khozin, MD, MPH (i.e, me), Roni Zeiger, MD (Google Health), and Ted Eytan, MD (Kaiser Permanente) at the Health 2.0 Conference

I’m happy to announce that Google Health now has full integration with our platform. Google recently announced the news on their official blog. Now my patients can seamlessly and securely exchange their health information with Google Health and the Hello Health platform.

This is the “3 eyes” of practical health IT design in action.

This year’s Nobel Prize in Physiology or Medicine is awarded to three scientists for their work on how chromosomes can be copied in a complete way during cell divisions and how they are protected against degradation.

The 2009 Nobel Prize in Physics goes to three scientists who have had important roles in shaping  modern information technology.

Each 2009 Nobel Prize will amount to 10 million Swedish kronor (~ $1,438,493), with the sum of the Nobel Prizes (Physics, Chemistry, Physiology/Medicine, Literature and Peace) totaling 50 million Swedish kronor (~ $7,192,465).

Source: http://nobelprize.org/index.html

Lots of new and exciting features implemented and many more to come…

On Monday, doctors from around the country will join the President at the White House to show their support for passing health insurance reform legislation this year. These doctors were invited for many reasons: Many are leaders in their communities. Others belong to one of the many physician organizations in this country. All are supporters of health insurance reform. Senior administration official: “We are reaching the end of the Senate Finance Committee process in Washington, so now is a good time to bring the discussion back to Americans who are struggling with rising costs and growing insecurity in the health insurance market in their home towns. Their local doctors see these struggles every day and know more than anyone how cruel and arbitrary the health care system can be. Doctors all around America believe that we need health insurance reform this year. They agree with the President that inaction is not an option, and they are offering their help and support.” Politico

We all know we need health insurance reform but is what the administration proposing the best way to go?

Last month, I talked to three European journalists about the healthcare system in the U.S. and opportunities to improve the care delivery system through a combination of  bottom-up innovation and top-down reform. Above is an article that appeared in an Italian magazine a couple of days ago, outlining the debate on healthcare reform in the U.S. and my thoughts on the issue.

Despite the fact that we spend more per capita on healthcare services, the problems that we have are very similar to those encountered in Europe. We’re all facing a growing demand for healthcare services due to an aging population that continues to acquire more complex, mostly age- and lifestyle-related, diseases.