Physicians writing on KevinMD about the diseases they treat and the people who have them: cancer and its screening arguments, pain and the drugs that treat it, diabetes and the obesity argument, mental illness and who gets treated for it, and the decisions at the end of a life. Five maintained records draw on this archive: Cancer: what physicians say, in their own words, Opioids: what physicians and pain patients say, in their own words, End of life: what physicians say, in their own words, Diabetes and obesity: what physicians say, in their own words, and Mental health: what psychiatrists and physicians say, in their own words.
Given all the complaining I and my colleagues do about the problems with the EMR, I figured I’d take the opportunity to tell you about something good that came from having my practice online.
A patient came to see me last week for a check up and requested a prescription for birth control pills. She’d used them in the past without problems. I wrote the script and sent her on her …
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One example where the EMR can really make a difference in outcomes
She asked me, “Is it OK to laugh?”
My patient Linda, who was only 12 weeks pregnant, had just had a chorionic villus sampling, or CVS. During this procedure, a small piece of placenta (chorionic villi) is removed via a long, thin needle inserted into the woman’s uterus, and then the sample is sent to a laboratory for genetic analysis. My patient fell into the category of advanced maternal age, and …
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It’s OK to laugh after a procedure
Weight is not a behavior, and weight is not a choice. Nobody wakes up and decides what to weigh today. In an age when healthy and unhealthy behaviors are increasingly subject to incentives and disincentives, respectively, this is all too easily forgotten.
Of course, weight is largely the byproduct of behaviors and choices, namely what and how much we eat, and what and how much we do: calories in and calories …
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Weight loss resistance is real
Interpreting studies is a dicey thing. Often I find what might be statistically significant translated into headlines that might not really get at the nuance of the study or the results.
Take these three for example:
- “Pine bark extract improves severe perimenopausal symptoms”
- “Two weeks of antibiotic therapy relieves IBS (irritable bowel syndrome)”
- “Study: ‘Female viagra flibanserin’ works”
The first line of the last article: “Need a boost to your sex life. The magic could be in …
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Statistical significance doesn’t always warrant a miracle headline
For years internationalists have being trying to make the argument to ordinary Americans that foreign policy matters — that we must contend with complex issues overseas like countering terrorism while also focusing resources and energies on economic issues at home. We have posed it as a trade-off.
We are making the foreign affairs case the wrong way. Rather than argue the positive merits of trade or the negative repercussions of unchecked …
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Cancer is an international war and peace issue
Clinical medical research — finding out which treatments help and which ones don’t (or even make the situation worse) — is tough research to do. In the laboratory a scientist can control conditions so that only one thing is different between the control and the experimental groups. This isolates the effect of the particular thing and one can see if there is any difference in outcomes depending upon what is …
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A case where a meta-analysis can help
A recent blog comes to the conclusion that non-vaccinating parents believe their pediatrician “would have to be staggeringly incompetent, negligent or malicious to keep administering (vaccines).” Using this as the premise, this pediatrician goes on to say that these patients should be dismissed from our practices.
First off, these parents don’t think we’re the enemy. The reason they bring their kids to see …
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How to answer difficult vaccine questions from parents
The smell of the grass, the crack of the bat and the roar of the crowd … baseball season is back. As spring training gets into full swing, a new Major League baseball rule takes effect. Though contact will still be allowed at home plate, base runners will no longer be allowed to intentionally run into a catcher.
The rule is intended to protect players from injuries, especially head injuries. Concussions …
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Baseball players’ heads finally getting the attention they deserve
During our weekly physician conference, I discussed a patient with a suspected autoinflammatory disease. An elderly male, he had a history of recurrent fevers, hives, and elevated inflammatory markers, which had gone untreated for many years. Eventually, he developed renal amyloidosis, and was finally referred to rheumatology clinic for further evaluation. Although he had many of the classic signs and symptoms of an autoinflammatory disease, his physicians had not recognized …
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What is an autoinflammatory disease?
A patient I see for psychotherapy, without medications except for an occasional lorazepam (tranquilizer of the benzodiazepine class), told me his prior psychiatrist declared him grossly undermedicated in one of their early sessions, and had quickly prescribed two or three daily drugs for depression and anxiety. He shared this story with a smile, as we’ve never discussed adding medication to his productive weekly sessions that focus on anxiety and interpersonal conflicts. Indeed, …
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What does it mean for a patient to be undermedicated?
I have a patient with very unusual visual symptoms and sense of imbalance that has persisted for more than a year. She describes very unusual and concerning symptoms including true diplopia, a sense of major visual disturbances like the floor buckling in her visual fields, vertigo, severe sense of imbalance and swaying, headache, memory fog and concentration difficulty.
Of note is that her symptoms seemed to start after a cruise. I …
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Mal de debarquement: Vertigo and dizziness after a cruise
While it is unusual for gastroenterologists to see colorectal tumors in patients under the age of 50, and even more uncommon before the age of 40, it does happen, so patients need to be aware of their risks. Colorectal tumors in young people are often detected either through symptom evaluation or because of a colonoscopy performed for an underlying risk factor, most commonly a family history of colorectal cancer (CRC).
During …
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Young patients with adenomas: Who should get genetic testing?
The page comes from the psychiatry intern on call. “There’s a situation with patient RB on the unit. Please advise.”
We gather in the hall outside the patient’s room. There are already three — no, four — security guards standing several feet away with their arms folded. Backup. Ready. Ready for what? We whisper in hushed tones as the intern explains what happened.
He was “acting out.” He was running through the …
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There’s movie psychiatry, and then there’s real psychiatry
I recently fulfilled my civic responsibility by completing a stint on jury duty. Somehow I had never previously been summoned. Being the Law & Order junkie that I am, I was kind of awestruck by my first up-close exposure to the court system.
I sat erect and at attention in the courtroom, listening to the judge charge us prospective jurors. I even became slightly teary when he spoke of the important role we …
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The difficulty in diagnosing autism: Feeling like judge and jury
Among the more contentious issues regarding health and weight control — perhaps surprisingly, contentious among professionals and the general public alike — is the role of personal responsibility. Unfortunately, this readily devolves into discord, because the cultural tendency of our time is denigrate those with whom we disagree, and hunker down in our distal, opposing corner. Just take a look at Congress to see how well this is working …
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Obesity: It’s time to compromise and meet in the middle
Schuur and colleagues in JAMA Internal Medicine listed five low value services in the emergency department (ED). Although compilation was not solicited by the American College of Emergency Physicians as part of the Choosing Wisely program, it has its ethos.
The list was developed by a technical expert panel after multiple iterations. The list is not only wise but derived from sound methodology. Most importantly, the recommendations are …
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CT in neck trauma: Changing the culture in the ED
