Treatment guidelines pros and cons

Conditions
February 17, 2011

I was puzzled by a Health Affairs article showing the public finds arguments against treatment guidelines a lot more compelling than arguments in favor. But after reading the technical appendix, which contains the full text of the survey, I think the problem is that the researchers framed the question poorly. In particular, the researchers portrayed guidelines as unrealistically rigid.

In A National Survey Reveals Public Skepticism About Research-Based Treatment …

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What makes a good, competent psychiatrist?

Physician
February 16, 2011

A reader recently asked, how does someone find a good psychiatrist?

Stated another way, the questions are:

  1. What qualities make a good, competent psychiatrist?
  2. How do I find a good, competent psychiatrist?
  3. How do I get my concerns heard about the direction of my treatment?

I typed the question “How do I find a good psychiatrist?” in Google and got almost half a million results from around the world. I find it hard to believe …

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Difference between proactive and reactive medicine

Physician
February 16, 2011

Looking back, some of my biggest medical mistakes have been times when I was reactive rather than proactive when faced with a clinical problem.  A doctor may have to be one or the other depending on the circumstances, but knowing when and which approach to take is one of the harder skills of medicine, taking time and experience to master.

What do I mean?  Here are some examples from my field.

Treating …

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When in the ER with abdominal pain, adjust your expectations

KevinMD
February 14, 2011

Abdominal pain is the bane of many emergency physicians.

Recently, I wrote how CT scans are on the rise in the ER.  Much of those scans look for potential causes of abdominal pain.

In an essay from TIME, Zachary Meisel discusses why abdominal pain, in his words, is the doctor’s “booby prize.”  And when you consider that there are 7 million visits annually by people who report abdominal pain, that’s a …

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Why your doctor’s education is unique

Education
February 14, 2011

What makes your doctor’s education unique from that of other health care providers?

Recently, I was sitting in on a lecture by one of my favorite physician-teachers (certainly my favorite neurologist).  I’ll call him Dr. Deeds (for his resemblance to a character from the movie, Mr. Deeds).  He was giving a sort of broad, generalized lecture to prepare us for a series of lectures on neurodegenerative diseases …

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How to become a licensed, board certified doctor

Physician
February 12, 2011

I am licensed to practice medicine and surgery in Georgia. But that doesn’t mean I should, or that you ought to let me—at least not the surgery part. I’m actually pretty good at carving a turkey, but that’s pretty much the only kind of surgery that I’m qualified to do.

Don’t let the license fool ya, I’m no surgeon. So what, exactly, does a doctor have …

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Pelvic exam by a medical student for the first time

Education
February 10, 2011

They say you never forget your first “real” patient.  Mine was a woman who didn’t need a pelvic exam, but who got one anyway.

Next door, minutes later, my second patient provided another personal first: a male genital and rectal exam, also, without need. Medical students like me begin training by practicing the basics on one another–listening to heart sounds, and looking into each other’s ears and eyes—but eventually, every clinician-in-training must lay …

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How to check your scientific paper for plagiarism

Education
February 8, 2011

We were taught in grammar school that plagiarism is wrong. It is stealing someone else’s property.

Imagine in high school asking your mother to buy you “Cliff Notes” so you can copy it word for word. Mother would not have liked that, and it wouldn’t have been right.

To write an essay today, you’ll probably start with a search engine. Instantly, Mr. Google delivers many intelligent commentaries on anything, probably better than …

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If you’re in medicine, you’re in politics

Education
February 7, 2011

by Nicholas J. Rohrhoff

Each generation of physicians has no choice but to take on the responsibility of learning the science of medicine – how best to care for patients.  But current circumstances dictate that we must also bear the burden of developing policy that creates the best system in which to provide that care.

Creation of a 21st century American healthcare system will require engagement and …

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Alternatives to NSAIDs, pros and cons

Meds
February 3, 2011

by Marianna Rakovitsky, RPh

Recently, I have talked about the concerns with the use of NSAIDs and their effects on the heart.  All medications carry a risk of adverse effects. NSAIDs are usually very effective in controlling pain especially muscle and bone pain, but they also carry a potential risk of side effects such as stomach and kidney problems, increased risk of bleeding and adverse effects …

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The threat of malpractice means doctors cannot acknowledge their fallibility

Physician
February 2, 2011

An excerpt from The Color of Atmosphere: One Doctor’s Journey In and Out of Medicine (Chelsea Green Publishing, 2011).

We all make mistakes. To err is human—unless you are a doctor. This is a lesson that began in med school. If something went wrong, some­one else was to blame. Attending physicians blamed the residents, who blamed the interns, who blamed whomever else was within range—med student, nurse, patient. We gave …

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Treating a patient in a small town versus a big city

Conditions
February 1, 2011

I usually work two or three shifts a month at a small, rural hospital about two hours from where I live. Why? Mainly, the small hospital is less than ten miles from my childhood home, where my widowed father still resides, and thus provides me an opportunity to catch up with Dad as well as four of my siblings and their families, all who live within five miles of Dad.

I …

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Laryngopharyngeal reflux disease and a complex case or chronic cough

Conditions
February 1, 2011

Chronic cough is a common condition that’s seen by many doctors, and in most cases, after a thorough history and exam, an answer can usually be found. However, just because a physician followed all the accepted guidelines and evidence based medicine principles to successfully address and treat a condition, it doesn’t mean that it was the right thing to do. Let me explain.

A 49 year old healthy woman presented to …

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FDA regulation and non-approved use of drugs

Meds
January 26, 2011

The other day, I happened to be talking to Mark, a sales representative from one of the pharmaceutical companies.  He’s the type of rep that many doctors don’t mind seeing – someone who is careful of your time, is happy to hunt down the answers to questions that come up on the medications his company makes, and brings by useful information about new drugs that seem to be practice-appropriate.  He …

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Useful things to buy during medical school

Education
January 26, 2011

The following is a brief list of some of the things I think have been useful and worth their money in my first two years of med school:

1. Large, widescreen computer monitor. The volume of information required to internalize during the preclinical years of medical school can’t be compiled and organized on paper. You would end up with bookshelves filled with those gigantic 4″ binders. Therefore, almost everything happens on …

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Depersonalization of the patient and the loss of compassion

Physician
January 25, 2011

A common complaint about modern medicine is the depersonalization of the patient and the loss of compassion.

So let’s take a look at compassion.

Compassion is derived from the Latin “cum” (together with) and “patior” (suffer). From the perspective of clinicians, compassion is defined by two concurrent emotions: (1) a feeling of deep sympathy and sorrow for another who is stricken by medical misfortune accompanied by (2) a strong desire to relieve that …

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Create a disease to market a new drug

Meds
January 24, 2011

An excerpt from White Coat, Black Hat.

by Carl Elliott

Many of us have a relatively simple, commonsense view of the way that drug development and marketing work.

People get diseases; scientists develop drugs to treat those diseases; and marketers sell the drugs by showing that the drugs work better than their competitors. Sometimes, however, this pattern works in reverse. Drug company scientists develop a drug …

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Can a doctor and a nurse be friends in the OR?

Physician
January 23, 2011

One of my best friends in med school was an O.B. nurse. Though she has moved almost all the way across the country and I haven’t seen her since I was in school, we’re still in touch and expect to be seeing each other at last in a couple of months.

By some coincidence one of my best friends now is also an O.B. nurse. I’ll call her Ziva (yes, I …

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How MD anesthesiologists have become victims of their own excellence

Physician
January 22, 2011

The New York Times has jumped all over a couple of recent scientific articles asserting that certified registered nurse anesthetists (CRNA’s) provide equivalent care as MD anesthesiologists. Already, it is legal in 15 states for CRNA’s to dispense anesthesia without the overarching supervision of a physician.

Furthermore, a study from the Lewin Group in California has demonstrated that CRNA-only models of anesthesia provision are far more cost effective that …

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