As a medical provider, while seeing a husband and wife, or a couple, regardless of gender, one comes across several situations that may be considered difficult to handle and that require a good deal of tact and confidentiality.
This is the case with seeing a husband and wife or (couple), together, for an examination. Ultimately, it depends on the rapport that the couple shares. If they …
The commonly prescribed breast cancer drug, Arimidex, was released as a generic in June 2010. The generic name is anastrozole. I called several local pharmacies last week to find out how much this medicine would cost for a one-month supply. I found some very surprising results:
Costco: $27
Walgreens (with Saver Card): $325 (without Card): $380
CVS: $361
Walmart: $347
Target: $340
These are not typos. Costco is selling a one-month supply of generic Arimidex for $27, …
This month of my intern year, I am covering night float for the private hospital. Compared to the massive county hospital teeming with laboring patients, churning at all hours of the day and night, the private practice pace is meant to be a luxury for interns seeking respite. And for the most part, life has been pretty nice.
This week however, has been nothing less than hell. One night, I was …
by Timothy Dempsey and Pamela Savitz
Last month, the National Football League inducted seven of its all-time great players into its Hall of Fame in a ceremony filled with nostalgia and memories of legendary careers long-finished.
While this was going on, there was another type of induction ceremony taking place around the country. Yet, these celebrations lacked recollections of past achievements by retired legends finally receiving …
If you wake up every morning needing to hack up lots of thick mucous or have throat pain, hoarseness, or a chronic cough, you’re not alone. You may think it’s the beginning of a cold, but a cold doesn’t continue for weeks to months without progressing into full-blown viral symptoms.
Instead, these symptoms are the beginnings of the most common throat problem sleep apnea sufferers face. And as I explain below, …
A rising second year medical student read some of my posts and wrote me a kind note asking if I would write something for students. I taught students and ran surgical clerkships at community teaching hospitals for my entire career until about 19 months ago.
I also was prompted to address this subject after reading a recent New York Times story about a new admissions policy at Mt. Sinai …
What does your breast type say about your cancer risk? Quite a bit, actually.
Whether you have large, small or lumpy breasts, self-awareness is very important. Getting to know how your breasts look and feel can help you recognize possible red flags.
Large vs. small breasts
When it comes to cancer risk, size really doesn’t matter. But, size can affect your mammogram and clinical breast exam.
For example, women with large breasts may need …
by Joanna Fief
About two years ago in the wee hours of the morning, I found myself in a local emergency room with severe stomach pain, incessant vomiting and dehydration. It wasn’t pretty, and I was desperate for something – anything – to ease my pain and stop my vomiting.
Gratefully, within minutes of receiving an IV with medications for pain and nausea, my symptoms subsided. After a couple of blood tests …
by Arnon Krongrad, MD
The noose was loose on its neck. At first I worried, but then I relaxed. This was a bottle of pomegranate juice, the antioxidant superpower. As the billboard implied, it could cheat death. Perhaps if I consumed pomegranate juice, I could cheat death.
Last week, the Federal Trade Commission charged POM Wonderful, LLC, makers of pomegranate products, with deceptive advertising. …
NPR has a great blog on their website called Shots about current events in health care. Recently, Scott Hensley, the main blogger there, posted a recent article on treatment of prostate cancer from the Archives of Internal Medicine.
If you look at the article, you may notice a very small subheading above the article’s title. It reads “Less is More.”
Very telling.
The thrust of the article and the …
I was recently scanning an online forum about pediatric health concerns. (What can I say? I sometimes need inspiration.) One thread within the forum was significantly longer than any other. Parent after parent posted about how they had noticed a knot on their infant or toddler. This concern parallels what I see in practice. An unexplained knot on the head is a common reason parents bring their child to be …
One of my docs was telling us about a patient’s experience at another practice. Apparently, the parent was at her wits end with her crying baby. She called the on call doctor to ask for advice and the doctor told the patient, “your baby has colic’s; turn on the vacuum and stop calling.”
It turned out the baby had some gastric condition (not colic) and needed treatment. The patient ended up …
Interesting article recently from Health Affairs about the clinical equivalence between the care provided by anesthesiologists and CRNAs. The article concludes by advocating that CRNAs be given permission to practice anesthesiology without physician supervision. It’s more cost effective. And there is no compromise to the quality of care delivered to patients.
We recommend CMS return to its original intention of allowing nurse anesthetists to work independently of surgeon or …
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Peter Orszag wants doctors to work weekends.
The former director of the White House Office of Management and Budget wrote as much in this past weekend’s New York Times:
Doctors, like most people, don’t love to work weekends, and they probably don’t enjoy being evaluated against their peers. But their industry can no longer afford to protect them from the inevitable. Imagine a drugstore open only five days a week, or …
“How many staffers should we have per doctor?” That’s a question I’m asked at almost every seminar I present. Of course, like many good consultants, I almost invariably respond “it depends.”
One of the factors that needs to be considered is what jobs we’re talking about — clinical or front office. It’s staffing in the clinical area that will do most to enhance a physician’s productivity, so that’s what we’ll focus …
Laryngeal sensory neuropathy (LSN) is a recently described condition felt to cause a chronic cough in patients when treatment for everything else (allergies, asthma, reflux, etc) has been evaluated and managed.
Treatment for this condition is with neuropathic medications including Neurontin, Elavil, Lyrica, nortriptyline, etc.
In the past few months, I have seen a few patients referred to me with chronic cough treated with these medications with minimal or no improvement. All …
Before he tells you how to get a straight answers from physicians, Doctor D is going to stall for time by explaining why doctors give vague answers.
Why would a good doctor give useless answers?
1. There is an answer, but your doctor doesn’t know it. Don’t be hard on doc for this one. There is no MD in the world that knows the entire breadth of medical knowledge. Some docs pretend …
I like Dr. Rob, the one with the distractible mind. And although I thoroughly agree with the stance he takes in his recent post against cholesterol screening in kids, I must take issue with his opening statement:
I have a unique vantage point when it comes to the issue universal cholesterol screening in children, when compared to most pediatricians. My unique view stems from the fact that …
We are a little over two years into our electronic medical records implementation at the time of this writing. Since we have been performing a gradual rollout, the entire process has been relatively uneventful. Most of the credit for this goes to our chief information officer (technospeak for the head of our IT department) and our practice administrator.
One of the biggest challenges we have been facing is how to convert …
by Neel Shah, MD
What are the top reasons doctors over-order tests?
1. How we’re taught. Doctors are taught to consider whether a procedure is safe and whether it’s likely to work. We’re almost never taught to consider cost — it’s considered taboo.
2. Trying to do our best for the patient. We’re worried. Often we over-order because of our personal risk aversion.
3. Pre-emptive ordering. For residents, who do much of …
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