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Should teenagers be screened to prevent sudden cardiac death?

Conditions and Diseases

September 6, 2011

It seems as if teenage student athletes have been dying by the month in often spectacular and dramatic fashion. Last September Texas high school senior Reggie Garrett died suddenly just after throwing a touchdown pass . Last week a 16-year-old Michigan basketball player died dramatically just after becoming a hero by scoring the winning basket to preserve an undefeated season. Then just a week later another 16 …

Phil Mickelson’s psoriatic arthritis explained

Michele R. Berman, MD

Conditions and Diseases

September 6, 2011

Golfer Phil Mickelson has had a rough year and a half. First, his wife and mother are diagnosed with breast cancer, and then he has a health scare of his own. Last year, after the US Open, Mickelson began to experience some troublesome symptoms.

In an interview with Extra’s AJ Calloway, Mickelson opened up about what was going on: “After the U.S. Open last year, I wasn’t able to …

Private rooms in the ICU can reduce length of stay

Marya Zilberberg, MD, MPH

Physician

September 6, 2011

We have known for quite some time now that the patient’s environment in a hospital matters to his/her outcomes. The concept of biophilia was applied by Roger Ulrich back in the 1980s to surgical patients in a series of experiments. Famously, this work showed that looking out your hospital room’s window on a bunch trees is associated with better and less eventful post-operative recovery than staring at a brick wall, …

10 ways to make a difference in the lives of your patients

Jan Gurley, MD

Physician

September 5, 2011

Most of us who write about health believe that knowledge can make a difference. But is the primary health issue facing us today a lack of knowledge? Or is it, instead, something I’d call the tenth-patient-of-the-day challenge?

Here’s what I mean: You pick up a chart and head to Exam Room B, reading as you speed-walk. Your patient’s blood sugar is running high again, she didn’t show at the smoking cessation …

Medical practice unintended consequences

Brandon Betancourt

Physician

September 5, 2011

The airlines, in an effort to recoup revenue, started charging passengers to check luggage a while back. Seems like a great strategy. Not only are they recuperating revenue, they are giving passengers a reason not to bring luggage they don’t need. This of course saves money on fuel.

The result? More bags in the main cabin.

Since there is an incentive not to check a bag, more people bring their bags as …

Don’t always blame anesthesia for problems in the OR

Anesthesioboist T., MD

Physician

September 5, 2011

People blame anesthesia personnel for everything. You name it, they blame us for it. They call us by the umbrella name “Anesthesia” and if there’s a problem, it’s always “Anesthesia’s” fault.

Got into the room late? Blame Anesthesia. (Even though the anesthetist’s been sitting at the bedside for twenty minutes waiting for the surgeon or the nurses to be ready.)

Patient craving ice cream when she woke up? Must be Anesthesia’s fault.

No …

The problem with early detection of disease in medicine

Dr. Joe Kosterich

Conditions and Diseases

September 5, 2011

Medicine is presented as being highly scientific. This is until information comes out which questions certain assumptions that underpin the practice of medicine.

One of the mantras of modern medicine is that early detection is good. This seems logical enough.

However there is an underlying assumption. That is that there will be a worsening of the condition if it is not detected and that treatment will improve the situation. What would happen …

MKSAP: 20-year-old with fever, myalgia, headache, and a rash

mksap

Conditions and Diseases

September 5, 2011

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 20-year-old female college student is evaluated in December because of a 12-hour history of fever, myalgia, headache, and a rash. Her only medication is an oral contraceptive agent.

On physical examination, the patient appears ill. Temperature is 38.8 °C (101.8 °F), blood pressure is 90/45 mm …

The CSI effect and high tech medicine are driving up tests

Evan Falchuk

Physician

September 4, 2011

I’m in Israel, home to some of the most innovative care in the world. Doctors here wanted to know if the high-tech tests that are an increasing part of their work help. A couple of weeks ago, they published their results.

It turns out that in about 90% of cases, it didn’t matter.

A physical exam, the patient’s history, and the basic set of tests that doctors have done for decades …

Should the elderly with dementia be given anti-psychotic drugs?

Merrill Goozner

Medications

September 4, 2011

The inspector general of HHS recently reported that nearly half of the anti-psychotic drugs fed to the demented elderly in nursing homes are inappropriately prescribed. That’s about one in fourteen nursing home residents.

Forget about cost, which is over a quarter billion dollars a year. “Government, taxpayers, nursing home residents as well as their families and caregivers should be outraged and seek solutions,” wrote Daniel R. Levinson, the HHS I.G. wrote …

How the price of preventing a preterm pregnancy went up

Allen Perkins, MD

Medications

September 4, 2011

One of the reasons cited for our expensive health care system is that drugs cost more in America (part of our capitalistic system). In June of 2003, a study was published in the New England Journal of Medicine about the use of a form of progesterone to delay the birth of certain preterm infants. This particular hormone is found in the human body, but the formulation …

A real doctor will first do no harm

Emily Gibson, MD

Patient

September 3, 2011

I’m really miserable and need that 5 day antibiotic to get better faster.

Ninety eight percent of the time it is a viral infection and will resolve without antibiotics.

But I can’t breathe and I can’t sleep.

You can use salt water rinses and decongestant nose spray.

But my face feels like there is a blown up balloon inside.

Try applying a warm towel to your face.

And I’m feverish and having sweats at night.

Your temp …

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A real doctor will first do no harm

Tips for doctors looking for the right EHR

Margalit Gur-Arie

Health Technology

September 3, 2011

Here we are going to talk about the second stage of shopping for an EHR. We are going to assume that you did your homework, defined your goals and constraints and prepared a comprehensive list of requirements for an EHR (if you have not done so already, go back and read part 1).

To continue our car shopping analogy, we are now ready to go kick some tires, and …

How diet and exercise beat high blood pressure

Eric Marcotte, MD

Patient

September 3, 2011

All day I badger and cajole my patients to take better care of their bodies:

“We really need to get some of this weight off, Mr. Jones.”

“This blood sugar level means diabetes is right around the corner – it’s time to get serious about changing your diet, Ms. Smith.”

“This blood pressure reading tells me that you’re not getting enough exercise, Bill.”

I’ve got pills for everything, it seems. I just wish I …

Improving efficiency and requiring Congress to live under our healthcare rules

Mitchell Brooks, MD

Health Policy

September 3, 2011

Here are my next two principles of affordable healthcare reform.

First, medicine must be practiced in a manner and in a place that is consistent with economic efficiencies, evidence based outcomes and the needs of the specific community that it serves.

In healthcare delivery, quantitative must be balanced by qualitative. Specific community needs and the culture of that particular community must have equal and in certain cases, greater value than the …

An informed screening choice for breast cancer

Margaret Polaneczky, MD

Conditions and Diseases

September 2, 2011

Most women in their 40′s believe they should have annual mammograms, regardless of what screening regimen their doctor might recommend.

So say researchers in Massachusetts who surveyed women (primarily white, highly educated) ages 39-49 presenting for annual checkups. They gave the women a fact sheet about the new USPSTF guidelines on mammogram screening in their age group, and asked them to read one of two articles either supporting or Read more…

An informed screening choice for breast cancer

Heart valve repair without open surgery

Stephen C. Schimpff, MD

Conditions and Diseases

September 2, 2011

A major innovation are the recent reports of success in replacing or repairing diseased or damaged aortic or mitral valves via catheter-based techniques instead of open surgery.

Mitral regurgitation is when the valve becomes unable to close tightly. Once the regurgitation becomes sufficiently severe to cause heart failure, the death rate reaches about 5% per year. Most such individuals are referred for cardiac surgery to either try to repair the valve, …

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Heart valve repair without open surgery

Overcoming barriers to building a direct primary care practice

Dave Chase

Physician

September 2, 2011

The federal health reform bill included a little-noticed clause allowing for Direct Primary Care (DPC) models to be a part of the state health exchanges. I believe this will fundamentally alter the health insurance market and is leading to what I call a “Do it Yourself Health Reform” movement. That little-noticed clause (item #3 in 1301(a) of HR 3590) should have the effect of massively …