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 …
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 …
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 …
“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 …
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 …
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 …
Since there are many antidepressants with varying dosage ranges, and many more degrees of variations between individual responses to particular antidepressants, psychiatrists have been unable to agree upon an operational definition of an “adequate trial” of an antidepressant.
However, it’s worth looking at some guidelines.
A 2003 study from the Journal of American Medical Association found that only 21.7% of Americans diagnosed with depression received “minimally adequate treatment” in the past 12 …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 62-year-old man is evaluated for an asymptomatic nodule on his shoulder that has been present for more than 1 year. Skin findings are shown.
Read more…
by Krupali Tejura, MD
I am treating a patient for head and neck cancer — which can be one of the most harrowing therapies.
To receive chemotherapy and radiation concurrently can be pretty debilitating. Swallowing foods can be next to impossible, and the taste changes and saliva changes are brutal. It’s one of the harshest areas to treat … and I warn the patients beforehand: …
I’ve been interested in the role of testosterone in physical performance, depression and aging for many years. While at the University of Iowa, I was involved in research to detect testosterone doping, the psychological effects of testosterone and the potential for testosterone to alleviate depression in older men.
One of the difficult questions facing clinicians is when is testosterone too low in older men.
One problem with answering this question is the …
Pathologists and radiologists don’t have the luxury of spending time with actual patients so they have to render professional judgments and determinations based on indirect data (radiographs, a mashed up slice of breast tissue, etc.).
I don’t envy them; the utter detachment from patient care would make me miserable. But they do have a tough job. They get one shot at getting it right. There’s no patient follow up. They never …
by Crystal Phend
Insufficient training among cardiologists in reading echocardiography results is wasting healthcare dollars and subjecting patients to unnecessary procedures, researchers said.
A review by sonographers of cardiologist-interpreted echocardiography findings at a Milwaukee medical center during a period of just over a year indicated major discrepancies in 29% of cases, leading to unnecessary further diagnostic testing or treatments for the wrong indication, according to a study presented here at the American …
“I’m worried about my daughter’s posture. What can I do about it other than constantly nagging her to stand up straight?”
You’re probably talking about “kyphosis,” which is the rounded-shoulders, hunched forward kind of posture common in children and many adults. It’s often called “postural kyphosis” because it can be corrected if the child tries to stand straight up. Rarely, there’s a genuine spinal deformity, called Scheuermann’s Kyphosis or Scheuermann’s Disease, …
ADVERTISEMENT
I have given anesthesia for a lot of breast surgery. I don’t think I’ll ever get used to the fog of pain and sorrow surrounding a double mastectomy.
All surgery is invasive in some way. Amputations, in particular, have a horror all their own; the idea that destroying someone – cutting off a body part, violating a coherent whole – should be necessary in order to save a life is almost …
Social and language issues dominate most of the discussion about the features of autism spectrum disorder (ASD).
A neglected area of study are the physical feature characteristics that have been known to be associated with ASD. Unlike some of the diagnostic physical changes in disorders such as Down Syndrome, physical features found in ASD are often subtle and missed by most clinicians.
Ozgen and colleagues from the Netherlands, UCLA and the UK …
As a typical guy, there are several painful illnesses that can hit our brotherhood in an instant. No warning was given. No “Get out of jail free” pass, either. Just cruising along, having another fine, healthy day, and bam! — suddenly, you are lying on the floor in severe distress.
The most feared? A testicular torsion. It can happen spontaneously. It can …
ADVERTISEMENT
Among medical specialties, some are more prestigious than others. You can generally tell which ones are more prestigious by how well they pay. Surgery and cardiology, for example, rank at the top of the prestige scale. Psychiatry and dermatology are near the bottom.
One can also ask if some diseases are considered more prestigious than others, in the opinion of doctors.
A Norwegian doctor, Dag Album, has been investigating the prestige …
Difficulty with sleep is one of the most common patient complaints presenting to the primary care office.
Chances are, you will suffer from difficulty with insomnia at some point in your lifetime. It can be distressing, and cause difficulty with functioning during your wake hours. The first thing you may want to do is to run to the doctor for a prescription for a medication to help you sleep.
However, you don’t …
Regular exercise has been shown to be helpful in the prevention and management of a variety of clinical neuroscience conditions including: Alzheimer’s disease, Parkinson’s disease, major depression and anxiety disorders. However, motivating people to get involved in a regular exercise program is a significant challenge. Wii Sports and Wii Fit Plus may provide the motivation edge for some patients to start and maintain an exercise program.
The Wii video game system …
ADVERTISEMENT
I walked into Room 35 to find a three year-old lying on the hospital cot. Her father sat alongside her bed, whispering softly to her. The patient appeared quite tired, wiped-out even, and if it weren’t for her complacent eyes tracking my every move, I would have thought she might be sleeping.
She was visiting our ER because, after a few days of cough and congestion, she had developed a fever. …
Get free updates delivered free to your inbox.
