Physicians as guardians of science have an obligation to teach the facts of life to our patients and our legislators. And today the need to dispel ignorance of biologic facts is more urgent than ever. Just as President Obama is deferring legislation on marriage to the states, I will defer the issue of whether the government can or should regulate marriage to legal scholars and our duly elected representatives. However, …
Why legislators need sex education
I’ve received several inquiries from women living in various regions of the country, asking how they should choose where to go for their mammogram, and if it really matters. I cannot emphasize this enough: It matters! Here are a few tips to help your search:
The most basic requirement is whether a facility is accredited under the MQSA (Mammography Quality Standards Act). The accrediting body for most states is the ACR …
Where you have your mammogram, and who reads it, matter
The trouble with many significant advances in medicine is that that they take us out of our moral depth. They may raise quite different problems from the ones we are used to and, if we are not careful, we may inadvertently undermine the wonderful potential of new technologies by forcing them into existing legal, ethical and institutional frameworks.
Transplantation is a case in point. Transplants save and transform lives; but the …
How transplants are causing ethical dilemmas
Facebook recently announced on Good Morning America that users in the U.S. and the U.K. can enroll as organ donors through links to official registries, making it easier for people who want to donate their organs to sign up. They’re working with Donate Life America, a nonprofit alliance of national organizations and state teams across the United States committed to increasing organ, eye and tissue donation.
But deciding to become an …
Becoming an organ donor requires more thought than a Facebook click
He had yellow nails, leather neck, stained teeth and a deep cough. He wheezed slightly, breathed too quickly and occasionally sprinkled the white handkerchief red. No surprise his ticket to my office was a lung mass to match. We talked about tests, treatment and prognosis. About the future, probably short. Devastated, he was not surprised. He was reaping the reward of 30 smoking years. He sadly admitted, “I knew better, …
Are smokers to blame for the damage they do to their bodies?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 22-year-old man comes for a routine evaluation. He has a history of type 1 diabetes mellitus and began taking insulin glargine and insulin lispro 8 years ago. Two days ago, he participated in a marathon race.
On physical examination, temperature is 36.4 °C (97.5 °F), blood …
MKSAP: 22-year-old man with type 1 diabetes mellitus
Much has been written about the positive benefits of communication between patient and physician. Today, in the increasingly time-pressured medical work environment, physicians are pushed to see more patients in less time. Patients are moved thru clinics as if on an assembly line. There are fewer opportunities for conversation and many patients and providers never really get to know each other on a “human” and interpersonal level. Care often suffers …
A shock and recall plan for ICD patients
Shannon Brownlee’s recent post, “Don’t discard shared decision making on the basis of PSA testing,” couldn’t ring more true. The crux of shared decision making is that the patient must decide, with his or her physician, which tests or procedures make sense, given the various risks, tradeoffs and outcomes. Discarding the construct on the basis of one test (PSA testing) is not only poor form in that it is a …
To test or not to test? Include the patient first
Vaccines have been a hot topic among parents, pediatrician and in the media for many years. Recently, there have been many news stories about pediatricians who will not care for families who either choose not to vaccinate their children or who do not follow the recommended schedule. These policies are based on knowledge about the safety of vaccines, the effectiveness of the recommended schedule and concern about the spread of …
Why this pediatrician makes the MMR vaccine mandatory in his practice
Mark Twain once said, “The difference between the right word and the wrong word is the difference between lightning and lightning bug.” He was referring to the power of language. With an allergist, the consequences of the right and wrong words have measurable consequences, ranging from comfort to chronic misery, to medical payments spent wisely or wasted, and sometimes life or death.
For example, people with lactose intolerance will mistakenly believe …
Injectable epinephrine often isn’t used quickly enough
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 65-year-old woman is evaluated because a screening urine culture for an insurance policy grows greater than 105 colony-forming units/mL of Escherichia coli. She does not have fever, dysuria, urinary frequency, or other symptoms. Medical history is unremarkable. She has no allergies and takes no medications. …
MKSAP: 65-year-old woman with E. coli in a urine culture
Participating in a patient’s first heart attack can be an extremely stressful event. Thirty years ago, I was an ER doc. At the end of a typical shift, I would come home to my wife and, often, would remark about how nervous family docs got when dealing with emergencies like heart attacks.
Thirty years later, I’m the family doc and heart attacks are unnerving. Yes, I know what to do. We …
When a heart attack is textbook perfect, it can be a beautiful thing
Should we all have the TB Blues? I think you’d agree that we should after listening to this 1931 classic by Jimmie Rodgers who died from TB.
Tuberculosis is known to have existed in ancient Egypt and TB may have even been referenced in the Bible – “The Lord will smite you with consumption, and with fever, inflammation, and fiery heat …” Deuteronomy 28:22.
Many well known authors, artists, musicians, and …
Singing the blues about tuberculosis
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In the last several weeks there has been much discussion concerning the St. Jude Medical Riata lead Class I recall. Prior to the Riata, there was the Medtronic Sprint Fidelis lead recall. Prior to Fidelis, there were multiple recalls involving Guidant (now Boston Scientific) devices. The common thread to all of these recalls is our patients. Our device patients have endured all of these events. How exactly does the recall …
Our patients live with the fallout of a device recall
Pain, in any form, can present a difficult challenge for even the most astute pain physician. The complexity of treating neuropathic or nerve pain stems from a variety of reasons, ranging from the lack of an obvious source of the pain to the inability of the patients to explain what ails them, to a arduous history that was poorly managed with the wrong medications, allowing the pain to progress to …
Thinking differently about treating neuropathic pain
An IOM report makes recommendations that aim to ensure that progress in omics-based test development is grounded in sound scientific evidence and is reproducible, resulting in improved health care and continued public trust in research. Another new IOM roundtable workshop report discussed the differences in evidence required for clinical use, regulatory oversight, guideline inclusion, coverage, and reimbursement of genomic diagnostic tests and focused …
The need for evidence in genomic medicine
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 78-year-old woman has a 3-month history of increasing fatigue. She has no other medical problems and does not take any medications.
On physical examination, temperature is normal, blood pressure is 130/80 mm Hg, pulse rate is 72/min, and respiration rate is 16/min. The patient appears pale. …
MKSAP: 78-year-old woman with increasing fatigue
Austin Frakt, health economics blogger at The Incidental Economist, has a post up commenting on Kenny Lin’s post about shared decision-making and PSA testing. The following is an edited comment I posted on that article.
I have to disagree with Kenny on this one, despite having written an article in the New York Times Magazine that strongly supported Kenny’s work at the US Preventive Services Task Force, which found …
Don’t discard shared decision making on the basis of PSA testing
Sometimes, the simplest tools in medicine are the ones that give us the most useful information.
Take the humble blood pressure machine, for example. It’s been around for years, and it’s cheap, compared with a lot of other medical devices. It’s simple to use, and it doesn’t require a medical or a nursing degree to operate. But the numbers it reports are valuable in helping predict a person’s risk of a …
Tips for successful home blood pressure monitoring
Hello, Pandora. What do you have in that box?
Yes, I am going to talk about … autism. The last time I did so I was inundated with people trying to convince me of the dangers of immunizations and their causal link to autism. I really, really, really don’t want to go anywhere near that one.
No, I am not going to talk about the cause of autism; I am going to …
Making sense of the rise in autism diagnoses
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