Finasteride, fruit, and the matter of prostate health

Meds
October 14, 2010

by Arnon Krongrad, MD

The noose was loose on its neck. At first I worried, but then I relaxed. This was a bottle of pomegranate juice, the antioxidant superpower. As the billboard implied, it could cheat death. Perhaps if I consumed pomegranate juice, I could cheat death.

Last week, the Federal Trade Commission charged POM Wonderful, LLC, makers of pomegranate products, with deceptive advertising. …

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Finasteride, fruit, and the matter of prostate health

Watchful waiting is underutilized for most men with prostate cancer

Conditions
October 8, 2010

NPR has a great blog on their website called Shots about current events in health care. Recently, Scott Hensley, the main blogger there, posted a recent article on treatment of prostate cancer from the Archives of Internal Medicine.

If you look at the article, you may notice a very small subheading above the article’s title. It reads “Less is More.”

Very telling.

The thrust of the article and the …

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Watchful waiting is underutilized for most men with prostate cancer

When parents should be concerned about a lump on their child

Conditions
October 8, 2010

I was recently scanning an online forum about pediatric health concerns. (What can I say? I sometimes need inspiration.) One thread within the forum was significantly longer than any other. Parent after parent posted about how they had noticed a knot on their infant or toddler. This concern parallels what I see in practice. An unexplained knot on the head is a common reason parents bring their child to be …

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When parents should be concerned about a lump on their child

Why doctors have poor customer service

Physician
October 7, 2010

One of my docs was telling us about a patient’s experience at another practice. Apparently, the parent was at her wits end with her crying baby. She called the  on call doctor to ask for advice and the doctor told the patient, “your baby has colic’s; turn on the vacuum and stop calling.”

It turned out the baby had some gastric condition (not colic) and needed treatment. The patient ended up …

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Why doctors have poor customer service

Should CRNAs practice anesthesiology without physician supervision?

Physician
October 5, 2010

Interesting article recently from Health Affairs about the clinical equivalence between the care provided by anesthesiologists and CRNAs. The article concludes by advocating that CRNAs be given permission to practice anesthesiology without physician supervision. It’s more cost effective. And there is no compromise to the quality of care delivered to patients.

We recommend CMS return to its original intention of allowing nurse anesthetists to work independently of surgeon or …

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Should CRNAs practice anesthesiology without physician supervision?

Doctors should work weekends, and how reformers alienate physicians

Policy
October 5, 2010

Peter Orszag wants doctors to work weekends.

The former director of the White House Office of Management and Budget wrote as much in this past weekend’s New York Times:

Doctors, like most people, don’t love to work weekends, and they probably don’t enjoy being evaluated against their peers. But their industry can no longer afford to protect them from the inevitable. Imagine a drugstore open only five days a week, or …

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Doctors should work weekends, and how reformers alienate physicians

How much staff should a doctor have?

Physician
October 1, 2010

“How many staffers should we have per doctor?” That’s a question I’m asked at almost every seminar I present. Of course, like many good consultants, I almost invariably respond “it depends.”

One of the factors that needs to be considered is what jobs we’re talking about — clinical or front office. It’s staffing in the clinical area that will do most to enhance a physician’s productivity, so that’s what we’ll focus …

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How much staff should a doctor have?

Chronic cough from laryngeal sensory neuropathy (LSN)

Conditions
September 30, 2010

Laryngeal sensory neuropathy (LSN) is a recently described condition felt to cause a chronic cough in patients when treatment for everything else (allergies, asthma, reflux, etc) has been evaluated and managed.

Treatment for this condition is with neuropathic medications including Neurontin, Elavil, Lyrica, nortriptyline, etc.

In the past few months, I have seen a few patients referred to me with chronic cough treated with these medications with minimal or no improvement. All …

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Chronic cough from laryngeal sensory neuropathy (LSN)

Why good doctors give useless answers

Physician
September 27, 2010

Before he tells you how to get a straight answers from physicians, Doctor D is going to stall for time by explaining why doctors give vague answers.

Why would a good doctor give useless answers?

1. There is an answer, but your doctor doesn’t know it. Don’t be hard on doc for this one. There is no MD in the world that knows the entire breadth of medical knowledge. Some docs pretend …

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Why good doctors give useless answers

What’s the difference between family practice and med-peds?

Physician
September 26, 2010

I like Dr. Rob, the one with the distractible mind. And although I thoroughly agree with the stance he takes in his recent post against cholesterol screening in kids, I must take issue with his opening statement:

I have a unique vantage point when it comes to the issue universal cholesterol screening in children, when compared to most pediatricians.  My unique view stems from the fact that …

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What’s the difference between family practice and med-peds?

Converting paper charts to electronic medical records tips

Tech
September 24, 2010

We are a little over two years into our electronic medical records implementation at the time of this writing. Since we have been performing a gradual rollout, the entire process has been relatively uneventful. Most of the credit for this goes to our chief information officer (technospeak for the head of our IT department) and our practice administrator.

One of the biggest challenges we have been facing is how to convert …

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Converting paper charts to electronic medical records tips

10 reasons why doctors over-order tests

Conditions
September 24, 2010

by Neel Shah, MD

What are the top reasons doctors over-order tests?

1. How we’re taught. Doctors are taught to consider whether a procedure is safe and whether it’s likely to work. We’re almost never taught to consider cost — it’s considered taboo.

2. Trying to do our best for the patient. We’re worried. Often we over-order because of our personal risk aversion.

3. Pre-emptive ordering. For residents, who do much of …

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10 reasons why doctors over-order tests

10 cancer signs women shouldn’t ignore

Conditions
September 22, 2010

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If you’re relatively young and healthy, gynecologic cancers probably aren’t on your radar. But they should be.

This year, more than 80,000 women in the United States will get a gynecologic cancer, such as endometrial (a.k.a. uterine), ovarian or cervical cancer. In general, gynecologic cancers occur more frequently in women after menopause, although they can occur in younger women. While all women …

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10 cancer signs women shouldn’t ignore

Social anxiety assumptions and their solutions

Conditions
September 20, 2010

Social anxiety refers to the fear of being around people due to the threat of embarrassment.

People who are socially anxious frequently freeze and are unable to seek the very company their hearts desire.  They may make adaptations: they may decide that they “hate” being around people; they may isolate and play video games; they may absorb themselves in their work, but no matter what they do, this anxiety always exists …

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Social anxiety assumptions and their solutions

DTC advertising, and its history with the FDA

Meds
September 18, 2010

Advertising is everywhere.

That should come as no surprise to anyone who has lived in modern America. It is impossible to turn on the television, ride the subway, or even sort through the daily mail without coming across an ad for a new car, a soft drink, or the latest digital toy. These advertisements have only one goal: to entice you to buy their products. This is harmless enough when these …

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DTC advertising, and its history with the FDA

Do all people with disturbing behavior have a psychiatric illness?

Conditions
September 18, 2010

“Hey Doc, this guy needs some help.”

I’ve heard that statement from countless correctional officers over the years. Its meaning is very simple: Someone is exhibiting thoughts or behaviors that the officers find disturbing and “not normal.”

I appreciate the officers expressing concern. Without their input I often would not be aware of cases where I might be able to be of assistance.

But, one of the questions that always pops into my …

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Do all people with disturbing behavior have a psychiatric illness?

There is no alternative medicine, only unproven medicine

Conditions
September 17, 2010

There is no Alternative Medicine.

Thus sprach Phil Fontanarosa and me in a 1998 JAMA editorial in the famous theme issue dedicated to Complementary and Alternative Medicine.

So I went to Mr. Google in 2010 and entered … Alternative Medicine … and clicked — 41,200,000 results; entered Complementary and Alternative Medicine, click — 3,210,000 results; entered CAM, click — 191,000,000 results, but that’s not fair; CAM can stand for many unrelated topics.

Let’s …

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There is no alternative medicine, only unproven medicine

Does the DSM-5 medicalize normal behavior?

Conditions
September 14, 2010

by John Gever

Just about everyone catches colds, and just about everyone who gets one is able to go to work and cook their meals, and they nearly always recover within a few days whether or not they take anything for it. That’s normal.

So, is the advice to take aspirin “medicalizing normal behavior”? Are drug companies that market decongestants and fever reducers “medicalizing normal behavior”?

The answer …

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Does the DSM-5 medicalize normal behavior?

Social science requirements for pre-medical students

Education
September 13, 2010

I thought I was an oddball in college. I’ve only recently learned that I was avant garde.

Right before beginning college in 1975, I decided I wanted to be a doctor. Being the first-born son – with decent SATs – of an upwardly mobile Long Island Jewish family, I had relatively little choice in the matter. Notwithstanding this predestiny, I felt confident that medicine was a good fit for my interests …

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Social science requirements for pre-medical students

How doctors can cope with stress

Physician
September 10, 2010

by Walter van den Broek, MD, PhD

Often I ask my residents that if you can’t take care of yourself, how do you expect to take care of your patients?

Or in another way: the only difference between God and a doctor is that God knows he’s not a doctor. These sound like cliches but there is some truth in them. In short, doctors are just ordinary people …

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How doctors can cope with stress

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