What is an adequate trial of an antidepressant?

Conditions
September 10, 2010

Since there are many antidepressants with varying dosage ranges, and many more degrees of variations between individual responses to particular antidepressants, psychiatrists have been unable to agree upon an operational definition of an “adequate trial” of an antidepressant.

However, it’s worth looking at some guidelines.

A 2003 study from the Journal of American Medical Association found that only 21.7% of Americans diagnosed with depression received “minimally adequate treatment” in the past 12 …

Read more…

Cosmetic foot surgery can have serious downsides

Physician
September 7, 2010

How far will some women go to fit into high heels? The menu of services at Beverly Hills Aesthetic Foot Surgery in Studio City, Calif., provides a clue.

There’s the trademarked “Cinderella Procedure”—a preventive bunion correction that makes feet narrower. The clinic also offers the “Perfect 10! Aesthetic Toe Shortening” that invisibly trims toes that hang over the end of sandals or have to be crushed into tight shoes. There’s also …

Read more…

Most doctors don’t like prescribing pills

Physician
September 3, 2010

I am a medical doctor.  I am also called an allopath, someone who practices “Western medicine.”

We allopaths like data, proof, science, randomized, double-blind, placebo-controlled trials.  We want to know the “mechanism of action.”  We want someone to prove that yoga or medication or some procedure actually helps your depression or blood pressure or back pain and that these treatments are safe before we prescribe them.  We feel more confident about …

Read more…

Hospitalist: Long hospital stays are often due to poor planning

Physician
September 2, 2010

Being a hospitalist, I often see patients sitting in the hospital for days at length for no reason other than poor planning.

Sometimes I feel that physicians who are involved in patient care are oblivious of each other. Everyone is in their own domain rather than working as a team. An increased length of stay in the hospital not only increases the cost of health care but also adds to the …

Read more…

An advocate for patients might save your life in the hospital

Physician
September 2, 2010

by Dennis Grace

So, you have to go to the hospital. You’ve had an accident and the doctor wants to keep an eye on you for a few days. Maybe you need major surgery. Whatever the reason for the stay, a lot a people think you should have an advocate with you.

Why? In my life, I’ve had lots of hospital stays. Why is this suddenly a big …

Read more…

Root beer bonds a chemotherapy patient with his oncologist

Conditions
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: …

Read more…

Does a stereotypical surgical personality exist?

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 …

Read more…

How drug companies sell psychiatrists on their drugs

Meds
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 …

Read more…

Checks and balances in health reform

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…

Positive reinforcement can motivate preventive behaviors

Physician
August 24, 2010

Eating right, exercising, avoiding the sun or using sunscreen, moderating alcohol consumption, abstaining from tobacco use, getting mammograms, Pap smears, colonoscopies—almost every measure we’re asked to take to safeguard our future health is difficult.  It’s a strange paradox that we have to work in some way, to expend energy, and experience discomfort of some kind in order to gain benefit in life.

Wouldn’t it be nice if the most pleasurable things …

Read more…

Medicine is an old profession, but not the oldest profession

Physician
August 22, 2010

Medicine is a very old profession. Ancient and honorable. Sadly, for the vast majority of recorded history, honor was pretty much all it had. The Hippocratean ideals of “first do no harm” and putting the patient first and all held special importance when medicine truly had nothing to offer. Make no mistake: up until the last two centuries, the vast majority of what passed as …

Read more…

ADVERTISEMENT

Why family medicine and internal medicine should not merge

Physician
August 21, 2010

Recently, I had a discussion with a prominent academic family physician.  I had last seen him 37 years ago when he was getting ready to graduate from medical school and I was a new medical student.

We had a wonderful discussion and agreed to disagree about merging primary care.   Long time readers know that I dislike the term for the tasks that outpatient internists do.  Most of the push for merger …

Read more…

Creatine causing muscle cramps and how supplements may be dangerous

Meds
August 18, 2010

About a month ago, a 44-year-old insurance executive came to see me with complaints of headaches and muscle cramps. His pain was caused by the typical cluster headache located behind one eye, accompanied by one-sided tearing and nasal congestion, and often triggered by occasional wine or chocolate. The muscle cramps mainly affected the legs and seemed to worsen after exercise.

When I got the results of his lab work, I was …

Read more…

Stop calling doctors fleas and teaching professionalism

Physician
August 15, 2010

At the recent AAMC meeting on how to integrate quality into teaching hospitals, the question that kept popping up from speaker after speaker was how to address the fact that doctors in teaching hospitals don’t get along.

Unfortunately, all the specialty bashing that takes place prevents the adoption of a team based culture necessary to advance quality and safety.  As one speaker highlighted, how can we really start to address this …

Read more…

ADVERTISEMENT

Apple’s iPad on medical rounds, a hands on physician review

Tech
August 13, 2010

by Felasfa Wodajo, MD

Recently, we had the chance to check in with Dr. Henry Feldman. He had posted a detailed summary of his experiences using the iPad as his main interface while rotating on service for a week as a hospitalist at Beth Israel Deaconess hospital (BIDMC) in Boston. Dr. Feldman is also Chief Information Architect for the Harvard Medical Faculty Physicians.

The summary of the …

Read more…

Pelvic exam etiquette that doctors need to know

Physician
August 13, 2010

I was in a room full of Family Doctors – who call themselves everything but Family Docs: Family Physicians (FPs) Primary Care Physicians (PCPs) General Practitioners (GPs). It was the Society of Teachers of Family Medicine (STFM) Spring Conference, at a session entitled: “Language Matters: Women-centered talk during pelvic exams.”

Two men amongst 20 women, all interested in learning more about being Politically Correct (PC) whilst conducting a pelvic exam. Session leaders Drs …

Read more…

ADVERTISEMENT

Testosterone and when should low levels be treated in older men

Conditions
August 6, 2010

I’ve been interested in the role of testosterone in physical performance, depression and aging for many years. While at the University of Iowa, I was involved in research to detect testosterone doping, the psychological effects of testosterone and the potential for testosterone to alleviate depression in older men.

One of the difficult questions facing clinicians is when is testosterone too low in older men.

One problem with answering this question is the …

Read more…

541
pages