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The Night Shift: Real life in the heart of the ER, an excerpt

Physician

September 21, 2010

Fear and Loathing

12:47 a.m.

Two police detectives were waiting for me near the main triage desk; one was a tall male in a sleek black suit, probably in his early forties. He was ruggedly handsome in the manner of Jean-Paul Belmondo, the French …

Prevention is the best influenza protection

William Schaffner, MD

Conditions and Diseases

September 21, 2010

For years, we have heard (and I have often said) that an average of 36,000 Americans die from influenza annually.

This figure is based on data from 1990-1999. Now the CDC is telling us that the range of annual deaths is too wide to continue using that single number. Based on a lot more seasons (1976-2007), the average is closer to 24,000 with a range of about 3,300 to …

ACP: Primary care education and training: Time for change?

American College of Physicians

Physician

September 20, 2010

A guest column by the American College of Physicians, exclusive to KevinMD.com.

by John Tooker, MD, MBA, MACP

The Annals of Internal Medicine recently published an article by Mullan and colleagues on the social mission of medical schools. In the article, medical schools were ranked on their record of educating and training physicians …

Health reform vaults the USPSTF into prominence

Glenn Laffel, MD, PhD

Physician

September 20, 2010

The most visible impact of Affordable Care Act is surely the expansion of health insurance coverage to 30 million uninsured Americans, but a lesser known provision in the overhaul will have far-reaching implications as well.

The provision catapults the US Preventive Services Task Force (USPSTF) from an obscure agency that produced unenforceable guidelines about screening and preventive services into one whose recommendations directly impact reimbursement.

According to the terms of the new …

How can anyone deny scientifically sound treatment for breast cancer?

Jackie Fox

Conditions and Diseases

September 20, 2010

I just don’t understand how someone can live in this day and age and deny the effectiveness of scientifically sound medical treatment when dealing with breast cancer. I was completely flummoxed when I came across the in-depth and thoughtful post “A horrifying breast cancer ‘testimonial’ for ‘holistic’ treatment” on Respectful Insolence, written by a surgeon and scientist who uses the pen name Orac.

Like others who came before and surely will come after …

When does a headache need to be seen at the hospital?

Chaim Colen, MD

Conditions and Diseases

September 20, 2010

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As a neurosurgeon, I encounter a lot of people who are concerned with ruptured brain aneurysms (blood vessel blisters). Ruptured brain aneurysms typically present with severe headache. I am incessantly asked, “When is a headache more than just a headache? When should I go to the hospital?”

A headache is considered to be pain located anywhere in the region of the upper …

Social anxiety assumptions and their solutions

Srini Pillay, MD

Conditions and Diseases

September 20, 2010

Social anxiety refers to the fear of being around people due to the threat of embarrassment.

People who are socially anxious frequently freeze and are unable to seek the very company their hearts desire. They may make adaptations: they may decide that they “hate” being around people; they may isolate and play video games; they may absorb themselves in their work, but no matter what they do, this anxiety always exists …

Why answering a cell phone during an office visit is a problem

Jill of All Trades, MD

Patient

September 19, 2010

Here is an unfortunate, but almost daily not-so-secret occurrence in my practice:

I am in the midst of an intricate follow-up visit with a rather complicated patient with diabetes, high cholesterol, and high blood pressure. I am feeling as though I am a CIA agent in a rather mission impossible assignment: she is here for lab results, is complaining of low back pain, and presents with an elevated blood pressure of …

Patient Protection and Affordable Care Act individual mandate controversy

Roger Collier

Health Policy

September 19, 2010

The individual mandate is the single most controversial feature of the Patient Protection and Affordable Care Act. Everyone who can afford coverage—unless an undocumented immigrant or exempted on religious grounds—is required to have it or pay a penalty of $695 or 2.5 percent of income.

The rationale is straightforward: without a mandate, many people would wait until they needed care before buying insurance, driving up premiums for those with ongoing coverage, …

Is it the doctor’s fault if an obese patient cannot lose weight?

John Mandrola, MD

Patient

September 19, 2010

I need help. In dealing with obesity as a medical problem, that is.

I am pretty solid at arrhythmia management, but as an obesity doctor, not so much. If I was the teacher, and my obese patients were the students, I would surely be fired for poor student test performance. At least, if the core measure was the patient’s BMI.

If a student does poorly on an achievement test, is it the student’s …

DTC advertising, and its history with the FDA

Ishmael Bradley, MD

Medications

September 18, 2010

Advertising is everywhere.

That should come as no surprise to anyone who has lived in modern America. It is impossible to turn on the television, ride the subway, or even sort through the daily mail without coming across an ad for a new car, a soft drink, or the latest digital toy. These advertisements have only one goal: to entice you to buy their products. This is harmless enough when these …

Do all people with disturbing behavior have a psychiatric illness?

Jeffrey Knuppel, MD

Conditions and Diseases

September 18, 2010

“Hey Doc, this guy needs some help.”

I’ve heard that statement from countless correctional officers over the years. Its meaning is very simple: Someone is exhibiting thoughts or behaviors that the officers find disturbing and “not normal.”

I appreciate the officers expressing concern. Without their input I often would not be aware of cases where I might be able to be of assistance.

But, one of the questions that always pops into my …

Are Alzheimer’s disease screening tests ready for the public?

Naomi Freundlich

Conditions and Diseases

September 18, 2010

In April, an independent panel established by the National Institutes of Health came to the disheartening conclusion that currently, there is nothing to prevent or delay the progress of Alzheimer’s disease in those of us who are destined to join the 5 million Americans currently suffering from this dreaded ailment.

The panel found that: “Although numerous interventions have been suggested to delay Alzheimer’s disease, the evidence is inadequate to conclude that …

Radiation risks of CT scans need to be taught to patients

Paul Dorio, MD

Physician

September 17, 2010

Radiation is emitted in various forms. Recently, CT scan radiation has preoccupied (or “absorbed”) the attention of the public and media. As explained: “X rays, γ rays, and neutron beams are considered ionizing radiation. Ionizing radiation may break molecules into pieces, creating ionic free radicals that can be very damaging to tissue.”

For this reason, it is imperative that the use of radiation is only by highly trained personnel and that …

For autism, vaccination is the simple answer that is tragically wrong

Amy Tuteur, MD

Conditions and Diseases

September 17, 2010

It is a curious fact, seldom remarked upon, that all diseases purportedly caused by vaccination share certain common characteristics. Chief among these characteristics is that the cause of the disease purportedly caused by vaccination is presently unknown.

Vaccine rejectionists never claim that a particular vaccine causes heart disease, gall bladder disease, bone abnormalities or any of the myriad diseases for which causes are already known. Vaccine rejectionists always insist that vaccines …

Triage pathways make patients feel disconnected from their doctors

Wendy Sue Swanson, MD

Physician

September 17, 2010

There are things we (the providers) do to health care that are hurtful. We make protocols and rules that divide us from our patients. Protocols that sometimes make patients feel alone, distant, and disconnected from their doctors. I don’t mean algorithms of care (safe, standardized ways of how and why to treat pneumonia, for example), I mean clinic rules for helping patients schedule and get in to see doctors appropriately.

Triage …

There is no alternative medicine, only unproven medicine

George Lundberg, MD

Conditions and Diseases

September 17, 2010

There is no Alternative Medicine.

Thus sprach Phil Fontanarosa and me in a 1998 JAMA editorial in the famous theme issue dedicated to Complementary and Alternative Medicine.

So I went to Mr. Google in 2010 and entered … Alternative Medicine … and clicked — 41,200,000 results; entered Complementary and Alternative Medicine, click — 3,210,000 results; entered CAM, click — 191,000,000 results, but that’s not fair; CAM can stand for many unrelated topics.

Let’s …

Chronic prostatitis is a public health problem

Arnon Krongrad, MD

Conditions and Diseases

September 17, 2010

by Arnon Krongrad, MD

David was afraid. After years of peregrinations with pain, he had exhausted all the options. David knew he wasn’t crazy. The problem was the doctors: They had no more treatments for chronic prostatitis. The doctors did not want to see him.

Chronic prostatitis is a public health problem. Contrasted with fibromyalgia, autism, and breast cancer, however, nobody talks about it. President Obama declared …

AMA: Ensuring medical education best prepares future physicians

Kevin

Medical Education

September 16, 2010

A guest column by the American Medical Association, exclusive to KevinMD.com.

by J. James Rohack, MD

This year marks the 100th anniversary of the landmark Flexner Report that standardized medical education in North America. Now, during this historic time of health system change, medical education reforms on the scale of those enacted a century ago are needed …

Powerful examples of using the iPad on the wards

Vineet Arora, MD

Health Technology

September 16, 2010

I recently completed a two week tour of duty on the wards in July with new residents, interns, and students.

Attending (serving as the supervising doctor for the team of residents, interns and students) in July can be challenging, but also one of the most rewarding clinical experiences as a faculty member. The interns and residents are eager to learn and your teaching may have a more lasting impact as the residents …

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