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Percy Harvin and how sleep apnea affected his migraine headaches

Diana E. Lee

Conditions and Diseases

December 7, 2010

by Diana E. Lee

It sounds like NFL Wide Receiver Percy Harvin (Minnesota Vikings) is one of the luckier chronic migraine patients out there.

He was actually able to identify a specific reason for his drastically increased number of migraine attacks (sleep apnea) and implement a treatment that seems to be helping (CPAP). He is performing solidly and confidently and taking contact without any issues.

I know a …

Commercially funded CME programs and whether bias can be removed

Thomas Sullivan

Medical Education

December 7, 2010

The growing criticism of industry funded continuing medical education (CME) over the past several years has had a number of significant effects on the CME community. As the Accreditation Council of Continuing Medical Education (ACCME) annual report showed, from 2007 to the present, commercial support of CME dropped 29.3%, and the number of directly sponsored CME activities decreased over 7% between 2008 and 2009.

CME funding is extremely important …

William Osler’s humor, and finding fun in medicine

Dr. Chris Nickson

Physician

December 7, 2010

In 1905 William Osler gave his farewell address as he prepared to leave Johns Hopkins for Oxford and England. After speaking to the assembled medical students about the tragic side of medicine he said:

The comedy, too, of life will be spread before you, and nobody laughs more often than the doctor at the pranks Puck plays upon the Titanias and the Bottoms among his patients. The humorous side is really …

Read more…

William Osler’s humor, and finding fun in medicine

Open dialogue on medical malpractice and patient safety

Kevin

Physician

December 7, 2010

A response to my recent post, The malpractice system doesn’t improve patient safety.

by Brian Nash

In his blog, Dr. Kevin acknowledges that in the “world of medical error, truth is often clouded in secrecy.” He then points out that “… taking the bold step of publicly describing your mistake is a brave one. Some would say it’s long overdue.”

Well so far, Dr. K, we’re …

Playing hurt and when to return to football after a concussion

Gregory Bratton, MD

Conditions and Diseases

December 7, 2010

The September issue of Journal Watch General Medicine included an article from the American Academy of Pediatrics about new criteria for diagnosis and management of concussions in children and adolescents.

Shortly after this issue was published, a segment aired on ESPN regarding a confrontation between the head football coach at Texas Christian University and its team physician over holding a player out of the game due to a concussion.

As a sports …

Early detection and improving cancer cure rates

Richard Leff, MD

Conditions and Diseases

December 6, 2010

Reading the newspapers and watching the news lately would lead you to believe that screening for cancer is largely a waste of time.

Yet, in the same week that the NEJM published Norwegian data showing a remarkably small survival benefit of 2% associated with screening mammography, HealthDay reported a decrease in cancer incidence of almost 1% per year from 1999 to 2006 and a decrease in cancer deaths …

Temperament of perfectionism in anorexia nervosa

William R. Yates, MD

Conditions and Diseases

December 6, 2010

Temperament is generally defined as innate early emotional and behavioral characteristics that precede puberty and adult development. Felt to have significant genetic components, temperament is also potentially influenced by environmental factors.

There are a variety of temperament domains that have received significant attention in childhood, adolescent and adult populations.

Some of the most commonly studied domains include:

neuroticism
harm avoidance
novelty seeking
reward dependence
perfectionism (subdomains have included: concern about mistakes, personal standards, doubts about actions, organization

The …

$11,000 hospital bill from the emergency department

Kevin

Patient

December 6, 2010

by Steve Sanders, DO

“What am I going to do now Doc?” asked Mike, a down on his luck, 29 year–old recently unemployed truck driver, as he handed me his hospital bill.

Mike was seen at our local emergency department on a Friday evening with complaints of indigestion. Earlier that day he and his wife Susan celebrated their second anniversary by splitting a store bought pepperoni pizza. …

Choose your primary care physician with particular care

Colleen Kelly Mellor

Physician

December 6, 2010

I told a friend what I did recently to get in to see a dermatologist and she was shocked.

“You wrote a letter asking her to take you as patient?” “Wow!” “Yes,” I admitted. “I’d called her office for an appointment; she wasn’t taking new patients; I needed to resort to an over-the-top approach.”

You see, I’d researched her (ok, I Googled her) and after reading her background, schooling, and patient reviews, …

Medicare rates will be influenced by comparative effectiveness

Bob Doherty

Health Policy

December 5, 2010

From its inception, Medicare has been agnostic about the effectiveness of different treatments when it sets payment rates. Once a treatment is found to be “reasonable and necessary,” Medicare establishes a payment rate that takes into account complexity and other “inputs” that go into delivering the service. But it is prohibited by law from varying payments based on how well an intervention works.

This would change under a “dynamic pricing” approach …

Redundant tests waste health care dollars

Doctor Grumpy, MD

Conditions and Diseases

December 5, 2010

B12.

Sounds simple, huh?

1 letter, 2 numbers. One of the B vitamins. It’s important in a number of body functions, particularly the nervous system and blood cell production. It’s in pretty much all meats and vegetables, and multivitamins you can buy.

To me, it’s also a good example of what’s wrong in health care.

Let’s take Mrs. Olde.

She goes to her internist, and is complaining of feeling weak and tired. So he checks …

Priapism is indicative of spinal cord injury in trauma

StorytellERdoc, MD

Conditions and Diseases

December 4, 2010

It had been a high-speed motor-vehicle accident. One car. A twenty-something male driver without passengers. No seat belt. And now, this same driver had no movement from his waist down and no sensations below his mid-abdomen.

According to bystanders, he had been driving his sedan dangerously fast, some estimates of nearly 100 m.p.h., before losing control. The car veered off the roadway to the right, flipping mid-air before smacking head-on into …

Sleep-breathing, your immune system, and colds

Steven Y. Park, MD

Conditions and Diseases

December 4, 2010

Have you ever wondered by some people never get colds? Why do other people get colds at the drop of a sneeze?

An opinion piece recently published in the New York Times explains away a common myth—that you have to strengthen your immune system to fight a cold. His argument is that your symptoms of a cold are actually your immune system over-reacting to harmless viruses. This is …

Why the Pre-Existing Condition Insurance Plan (PCIP) fails

Kevin

Health Policy

December 4, 2010

by Ray Carlson

As we all know, this past March Congress passed and the President signed The Affordable Care Act. One component of the new legislation was the creation of a program called the Pre-Existing Condition Insurance Plan (PCIP). This is a federally funded high risk pool for state residents who – having been denied individual insurance coverage within the past 12 months for a pre-existing condition – would now, theoretically, …

Waste at hospitals in developing countries

Yann Meunier, MD

Physician

December 3, 2010

Year: 1993

Setting: Mendi Hospital, Southern Highlands province, Papua New Guinea
Position: Chief medical officer for Chevron

Chevron is contributing to the budget of Mendi Hospital in the capital city of the Southern Highlands province. Each year, the hospital director sends a financial request to the company’s medical department, and this is my first time to review and approve it. Curious about how the money will be used, I phone the director to …

Appendicitis in children and radiation exposure from CT scans

Skeptical Scalpel, MD

Conditions and Diseases

December 3, 2010

Recently, medical writer and pediatrician Perri Klass wrote in the New York Times about evolving issues regarding the diagnosis of appendicitis in children, which are also applicable to adults. There is well-documented concern regarding the excessive radiation exposure associated with CT scans.

For example, a recent paper reported that a single abdominal CT scan with contrast delivers a radiation dose equal to undergoing more than 200 regular …

How the pharmaceutical industry changed psychiatry

Jan Henderson, PhD

Medications

December 3, 2010

What’s happened to psychiatry over the last 15 to 20 years? That’s a big subject, discussed in many recent and excellent books. One of those books is by Daniel Carlat, author of Unhinged: The Trouble with Psychiatry – A Doctor’s Revelations about a Profession in Crisis.

One of the problems Carlat readily acknowledges is that psychiatry is excessively focused on psychopharmaceuticals at the …

Educate the patient about their disease and discharge plan

Lyle Fettig, MD

Physician

December 3, 2010

Have you ever discharged a patient from the hospital and had a gnawing feeling that maybe you could have done more to educate the patient about their disease, medications, and plan of care?

Probably so. A recent survey published in the Archives of Internal Medicine tells us that this feeling is based in reality (I’m guessing that you already knew this) and that you are not alone.

The …

A better system is needed to migrate to electronic health records

Steven Reznick, MD

Health Technology

December 2, 2010

Five years ago my associate and I invested sixty thousand dollars to purchase and set up an electronic health record system and eliminate extensive paper use.

We researched all available systems and decided upon MediNotes because it was a large company with an excellent record of service and their system met all the national requirements for certification. We worked through our local computer vendor’s family …

Learning from the Massachusetts experiment in universal coverage

Joseph Paduda

Health Policy

December 2, 2010

We’re learning a lot from Massachusetts’ experiment in universal coverage – and some of the lessons are rather enlightening.

According to Bestwire, Lora Pellegrini, president of the Massachusetts Association of Health Plans, said something along the lines of “That’s the problem with the new U.S. health care reform law … it offers millions of uninsured Americans access to health insurance but doesn’t address underlying medical costs, which are contributing to costly …

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