Children and Dental Care

Children and Dental Care

As a new parent, it can sometimes be challenging to know if you’re doing it right! While there are an infinite number of decisions to be made, one that will impact your child’s life will be your selection of a pediatric dentist. In addition to asking for referrals from friends and family, you will want to find a dentist in Midwest City who is gentle and makes going to the dentist a fun, learning adventure!

No matter the age of your child, from toddler to teen, the beginning of a great smile begins with the first visit. A soothing and relaxed environment will put your child at ease. Oftentimes, pediatric dentists will offer fun themes or incentives for their young patients, from jungle motifs to treasure boxes to video games, for older kids. While these items shouldn’t be the most important aspect of your child’s dental care, they can certainly go a long way to making your child feel comfortable in his or her surroundings, and that always makes for a better dental appointment! Some pediatric dental offices offer a “kids zone” or a “no cavity club” or a “brushing bonus” to reward children for proper oral hygiene. Finding a “dental home” where your child feels content is often the first step on the path to your child’s lifetime of oral health care.

How can parents help young children maintain a healthy attitude about dental care? First, children will follow your lead. If you are apprehensive about going to the dentist, your child will be, too. No one is born being afraid of the dentist; it is an acquired fear that can be quashed early on in a child’s life. Next, helping a child to brush at least twice a day and help with routine flossing will help maintain a healthy mouth. Children as young as age 2 or 3 can begin to use toothpaste when brushing, as long as they’re supervised to avoid ingestion of large amounts of toothpaste.   Parents must work with children to teach good oral health habits. Tooth discoloration can also occur – sometimes caused from prolonged use of antibiotics or medications that contain a large amount of sugar. Parents should encourage children to brush after they take their medicine, particularly if the prescription will be long-term. Additionally, regular exams by a pediatric dentist are a critical part of maintaining your child’s oral health… but follow-up at home plays an equally important role.

So what is the difference between a regular dentist and a pediatric dentist? A pediatric dentist offers specialized services, just for children. A pediatric dentist is a medical specialist dedicated to the oral health of children from infancy through the teen-age years. These doctors have had special pediatric dental training, which allows him or her to provide the most up-to-date and thorough treatment for a wide variety of children’s dental problems. When searching for a dentist for your child, ask if they offer pediatric services such as restorative dentistry, as well as interceptive orthodontic treatments to help straighten your child’s smile before the actual braces phase. Because preventive dentistry helps avoid future dental problems, it’s important that the doctor regularly monitor the development of your child’s teeth. Building a relationship with your dental professional is key in assuring long term benefits for your child.

As a new parent, when do you start taking your child to the dentist? What are some of the possible problems your child can encounter? According to the American Dental Association, the recommendation is that a child’s first visit take place by his or her first birthday. It may vary from office to office, but generally, at the first visit, the dentist will conduct a modified exam while your baby sits on your lap. He or she will explain proper brushing and flossing techniques and answer any other questions you may have. Such visits can help in the early detection of potential problems, and help kids become accustomed to visiting the dentist so they’ll have less fear about going as they grow older. Many parents know they want to prevent cavities, but they don’t always know the best way to maintain their baby’s dental health. Proper dental care begins even before a baby’s first tooth appears. Running a damp washcloth over your baby’s gums following feedings can prevent buildup of damaging bacteria. Once your child has a few teeth showing, you can brush them with a soft child’s toothbrush. Putting a baby to sleep with a bottle in his or her mouth can harm the baby’s teeth, creating a condition known as bottle mouth. Severe cases result in cavities and the need to pull baby teeth. Care should be taken to avoid damage and to provide babies with the oral care necessary for overall health. Good oral hygiene and regular dental visits are the most important part of cavity prevention. Your child’s dental visits may include preventative treatments such as the application of fluoride and tooth sealants. Fluoride hardens the tooth enamel, helping to ward off the most common childhood oral disease – dental cavities. Keeping kids’ teeth healthy requires more than just daily brushing. During a routine well-child exam, you may be surprised to find the doctor examining your child’s teeth and asking you about your water supply. That’s because fluoride, a substance that’s found naturally in water, plays an important role in healthy tooth development and cavity prevention. Fluoride exists naturally in water sources and is derived from fluorine, the thirteenth most common element in the earth’s crust. It is well known that fluoride helps prevent and even reverse the early stages of tooth decay. If you have any questions fluoride, talk to your doctor for more information. In addition, as your child’s permanent teeth grow in, the dentist can help seal out decay by applying a sealant to the back teeth, where most chewing occurs. This protective coating keeps bacteria from settling in the hard-to-reach crevices of the molars. With regular dental visits and good oral health habits at home, your child will have the best chance to avoid cavities in the future.

Selecting the right pediatric dentist for your child can set the foundation for a lifetime of excellent oral health. Make sure to research your doctor and to find a dental home where you and your child feel welcome and comfortable. Your child’s beautiful smile will be worth it!

Why To Visit Dentist On A Regular Basis?

Why To Visit Dentist On A Regular Basis?

Just like you have to take care of your physical and mental health, it is important to take the dental health seriously. Teeth and gums are important parts which can help you in different ways. Whether it is chewing or smiling, beautiful and healthy teeth is always important. Hence, you need to look for one of the best dentists in Oklahoma City and visit him/her. Many people ask why it is essential to visit the dentist on a regular basis. There are many reasons behind visiting the dentist on a regular basis.

Benefits of visiting dentist regularly

Here are some of the benefits of visiting dentists on regular basis:

  1. Early detection of dental problems

You may not have signs or symptoms for diseases or dental problems. But if you are visiting your dentist regularly, you can be sure of detecting any issues. As soon as you visit the sedation dentist in Oklahoma City, he/she will examine your oral health first. So, it gets easier to diagnose or detect any dental issues such as cavities, oral cancer and gum diseases. The dentist will check for cavities, examine your gums and check for plaque.

  1. Better and beautiful smile

When you visit the dentist, he/she will perform all the regular cleaning processes. It is important to ensure that your teeth and gums are completely safe. Regular dental visit will help you to keep your teeth whiter and healthier which will make your smile better and beautiful. Also, this can increase your self-esteem and make you more confident.

  1. Prevents bad breathe

Another reason to visit the dentist regularly is to prevent bad breathe which can be caused due to poor oral hygiene, stuck food morsels and gum diseases. With regular checkups and professional teeth cleaning, you can prevent any kind of bacteria buildup. When the bacteria increases, you can have a bad breathe.

  1. Avoid teeth loss

Decaying of teeth or gum problems can lead to teeth loss. You need to be very careful about this problem. The decaying teeth problem or the gum problems can lead to several problems including loss of teeth. You can avoid this by simply visiting the dentist on a regular basis.

  1. Overall wellbeing

One thing that you may not know is that the oral health is linked to the overall health. Poor dental health can cause a lot of other health issues such as osteoporosis (fragile bones), heart diseases, cancer and diabetes. A professional experienced dentist can help you to have a healthier oral condition.

Last words

These are some of the reasons why you need to visit dentist in Oklahoma City. Maintaining a healthy dental condition is very important. It is not possible to keep your teeth in the right condition without proper care. Besides brushing and flossing regularly, it is also important to make sure that you are visiting the dentist regularly. It can help you to keep your dental problems away and keep your overall health perfect. You need to find an experience dentist and visit him/her once in every month.

Contact US:

Reflections Dental Care
Address: 10924 Hefner Pointe Dr ,Oklahoma City, OK
Phone: (405) 563-7097

Young Health Leaders Unite! | Alex Maiersperger & Antwan Williams, Advancement League

Young Health Leaders Unite! | Alex Maiersperger & Antwan Williams, Advancement League

BY JESSICA DAMASSA, WTF HEALTH

While the “healthcare ecosystem” sounds like a nice place to begin a career, the day-to-day can often make it feel like the industry is about survival of the fittest — especially for young professionals who are just starting out. Enter The Advancement League, an organization-slash-support-system for young leaders and entrepreneurs. Co-founders Alex Maiersperger and Antwan Williams started the organization as a way to unite bright-eyed, up-and-comers from health systems, health plans, and startups who not only want to build big careers in health, but who also want to apply their youthful optimism, new ideas, and tech to changing the experience of healthcare for the better. How can you get involved? Tune in for all the details about the organization’s events, especially their “big one,” the Young Health Leader’s Summit.

Filmed at HLTH 2019 in Las Vegas, October 2019.

Jessica DaMassa is the host of the WTF Health show & stars in Health in 2 Point 00 with Matthew HoltGet a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health.

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Revisiting the Concept of Burnout Skills

Revisiting the Concept of Burnout Skills

By HANS DUVEFELT, MD

I looked at a free book chapter from Harvard Businesses Review today and saw a striking graph illustrating what we’re up against in primary care today and I remembered a post I wrote eight years ago about burnout skills.

Some things we do, some challenges we overcome, energize us or even feed our souls because of how they resonate with our true selves. Think of mastering something like a challenging hobby. We feel how each success or step forward gives us more energy.

Other things we do are more like rescuing a situation that was starting to fall apart and making a heroic effort to set things right. That might feed our ego, but not really our soul, and it can exhaust us if we do this more than once in a very great while.

In medicine these days, we seem to do more rescuing difficult situations than mastering an art that inspires and rewards us: The very skills that make us good at our jobs can be the ones that make us burn out.

Doctors are so good at solving problems and handling emergencies that we often fall into a trap of doing more and more of that just because we are able to, even though it’s not always the right thing to do – even though it costs us energy and consumes a little bit of life force every time we do it. And it’s not always the case that we are asked to do this. We are pretty good at putting ourselves in such situations because of what we call our work ethic.

The Harvard Business Review piece listed four pitfalls and described two types of leaders, which in our case would be clinical leaders: Leader A and Leader B.

Dr. B is a walking recipe for burnout and Dr. A may be the one whose job feeds his soul, at least to some degree (you still have to like people and medicine):

These four pitfalls run through the minds and daily realities of primary care doctors constantly, I dare say:

Just do more: The future reimbursement model is said to be based on value, loosely speaking. But clinics’ quarterly cash flow is largely determined by patient volume. Doctors have patient quotas, and any quality related incentives or requirements are typically tacked on top of the productivity targets without much infrastructure or time set aside for figuring out how to reach those targets in any kind of systematic way.

Just do it now: We certainly are operating in a constant state of emergency to at least some degree. Particularly the addition of quality targets is done in a not very proactive fashion, but much more reactive, with short term “fixes” that tend to be disjointed, as if we are all trying to make improvements to a moving vehicle while also trying to keep an eye on the road.

Just do it myself: Oh, yes, we have all heard about every staff member practicing to the top of their license, but everyone seems so busy, so how many times a day do we think “It’ll take me longer to get this done if I delegate it to someone else, I’ll have to tell them I need this done, how to do it and then – will I trust that it actually got done?”

Just do it later: Sometimes now is the right time, and sometimes later is the right time. But who decides?Physicians tend to put what the HBR calls “value add” work on the back burner, because changing how we work requires detaching from the short sighted thinking of getting through the piecework of the day. We don’t take enough time to think about what we’re doing and why.

Burnout happens when you work hard without seeing real alignment between your efforts and your goals and values, if you get right down to it. I have read and written much lengthier definitions, but the graph in this article made me shorten mine.


Hans Duvefelt is a Swedish-born rural Family Physician in Maine. This post originally appeared on his blog, A Country Doctor Writes, here.

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Reference Manuals May Be Facing Obsolescence

Reference Manuals May Be Facing Obsolescence

We must ensure their relevance to contemporary patient care

By LONNY REISMAN, MD

It’s 1992 and disruptive technologies of the day are making headlines: AT&T releases the first color videophone; scientists start accessing the World Wide Web; Apple launches the PowerBook Duo.

In healthcare, with less fanfare, a Harvard physician named Dr. Burton “Bud” Rose converts his entire nephrology textbook onto a floppy disk, launching the clinical tool that would ultimately become UpToDate. Instead of flipping through voluminous medical reference texts, such as the Washington Manual, doctors could for the first time input keywords to find the clinical guidance they needed to make better treatment decisions.

The medical community embraced UpToDate’s unique ability to put knowledge at their fingertips. Today more than 1.7 million clinicians around the world use UpToDate to provide evidence-based patient care with confidence. For many, it along with other reference sources has become foundational to providing high quality medical care.

More than just an easy-to-use reference, UpToDate has gone on to improve patient outcomes, according to the Journal of Hospital Medicine.

In the new era of 21st century digital medicine, however, there are opportunities to go further in support of clinicians and patients. Reference tools must be powered by predictive and prescriptive analytics, be personalized to individual patient circumstances, and be integrated into clinician workflow. In some cases, clinicians may be unaware of which questions to ask of a computerized reference manual, or how to incorporate the nuances of an individual patient’s case into the general insights of a reference. Searching for heart failure treatment, for example, may be too broad a query and the resulting recommendations therefore may not provide optimal care for a specific patient’s unique medical circumstances. New digital health solutions that consider patients’ co-illnesses, contraindications, symptomatology, current treatment regimens, and hereditary risks are essential.

Additionally, the pace of change in medical science continues to accelerate, and with it, the proliferation of life-saving treatments and diagnosis. When I enrolled in med school in the 1970s, medical knowledge was doubling every seven years; now it’s closer to every two months. That makes it virtually impossible for clinicians to truly be informed regarding the latest studies and guidelines – therefore making it ever more challenging to effectively query medical reference materials.

This heightened pace of evidentiary change has exacerbated the historically slow diffusion of new medical knowledge into general practice, to the detriment of patients. As a member of the American College of Cardiology’s Science and Quality Committee, I spend countless hours each year reviewing the guidelines for cardiac care, knowing full well that it will be years before these new evidentiary approaches become adopted into mainstream practice.

We need 21st century solutions to support increasingly complex medical care. Just as we made the leap from paper to floppy disks to apps, we must now take advantage of recent developments in clinical AI to make another leap: this time to a dynamic and proactive approach to applying medical guidelines to individual patients.

Here’s how clinicians can bring the reference manual truly “UpToDate” for our modern medical times:

1. Personalize for Every Patient

Historically, clinical decision support tools have been used for universal, population level alerts or gaps in care based on simplistic quality measures that apply to all patients…smoking cessation, healthy diets, and exercise. With the advances in AI, nuanced medical guidelines can now follow each patient.

For example, clinical AI tools now exist that can interrogate a variety of patient data – such as electronic health records (EHRs), insurance claims, and patient-generated data – and drill down into clinical, genomic, social and behavioral factors to align patient care with the individualized guideline-directed treatment. This individualized approach ensures each patient receives optimal diagnostic and therapeutic care that is designed to improve outcomes.

2. Dynamically  and Proactively Deliver within Clinical Workflow

Today, most clinicians live their daily lives toggling between their EHR, reference apps like UpToDate and a myriad of other portals. Have a question about the best treatment for your patient with atrial fibrillation and a high bleeding risk? Open a reference app and you will find a multitude of articles to read which may not provide all pertinent information. For example, you may not know to search for “non-pharmacologic treatment” to find information on Left Atrial Appendage Closure (LAAC) device alternatives for a particular patient who is unsuitable for long-term oral anticoagulation. A clinician cannot know to query what they don’t know exists as an alternative for a patient.

Clinical AI tools can proactively deliver these patient-specific recommendations based on the latest medical guidelines directly within a clinician’s workflow, thereby eliminating the need to go searching for the optimal treatment for patients with complex medical needs.

 3. Apply the Guidelines for On-Demand Care

Clinical decision support tools have largely been limited to use at the point of visit, but traditionally offer little insight into recommended patient care outside the four walls of an office visit. Today’s technology can continually analyze new patient data, identify rising health risks,  and promote opportunities to provide optimal care. When lab results, new medications, EHR orders, or third-party data from wearable devices indicate an alteration in patient health status that warrants consideration of a guideline-directed diagnostic or treatment intervention, new guidance can be proactively sent to the clinician and patient – driving purposeful virtual or in-person engagement.

Digitized reference materials have come a long way, but clinicians and health systems today must evolve these capabilities to continually and efficiently apply the medical guidelines – the bedrock of medicine – for the patients they serve.

Dr. Lonny Reisman is the founder and CEO of HealthReveal, and former chief medical officer of Aetna

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Fertility Predicting Wearable Expanding into Birth Control, Menopause | Lea Von Bidder, Ava Science

Fertility Predicting Wearable Expanding into Birth Control, Menopause | Lea Von Bidder, Ava Science

BY JESSICA DAMASSA, WTF HEALTH

Ava Science is a FemTech company best-known for their fertility-predicting wearable device that collects biometric data from a woman’s wrist in order to track ovulation. The device predicts fertility with 89% accuracy (according to published clinical trial data) and is among one of the most well-funded FemTech startups out there, having raised a cumulative $47M. So what’s next? Lea von Bidder, Ava’s CEO, explains the data-driven vision for the company, which is currently one of the few medical device wearables that is approved for collecting digital biomarkers. The startup is eager to capitalize on that first-mover advantage in the women’s health space, and is looking at other ways to use their data. Lea talks through her plans for exploring a full-range of women’s health applications, from non-hormonal birth control to new products that might appeal to women during pregnancy or menopause.

Filmed at HLTH 2019 in Las Vegas, October 2019.

Jessica DaMassa is the host of the WTF Health show & stars in Health in 2 Point 00 with Matthew HoltGet a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health.

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Will Your Health Plan Tell You That It Can Save Your Life?

Will Your Health Plan Tell You That It Can Save Your Life?

By MICHAEL MILLENSON

At kitchen tables everywhere, ordinary Americans have been grappling with the arcane language of deductibles and co-pays as they’ve struggled to select a health insurance plan during “open enrollment” season.

Unfortunately, critical information that could literally spell the difference between life and death is conspicuously absent from the glossy brochures and eye-catching websites.

Which plan will arrange a consultation with top-tier oncologists if I’m diagnosed with a complex cancer? Which might alert my doctor that I urgently need heart bypass surgery? And which plan will tell me important information such as doctor-specific breast cancer screening rates?

According to Matt Eyles, president and chief executive officer of America’s Health Insurance Plans (AHIP), insurers over the last decade have made a “dramatic shift” to focus more on consumers.  That shift, however, has yet to include giving members the kind of detailed information available to corporate human resources managers and benefits consultants (one of my past jobs).

What’s at stake could be seen at a recent AHIP-sponsored meeting in Chicago on consumerism. Rajeev Ronaki, chief digital officer for Anthem, Inc., explained how the giant insurer is using artificial intelligence to predict a long list of medical conditions, including the need for heart bypass surgery. Information on individual patients is passed on to clinicians.

“The future of care delivery will see physicians, scientists and consumers alike empowered with the most accurate clinical information in real time,” Ronaki declared.

That may be the future, but it’s not the present for the one in eight Americans that Anthem serves today in its various plans, most affiliated with Blue Cross and Blue Shield. Anthem members have to rely on the limited information available in a new mobile app with the gender-vague name of “Sydney” that’s blandly touted as “smart” and “personal.”

As for obtaining a sophisticated cancer consult, an oncologist working with 2nd.MD, which contracts with the top 20 cancer centers in America for virtual consults, related how a man who was diagnosed with advanced cancer had a grim diagnosis offering perhaps a few months to live. But after the consultant, Dr. Charles Balch, directed him to an advanced cancer center, the man showed “an almost complete response” to immunotherapy, Balch said.

Do you know if your health plan offers that kind of service? Who would even think to ask before enrolling?

Meanwhile, as a consultant I’ve seen the detailed information about individual hospitals and doctors that’s available to some insurers. While a few plans do a good job of sharing meaningful data, most settle for limited information posted in a dusty corner of their website. 

Given health insurers’ negative image – in one national poll, just 16 percent of respondents believed insurers put people over profits –why don’t health plans highlight these kinds of valuable services? Here’s where consumerism confronts unpleasant realities.

Take cancer consults. While a world-class second opinion may save money in the long run, if everyone who thinks they’re a cancer risk joins your plan, that “adverse selection” among the enrolled population could boost medical expenses. 

When it comes to publicizing the use of algorithms to predict illness, the adverse selection problem is complicated by the additional issue of public trust. Even though early intervention can save money, will members believe that a company that gained national notoriety for denying claims for emergency room visits – as Anthem did – has their best interests at heart when it comes to their heart? Other plans have similar trust issues.

And speaking of trust, can members trust that their health plan will risk the ire of doctors and hospitals by publicizing usable data showing that some perform much better than others? 

The way to overcome these issues, I believe, is for powerful national employer groups such as the Federal Employees Health Benefit Program to demand detailed disclosures by health plans to consumers. That puts all plans on an equal footing. Plans should answer carefully defined questions in three areas: What will you do to keep me well? What information will you give me about doctors and hospitals? And what resources do you offer in case of serious illness?

It’s important that insurers’ pay members’ bills without bogus bureaucratic barriers. But it’s even more important to give prospective plan members full and complete information about services that might one day save their life.

Michael L. Millenson is president of Health Quality Advisors LLC and adjunct associate professor of medicine at Northwestern University Feinberg School of Medicine. This article originally appeared on Forbes here.

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Doctoring at Christmas

Doctoring at Christmas

By HANS DUVEFELT, MD

I find myself thinking about how being a doctor has come to impact the Christmas Holiday for me over the years. I have written about working late and driving home in the snow and dark of Christmas Eve in northern Maine; I have shuffled Osler’s written words into something that speaks to physicians of our times; I have written about the angst around the Holidays I see in my addiction recovery patients.

This year, my thoughts go to the way Christmas is a time of reconnection for many people. We reconnect with family and friends we may not see as often as we would like, and many of us reconnect with secular traditions dating back to our childhood. Many people also reconnect more deeply with their Christian traditions, the ancient celebration of Hanukkah or the newer one of Kwanzaa.

As a doctor, I think Christmas is a time when individuals are more open toward others, more willing to extend “good will toward men” (Luke 2:14). It can be an opener for future relationships to form or grow, a time to share our humanity in the context of experiencing something larger than ourselves and our everyday existence. It allows us to get a little more personal by sharing something of what we all have in common – the need for togetherness with those we love.

Many people in this country routinely say things like, “have a good weekend”. I’m not sure that is such a universal high point in life. For some, it is a time for dreaded chores, for others a time to muster enough energy for that second job to help pay the bills.

Christmas is a more universal time of feeling celebratory and unselfish, and for me it marks the passage of time as well as the consistency of it. It was my time of awe and delight when I was a child, and now it is that for my grandchildren. As Christmas week culminates in the New Year celebration, it also helps me think about what’s next – for me and everyone in my family.

During the coming weeks, I will make sure to share some of the joy and peace I feel in my own heart with my patients and I will be more than usually sensitive to signals of holiday blues or distress in them.

This is not a time to flaunt what we have – lavish presents, successful relatives, gourmet food, fancy decorations or invitations to fun parties. It is a time to share some simple human warmth in the darkness and bitter cold of the northern Maine winter in a time of divisiveness, strife and unrest.

It is a time of “peace, good will toward men”, of greater openness to others. It is a good time for reconciliation or rekindling of relationships we may have neglected since the last time we wished each other Merry Christmas.

Hans Duvefelt is a Swedish-born rural Family Physician in Maine. This post originally appeared on his blog, A Country Doctor Writes, here.

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The Intrusion of Big Tech into Healthcare Threatens Patients’ Rights

The Intrusion of Big Tech into Healthcare Threatens Patients’ Rights

By ANDREW DORSCH, MD

The question of how much time I spend in front of the screen has pestered me professionally and personally. 

A recent topic of conversation among parents at my children’s preschool has been how much screen time my toddlers’ brain can handle. It was spurred on by a study in JAMA Pediatrics that evaluated the association between screen time and brain structure in toddlers. The study reported that those children who spent more time with electronic devices had lower measures of organization in brain pathways involved in language and reading. 

As a neurologist, these findings worry me, for my children and for myself. I wonder if I’m changing the structure of my brain for the worse as a result of prolonged time spent in front of a computer completing medical documentation. I think that, without the move to electronic medical records, I might be in better stead — in more ways than one. Not only is using them potentially affecting my brain, they pose a danger to my patients, too, in that they threaten their privacy. 

As any practicing physician can tell you, electronic medical records represent a Pyrrhic victory of sorts. They present a tangible benefit in that medical documentation is now legible and information from different institutions can be obtained with the click of a button — compared to the method of decades past, in which a doctor hand-wrote notes in a paper chart — but there’s also a downside. 

For one, while they are supposed to maximize the efficiency of documentation,  the use of auto-filling “smart” phrases and other techniques designed to save time spent writing notes make them that much more difficult to read. Bloated notes contain limited nuggets of useful information buried within reams of data, where they serve as treasure troves for data miners but as barriers to efficient communication between medical providers.

Aside from the fact that any type of screen time can potentially degrade the structure of my brain, more time spent face-to-screen and less time face-to-face with the patient drains the medical encounter of its essential humanity. 

If anyone can disrupt a human connection, it’s the big tech companies. Last month Google announced a collaboration with the Ascension medical system, which operates hospitals across the country. In a blog post, Google stated that they would utilize their cloud computing and artificial intelligence expertise to develop tools that enable care providers to “more quickly and easily access relevant patient information.” 

This isn’t new; the announcement followed collaborations between Google and academic medical centers such as Stanford, UCSF, and the University of Chicago.

Leveraging the large patient populations of these institutions, Google has developed technologies that with intersect with patient care in ways ranging from the automatic recognition of words spoken during conversations in the doctor’s office to developing predictive models aimed at preventing unnecessary hospitalizations.These provide enticing solutions to the current drudgery of documentation.

But I am still hesitant to celebrate them. I’m already wary of big tech companies’ using and monitoring consumers’ private data and my concerns are only heightened by the entry of these businesses into the healthcare space.

The collaboration between Google and the University of Chicago, for example, is the focus of a lawsuit claiming that personal health information was shared without the express written consent of patients. Once companies like Google enter into the healthcare space, how do we know they will abide by the rules protecting the personal health information contained in medical records and, more importantly, who would know if they didn’t?

In an age where individuals can be identified from purportedly anonymous DNA samples and imaging algorithms have been used to identify individual faces reconstructed from routine MRI scans , Google’s being adjacent to — if not outrightly inside of   — my and my patients’ medical files requires more protections than the  Health Insurance Portability and Accountability Act (HIPAA) currently offers. 

Back in 1996 the framers of the seminal privacy law didn’t anticipate that people’s activity, financial, and search data would be stored alongside — perhaps even among — our medical diagnoses and symptoms. Questions regarding the provenance, permission, and permanence of the meta-data linking these types of information may not have even been conceived of as it would not have been thought possible that the technology would know us better than we know ourselves.

If HIPAA is insufficient to protect us, it’s probably easier to amend it than stop the steamroller that is big tech. For one, HIPAA should include explicit provisions about separating medical data from what is essentially marketing data. Google is here to make a sale. I’m here to save lives. 

Efforts to approach the documentation problem at its source by have been proposed by the Center for Medicare & Medicaid Services, which will implement new requirements for clinical encounters in 2021. While these changes will make electronic medical records easier to manage, it will not make them safer from invasion.  We need updated methods to protect all types of medical data and prevent the complete erosion of privacy that has already occurred with other online activities. 

Andrew Dorsch, MD, is an Assistant Professor in the Department of Neurological Sciences at Rush University Medical Center in Chicago and a Public Voices Fellow with The OpEd Project. 

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Getting Healthcare Providers Paid in Real-Time. FOR REAL. | Seth Cohen, Ooda Health

Getting Healthcare Providers Paid in Real-Time. FOR REAL. | Seth Cohen, Ooda Health

BY JESSICA DAMASSA, WTF HEALTH

Disruption of the healthcare payment model? We’re IN! Meet Ooda Health a two-year old startup that is working to change the way healthcare is paid for by changing WHEN it’s paid for: BEFORE the patient leaves the hospital or doctor’s office. How can we possibly live in a world without EOBs? We’re dying to find out. Seth Cohen, President & Co-Founder of Ooda Health, talks about the launch of the startup’s first service, Ooda Pay, which just went live with BCBS of Arizona, Blue Shield of California, and care provider, Common Spirit Health. How did it go? We may be closer to disrupting healthcare billing (and it’s paperwork and admin expense) than we thought.

Filmed at HLTH 2019 in Las Vegas, October 2019.

Jessica DaMassa is the host of the WTF Health show & stars in Health in 2 Point 00 with Matthew Holt.

Get a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health. 

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A System that Fails Migrant and Seasonal Agricultural Workers

A System that Fails Migrant and Seasonal Agricultural Workers
Connie Chan
Brooke Warren
Phuoc Le

By PHUOC LE, MD, CONNIE CHAN, and BROOKE WARREN

I recently took care of Rosaria[1], a cheerful 60-year-old woman who came in for chronic joint pain. She grew up in rural Mexico, but came to the US thirty years ago to work in the strawberry fields of California. After examining her, I recommended a few blood tests and x-rays as next steps. “Lo siento pero no voy a tener seguro hasta el primavera — Sorry but I won’t have insurance again until the Spring.” Rosaria, who is a seasonal farmworker, told me she only gets access to health care during the strawberry season. Her medical care will have to wait, and in the meantime, her joints continue to deteriorate.

Migrant and seasonal agricultural workers (MSAW) are people who work “temporarily or seasonally in farm fields, orchards, canneries, plant nurseries, fish/seafood packing plants, and more.”[2] MSAW are more than temporary laborers, though— they are individuals and families who have time and time again helped the US in its greatest time of need. During WWI, Congress passed the Immigration and Nationality Act of 1917[3] because of the extreme shortage of US workers. This allowed farmers to bring about 73,000 Mexican workers into the US. During WWII, the US once again called upon Mexican laborers to fill the vacancies in the US workforce under the Bracero Program in 1943. Over the 23 years the Bracero Program was in place, the US employed 4.6 million Mexican laborers. Despite the US being indebted to the Mexican laborers, who helped the economy from collapsing in the gravest of times, the US deported 400,000 Mexican immigrants and Mexican-American citizens during the Great Depression.

Image from the Bracero History Archive of braceros in California (1959).

Today, there are about who live and work throughout the US, providing crucial labor for the US economy. Unfortunately, as with other exploited minority communities, MSAW have had to withstand from the effects of structural determinants which have ultimately led to poor health outcomesIn fact, 11.4% of MSAW infants versus 8.9% of non-MSAW infants are found to have perinatal medical conditions. This means MSAW infants are almost 30x more likely to experience perinatal medical conditions.

At the forefront of these structural determinants that determine health and wellness is economic stability. The average annual income of MSAW is between $15,000 to $17,499 per person and $20,000 to $24,99 per family. Workers are not paid per hour like many temporary jobs. Instead, they are “… often paid by the bucket; in some states they earn as little as 40 cents for a bucket of tomatoes or sweet potatoes.”[4] To earn $50, farmworkers need to pick about two tons of produce.

How can we tell patients to make their health a first priority when they are doing painstaking work that does not allow them to attain enough economic stability to provide for themselves and their families?

Although their livelihoods are dependent on the cultivation of food, many farmworkers, ironically, are food insecure. The reality that 59% of Indigenous farmworkers in Ventura, CA who said they did not have enough food for their families should give us pause.

Mural created by the Salinas community depicting the impact of pesticides in children.

Another structural determinant of health is dangerous work conditionsFor example, pesticide drift exposure is hazardous for MSAW and their families. The relationship between exposure to pesticides on health outcomes in agricultural communities has been the focus of the Center for the Health Assessment of Mothers and Children of Salinas study, a longitudinal cohort study run by the UC Berkeley School of Public Health.[5]  The CHAMACOS found that “mothers who lived in close proximity to agricultural operations using the highest percentage of pesticides – the top 1 percent – had an 11 percent increased probability of preterm delivery and a 20 percent increased probability of having a low birthweight baby.”[6] The CHAMACOS study also found that living near farms is associated with respiratory problems in children. The youth who live in Salinas Valley’s agricultural community (a half-mile or less from pesticide application) have “…reduced lung function, more asthma-related symptoms, and higher asthma medication use…”[7] compared to unexposed children. This was found to be the direct result of organic farms using elemental sulfur to control fungal growth of crops and pests.[8]

Infographic of the MSAW health in 2017 from the NCFH.

Finally, access to healthcare is severely lacking for MSAW. . Twenty-two percent of farmworkers have an H2A visa (47% are unauthorized, 31% are US citizens)[9]Employers are not required to provide health insurance under the ACA for H2A because of their temporary status. The ACA only requires that employers let H2A recipients know of the health insurance options they can purchase themselves. California actually expanded federal Medicaid, allowing H2A workers who fall below 138% poverty level to qualify for Medicaid.

Many of these structural determinants impact MSAW patients well before they even step into the examination room. Even so, providers should assist in offering necessary care and advocacy for MSAW patients as well as make it a point to understand these structures in order to have context for conversations about care plans. Clinicians can help MSAW by supporting organizations like Farmworker Justice, Migrant Clinicians Network, and the National Center for Farmworker Health, Inc (NCFH) who work with, by, and for the MSAW community. Providers can join arms with organizations like these to advocate for migrant and seasonal agricultural workers who have been systematically oppressed by structural forces outside of their control. If we don’t, we will be jeopardizing the health of our patients, like Rosaria, whose health and livelihood are dependent on the current system that fails them.


[1] Name changed for patient confidentiality

[2] https://www.migrantclinician.org/issues/migrant-info/migrant.html

[3] Mexico was not included in migration restrictions that the Immigration and Nationality Act of 1917 set in place for Eastern European, Southern European, and Asian immigrants.

[4] https://saf-unite.org/content/united-states-farmworker-factsheet

[5] The cohort participants were primarily born into families of immigrant farmworkers.

[6] https://www.reuters.com/article/us-health-preemies-pesticides/moms-most-exposed-to-pesticides-more-likely-to-have-preterm-babies-idUSKCN1BN2YC

[7] https://www.futurity.org/elemental-sulfur-children-1515012/

[8] Although elemental sulfur is found in our everyday food, when inhaled, it is results in poor respiratory outcomes.

[9] An H2A Visa given by agricultural employers who anticipate a shortage of domestic workers to bring non-immigrant foreign workers to the US to perform agricultural labor or services of a temporary or seasonal nature


Internist, Pediatrician, and Associate Professor at UCSF, Dr. Le is also the co-founder of two health equity organizations, the HEAL Initiative and Arc Health.

Connie Chan and Brooke Warren are currently interns at Arc Health. Chan is an Economics and Public Health double major and graduate of UC Berkeley. Warren is a Native American Studies major and recent graduate of UC Davis.

This post originally appeared on Arc Health here.

The post A System that Fails Migrant and Seasonal Agricultural Workers appeared first on The Health Care Blog.