Should peripheral IV sites be changed routinely? NO

Peripheral IV sites are changed routinely every 3 days in at least one of the hospitals where I practice. The results of the 2013 Update of a 2010 Cochrane review comparing clinically indicated change versus routine replacement of peripheral venoous catheter sites continue to challenge this practice. There was no  statistical difference in rates of suspected catheter-related bloodstream infections between the two methods of replacement. Neither was there a difference in phlebitis rates. In their conclusions, the authors recommend that peripheral venous sites be inspected every shift and changed only if there is one of the following signs: inflammation, infiltration or blockage.

http://www.ncbi.nlm.nih.gov/pubmed/23633346?dopt=Abstract

Re-imagining geriatrics: an interesting geriatric care model

I like this geriatrician's model for delivering geriatric care. It sounds like a win-win for her and her patients. I wonder how this could be adapted to the Philippine setting.

http://www.over65.thehastingscenter.org/reimagining-geriatrics/

Who are more handsome - surgeons or internists?

In Barcelona, surgeons are taller and more handsome than internists. The 6-year old journal article was brought to my attention reading another physician's blog. Here is the link:

http://www.bmj.com/content/333/7582/1291

Change in Clinic Schedule

Clinic days in Santiago are re-schedule from 5- and 7-October to 28- and 30-Sep. Please make a note of this. Thanks!

Time off for the doctor: is it good for patients?

     "Do you have clinics on Saturdays?" one of my patients asked me today. "No," I replied. "The company told me you had Saturday clinics," she countered. I had to explain to her that I did quite a few years back.

     This conversation made me think about why I no longer hold Saturday hours in my city clinics. I need to take time off to renew myself every week.

     I have been taking time off more or less regularly on an annual basis. I spend time in silence, prayer and deep conversation. This helps me renew in mind, body and spirit. This has become a habit such that I look forward to it when it is due, and I long for it when I am unable to do it at the usual time.

     My provincial clinic is a different story. Because I only go there a few days a month and my patients get agitated when I don't keep my scheduled days, I have been sticking strictly to my published dates. That is until this year. This April and May - when medical school is out - I have cut down my scheduled days.

     I wonder how my patients feel about their doctor taking time off - for weekends, for school breaks, and yearly. I hope they would agree that it is good for the doctor, and for them as well.
   

Doc, these are important to me!

Have you noticed that when making health care decisions, you can have as many choices as there are people involved? Use of the worksheet suggested in the following link may help facilitate such decisions. Read and fill it out to bring to your next appointment to your doctor.

http://thegeriatrician.blogspot.com/2011/08/communicating-to-physicians-goals-of.html?spref=fb

When more is NOT necessarily better for patients

Choosing Wisely, an initiative of the American Board of Internal Medicine, says NO. Here are the links for 5 tests or treatments (and the situations) that patients should question.

For adult patients (internal medicine)

For older adults (geriatric medicine)

For patients with arthritis and other rheumatic disease (rheumatology)