Saturday, October 31, 2009

Data Storage Laws and Electronic Medical Records

Rules surrounding data storage are becoming more and more important as we become a more digital society. The BBC reports that Microsoft senior vice-president Brad Smith is calling for international trade laws around data storage.

Apparently different countries have different rules around how long data must be stored and when it must be destroyed. This can become a confusing issue to navigate for companies offering data storage to an international market. Should they follow the data storage laws of the country that the consumer inputted the data from or the country the data is being stored in?

Rules around data storage also complicate electronic medical records, which some hail as the next technological revolution in medicine. Medical data is completely confidential, so many would argue the idea of storing the data outside of the country is preposterous. This takes away the complexity of having two sets of laws around the storage of the data; however, it means that we cannot take advantage of cheaper rent and maintenance fees found by establishing data centers in foreign countries. Keep in mind that having these data centers within our borders does not really make the data more secure. Hacking only requires accessibility and if the data center is connected to any kind of network on the internet, its physical location has no influence on its security. So does it really make sense to demand that medical data is stored within the country?

Considering laws regarding how long medical data must be stored, we currently have rules around how long paper medical charts must be held by a physician. Would these rules be the same if/when we move to digital records? Digital records are much easier to manage than their paper counterparts, so it may make sense to store them indefinitely, or at least for a longer period of time. This would certainly be of added benefit in research. We could learn a great deal if we had over 40 years of patient data to study. Of course, this is only true if researchers gain patient consent to view the data.

As data storage becomes a more frequent point of discussion in politics, I think we will see health officials begin to weigh in on data storage policy, at least with regards to how data storage affects health care.

Tuesday, October 27, 2009

Patient Trust

Nanos Research reports that physicians are the most trusted professionals by Canadians. 77% of respondents considered medical doctors' standards of ethics and honesty to be "high" or "very high". These results aren't terribly surprising considering physicians know they must carry themselves in a manner that elicits trust. After all, they ask you very personal questions, make you to strip naked for examinations, and occasionally anaesthetise you before cutting you open and placing instruments inside your body. If they didn't have your trust, they would be unemployed.

What does constantly surprise me is how much trust patients have in me, a medical student. When I first started seeing patients last year, I assumed most of them would be unwilling to see me and tell me that they came in to talk to an actual doctor. This never happened, not once, patients were more than happy to talk to me. In fact, most of them were happy to play a part in training the next generation of physicians (which I and all my classmates are of course grateful for). Of course, in the beginning all I did was perform a medical interview, but still, these patients were willing to answer personal questions asked by a complete stranger with less than two months of training.

Now in second year, I have a better understanding of how to perform a medical interview and several clinical exams (read: "I can actually do stuff"); yet, this year has been even more astonishing than the last. A few months ago, a family allowed me to examine their seven day old daughter. They let me place a giant microphone to her chest (also called a stethoscope), shine a bright light into her eyes (looking for the red reflex), palpate her head (feeling for fontanelles), and feel her abdomen for any abnormalities. These parents didn't know me, but because I'm a physician (in training) they trusted me with their new child.

That's a lot of responsibility. I better go study...

Saturday, October 10, 2009

Nanomedicine Begins Changing the Face of Medicine

"Sir, you have glioblastoma multiforme, a brain cancer with a very poor prognosis. Normally your chance of survival would be very low..."


"Don't worry, we're sending in the robots*..."

Nanomedicine is the use of nano (meaning very very small) technology in health care. Nanomedicine is an exciting new field that will probably change management options for a wide array of diseases. Of course, I say this as an electrical engineering graduate, who worked at Microsoft, and is now in med my passion for the topic may not be representative of the general feeling in the medical community. However, I recently came across two articles that show how nanotechnology is truly moving medicine forward.

First, an article recently published in h+ discusses a recent study demonstrating nanotechnology fighting brain cancer. This nanotechnology seems to be far more effective than chemotherapy and radiation therapy, and safer than surgery, which are the current treatment options. Nanoparticles were used to target cancerous cells. Once they were bound to the cancerous cells, a light beam activated them and made them toxic, kill the attached cell. These nanoparticles can clear 80% of a brain tumour in 5 minutes!

Second, not only can nanotechnology fight existing cancer, but it is being used to detect cancers earlier than current technology allows. Detecting cancer early makes treatment more effective and reduces those cancer related complications we all hate, like death.

Nanotechnology has amazing potential to increase patients' quality of life and reduce their disease burdens. In an attempt to emulate Nostradamus, I predict that there will be a vast array of new developments within nanomedicine in the next 5 years and after that we will start seeing the use of nanotechnology as a common option in every physician's medical toolbox.

Saturday, October 3, 2009

Emergency Rooms and Sick Children, Not a Waste of Time

The Vancouver Sun has an article wherein ER doctors can be found encouraging patients to come in with their children if they have even the smallest concerns about their childrens' health. I found this surprising because many of the ER doc bloggers are constantly complaining about parents who come in with their children who have nothing worse than a bad cough.

I wonder if the physicians in the article meant what they said or if it was the only statement they could make considering it really wouldn't be acceptable to say "stop wasting our time with your kids' runny noses". The difference in opinion could also be attributed to a difference in Canadian ER docs from American ER docs (who are certainly more avid bloggers), or perhaps a different opinion coming from this ER doc who is in a quieter hospital than most metropolitan ER docs.

Thursday, October 1, 2009

Reminder: Low Volume vs. Low Osmolality

When the kidney is faced with low intravascular volume and low serum osmolality, low volume wins, ADH is released.

The kidney plays a key role in regulating intravascular fluid volume and osmolality. When volume is low, water is preserved and ADH is released. When osmolality is low, ADH is not released. However if volume AND osmolality is low, volume is considered more important and ADH is released.

Reminder: What are Reminders

Posts titled "Reminder:" are made to help me remember specific medical information that I think is important, but I keep forgetting. I'm putting these up on my blog because I figure if I forget them, other med students will too. The info may be of interest to lay readers too; however, these posts aren't meant to teach anything, so the details will not be explained.