Do drugs aid and abet genius or does genius lead to drugs?

Physician
October 13, 2012

Who is your favorite addict? I guess we have to talk about addiction as a preface to that question.

Everybody I know takes psychoactive drugs, except maybe some Mormons, Seventh Day Adventists, and the like.

All drugs are habit-forming, but only a subset of psychoactive drugs can produce psychological and physical dependence, tolerance, and withdrawal symptoms when taken away, the usual definition of addiction.

Most people who become addicted to one drug often …

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Chuck Pagano has leukemia: An oncologist discusses his prognosis

Conditions
October 10, 2012

I’ve been getting a lot of questions about Indianapolis Colts’ Head Coach Chuck Pagano lately, so I thought I would dedicate a blog entry to discussing his disease and prognosis.

Coach Pagano was recently diagnosed with acute myeloid leukemia (AML), a form of blood cancer that typically carries a rather grim long-term prognosis in adults.  While early reports were quite sketchy on the details of Pagano’s presenting symptoms, it seems that …

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How America’s healthcare system will keep you sick

Physician
October 7, 2012

Have you ever worried about how you’re going to get healthy these days? Has your doctor recommended diet and exercise? Well, if you’re like millions who are struggling to find health, you’re going to need a lot more than just diet and exercise. You’re going to have to fight like crazy against a mind-set of disease that’s paradoxically disguised as health care.

America’s healthcare system – health insurance companies, government health …

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Why doctors need to be better social workers

Physician
September 30, 2012

Doctors are already busy, but do they need to do more in a day? If you think a physician’s job is to take the best possible care of patients, then the answer is a resounding yes. But additional responsibilities do not necessarily mean more work—they just require different training.

It doesn’t take unique insight to understand that doctors, in many ways, act as social workers. They help patients schedule follow-up appointments, …

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Taking medications in the middle of the night can be risky

Meds
September 30, 2012

You may have heard that veteran NBC News correspondent Tom Brokaw was hospitalized recently after he reported feeling lightheaded after making an appearance on MSNBC’s “Morning Joe.”

He’s fine. Brokaw tweeted, “All is well. Early a.m. I mistakenly took a half dose of Ambien and made less sense than usual.”

And that’s what you’ve got to be careful not to do.

Any time you get up in the wee hours of …

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Why I quit internal medicine for physiatry

Physician
September 29, 2012

Some of you may know that I started out in an internal medicine residency and quit for physical medicine and rehabilitation (PM&R). Switching residencies? Not recommended. But entirely doable.

I spent most of my first half of internship being really, really miserable. I remember sitting in the call room during my ICU month, talking to my mother about how badly I wanted to quit and what my options would be if …

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My first day as a surgery intern

Physician
September 23, 2012

Virtually every medical school graduate immediately enters at least three years of post-graduate medical training (internship-residency). The exceptions are those who:

1. combine the MD with a JD or PhD;

2. leverage the not-yet-dry diploma into a post as health policy advisor to a state or federal legislator, usually one of Dad’s chums;

3. are named Michael Crichton.

Commencement is in late spring, so post-graduate training begins on July 1. Every year my surgery …

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Should doctors stop prescribing inhalers for smokers?

Meds
September 18, 2012

I’ve always had a tough relationship with cigarettes and the people who love them. As a lung doctor I hate cigarettes, and I hate that patients I see everyday continue to use them. But I also understand that vilifying smokers seems to be in vogue right now. I figure that if someone does something that is not considered socially palatable, and that does them harm, even as they strive to …

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Restless legs syndrome in children: How the kids see it

Conditions
September 17, 2012

When I was a kid, my parents used to avoid giving me Coca-Cola after lunch. Not because they were overly concerned about my health. (If they had been, my mom wouldn’t have given me milkshakes when I watched Kung Fu Theater every Sunday afternoon. But that is a different story).  The reason was that I would have really severe problems falling asleep about a quarter of the time. I would …

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Can I still have a bladder infection with a negative urine culture?

Conditions
September 16, 2012

In a word, yes.

And this is a difficult concept for many doctors to get because we have long been taught that the gold standard is culture.

Let’s back up a little. These are the symptoms of a bladder infection: needing to empty your bladder a lot (urinary frequency), when you gotta go, you gotta go (urgency), pain just over the pubic bone, blood in the urine, burning when you empty your …

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These are the reasons why nurse practitioners are special

Physician
September 15, 2012

By now most of us have heard of a nurse practitioner. But what exactly is a nurse practitioner? What can they do? How can they be incorporated into a medical practice?

A nurse practitioner is a registered nurse who has completed graduate-level education and advanced practice training. Nurse practitioners can see a wide range of patients, both well and sick, and perform many in-office procedures. Prescribing medications, ordering and interpreting tests, …

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Practices are getting larger to provide micropractice service

Physician
September 13, 2012

Medicine has gone down Alice in Wonderland’s rabbit hole. Looking at the size of practices today, it seems like some of them have taken red pills and the rest have taken blue ones: most of them are getting bigger and bigger and bigger, while some are getting smaller and smaller. As the giant practices gobble up their competition to become ever more gargantuan, others are shrinking down into micropractices.

Everyone has …

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When the fear of needles paralyzes medical care

Conditions
September 11, 2012

When I was a kid, my pediatrician was a friend of my parents who practiced out of a first floor office in his home across the street from ours. He was a wonderful man and doctor, I’m sure, but I was terrified of him because I associated him with the injections he gave me periodically. Even when he and his wife came to our house for dinner I hid–just in …

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Would you accept obesity advice from a fat doctor?

Conditions
September 7, 2012

Something that has been on my mind recently is obesity, specifically obesity in doctors. This may be because we cover obesity in a high percentage of our stories (1 in 3 Americans is obese, after all) or because I recently discovered that I gained ten pounds since moving to New York City. Either way, after watching Dr. Snyderman speak her mind on national television about how obese leaders are unfit …

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Striking the balance between the public good and patient privacy

Tech
September 6, 2012

Everybody has a shadow. Although as a small child you may have tried, you cannot separate yourself from your shadow no matter what you do. Electronic medical records may be the first tiny step on the road to attaching yet another indivisible part to your persona, a “panoramic, high-definition, relatively comprehensive view of a patient that doctors can use to assess and manage disease”, and this, in the words of …

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Any doctor can make the decision for mental capacity

Physician
September 5, 2012

Many elderly patients get admitted to the hospital with profound weakness due to their acute and chronic medical conditions. Many of them will leave the hospital with profound weakness from their acute and chronic medical conditions (and unfortunately without a palliative care consult). In many situations, these patients will be too weak to take care of themselves.  They will need extra help with their activities of daily living either from …

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Why weight loss advice may be unethical

Physician
September 4, 2012

And issue of Newsweek quotes me as saying, “A lot of our weight-loss recommendations are unethical because we shouldn’t be saying lose weight when there is no chance people will keep it off.“

This quote appears in the context of a lengthy article by Daniel Heimpel that examines whether or not the obesity epidemic is being oversold.

While I personally do not think that the obesity epidemic is being oversold, I do …

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How we die should never be taken lightly

Physician
September 3, 2012

It was another day in the intensive care unit. The night was clean and calm, ventilators beeping their expected  melody, and the laborers of medicine went about their night shifts uneventfully, including me sitting with the obnoxious admission pager attached to my hip. The smoothness of it all shattered when the beeper started screaming – I picked up the phone and soon the emergency room physician was on the line.

“We …

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Why doctors complain: A history of physician income

Physician
September 2, 2012

We’re not going for sympathy here. Doctors as a whole enjoy less sympathy than many other professional groups (members of Congress enjoy the least, I would think), and that’s probably appropriate. They have high incomes and many prerogatives and rank highly in esteem polls as individuals, if not as a group. It’s not where they are that is causing the grieving, it is where they are coming from.


Let’s deal with …

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