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.
What is “MRI Abuse”? This is when the health care provider orders MRIs (Magnetic Resonance Imaging) in excess or for the wrong reasons. There are many causes of MRI abusive behavior but most evolve out of a significant misunderstanding of how to properly utilize this diagnostic tool. MRI imaging has a high sensitivity to detect anatomic abnormalities, does not expose the patient to high doses of radiation like a CAT …
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MRI abuse can be dangerous and expensive for patients
Pharmaceutical companies and their shareholders are always looking for the next “blockbuster” drug, the label given to a drug that generates more than $1 billion of revenue per year.
Blockbuster drugs don’t necessarily have to save many (or any) lives – slick marketing more than compensates for marginal improvements in treatment efficacy — but they do need to target conditions that are common enough that millions of patients will buy them. …
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How health reform will help breastfeeding mothers
by James Baker, MD
Using the diagnosis “bipolar disorder” for children with problems in mood has been controversial ever since a surge in its use in the mid-1990’s.
A recent article in the Los Angeles Times gives the pros and cons on the use of “bipolar disorder” in children through the opinions of two psychiatrists on opposite sides of the controversy.
The problem with using “bipolar” is that it requires a too-loose interpretation …
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Can children really have bipolar disorder?
They say an ounce of prevention is worth a pound of cure, but is that still true in today’s money? Recently I had an illuminating conversation with a patient that got me thinking about how I may try to answer this question. This is the first in a short series on the price of preventive health care.
Mr. GR, as I will call him, had recently turned 60 years young. Though he …
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Shingles vaccine and the price of preventive care
Though I’ve never lost a friend or family member to suicide, I have lost a patient.
I have known a number of people left behind by the suicide of people close to them, however. Given how much losing my patient affected me, I’ve only been able to guess at the devastation these people have experienced. Pain mixed with guilt, anger, and regret …
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6 reasons why people commit suicide
If a person tries to commit suicide, could that be considered as a statement that this person wishes to die and does not want aggressive treatment to save his or her life?
Not from a legal standpoint, and not if you are living in the United States.
A middle-aged man with a long standing history of depression decides to end his life. He puts a large caliber gun straight to his forehead …
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Patients who attempt suicide and withdrawal of medical care
The topic of nurse practitioners in the context of primary care has been resurgent of late, most notably in this post by Maggie Mahar. Much of the conversation is dominated by assertions such as this:
…Nurse Practitioners have the needed training and that, in fact, doctors who have gone through the full medical school curriculum are over-qualified for a job that, today, is more about coordinating …
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Nurse practitioners, doctors, and the lost art of diagnosis
by John Gever
Easy access to CT colonoscopy may not reduce the number of conventional colonoscopies performed.
After the University of Wisconsin’s (UW) health system persuaded local insurers to cover the imaging-based screens in 2004, there was little sign that patients preferred them to standard endoscopic exams, according to Patrick Pfau, MD, the university’s director of clinical gastroenterology.
Mean quarterly counts of optical colonoscopies performed at UW rose from 1,104 in 2003 to …
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Virtual colonoscopy access may not reduce lower endoscopy rates
Female sexual dysfunction has been reported in up to 40% of women, and described as causing actual distress in approximately 12% of women.
Therefore, it is an important topic to familiarize with and screen for as a primary care physician, as many patients may not report these symptoms unless they are elicited during the history taking process of the patient encounter. Female sexual dysfunction is often multifactorial and complex; it is …
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Female sexual dysfunction treatment options
Waterbirth has become a central component of “natural” childbirth dogma, despite the fact that for primates giving birth underwater is entirely unnatural. You don’t need a medical degree to appreciate the idiocy of birth in water. The most critical task for the newborn is to take its first breath.
Inhaling a mouthful of fecally contaminated water instead of air is profoundly dangerous. Not surprisingly, as the popularity of waterbirth has grown, …
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Waterbirth dangers to newly born babies
Whenever I diagnose a person with asthma or allergies, I usually ask a few questions about his or her living environment. Is there shag carpeting in the bedroom? Is the air conditioning filter changed every month? Is there evidence of roaches and other vermin? I ask these questions because mold, dust mites, animal saliva and insect droppings can worsen the symptoms of asthma and other illnesses.
But some of my patients …
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Rental housing can worsen your health
Radiation. Powerful enough to turn Dr. Bruce Banner (Bill Bixby) into The Incredible Hulk (Lou Ferrigno), or meek Peter Parker (Tobey Maguire) into The Amazing Spider-Man (still Tobey Maguire, but more buff and spandexed). It also obliterated two cities in Japan, and continues to contribute to cancers near Chernobyl. It’s sciency, strong, and scary. No wonder it creates so much apprehension.
We’re all living every day surrounded by radiation sources, and …
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Radiation and whether cell phone towers are dangerous
by Kristina Fiore
Medical imaging for cancer patients and resulting costs have increased over the last decade, particularly in positron emission tomography (PET), researchers have found.
Annually, use of the diagnostic screen rose significantly between 1999 and 2006 — ranging from 36% in lung cancer to 54% in breast cancer, Kevin A. Schulman, MD, of Duke University, and colleagues reported in the April 29 Journal of the American Medical Association.
Imaging costs also …
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Medical imaging is increasing in cancer patients
Ahhh spring.
The lovely blooms unfurling. The trees budding.
It’s enough to make a girl get tears in her eyes.
And sneezes in her nose.
And itching on her face.
Yes, it’s allergy season again — but what can you do to make yourself more comfortable without emptying your wallet?
1. Avoidance. Close the windows. Make someone else cut the grass. Stay inside. (Yes, I hate this one too- let’s move on.)
2. Neti pot or other nasal saline rinsing. LOVE …
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Allergy drug recommendations for patients on a budget
A common clinical problem in aging is when should driving a motor vehicle be discontinued. When does driving become a significant safety hazard as cognition and motor skills decline?
The American Academy of Neurology recently published a Practice Parameter update: Evaluation and management of driving risk in dementia. This important review provides clinicians and family members with assistance in making an accurate and timely decision.
The authors of the guideline review research …
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Patients with dementia and when they should stop driving
She was 50. Prior to being transported to our ER, her only complaint had been for non-traumatic elbow pain over the past two weeks. She was on no medications and had no significant medical history.
She was at home, preparing to visit her doctor for a scheduled visit, when she collapsed. Because she didn’t drive, her elderly father had planned on swinging by to pick her up. He had just called …
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Father of a patient with a sudden brain hemorrhage
Whether I’m wearing my health policy hat or seeing patients in the office, one condition continues to surface as a source of concern and frustration.
Diabetes, one of the nation’s most serious and costly health burdens, now affects almost 25 million people in this country — a conservative estimate. Another million new cases are diagnosed each year.
Three years ago, the American Diabetes Association estimated the total diabetes cost in the U.S. …
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Diabetes prevention can be led by health insurance companies
by Todd Neale
Clinicians should actively persuade families not to participate in the ritual cutting of female genitalia, the American Academy of Pediatrics urged.
However, the organization suggested that legislatures and doctors might ultimately consider legalizing ritual “nicks” to satisfy cultural or religious demands without more serious and problematic cutting.
The centuries-old practice, which is illegal in the U.S. and several other developed countries, carries with it a host of physical and psychological …
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Female genital cutting complications
by Kristina Fiore
The scale of the obesity epidemic may be much worse than currently believed, because the usual measure, body mass index (BMI), is a very insensitive measure of excess body fat, researchers said.
In a single-center study, 66% of patients classified as obese on the basis of DEXA scanning had BMI values in the nonobese range, according to Eric Braverman, MD, of New York Presbyterian Hospital/Weill Cornell Medical Center.
Among more …
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Body mass index (BMI) may not measure obesity accurately
