A friend delivered twins early. One is in the NICU, one died. What can I say or do?
This question was sent to me via Twitter. The person who added my name to the tweet knew that I might have something to offer because 10 years ago I was that friend. I entered the hospital with ruptured membranes at 22 1/2 weeks, pregnant with triplets. My son Aidan died at birth …
What to say to anyone who has a baby in the NICU
The Institute of Medicine (IOM) recently released a report on the state of cancer care in the United States. The IOM generally knows what it’s talking about. It’s a non-profit, non-governmental advisory group essentially. To get on one of their advisory boards you have to be a national, if not international, expert in whatever field is being studied. According to the cancer advisory board, the state of cancer care in …
Testosterone is one of the most over-prescribed and poorly understood medications. It is prescribed to millions of men for myriad indications, many of them unproven. Athletes believe it will improve their muscle mass and strength. Older men look to it as an anti-aging remedy. Men with flagging libido hope it will restore their sex drive. Testosterone has developed a mythology of masculinity. This is very similar to the notions we …
Estrogen in men: Masculinity isn’t a molecule
I open my car door to walk in to work. I’ve never heard crickets as loud as the ones this summer in Georgia. A wall of steam-heat blasts me simultaneously as a giant bzzz! bzzz! dive-bombs my ear. Man, it’s hot in Georgia. And the bugs! I think to myself. I walk slowly towards the ED doors, barely moving, but still breaking a sweat. I walk through the double doors now …
A case of paralysis, cured in the emergency department
A recent study has concluded that women with breast cancer who failed to get annual mammograms are more likely to die from their disease than those who had annual mammograms, and argues that more frequent mammograms are warranted in women under age 40. Unfortunately, despite all the media attention this study is getting, I don’t think the researcher’s conclusions are supported by the study results.
The researchers did a retrospective medical record …
Mammograms in younger women: Is the data there?
Whether delivered by a boss regarding a work goal, by a coach regarding an athletic performance, or by a trusted reader regarding the quality of a rough draft, the feedback we get often powerfully influences our ability to succeed. Yet significant controversy exists in the scientific literature about which type of feedback, positive or negative, is most effective.
As researcher Ayelet Fishbach explains: ”Several motivation theories attest that positive feedback is more …
Positive or negative feedback: Which is best?
Cancer screening is of little benefit in persons with dementia but can cause very serious harms. Older persons with dementia have limited life expectancies which makes any benefit from cancer screening very unlikely. This is because cancer screening works by identifying a cancer many years (generally at least 5-10 years) before it would threaten health.
But cancer screening tests cause lots of burdens when given to persons with dementia. The …
Stop cancer screening in patients with dementia
Joan was 42, married, but appeared to be younger than that. Her husband was with her when we first met, as was her beautiful two-year-old son. “We couldn’t get a baby sitter, if you can believe that!” she said.
Sarah was 38 and was also married. She and I were closer to the same age, which was not lost on either of …
People who participate in clinical trials are trailblazers
When I was a second year medical student, I gave blood at a Red Cross drive and noticed a week later that I had a hard and slightly tender blue spot on my left forearm arm where they had drawn blood. I described it to my PCP through our online portal, and I mentioned that I’d had a similar occurrence a couple years prior after having an IV during an …
A medical student experiences sticker shock
Minutes from melting in the summer heat, I dumped my stuff at a table and homed in on the hospital café’s soda display for something -cold. The gentleman at the next table glanced my way and said, “Are you in the medical field?”
“Yes sir, I’m a medical student.”
He eyed my drink and asked, “Did you hear that diet soda can increase your risk of diabetes by 70%? Even just a few …
A 15 minute office visit cannot dispel a year’s worth of confusion
Every major city has its well-advertised and well-anticipated spa week. This wonderful week of facials, massages, and rest and relaxation all at discounted prices is enough to get even the most cynical and uptight of my fellow New Yorkers giddy with excitement. With the advent of the juice cleanse craze on the scene, another cleanse that is again gaining attention is colon hydrotherapy, better known as the “colon cleanse, or …
Selling colonics to detoxify is false advertising
We all know that physician-patient communication is important. Poor communication, not deficient clinical skill, is the primary driver of malpractice suits; conversely, good clinical communication alone can improve patient outcomes. For example, patients of physicians with superior communication skills have been shown to have superior blood pressure control. Fortunately, physicians generally recognize the significance of good communication, and often take the time to ensure that it happens. Yet there …
Use visual aids to teach patients and improve decision making
Today in clinic, I interviewed a formerly morbidly obese woman. She has lost almost 300 pounds since undergoing gastric bypass surgery a few years ago, a presentation that has become increasingly common. She was here to see the plastic surgeon for her four week follow up appointment, status post abdominal skin flap removal.
See, after losing a ton of weight, loose skin remains, especially in places like the arms and abdomen. …
When should insurance cover body contouring?
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Nathan Pritikin: 69. Robert Atkins: 72. Roy Walford: 79. Adelle Davis: 70. Aveline Kushi: 78. Marjorie Shostak: 51. Jack LaLanne: 96. Ancel Keys:100.
David Murdock is a billionaire who believes that he knows the formula for the perfect diet. Not only has he built his own research institute to refine his theories, but he is confident that his food choices will keep him alive to the age of 125. This …
Don’t waste your time finding the perfect diet
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 54-year-old man is evaluated during a follow-up visit for five previous episodes of nephrolithiasis. Two of these stones were composed primarily of uric acid. After his third episode, potassium citrate was initiated. Medical history is notable for type 2 diabetes mellitus, hypertension, and hyperlipidemia. He does not have a known history of gout. …
MKSAP: 54-year-old man with nephrolithiasis
In a thoughtful, measured and well-reasoned blog post, Dr. Keith Ayoob recently discussed the AMA’s decision to classify obesity as a disease. As he concluded his post, Dr. Ayoob wrote: “I don’t care how obesity is categorized. I care about what’s being done about it … We need to stop talking about whether obesity is or is not a disease and start talking about preventing it altogether.” This got me thinking: …
Does the process of diseasification hold any promise in obesity?
Recently, parents all over the Kansas City area waited patiently for the news that the 6th graders were okay. Many were holding their breath.
And those of us whose children ever step foot onto a school bus, thoughts came to our brains that we don’t like to talk about.
The good news is that the kids were fine. Certainly shaken, but no critical injuries. The community is thankful …
Should school buses have seat belts?
Involuntary commitment refers to hospitalizing people against their will for psychiatric reasons. It is a controversial topic because this is where medicine and civil liberties intersect: Physicians have the ability to take away the rights of fellow citizens. (I suspect that few people who become psychiatrists realize that making recommendations about involuntary commitment is part of the job. I certainly did not know this. I also did not appreciate the …
Hospitalizing people against their will: 4 questions to ask
One of the more salient and concerning items of medical news reported this past week is an analysis by the CDC indicating that there is 10 times as much Lyme disease in the U.S. as formal reporting channels suggest. Rather than the 30,000 official cases each year, which would already make Lyme the most common tick-borne illness in the country — there are roughly 300,000 cases. An increase in Lyme prevalence by …
Chronic Lyme symptoms after treatment deserve respect
Read the original op-ed from the TED speaker who inspired this post: “Why I Thank the Voices in My Head.”
Eleanor Langdon is an extraordinary woman who has shown remarkable grit and creativity in transforming her disturbing symptoms into useful tools. Hats off to her for finding such a fruitful path to personal recovery and for sharing her techniques and inspiring story so that others may benefit from what she has learned.
There are …
The voices of schizophrenia: Treatment still has a long ways to go
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