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Proton pump inhibitors and B12 deficiency: What to do now

Meds

December 19, 2013

We can now add vitamin B12 deficiency to the growing list of risks of long term use of the proton pump inhibitors (PPIs).

The New York Times had an article outlining the evidence that prolonged use of both proton pump inhibitors (PPIs) like Prilosec, Protonix, Prevacid and others, as well as the less potent H2 blockers like Zantac and Pepcid, can lead to vitamin B12 deficiency. This is in addition …

The downward spiral of the stubborn patient

Val Jones, MD

Physician

December 16, 2013

Over the years that I’ve worked in acute inpatient rehab centers, I have been truly vexed by a particular type of patient. Namely, the stubborn patient (usually an elderly gentleman with a military or armed forces background). I know that it’s not completely fair to generalize about personality types, but it seems that the very nature of their work has either developed in them a steely resolve, or they were …

There is only one reason why I still accept Medicaid

Tiredoc, MD

Physician

December 15, 2013

To err is human. To really screw things up, you need government.

One half of my patient population and one fourth of my receipts are from Medicaid patients. My state has a mandatory balanced budget, which means in this age of perpetual recession Medicaid runs out of money every year.

Last year, my state capped the monthly brand name prescriptions to 1 for the summer. Apparently the information that asthma inhalers and …

The problems with the BRCA test from 23andMe

Nitin Roper, MD

Conditions

December 15, 2013

It’s been very interesting to read the range of responses to the recent FDA recent crackdown on the personal genetic service company 23andMe. Some have decried the FDA as too paternalisticwhile others have said the FDA is rightfully protecting the health of the public.

The evidence, I believe, shows the FDA is correct: 23andMe should not be doing genetic tests that have serious medical implications. Let’s look at an …

Doctors: 10 lessons from the humble bumblebee

Neil Baum, MD

Physician

December 7, 2013

Bumblebee_05

Practice medicine like the bumblebee.

We also know the basics of the beehive containing a single queen bee, hundreds of worker bees, and several hundred to several thousand drones with their only function is to mate with the queen (and after they perform this function they die!), each with their own degree of specialization and place in the honeybee society. However, there is …

Medicine is a universal language

Heather Lee, MD

Conditions

December 7, 2013

This past spring, I went to Dar es Salaam, Tanzania to do an internal medicine elective at Muhimbili University of Health and Allied Sciences. I rotated through two sub-divisions of internal medicine while I was there: infectious disease and cardiology.

The medicine

When I initially stepped onto the infectious disease ward, I saw the janitors mopping the cement floors with soap and water. The ward was crowded and the patients lying on …

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Medicine is a universal language

MKSAP: 74-year-old woman with fatigue, anorexia, and weight loss

mksap

Conditions

December 7, 2013

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 74-year-old woman is evaluated for a 2-month history of fatigue, anorexia, and a 6-kg (13.2-lb) weight loss. She was treated with chemotherapy for ovarian cancer 6 months ago. She also has hypertension managed with hydrochlorothiazide.

On physical examination, temperature is 36.2 °C (97.2 °F), blood pressure is 132/75 mm Hg without postural …

An anesthesia practice is sold, and a warning to young doctors

Karen S. Sibert, MD

Physician

December 6, 2013

shutterstock_48561775

We were startled to learn recently that Sheridan Healthcare Inc., a physician services company based in Florida, has bought one of the largest private anesthesiology group practices in California, the Medical Anesthesia Consultants Medical Group Inc. (MAC) of San Ramon.

The deal, which closed November 14, is Sheridan’s first in California, and “provides a platform that will accelerate our expansion in the California …

The personal costs of a living donor liver transplantation

Meera Gupta, MD

Physician

December 5, 2013

Partial liver donation is the only life-saving deed that a non-surgeon can do for another person suffering from end stage liver disease. On the other hand, a major operation on a healthy individual with no indication for surgery has been viewed by society with caution and skepticism.

One could wonder why a young, healthy individual would succumb to an elective high risk procedure. Simple answer: they want to save a life. …

Standardize drug names and reduce the risk of medication errors

John Schumann, MD

Meds

December 5, 2013

Ever get confused over the names of medicines?

I do.

There’s Zantac and Xanax. Zanaflex and Zaleplon.

But Zanaflex is also known as tizanidine. Tizanidine functions very differently than Zantac and its other name, ranitidine, even though they sound alike.

Every drug has (at least) two names — one proprietary, and one generic. Proprietary names are created to sound catchy by the original manufacturer, almost always under a patent. The generic names are more like chemical …

I see chest pain all day, every day

Edwin Leap, MD

Conditions

December 5, 2013

Sometimes I feel as if my entire emergency medicine career is dedicated to one patient complaint. And that one complaint is chest pain. It may be that the incidence and prevalence of chest pain was the same during my medical school and residency training as it is now. But I doubt it.

I recall how I struggled to learn the salient questions. ‘Where is your chest pain? Is it heavy, dull, …

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I see chest pain all day, every day

I have a shellfish allergy. Can I have contrast?

Jennifer Gunter, MD

Conditions

December 2, 2013

I hear it over and over again.

From a nurse, “She can’t have providine prep, she has a shellfish allergy.”

From the patient, “I can’t have the contrast because I’m allergic to iodine and shellfish.”

The list of allergies placed in the chart by a doctor, “Radiocontrast. Iodine. Shellfish.”

It’s not the fault of the patients who are typically repeating the medical misinformation they have been given. However, the medical professionals who perpetuate the …

Is health care a right or a business? It’s time to make a choice

Luis Collar, MD

Policy

December 1, 2013

The recent health care discussion in the media has centered around the implementation of the Affordable Care Act, now no longer a lengthy, inert document but rather a living, breathing manifestation of what should be a collective, unambiguous vision for the delivery of care in the United States. It is, however, anything but comprehensive in scope, and the coverage has primarily focused on crashing websites, politics, calls for resignations, and …

Patients must be given the results of their tests

Fred N. Pelzman, MD

Physician

November 28, 2013

Just the other day one of the medicine residents presented a case to me, and mentioned that in looking through the patient’s chart he noticed that the patient had undergone a prostate biopsy 1 month prior to this visit, with a follow-up appointment in urology scheduled next month. The result of the biopsy was positive for cancer, but that had not been communicated to the patient. His first instinct, he …

The human side of medicine that no computer can ever touch

Suneel Dhand, MD

Tech

November 27, 2013

As I look back all those years ago to when I chose medicine as a career, I suspect that my motives were similar to most people who enter this wonderful profession. I wanted to become a doctor because I had a genuine and sincere desire to help people. I also liked the idea of a busy and energetic job, one where I was comfortably as far away as possible from …

Who do you want reading your EKG?

Wes Fisher, MD

Tech

November 27, 2013

I know what you’re thinking, punk. You’re thinking “did he fire six shots or only five?” Now to tell you the truth I forgot myself in all this excitement. But being this is a .44 Magnum, the most powerful handgun in the world and will blow you head clean off, you’ve gotta ask yourself a question: “Do I feel lucky?” Well, do ya, punk?
– Harry Callahan (played by Clint …

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Who do you want reading your EKG?

Doctors who call patients hypochondriacs are committing malpractice

Zackary Berger, MD, PhD

Physician

November 25, 2013

There’s one question I get asked a lot: “I research my health problems on the Internet. Am I a hypochondriac?”

First, we should ban that word when talking about ourselves. No one wants to be called that, and doctors who use that word are committing malpractice. Everyone has some range of complaints and worries in life, often physical and mental together, and this is our job as doctors: to hear them …

Can student run free clinics help the health care safety net?

Jennifer Xu

Education

November 23, 2013

While interviewing for medical schools last fall, I observed a strange phenomenon: every institution I encountered would underscore its student-run free clinic as a major highlight of the medical education they could offer. First- and second-year students would speak rapturously about the experience they gained from clinic. Working there, they said, reminded them of why they wanted to become doctors in the first place.

Today, the majority of all U.S. medical …

To put patients’ interests first, we have to put our own aside

Allan Joseph

Policy

November 23, 2013

I first read Dr. Matthew Moeller’s piece from this past March for the first time this week after a classmate of mine passed it on to me. I’m a first-year medical student — bright-eyed but sleep-deprived, trailing the smell of the cadaver lab everywhere. I entered medicine fully aware of the long, arduous road ahead, almost exactly as Dr. Moeller described it; with many of my classmates in my …

Don’t resign your professional license in the midst of an investigation

George F. Indest III, JD

Physician

November 23, 2013

Do you have a medical, pharmacy or nursing license in several different states? Do you have a license in more than one health profession? Have you been notified that an investigation has been opened against you? Are you thinking about resigning your professional license or voluntarily relinquishing such a license? Then you must be aware of the following.

First, you should never voluntarily relinquish or resign your license after you know …