Les called me about his PSA.
“Jim, it’s rising and now up to eleven and they’re recommending treatment. What would you do?”
Even as a long retired MD, I still get medical calls from friends and relatives. Actually, I feel honored and try to do my best, researching the latest journal articles and editorial opinions. Of course, the prostate cancer literature is cloudy at best with scant evidence that the huge number …
Hospice stays remain far too short
I rather doubt you need me to bring the roiling statin debate to your attention, given its prominence in scientific circles and mass media alike. In essence, a new set of guidelines for the use of lipid-lowering drugs to prevent heart disease was issued with considerable fanfare and then set off a firestorm of controversy. The old approach relied heavily on levels of LDL cholesterol, while the new …
The statin debate ignores the signal of lifestyle as medicine
Part of Katie Couric’s controversy on her show about the HPV vaccine was the claim by her expert, Dr. Diane Harper, that the vaccine only lasts for 5 years. I mean, why promote a 5 year vaccine to adolescent girls that will wear off and leave them at risk during their 20s?
The problem with this controversy over the duration of vaccine effectiveness is that it is entirely manufactured.
Dr. …
Effects of the HPV vaccine last longer than 5 years
Adrian Bell didn’t look dehydrated, but his diarrhea had come and gone for a week and a half when I saw him a few weeks ago.
“Is anyone else sick with the same thing?” I asked, beginning my usual line of questioning.
“No,” answered Eleanor, his wife.
“Have you had any water to drink from a new or unknown source, or have you traveled away from home?”
“No,” both answered in unison.
“Any new foods …
Medicine is like twenty questions
I was contemplating writing a blog post about the movement by the Boston-based advocacy group Campaign for a Commercial Free Childhood urging Fisher-Price to recall the baby bouncy seat with an attachment for insertion of an iPad. When I then received an email from a colleague with a link for another product — a potty seat with an attachment for an iPad — there …
iPad on the potty: A violation of infants’ rights?
As Dr. David Green reported recently in NEJM Journal Watch, the American Society of Hematology is the latest society to comment on appropriate and cost-conscious care in the ABIM Choosing Wisely campaign. I’ve followed the Choosing Wisely campaign closely and have been using it on the wards and in clinic as academic ammunition. A specialist society’s public advice about showing restraint is an excellent means to challenge the dogma of our …
How can we encourage medical residents to truly choose wisely?
We can now add vitamin B12 deficiency to the growing list of risks of long term use of the proton pump inhibitors (PPIs).
The New York Times had an article outlining the evidence that prolonged use of both proton pump inhibitors (PPIs) like Prilosec, Protonix, Prevacid and others, as well as the less potent H2 blockers like Zantac and Pepcid, can lead to vitamin B12 deficiency. This is in addition …
Proton pump inhibitors and B12 deficiency: What to do now
Referring to the idea that, like athletes, surgeons are engaged in demanding physical work, I wrote about having an “off-day.” Another side of the same coin is having a tough day: as distinguished from not being on one’s game, here I mean to describe what it’s like to face an exceedingly difficult and danger-filled situation.
Notwithstanding having one’s faculties and wits gathered and finely honed, as in command of yourself as you …
It’s hard to feel pride after having lucked out
A woman comes to the doctor with depression, fatigue and insomnia. A co-worker stays late in the office even when there is not much to do. A sales associate appears tired and distracted.
For each of these individuals, domestic violence — physical, sexual, verbal, emotional or psychological abuse against an intimate partner — could be the underlying cause of distress. Historically, domestic violence has been viewed as a criminal issue — …
Domestic violence is a social, business and health priority
When a doctor finishes medical school, he or she then faces what is truly the most difficult part of their journey into becoming a physician: graduate medical education. The goal of internship, residency, and fellowship training programs — what is collectively called graduate medical education, or GME — is to take newly minted doctors, just out of medical school, and turn them into competent physicians, able to practice in their specialty independently. And …
Why graduate medical education is failing
Let’s say you were inventing a new flea powder, called Flea-B-Gone. To test it and manufacture it, you’d need a whole mess of fleas. As everyone knows, kangaroo fleas are hardy and docile, so you open up a kangaroo farm to grow your fleas. You treat the kangaroos well, and other than itchiness, they don’t have much to complain about as you scrape off their fleas to make your Flea-B-Gone. …
Anti-vaccine propagandists and the rogues’ gallery of misinformation
My older brother is also a doctor, but not a PCP like me. He’s a specialist: a limnologist. If you have problems with blue-green algae in your lake, he’s the man to see. Limnology is the study of lakes, and fittingly, Bill works in the “Land of a Thousand Lakes” as a professor in fresh water ecology.
I’m not sure he’s thinking of switching over to direct-care limnology. I’ve been afraid …
Health care is not about achieving wellness in people
Current efforts of clinicians, hospitals and researchers to make health care more “patient-centered” include inviting some of us to advise on research priorities, care organization and delivery under the assumption that, as patients, we understand what patient-centered outcomes and care are. These invitations and our acceptance of them often result in confusion and disappointment for everyone, regardless of good intentions. What do patients know about the inner workings of …
Valuing patient and family input in health care
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The institution that employs me is very bullish on customer satisfaction. Having come from a fourteen year stint in private practice before I came back into the university fold six years ago, the little things that make a practice run smoothly come naturally to me.
Patients are typically seen within a week of the consultation request — same day if they are in an emergency situation. My front office staff actually …
Eagerly awaiting the results of a patient satisfaction survey
“Well I don’t know why I came here tonight, I got the feeling that something ain’t right,” the song hummed through the speakers of the DC medical examiner’s office.
Something definitely is not right, I thought as I watched the pathologist and his assistant begin the first autopsy of the morning. With rough strokes, the assistant dissembled the body before us. Unlike the cadavers we had dissected one year previously, this …
Bodies are veritable storybooks of suffering and experience
Research shows that about 1 in every 5 pediatric visits for “sick visits” results in an antibiotic prescription. Now not all of those antibiotics are taken; many pediatricians now use the rx pad for “wait and see” or “delayed prescribing” antibiotics. They give a prescription and allow the family to watch and wait — if a child is not getting better, they advise parents to start taking them.
However, in total …
5 ways to reduce antibiotic use in children
How dare you!
Life can change in a heartbeat. Most of us believe that our lives, our loves and all the that things that make us who we are is a gift from a higher power. One that can be taken away as swiftly as it is given. But somewhere in the shuffle of taking kids to practice, catching up on emails, worrying about bills, and the search for the perfect …
When end of life care becomes a confrontation
I had thought that apologizing was a straightforward act, but I now realize that it is a nuanced art form. We’ve all heard the “mistakes were made” version, usually issued by politicians who attempt to insert a layer of passive voice insulation between themselves and their screw-ups.
There is also the ever present conditional apology which by definition falls short of complete responsibility acceptance. The template here is: “I’m sorry for …
How should a physician apologize after a medical error?
In the North American hemisphere flu season is here. Influenza, as most people know, is a serious respiratory infection that can be life-threatening in the very young and the very old. Some strains, as we’ve all heard about in the press in the past, are more deadly than others and may threaten even the strong. Luckily, however, we’ve developed a vaccine. It doesn’t guarantee you won’t get the flu: the …
Patients who refuse their physicians’ advice
So a guy has his car towed to the mechanic. All four tires are slashed. He has a simple request.
Please replace the tires.
But this is one of those comprehensive care mechanics. He not only examines the tires, he does a full once over. He pops the hood and immediately knows that the engine is shot. It’s fried. The cost of fixing the engine is more than the value of the …
Unlike mechanics, doctors have been denied the basic logic of futility
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