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Watchful waiting pays off for a torn ACL

Conditions and Diseases

August 30, 2010

“Why golf,” my friends often ask. They, like too many Americans, assume it is a sport for the country club set, and have a hard time fathoming why someone like me — liberal, somewhat intellectual, decidedly anti-elitist — would passionately embrace the game.

My answer is always brief and direct. When I was 35, I tore my right knee’s anterior cruciate ligament during one of my twice-weekly pick-up basketball games in …

Whooping cough and pertussis tips you need to know

Jan Gurley, MD

Conditions and Diseases

August 30, 2010

As a whooping cough epidemic hits California, you may be asking yourself, “hey, weren’t we all vaccinated for that?” Even as the headlines imply a Victorian-level outbreak of hacking and coughing, perhaps you’re looking around and wondering where, exactly, this epidemic is located. And what you should know about whooping cough to protect you and yours.

Here are some fun, weird, and sometimes worrying tidbits to know about whooping cough. Pass …

Southern states may block the government from delivering health care

Allen Perkins, MD

Health Policy

August 30, 2010

I have lived on the Gulf Coast for all but 5 of my 50 years. I grew up in Baton Rouge, Louisiana and now live in Mobile Alabama.

I was educated in the public schools during the height of the desegregation battles and my experiences were colored by those battles in a number of ways. I ran track in high school and was in the racial minority on that team (as …

Root beer bonds a chemotherapy patient with his oncologist

Kevin

Conditions and Diseases

August 30, 2010

by Krupali Tejura, MD

I am treating a patient for head and neck cancer — which can be one of the most harrowing therapies.

To receive chemotherapy and radiation concurrently can be pretty debilitating. Swallowing foods can be next to impossible, and the taste changes and saliva changes are brutal. It’s one of the harshest areas to treat … and I warn the patients beforehand: …

Why the sustainable growth rate formula (SGR) is here to stay

Jaan Sidorov, MD

Health Policy

August 29, 2010

According to the Washington Post, it is highly unlikely that Congress will undo the planned “sustainable growth rate formula” (SGR) mandated Medicare fee schedule cuts. While there’s an outside chance of a fix, the American Medical Association, as well as other organized physician groups, can’t be happy about the constant threat of the 20% payment reductions.

Recall that the SGR was signed into law back in 1998. It was designed to …

Effect of the Massachusetts Gift Ban law on area restaurants

Daniel J. Carlat, MD

Medications

August 29, 2010

I recently debated Steve DiFillippo, owner of Davio’s and Avila’s restaurants, on the WGBH program Greater Boston, hosted by Emily Rooney. The topic? The effect of the Massachusetts Gift Ban law on area restaurants.

On one level, it was a friendly debate on the economic impact of the law on those restaurants that depend on drug company sponsored dinners for a chunk of their income.

But on another level, this is a …

Computerized Physician Order Entry (CPOE) affects patient safety

Margalit Gur-Arie

Health Technology

August 29, 2010

Recently, yet another alarming Computerized Physician Order Entry (CPOE) study made headlines.

According to Healthcare IT News, The Leapfrog Group, a staunch advocate of CPOE, is now sounding the alarm on untested CPOE as their new study “points to jeopardy to patients when using health IT.” Up until now we had inconclusive studies pointing to increased and also decreased mortality in one hospital or another following CPOE implementation, but …

Too many young children are medicated with powerful drugs

Claudia M. Gold, MD

Medications

August 28, 2010

Recently while cleaning out my office in anticipation of my new job, I discovered that I had unknowingly been witness to an historic moment in child psychiatry. I found a binder from a course I had taken in June of 2001 sponsored by Harvard Medical School on Major Psychiatric Illnesses in Children and Adolescents.

Though I did not remember until I looked at my scrawled notes in the margins, on Saturday …

Does a stereotypical surgical personality exist?

Kevin

Physician

August 28, 2010

by Shawn Vuong

Recently, our class learned and practiced how to correctly ‘scrub’ for surgery. During this little lab activity, we were all gowned up and washing our hands when a couple of classmates asked if I was going to be a surgeon.

I said I didn’t really know yet, although I did find surgery pretty fascinating. With that, they told me that they thought I would make a good surgeon. due …

Obesity is a complex problem that may not have simple solutions

Arya M. Sharma, MD

Conditions and Diseases

August 28, 2010

A single mom juggling two jobs and four kids may be right in thinking her life is complicated – but it is certainly not complex – at least not in the scientific sense of the word.

In medicine we also differentiate between procedures that are complicated (difficult, requiring skill) and complex (no clear solutions, unknown and incalculable risks, unpredictable outcome).

The best description of complexity was the “simplified” one I found in …

Contract pregnancy ethics and moral issues

Kevin

Patient

August 27, 2010

An excerpt from Why Some Things Should Not Be for Sale: The Moral Limits of Markets.

by Debra Satz

Sometimes what critics of pregnancy contracts have in mind is not the effect of such contracts on the relationship between reproductive labor and a woman’s sense of self, but their effect on her views (and ours) of the mother-fetus and mother-child bond.

On this view, …

Treating vitamin D deficiency requires caution

Kenneth Lin, MD

Conditions and Diseases

August 27, 2010

Vitamin D seems to be all the rage in medicine these days. A family physician colleague commented to me recently that the laboratory test for vitamin D deficiency is becoming the most frequently ordered test in his practice.

This clinical bandwagon is likely a response to data from multiple recent studies that found low vitamin D levels in the majority of children and adults of all ages. While vitamin D has …

Statins for heart disease and stroke, and debunking statin myths

Eric Van De Graaff, MD

Medications

August 27, 2010

There is no class of medications in the history of the world that has been better studied that statins.

This class of drugs is more properly termed HMG CoA reductase (3-hydroxy-3-methyl-glutaryl co-enzyme A reductase) inhibitors, but with a name like that a terser nickname is almost mandatory (the name statin comes from the suffix of the members of this class: lovastatin, pravastatin, etc.).

Simply …

For women with endometriosis, motherhood is elusive

Kevin

Conditions and Diseases

August 27, 2010

by Lone Hummelshoj

Earlier this year, we finished a month dedicated to women and mothers. In the U.S., we celebrated “National Women’s Health Week” and before it Mother’s Day. One study suggested Americans would spend a total of $14.6 billion in May alone to honor our mothers. And we should honor our mothers!

However, for millions of women with endometriosis, motherhood is elusive. In fact, an estimated …

Assumptions in medicine can inhibit care

Patrick W. Hisel, MD

Patient

August 27, 2010

Assumptions are ubiquitous. Neither patients nor physicians are exempt. Sometimes they are justified, other times entirely misguided.

Webster’s defines “assume” as “to take as granted or true.” The cliché’s have probably always existed: Doctors are greedy and paid too much, and are uncaring. Some patients believe doctors do care and that their doctor actually likes them. That’s an assumption too. Some assumptions are newer. Patients assume doctors will substitute their prescription …

How drug companies sell psychiatrists on their drugs

Daniel J. Carlat, MD

Medications

August 26, 2010

An excerpt from Unhinged: The trouble with psychiatry- a doctor’s revelations about a profession in crisis. Copyright © 2010 Daniel Carlat. Excerpted with permission by Free Press, a Division of Simon & Schuster, Inc.

In 1993, the FDA approved Neurontin for the treatment of epilepsy. This should have been a cause for celebration at Warner-Lambert, the drug company that introduced it, but the celebration was muted. The FDA had …

Checks and balances in health reform

Richard Reece, MD

Health Policy

August 26, 2010

What follows are ten thoughts on checks and balances in health reform.

I am writing from Oak Ridge, Tennessee, where I am attending a high school class reunion. My son Spencer, a nationally known poet and a candidate for the Episcopal priesthood, is with me. He is checking on my past, and I am trying to provide balance so he can understand his father’s legacy.

There …

Read more…

Checks and balances in health reform

Converting from paper chart to an EMR: Keep daily use in mind

Rosemarie Nelson

Health Technology

August 26, 2010

Maybe you’ve been assuming that when it comes time to go live on your EMR, you’ll simply scan each patient’s old paper chart into the electronic system.

Maybe you haven’t given it much thought because you’re focusing on the change in your work flow when you start to use the EMR to document patient encounters.

Well, it’s time to pay attention to the transfer, because the conversion of the paper chart can …

The medical system Donald Berwick prefers in the United States

Kevin

Health Policy

August 26, 2010

by James Gaulte, MD

Apart from some apparently radically contradictory expressed views on patient “centeredness” and patients being in control, the newly appointed head of CMS, Dr. Donald Berwick, has made it clear what sort of medical system he would have for the United States.

What he wants is well explained in this commentary from National Review Online as is the authors’ reasoning of why …

Fix the July Effect for incoming interns and residents

a medical resident, MD

Medical Education

August 25, 2010

According to an article published in the Journal of General Internal Medicine, counties with teaching medical hospitals experienced a 10% increase in fatal medication errors as compared to counties without teaching medical hospitals.

First, what is the July Effect? It represents an entire transition in the hospital, during which medical students become interns, interns become senior residents, and second or third-year residents become chief residents. …

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