Pain control in a patient with rib fractures and a spinal cord transsection

Physician
June 1, 2011

When I was called to see the patient after a motorcycle accident I expected the worst. The patient sustained a thoracic spine injury with cord transsection at T5 level as well as significant chest wall injury on the right side.

Multiple ribs were broken; some with a significant displacement. Managing patients with a significant chest wall trauma could be a nightmare. Pain control is only one of the challenges.

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The legal issues of doctors and chiropractors working together

Physician
June 1, 2011

by Jeffrey L. Cohen and Albert R. Meyer

Chiropractors and medical doctors (or D.O.s) have had a long and somewhat complex relationship.

Though they approach healthcare issues differently, there are many instances where they share care or even work together.  Such “M.D./D.C.” relationships are legally complex, but often prove to be rewarding in many respects.  Properly constructing the arrangements is critical, especially since government regulators and payers tend …

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Should doctors be addressed by their first name?

Physician
May 29, 2011

I was sitting next to a resident in the preceptor room yesterday.  He was calling a patient to discuss lab results, and introduced himself on the phone by his first name and last name … but not with “Doctor.”  (e.g., “Hi, this is John Smith from the Family Health Center.”)

I occasionally see the residents’ patients for urgent visits.  When I ask them who their regular PCP is at the office, …

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The three most useful words for a doctor

Physician
May 26, 2011

Here are the three most useful words for a doctor: “I don’t know.”

A close second would be “I’m not sure,” another three that have got me out of trouble more times than I can remember.  The older I get, and more experience I have, the more useful it becomes.

Pattern recognition is essential in effective medical practice.  So often patient complaints are vague and nondescript, and in the absence of physical …

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Why you shouldn’t ignore a swollen knee

Conditions
May 24, 2011

If you develop a swollen knee, please don’t consider it a normal occurrence.

If there was a clear cause, such as a fall to the knee, or some twisting injury to the knee, it’s likely that the cause is due to some mechanical damage. An easily recognized example would be a football or rugby player sustaining such an injury on the playing field. In that case, its typically serious and when …

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How managed care caused the mental health care crisis

Physician
May 24, 2011

by George H. Northrup, PhD

No one becomes a mental health professional—in my case, a clinical psychologist—for the financial rewards.

With comparable (or less) education, far more lucrative careers exist in law, business, or other health care specialties.  Psychotherapy tends to draw practitioners who are fascinated by the mysteries of the mind and who find satisfaction helping others in distress.   Money has typically been a …

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Pros and cons of private or hospital owned practice

Physician
May 24, 2011

Private practices are organized in a corporate model where the physicians are shareholders, or where one or more physicians own the practice and employ other physicians or providers.   Private practices are almost exclusively for-profit.  Physician practices are organized into corporations for the tax benefits as well as protecting the owners from liability judgments.

Hospitals can be for-profit, not-for-profit …

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Vascular diseases that present as obstructive atherosclerotic arterial disease

Conditions
May 23, 2011

by Joe F. Lau, MD and Jeffrey W. Olin, MD

Physicians who perform percutaneous endovascular procedures encounter a multitude of vascular diseases that may masquerade as obstructive atherosclerotic arterial disease. While atherosclerosis is clearly the most common condition seen, complex inflammatory, genetic or structural processes may either not be amenable to an endovascular approach or actually be harmful and thus lead to outcomes that are not …

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Pay attention to the color and smell of your urine

Conditions
May 20, 2011

Most of us are uncomfortable talking about our waste products, urine and feces. However, changes in the color and odor may signify disease that can be treated or prevented. This article will review causes of discoloration of urine and when there is a change in the odor of urine.

For hundreds of years doctors have looked at urine as a barometer of what is happening in the body. The urine can …

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Going through Netter’s to teach medical students pelvic anatomy

Education
May 20, 2011

I recently had the opportunity to go to the anatomy lab and help the first years go through the pelvic anatomy.  What a blast!  There is nothing like dissecting a cadaver to tune up one’s surgical anatomy skills, and helping young eager medical students through it is a great experience.

Prior to going into the lab, I spent many hours going through Netter’s atlas to brush up on the anatomy so …

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Prevent foot fractures while wearing heels

Conditions
May 17, 2011

As 30-year-old New Yorker Carrie Donnelly began her bachelorette party in her new black open-toe five-inch heels, she fell, her foot going one way and her ankle the other.

“When I woke up the next day, my ankle was throbbing and had become extremely swollen,” she said. It was a month before her wedding—the last thing she wanted to do was to walk down the aisle in a cast.

Super-high heels like …

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