In his brilliant 1993 satire “Et Tu, Babe,” Mark Leyner proposed a new concept in body art, which is the specialty of “visceral tattoos.” The narrator travels to Mexico where his chest is opened and the insignia of a “guy surfing a wave of lava, wearing polka-dotted trunks,” is tattooed directly on his heart. The dye used shows up on CT scans and apparently women, especially x-ray technicians, love it. …
The deep psychic effects of medical care
The Greek hero of the Trojan war, Achilles, had only one vulnerable area on his body, his heel. Similarly, modern humans also have a vulnerable part of the our anatomy, the upper airway, which simultaneously accommodates for breathing, swallowing, and speaking. The ability to talk, however, came at a price.
Evolutionary biologists have stated that speech and language development was detrimental to our health. Overdevelopment of our speech structures compromised our …
Why speech is the Achilles’ heel of the human race
Generic formulations of drugs using active pharmaceutical ingredients are an immense cost savings to patients and healthcare systems.
On the other hand, questions remain as to whether generics are truly equivalent to brand name pharmaceuticals. Are the pharmacokinetics the same? Are they bioequivalent? While this is a difficult topic to research clinically, I would argue that the vast majority of brand name and corresponding generic drugs are indeed equivalent (though there …
Warn patients that generic pills look different
There is a serious cost problem in USA health care which no one denies.
Yet when it comes to suggested solutions, there is a wide divergence of opinion. Attempts to use experts and evidence based guidelines for care are somehow viewed as government interfering with decisions which should be between the doctor and her patient.
States and insurance schemes have made varying attempts to deal with this. The Oregon Health …
Does Oregon have the answer to rational rationing?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 25-year-old man is evaluated after being turned down as a blood donor because of abnormal liver chemistry tests. The patient is healthy, takes no medications, does not smoke, and drinks alcohol socially. His parents and siblings are alive and healthy; his maternal grandfather developed type 2 diabetes mellitus at age 75 years. The …
MKSAP: 25-year-old man with abnormal liver chemistry tests
I was trained at a time when medical care was not a commodity. It was part art, part science, and not delivered in bits in pieces but imparted with an eye to the whole patient.
And I was trained by a master of the art and the science and the whole patient. Dr. Robert Ruben has spent his life studying the effects of communication disorders on the lives of children who …
Hearing loss is an invisible handicap
A palpable tension was present in our cab as we drove west. The taxi driver taking us to the retirement home of our patient filled the air with stories of the local prisons and the beauty of this area in the summer time. I am sure that I laughed at his light-hearted anecdotes but all I really could focus on was my heartbeat, its obvious crescendo as we drew kilometer …
Death is not supposed to be a comfortable subject
When it comes to public-private partnerships between health organizations and the food industry, there are many shades of grey — but Cheetos orange isn’t one of them. On September 9th of this year, however, the American Heart Association (AHA) Dallas Heart Walk saw Frito-Lay’s Chester the Cheetah riling up the crowd and helping to associate Frito-Lay and Cheetos with the emotions of the day — joy, hope, charity, happiness, spirit, camaraderie, health, …
Big Food is our modern day Big Tobacco
By now, it’s common knowledge that people should be careful about what they post to social media sites — especially job seekers. But if you’re a resident or physician, you need to be especially careful because of HIPAA.
Again, this seems like common sense. But the more popular social media becomes, the more the lines are blurred. For most people, Facebook, Twitter, Linkedin and other sites are a part of day-to-day life. It’s easy …
Medical residents: Tips to keep a clean social media profile
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 59-year-old man is evaluated for recently discovered spontaneous hypokalemia and hypertension. The patient had normal blood pressure at a visit 1 year ago. He has no symptoms and takes no medications.
On physical examination, temperature is 36.9 °C (98.4 °F), blood pressure is 148/96 mm Hg, pulse rate is 58/min, respiration rate is 18/min, …
MKSAP: 59-year-old man is evaluated for hypokalemia and hypertension
From the moment I first stepped into a restaurant kitchen, it felt like home; even though for the past eight years my real home has been an operating room, as I am a surgeon.
Though many on the outside may not realize it, the chef and the surgeon have much in common. Both profess modest beginnings. Cooks were slaves and surgeons were barbers. Those who did the cutting were not even …
The chef and the surgeon have much in common
A patient I’ll call Mildred came to her appointment and handed me a report from a medical screening fair at her church. She wanted to know what to do about it. The print-out said that she had a “mild” blockage in her carotid artery. They told her to discuss it with her primary care doctor (me).
You may have seen the advertisements in your local paper, or even on your local …
Companies should not scare us to sell unnecessary screening exams
Earlier this May, nurses around the country were acknowledged on a countrywide scale for their hard work and dedication to patient care during National Nurses Week. Unfortunately, as with most national appreciation days that I cannot personally be recognized for, I failed to take much notice.
Now that new doctors around the country, including myself, are in the process of growing into our roles as team-based healthcare providers, we are in …
Every week should be National Nurses Week
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We recently spoke with Nayan Kothari, MD, associate dean for education, chair and program director of the department of medicine at Drexel University College of Medicine/Saint Peter’s University Hospital in New Brunswick, N.J. He is 74 years old with long-standing spinal stenosis. He told us that his condition did not prevent him from biking and hiking regularly, and he was otherwise in good health. His medications included baby aspirin, atorvastatin …
I teach the anchoring error, but I couldn’t avoid it myself
Personal genomic tests are laboratory tests that examine up to one million or more genetic variants from a sample of saliva. These tests are available directly to consumers without involving a health-care provider. Test results are sometimes interpreted with the intention of informing disease risk and prevention strategies. Personal genomic tests are now widely available and sold directly to consumers, …
Personal genomic tests may offer a teachable moment
Mommy wars aside, I think you’d have to be living under a rock if you haven’t heard the enormous and real benefits of breastfeeding. Breastfeeding is awesome on so many levels. Health of baby and mom alike. Both physical and emotional.
But, what if it doesn’t work? What if you’re a mom (like me) who couldn’t produce enough milk? Hardly any in my case.
What if you’re an adoptive parent or your baby …
The overzealous push to get all moms to breastfeed
A very insightful editorial appeared recently in the Archives of Internal Medicine.The article gave several examples of overdiagnosis in medicine, but I thought the authors did a particularly good job explaining the false hope of CT scanning to detect pulmonary emboli. Emboli occur most often when a blood clot in the veins of the legs breaks off, travels through the right side of the heart, and gets stuck …
More information does not equal better care
Mitt Romney’s “let them eat cake” comments on 60 Minutes serves to illustrate how badly both sides of a political debate can confuse an issue. In 2010 he criticized emergency room care as a potential loophole used by people to get “entirely free care” while avoiding having to pay for health insurance and in his book No Apology, the Governor outlined the idea behind Massachusetts health care …
ER utilization shouldn’t be a measuring stick for health care reform
When I was a resident physician, I had the coolest classmates ever. We worked together, laughed together, learned together and many of us stay in touch to this day. Our practices have crossed the gamut of emergency medicine, with some in academics, some in private practice, some administrators, two involved in auto-racing medicine, one a bush-pilot/fishing guide and one an amateur mountaineer.
But one of the things that united us, one …
Emergency physicians who love their guns
When I was the director of undergraduate medical education for OB/GYN at a Midwestern university (a state school), it came to my attention that a medical student was refusing to have anything to do with contraception as it was against her religion.
So I spoke with her. I explained that over the course of her career she would undoubtedly see people from …
The only religion that my patients see me practice is medicine
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