Oil spill got you down? Here’s what to do about it

Conditions and Diseases
July 6, 2010

As I’ve watched all of the media reports and videos of the oil uncontrollably gushing into the sea, the decaying marshlands, and the suffering or dead wildlife, the profound sense of sadness, anger, helplessness, and disappointment that I felt after 9/11 returned.

I don’t feel it all the time—it’s not clinical depression. It’s just strong negative emotion associated with the fact that both 9/11 and the oil spill were man-made disasters …

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Oil spill got you down? Here’s what to do about it

Does prevention improve health care outcomes and lower costs?

Health Policy
July 5, 2010

by Joseph W. Stubbs, MD, FACP

The eighth paragraph of the modern Hippocratic Oath reads: “I will prevent disease whenever I can, for prevention is preferable to cure.”

Support and encouragement of prevention are deeply rooted among physicians. Intuitively, to prevent a deadly or disabling disease from occurring or stop it at an early stage seems like a bread-and-butter concept with obvious health benefits.

But it should also accrue cost savings by avoiding …

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Does prevention improve health care outcomes and lower costs?

PTSD frequency in National Guard soldiers

Conditions and Diseases
July 5, 2010

by Kristina Fiore

After combat duty in Iraq, members of the National Guard appear to have higher rates of mental health problems than soldiers in the Active Component, researchers have found.

Rates of post-traumatic stress disorder (PTSD) with serious functional impairment increased from about 7% to more than 12% over a nine-month period, compared with only about a 1% increase among those in the Active Component, according to Jeffrey L. Thomas, PhD, …

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PTSD frequency in National Guard soldiers

Kidney stone pain, as experienced by a man and a woman

Conditions and Diseases
July 5, 2010

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As a typical guy, there are several painful illnesses that can hit our brotherhood in an instant. No warning was given. No “Get out of jail free” pass, either. Just cruising along, having another fine, healthy day, and bam! — suddenly, you are lying on the floor in severe distress.

The most feared? A testicular torsion. It can happen spontaneously. It can …

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Kidney stone pain, as experienced by a man and a woman

Anal cancer screening in HIV+ men

Conditions and Diseases
July 4, 2010

In Journal Watch AIDS Clinical Care, we published a simple case: Clinically stable HIV+ gay man, on HIV treatment; anal pap comes back with “atypical squamous cells of undetermined significance” (ASCUS).

What to do with this result? Two experts weighed in, Howard Libman and Joel Gallant. In Howard’s thoughtful response, he acknowledges the limitations of the data thus far, but said he would refer the patient for high-resolution anoscopy (HRA) and …

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Anal cancer screening in HIV+ men

Abuse is linked to obesity in children

Physician
July 4, 2010

by Todd Neale

Children whose mothers reported chronic abuse at the hands of an intimate partner were more likely to be obese at age 5 than those from violence-free families, researchers found.

After controlling for several potential confounders, including maternal obesity and depression, children whose mothers reported chronic violence had 1.8 times the odds of being obese, according to Renée Boynton-Jarrett, MD, ScD, of Boston University, and colleagues.

The association appeared to be …

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Abuse is linked to obesity in children

Ranking prestige of medical diseases

Conditions and Diseases
July 4, 2010

Among medical specialties, some are more prestigious than others. You can generally tell which ones are more prestigious by how well they pay. Surgery and cardiology, for example, rank at the top of the prestige scale. Psychiatry and dermatology are near the bottom.

One can also ask if some diseases are considered more prestigious than others, in the opinion of doctors.

A Norwegian doctor, Dag Album, has been investigating the prestige …

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Ranking prestige of medical diseases

How to treat patients who want everything

Patient
July 3, 2010

The Annals of Internal Medicine had a perspective article by palliative medicine communication gurus Drs. Tim Quill, Bob Arnold, and Tony Back which details an approach to discussing treatment preferences with patients who want “everything.”

When I think of a patient requesting “everything,” I typically think of it as a response to a physician who offers the patient the choice of “doing nothing” if the patient’s heart should stop or …

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How to treat patients who want everything

Post-traumatic stress disorder (PTSD) may increase dementia risk

Conditions and Diseases
July 3, 2010

by Todd Neale

Older U.S. veterans with post-traumatic stress disorder (PTSD) appear to have an increased risk of developing dementia, a retrospective study showed.

Compared with those without PTSD, predominantly male veterans with the disorder had a 1.77-fold (95% CI 1.70 to 1.85) greater risk of developing dementia, according to Kristine Yaffe, MD, of the San Francisco Veterans Affairs Medical Center and the University of California San Francisco, and colleagues.

The results were …

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Post-traumatic stress disorder (PTSD) may increase dementia risk

Euthanasia in dogs and the moral lessons for doctors

Physician
July 2, 2010

We had our dog put down yesterday.

Simon joined our family when our son was 10 years old as a two year old that we adopted from the Purdy Prison Pet Parole Program and was with us until he developed status epilepticus forcing our decision to have Simon euthanized.

Simon had been getting old, lame, nearly blind, and uncomfortable most of the time, but we felt he still had some enjoyment in …

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Euthanasia in dogs and the moral lessons for doctors

Florida EMTs may go bankrupt because of a malpractice lawsuit

Physician
July 2, 2010

An ambulance service was recently held liable for failing to “do what was necessary” before accepting emergency transport of pregnant patient.

A child was born at 25 weeks gestation — 15 weeks premature — and was not breathing. Babies born at this age have a viability of 50-70%. In other words, up to half of children born at this age of gestation die. The family called 911. The paramedics arrived, performed …

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Florida EMTs may go bankrupt because of a malpractice lawsuit

Drinking and smoking associated with migraine headaches

Conditions and Diseases
July 2, 2010

by Kristina Fiore

Drinking coffee and alcohol, smoking, and lack of physical activity all appear to be associated with migraine and tension-type headaches in teenagers, researchers found.

High consumption of cocktails appeared to put students at the greatest risk for these headaches, increasing the odds almost three-and-a-half-fold, Astrid Milde-Busch, PhD, of Ludwig Maximilians University Munich in Germany, and colleagues reported online in the journal Headache.

“Rather unexpectedly, recommendations to increase fluid intake as …

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Drinking and smoking associated with migraine headaches

A medical home does not guarantee increased patient satisfaction

Physician
July 2, 2010

One of the more notable findings from the special report on the TransforMED National Medical Home Demonstration project was that “patient satisfaction doesn’t automatically go up.”

Terry McGeeney, CEO of TransforMED, attributed the lack of increased patient satisfaction experienced by the 18 participating physician practices to a variety of factors, chief of which “was the turmoil of change experienced by patients as practices implemented after-hours access, quick access to laboratory results …

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A medical home does not guarantee increased patient satisfaction

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Chemicals that cause cancer can’t be accurately studied

Conditions and Diseases
July 1, 2010

Nicholas Kristof in the New York Times writes about a new report from the President’s Cancer Panel calling attention to the role common chemicals may play in the development of cancer.

The overarching message is that we should be exercising much more caution in our trust of chemicals.

I am not familiar with the nuances of regulatory policies for chemicals, but (as Kristof points out) the “existing regulatory presumption [is] that …

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Chemicals that cause cancer can’t be accurately studied

Customer service needs to be a priority in health care

Patient
July 1, 2010

What do Enterprise Rent-a-Car, KeyBank, and the Cleveland Clinic have in common?

They all make customer (patient) satisfaction a top priority.

They accomplish this in industry-specific ways, but together their emphasis on service as a passion shares common themes:

1. Buy-in for a service culture comes straight from the top, and permeates the entire organization.
2. Copious resources are delegated to building a service culture, starting with hiring.
3. Employees are “hired for fit.” If …

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Customer service needs to be a priority in health care

Children of lesbian mothers have healthy psychological growth

Conditions and Diseases
July 1, 2010

by Kristina Fiore

Children born to lesbian mothers appear to have healthy, if not better, psychological development when compared with average American children, researchers have found.

In the first prospective cohort study of its kind, these children were found to have better social, academic, and overall competence and significantly fewer social problems than typical American children, according to Nanette Gartrell, MD, of the University of California, San Francisco, and Henry Bos, PhD, …

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Children of lesbian mothers have healthy psychological growth

Why patients don’t value primary care doctors

Physician
June 30, 2010

“Hey doc, all I need is this referral.”

I’ve been encountering more of this lately. A patient who has not been seen in the office for months to years (well beyond when they were supposed to come back for a follow up visit) walks in and requests a “referral” for a specialist visit but they can’t be bothered with actually being seen and evaluated in the office or to be compliant …

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Why patients don’t value primary care doctors

Surgeons need to reconnect with patients after an operation

Physician
June 30, 2010

It’s worth your while to browse through Sid Schwab’s sampler one rainy Saturday afternoon when you get a chance.

The old man can write. I was reading through a couple of his old posts the other day when I stumbled upon this one. It’s a shorter post (for him) but very powerful and moving.

He describes what it’s like to enter an abdominal cavity of a patient, with all its …

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Surgeons need to reconnect with patients after an operation

Medication errors spike when new residents start in July

Medical Education
June 30, 2010

by Kristina Fiore

Deaths from medication mistakes appear to spike in July, when medical residencies begin, researchers say.

Over nearly a 30-year period, fatal medication errors appear to jump 10% solely in that summer month in U.S. counties with teaching hospitals, David P. Phillips, PhD, of the University of California San Diego and Gwendolyn E.C. Barker, BA, of the University of California Los Angeles, reported online in the Journal of General Internal …

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Medication errors spike when new residents start in July

Vitamin D myths and advice for patients

Conditions and Diseases
June 29, 2010

As the mountain of vitamin D research showing its importance grows to Everest heights, you may be wondering about some statements that are thrown around as “truth.”

Here are some fun vitamin D myths to pass along to friends, family and loved ones, because, when it comes to vitamin D, you want to get your dose (even of information) just right.

1. Just go out in the sun, already. That will fix …

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Vitamin D myths and advice for patients

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