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We need a movement to deconstruct the ADHD diagnosis

Conditions and Diseases

December 10, 2013

When the American Academy of Pediatrics changed the guidelines for ADHD to expand age of diagnosis to include children from age 4-18 (from 6-12), that number of cases would rise was, by definition, inevitable. The recent survey by the CDC, published in the current issue of the Journal of the American Academy of Child and Adolescent Psychiatry, indicating that one in 11 children in the US carry a diagnosis of ADHD, …

23andMe is providing data that physicians don’t know how to manage

Jennifer Gunter, MD

Conditions and Diseases

December 10, 2013

The FDA has ordered 23andMe, a company that does direct to consumer genomic testing, to halt sales. I can’t speak on the accuracy of the results with 23andMe, I think that’s what the FDA is interested in. And this isn’t a post about transparency, because I think everyone should have access to their medical data. This also isn’t a post about genomics being bad. On the contrary, I believe …

23andMe and the FDA: Did the government overreach?

James Marroquin, MD

Conditions and Diseases

December 10, 2013

23andMe is a personal genomics and biotechnology company which for $99 conducts a comprehensive analysis of your DNA. In recent days, the Food and Drug Administration (FDA) instructed 23andMe to halt sales of its main product. The FDA’s problem with 23andMe does not seem to be the accuracy of their testing methods.

The FDA’s concern is apparently that the company has not met all of the complex regulatory requirements demanded by the type …

Are we making progress in the fight against childhood obesity?

Christopher Johnson, MD

Conditions and Diseases

December 9, 2013

It is well known that more people today are overweight or obese than in the past. This has been a steady trend for decades, but there is some recent evidence this increase has stabilized. This is promising. Since many obese adults began as obese children, during the last decade physicians who care for children have devoted considerable effort to reversing the trend. This is important because obesity sets up the individual …

What leaders can learn from the failure of Healthcare.gov

Amy Edmondson

Health Policy

December 9, 2013

It’s lonely at the top. The buck stops here. I take full responsibility.

Noble sentiments. But the idea that one person, at the top, or elsewhere in an organization, is solely to blame for a complex failure in novel territory is as unhelpful as it is limited. In fact, the blame game is less useful today than ever before. Consider Healthcare.gov.

The idea that a project as complex, new, and large as the Healthcare.gov website …

Are we prepared as the Boomer generation downsizes?

Jim deMaine, MD

Physician

December 9, 2013

John and Eva had ongoing conversations about their home which was now far too big for their needs and lots of trouble and expense to repair and keep up. John said, “It’s the yard, the leaves, the painting, and general repair and replacement problems. What’s next to go? The refrigerator or me?” Eva was tired of shopping and cooking. Her arthritis was slowing her down. She told John, “Ok, you …

Health care transparency as more than an amenity

Oliver Kharraz, MD

Health Policy

December 9, 2013

Would you purchase a new phone without knowing its data plan? For almost everybody, the answer is an obvious “no.” We simply cannot make a good choice if we don’t know how much coverage the phone will offer, or how much money it will end up costing us.

Unfortunately, this type of blind decision is exactly the sort that many could face when purchasing a plan in the new health insurance …

Direct pay primary care and the ACA still don’t mix

Rob Lamberts, MD

Health Policy

December 9, 2013

Lately I’ve gotten hooked on watching the reality TV show, the Deadliest Catch. It’s astounding to me what these guys go through to catch crab in the Bering Sea.

One of the recurring themes on the show is the new crop of “greenhorns” — new recruits to the profession of working crab boats — that try to show they can hack “the world’s most dangerous job” each year. They often come with …

You can’t legislate doctor-patient relationships

J. Russell Strader, MD

Physician

December 8, 2013

I was on call this past weekend, rounding at about 8am on the cardiology floors, and a woman I didn’t recognize approached me. She asked if I remembered who she was, and was quick to tell me that if I didn’t it was ok. She had had bariatric surgery about 6 months previously, and I had seen her in the office for a pre-surgical consultation.

She went on to tell …

Is deep learning in medical education possible?

Tom Peteet, MD, MPH, MEd

Medical Education

December 8, 2013

Despite recent buzz about shifting resident education to community health centers, hospital based education is here to stay. The model of education, though outmoded, is simple. Get residents exposed to as much disease as possible, in the shortest amount of time. The future of American health care is not in acute management of tertiary care; but in integrated, team-based care. To get there involves focusing not only on educational content, …

Radiologists and primary care doctors need to talk to one another

Dr. Saurabh Jha

Physician

December 8, 2013

Recently, I spoke with a primary care physician (PCP) about a young runner who had a syncopal episode. Because of the increasing awareness of sudden cardiac death in athletes, she had an electrocardiogram and an echocardiogram to look for structural abnormalities of the heart.

The PCP was inclined to dismiss the syncope as an isolated episode. However, the echocardiogram, otherwise normal, equivocated: “possible hypertrabeculation of the left ventricular apex, consider cardiac …

Doctors might not really have a grasp on the art of diagnosis

Martine Ehrenclou, MA

Patient

December 8, 2013

January of 2010 initiated me into the life of a chronic pain patient. For sixteen months I plunged into a diagnosis journey that brought with it ten misdiagnoses by eleven respected physicians, fifteen procedures and tests, twenty-two medications and crushing pelvic pain.

People have asked me if I am angry about it all; the misdiagnoses, prolonged pain, time spent, needless tests and sometimes painful procedures. Anger is not the presiding feeling, …

Let’s bring up family health history during the holidays

Rebecca Sutphen, MD

Conditions and Diseases

December 8, 2013

As we plan for holidays with family and friends, many are reminded to avoid religion and politics as topics of conversation, and while it may be advisable to skip these, there is another potentially uncomfortable topic that I urge everyone to bring up: family health history. Though it may not seem palatable to discuss diabetes and heart disease over servings of pumpkin pie, these conversations can be critical in helping …

Speakers need to explicitly state financial relationships

James Colbert, MD

Medications

December 8, 2013

I just returned from the annual American Heart Association meeting where I heard distinguished cardiologists and researchers from around the world present the latest in cardiovascular disease.

Yet, amidst all the late-breaking clinical trial presentations and ask-the-expert sessions, what I didn’t hear were the speakers’ financial conflicts of interest.

Don’t get me wrong — the AHA mandates that all speakers present a disclosure slide at the beginning of every talk, and this rule was …

The new cholesterol guidelines: Emphasize patient preference

James McCormack, PharmD and Mike Allan, MD

Conditions and Diseases

December 7, 2013

There has been much discussion recently, by journalists and health professionals, on the new guidelines for the treatment of blood cholesterol put forward by the American Heart Association (AHA) and the American College of Cardiology (ACC). Critics have raised concerns the revised guidelines will increase the number of healthy people who take statin drugs by 70 percent, that treatment thresholds are too low and that some guideline writers have links …

Doctors: 10 lessons from the humble bumblebee

Neil Baum, MD

Physician

December 7, 2013

Bumblebee_05

Practice medicine like the bumblebee.

We also know the basics of the beehive containing a single queen bee, hundreds of worker bees, and several hundred to several thousand drones with their only function is to mate with the queen (and after they perform this function they die!), each with their own degree of specialization and place in the honeybee society. However, there is …

We’re already throwing grandma under the bus

Gene Uzawa Dorio, MD

Physician

December 7, 2013

“Throw grandma under the bus” clearly conveys anger, sympathy, and fear when health care decisions are made outside the realm of medical professionals. Within the doctor-patient relationship, alignment of physician expertise with an individual’s personal decision should keep insurance company executives, hospital CEOs, and government authorities from interfering.

Are we naive to believe interference isn’t already occurring?

A doctor orders a breast MRI to further evaluate an abnormal mammogram, but the insurance …

It’s a fearful time for medical students

Nathanial Nolan

Medical Education

December 7, 2013

Imagine you, like most traditional medical students, went to college for four years to earn an undergraduate degree. Like many, you might also have obtained a graduate degree or worked for a period of time. You then spend time and money fulfilling extracurricular activities, taking the Medical College Admission Test (MCAT), applying to schools and traveling for interviews. If you are part of the lucky minority — roughly 40 percent …

Medicine is a universal language

Heather Lee, MD

Conditions and Diseases

December 7, 2013

This past spring, I went to Dar es Salaam, Tanzania to do an internal medicine elective at Muhimbili University of Health and Allied Sciences. I rotated through two sub-divisions of internal medicine while I was there: infectious disease and cardiology.

The medicine

When I initially stepped onto the infectious disease ward, I saw the janitors mopping the cement floors with soap and water. The ward was crowded and the patients lying on …

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Medicine is a universal language

MKSAP: 74-year-old woman with fatigue, anorexia, and weight loss

mksap

Conditions and Diseases

December 7, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 74-year-old woman is evaluated for a 2-month history of fatigue, anorexia, and a 6-kg (13.2-lb) weight loss. She was treated with chemotherapy for ovarian cancer 6 months ago. She also has hypertension managed with hydrochlorothiazide.

On physical examination, temperature is 36.2 °C (97.2 °F), blood pressure is 132/75 mm Hg without postural …