After a week of medical school orientation, followed by two weeks in the classroom studying cellular organelles and biochemical pathways, our class was finally going to start the centuries-old rite of passage that is human gross anatomy. For many students, it will be first time seeing a dead body. The anatomy lab is where future surgeons will make their first cut with a scalpel, without the pressure of life and …
How gross anatomy changes you forever
Health care reform is a locomotive barreling down America’s tracks. In two years, the Affordable Care Act (ACA) will cover some 30 out of 50 million of us that currently lack health insurance. Political beliefs aside, it would seem that supplying insurance to protect the health of more people is a societal good. Though the costs of reform will be debated for years to come, one major question remains that …
Having our own doctor treat us in the hospital is a thing of the past
I struggle every time I’m ill. This week, it’s not so much my own illness that’s been the major problem. It’s the kids. Because they can’t sleep. And if they can’t sleep, we can’t sleep.
It started last week with this upper respiratory bug that’s going around. Cold viruses mutate just enough over time that every few years, I get hit hard. I call it the “three year cold.” This one …
When can a doctor call in sick?
One of my biggest problems of the RVU system is that it decided by a secret society composed of specialists. Nobody seems to have a problem that a “secret society” decides how much work and how much cost should be allocated to a medical service.
Medical procedures are very dangerous and have a lot of risk, but so is trying to provide healthcare to a complicated 2-year old that can’t tell …
Why the RVU system gives a false sense of productivity
It’ll be no surprise to the readers of this blog that physicians’ use of Twitter and other social media has been exploding over the last couple of years. But it may surprise you to know how hard it is to really analyze that data.
Last year Dr. Katherine Chretien of the VA Medical Center in Washington, DC, published an eye-opening study in a JAMA letter. Until that point, …
Physician use of Twitter: Examining the data
Viewpoint #1. Training programs might say: we are headed for a major league collision in the training of women physicians. Soon 50% of all trainees will be women, and in some specialties, such as OB/GYN, they will be 80-90% of the residents in any particular program. Training years coincide with prime child bearing years. Imagine if even only half the residents in a program were pregnant at once. What would happen …
Are pregnancy and residency compatible?
Good, it’s about time that these greedy doctors get smacked down for being the financial rapists that they are. Medicine in this country is the biggest, most destructive SCAM going on today. Doctors think they are entitled to RIDICULOUS amounts of money for simple routine procedures.
– Johnathan Blaze
It is generally agreed upon that the more one values a good or service, the …
To the patients who resent greedy doctors
We can’t, of course, plan the way we’re going to die (with the obvious exception of suicide). We can, however, live in such a way that reduces the likelihood of our dying from certain diseases. Which is why it’s now almost universally accepted that we should exercise regularly, not smoke, drink only in moderation (if at all), avoid too much fat in our diet (and now probably too much carbohydrate), …
What is the best disease from which to die?
Linzess is a new drug that received FDA approval by Forest Laboratories for use in irritable bowel syndrome (IBS) with constipation and in chronic idiopathic constipation. It got my attention because of its biochemistry.
Learning about the mechanism of action of new drugs like Linzess reminds me how much more is understood about the molecular biological level of physiologic function of the human body than when I was in med school. Linzess …
Does Linzess have a role in IBS with constipation?
Who is your favorite addict? I guess we have to talk about addiction as a preface to that question.
Everybody I know takes psychoactive drugs, except maybe some Mormons, Seventh Day Adventists, and the like.
All drugs are habit-forming, but only a subset of psychoactive drugs can produce psychological and physical dependence, tolerance, and withdrawal symptoms when taken away, the usual definition of addiction.
Most people who become addicted to one drug often …
Do drugs aid and abet genius or does genius lead to drugs?
I’ve been getting a lot of questions about Indianapolis Colts’ Head Coach Chuck Pagano lately, so I thought I would dedicate a blog entry to discussing his disease and prognosis.
Coach Pagano was recently diagnosed with acute myeloid leukemia (AML), a form of blood cancer that typically carries a rather grim long-term prognosis in adults. While early reports were quite sketchy on the details of Pagano’s presenting symptoms, it seems that …
Chuck Pagano has leukemia: An oncologist discusses his prognosis
Have you ever worried about how you’re going to get healthy these days? Has your doctor recommended diet and exercise? Well, if you’re like millions who are struggling to find health, you’re going to need a lot more than just diet and exercise. You’re going to have to fight like crazy against a mind-set of disease that’s paradoxically disguised as health care.
America’s healthcare system – health insurance companies, government health …
How America’s healthcare system will keep you sick
Doctors are already busy, but do they need to do more in a day? If you think a physician’s job is to take the best possible care of patients, then the answer is a resounding yes. But additional responsibilities do not necessarily mean more work—they just require different training.
It doesn’t take unique insight to understand that doctors, in many ways, act as social workers. They help patients schedule follow-up appointments, …
Why doctors need to be better social workers
You may have heard that veteran NBC News correspondent Tom Brokaw was hospitalized recently after he reported feeling lightheaded after making an appearance on MSNBC’s “Morning Joe.”
He’s fine. Brokaw tweeted, “All is well. Early a.m. I mistakenly took a half dose of Ambien and made less sense than usual.”
And that’s what you’ve got to be careful not to do.
Any time you get up in the wee hours of …
Taking medications in the middle of the night can be risky
Some of you may know that I started out in an internal medicine residency and quit for physical medicine and rehabilitation (PM&R). Switching residencies? Not recommended. But entirely doable.
I spent most of my first half of internship being really, really miserable. I remember sitting in the call room during my ICU month, talking to my mother about how badly I wanted to quit and what my options would be if …
Why I quit internal medicine for physiatry
Virtually every medical school graduate immediately enters at least three years of post-graduate medical training (internship-residency). The exceptions are those who:
1. combine the MD with a JD or PhD;
2. leverage the not-yet-dry diploma into a post as health policy advisor to a state or federal legislator, usually one of Dad’s chums;
3. are named Michael Crichton.
Commencement is in late spring, so post-graduate training begins on July 1. Every year my surgery …
My first day as a surgery intern
I’ve always had a tough relationship with cigarettes and the people who love them. As a lung doctor I hate cigarettes, and I hate that patients I see everyday continue to use them. But I also understand that vilifying smokers seems to be in vogue right now. I figure that if someone does something that is not considered socially palatable, and that does them harm, even as they strive to …
Should doctors stop prescribing inhalers for smokers?
When I was a kid, my parents used to avoid giving me Coca-Cola after lunch. Not because they were overly concerned about my health. (If they had been, my mom wouldn’t have given me milkshakes when I watched Kung Fu Theater every Sunday afternoon. But that is a different story). The reason was that I would have really severe problems falling asleep about a quarter of the time. I would …
Restless legs syndrome in children: How the kids see it
In a word, yes.
And this is a difficult concept for many doctors to get because we have long been taught that the gold standard is culture.
Let’s back up a little. These are the symptoms of a bladder infection: needing to empty your bladder a lot (urinary frequency), when you gotta go, you gotta go (urgency), pain just over the pubic bone, blood in the urine, burning when you empty your …
Can I still have a bladder infection with a negative urine culture?
By now most of us have heard of a nurse practitioner. But what exactly is a nurse practitioner? What can they do? How can they be incorporated into a medical practice?
A nurse practitioner is a registered nurse who has completed graduate-level education and advanced practice training. Nurse practitioners can see a wide range of patients, both well and sick, and perform many in-office procedures. Prescribing medications, ordering and interpreting tests, …
These are the reasons why nurse practitioners are special
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