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Learning to love primary care via an emergency department rotation

Kevin

Medical Education

March 2, 2011

by Stella Safo

It is Saturday night at an Emergency Department (ED) in Boston, MA and I am faced with a medical student’s dream dilemma: which one of the many interesting cases should I observe? Should I watch trauma surgeons operate on the 17-year-old gunshot victim or work with the ED docs to assess whether a 59-year-old woman is having an acute stroke?

That is exactly what …

Viewing physicians source of care, rather than a barrier to care

Sakina Shikari Bajowala, MD

Physician

March 2, 2011

Clinician. Diagnostician. Prognostician. Healer.

A physician has many jobs to perform, all critical to the appropriate management of what ails our patients. Without astute physical exam skills or a keen ability to sort through a medical history to uncover salient data, the physician is no better at diagnosing a patient than a Google search (and we’re quite a lot better, in case anyone was wondering). Without a proper understanding of physiology …

The physical exam of the head and neck is both simple and challenging

Bruce Campbell, MD

Physician

March 1, 2011

No great artist ever sees things as they are. If he did, he would cease to be an artist.
-Oscar Wilde

The physical exam of the head and neck is both simple and challenging. Simple, in that even children are familiar with the shape of the face, the sheen of the eye, the curve of the ear, and the texture of the tongue. Challenging, because when complicated, interlacing structures malfunction, they send …

Apple iPad, Amazon Kindle, or the Nook for medical students

Scrub, MD

Health Technology

March 1, 2011

The e-reader battles are clearly heating up, with the Apple iPad, the aggressive marketing of the Kindle and the Nook trying to sneak its way into the conversation. What does this mean for medical students? Should iPads be mandatory in medical school?

Joseph Kim of Mobile Health Computing argues that it certainly should be, but I think …

Patients are not to blame for the miscommunication about cardiac stents

Carolyn Thomas

Patient

March 1, 2011

When I had a heart attack two years ago, I was taken immediately from the E.R. to the O.R. for emergency treatment, including cardiac catheterization and a stainless steel stent implanted in a major coronary artery that was 99% blocked. But, overwhelmed and terrified, I knew nothing about what was about to happen, even though I have a vague memory of the cardiologist explaining something to me before I was whisked …

Lack of sexual interest is the most common sexual complaint in women

Juliet K. Mavromatis, MD

Conditions and Diseases

February 28, 2011

Lack of sexual interest is the most common sexual complaint in women.

The latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), which defines psychiatric disorders, defines Hypoactive Sexual Desire Disorder (HSDD) as ‘‘persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity’’ that causes ‘‘marked distress or interpersonal difficulty.’’ Epidemiologic surveys have suggested that from 25 to 50 percent of women report prolonged periods …

Fewer physicians are taking call in rural emergency rooms

Edwin Leap, MD

Physician

February 28, 2011

My partners and I have long struggled with the lack of specialty back-up at our hospital. Semi-rural hospitals, out of the way facilities, just can’t always attract specialists. So, we’re happy to have cardiologists every night, but understand that we only have an ENT every third night. We’re thankful to have neurologists, even if they don’t admit anyone. We’re glad to have radiologists, even if they don’t read plain films …

Patients are closing the health gap online

Kevin

Patient

February 28, 2011

by Jerry Levin

For all of us — young, old, and those in the middle — life is simply an interlude between doctors’ visits. This perspective, while obvious, perennially stays beneath our consciousness since we are consumed by the daily pursuit of personal identity as if our mind-body-and-spirit were to function without incident and without end. More powerfully of late is the recognition that the explosive neglect of mental …

Requests for OTC prescriptions for a FSA burdens primary care

Matthew Mintz, MD

Health Policy

February 27, 2011

As reported by MSNBC, the federal government will no longer allow flexible spending accounts (FSAs) to be used for over the counter medications, without a prescription. FSAs, which are offered by many employers, allow you to use tax free dollars for medical expenses that aren’t covered by your insurance. FSAs are a great idea and can be used for things like eye glasses, dentistry, or even …

Supermarket tips for preparing nutritious meals

Roxanne B. Sukol, MD

Patient

February 26, 2011

On the subject of shopping for and preparing nutritious meals, one piece of advice that I like to share is that it’s best to stick to the outer walls of the supermarket and avoid the center. So with only a few exceptions, like flour, oil and beans, that’s exactly how I shop. What does it mean to shop at the edges of the supermarket? Let me show you what I …

Understand the medical economics of a primary care practice

Maggie Kozel, MD

Physician

February 26, 2011

If we are going to make rational decisions about health care reform, it helps to understand the medical economics of a primary care practice.

I was ten years out of medical school by the time I joined Narragansett Bay Pediatrics, a group practice in southern Rhode Island, and I was earning a salary of $48,000 for my “part-time” position. I worked in the office 24 hours per week, and covered nights …

Can I be a doctor with bipolar disorder?

Dinah Miller, MD

Physician

February 25, 2011

“I have bipolar disorder. Can I be a doctor?”

It’s one of those questions to which there is no real answer. Being a doctor takes a long time, it requires reliability, diligence, and a willingness to learn things you may not want to learn and do things you may not want to do. It requires endurance and passion. You need to be tolerant of many things: arrogant supervisors, irritable colleagues, sick …

The torture and emptiness of psychological hoarding

Srini Pillay, MD

Conditions and Diseases

February 25, 2011

Humans are imbued with a competitive spirit. And as a result, we like to count our victories.

There are an infinite number of possibilities in human experience. And when the possibility of death looms over us, the sudden fear that we might not have done everything we might have creates immense distress. This “range” or “number” idea rarely has the effect it is supposed to have. Every kind of sex, every …

Save the Boobs, and whether humor has a role in breast cancer

Jackie Fox

Patient

February 25, 2011

Last year it was the “Save the Boobs” video. This year it’s the “I (Heart)Boobies” bracelets.

Some people were very offended by the video’s slow-motion close-ups that were more reminiscent of a beer commercial. Now, some schools are banning kids from wearing the bracelets. And in a recent post on Salon, Tracy Clark-Flory made the eloquent case that we’re more than the sum of our body parts, and recounted her mom’s battle with metastasized lung cancer.

I agree …

Sharing information about your health with specialists is difficult

Jessie Gruman, PhD

Patient

February 25, 2011

As far as my chemo nurse Olga (not her real name) is concerned, I can do nothing right.

She scolded me for sending an e-mail when she thought I should have called and vice versa. She scolded me for going home before my next appointment was scheduled. She scolded me for asking to speak to her personally instead of whichever nurse was available. She scolded me for calling my oncologist directly. …

When your privacy is violated in the doctor’s office

Joel Sherman, MD

Patient

February 25, 2011

Few patients enter our health care system prepared for the unexpected and embarrassing circumstances that can routinely happen.

Most can accept it when we’re treated with modesty and respect. But not many are prepared for those times when you might be unnecessarily exposed or treated rudely. The possibilities for embarrassment are endless and it is usually unexpected. When avoidable incidents do happen, most patients are not prepared to speak up. Many …

Gastric bypass is not a short cut to treat obesity

Michael Kirsch, MD

Conditions and Diseases

February 24, 2011

Recently, a female patient saw me in the office for the first time to discuss her chronic digestive issues. Luckily for her, my recommendations did not include probing into her alimentary canal with the endoscopic serpents that we gastroenterologists rely upon.

As the visit concluded, she advised me that she intended to have a gastric bypass (GIB) procedure performed, and even used the medical term of bariatric surgery. I suppose that …

Is alcohol good for me? The data behind drinking and your heart

Kevin

Conditions and Diseases

February 24, 2011

by Aditya Mattoo, MD

Not too long ago, a patient came to my clinic and said (I’m paraphrasing of course), “I never cared for alcohol, doctor, so I haven’t had much to drink since my college days. Maybe champagne or wine on the rare special occasion, but I keep hearing about how wine is good for your heart, so I am thinking I should start drinking …

How two different attending physicians approach similar conditions

MomTFH, DO

Physician

February 24, 2011

I recently finished my second month of internal medicine. I had a different attending physician for each month. It is interesting to see how two different attending physicians will approach similar conditions. There is a lot of flexibility in the standard of care. Neither of them is wrong by any stretch of the imagination. Just different.

It is also amazing how much of a difference a good, well informed resident can …

A balanced approach to informed consent

Kevin

Patient

February 24, 2011

by Zakari Tata, MD

Informed consent has continued to generate a lot of interest in medicine worldwide.

The reason is because patients in medicine and subjects in clinical trials need protection from the multitude of injuries and harms that have been caused by intentional or accidental actions. The controversies generated by various lapses of informed consent, in my opinion, have not been addressed and more safeguards need to be put in place …

Read more…

A balanced approach to informed consent

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