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Neuropsychologists in the evaluation of ADHD

Conditions

November 6, 2011

Recently, the media has reported that the American Academy of Pediatrics (AAP) has broadened its 2000-2001 guidelines for the diagnosis of and treatment of ADHD. While the prior guidelines focused on children from ages 6 to 12, the new guidelines cover ages 4 to 18. The story is being covered by the media with lead-ins such as saying that AAP is “expanding the age range for diagnosis and treatment.”

This is …

What happened to the art of medicine?

Sharon Bahrych, PA-C, MPH

Physician

November 2, 2011

During our medical training we are taught to use evidence based medicine. This means using the most up to date scientific research data that has been analyzed and accepted as fact. But does this mean every patient we see fits into the evidence based medicine algorithm that we have been taught to use?

I hope not. For this would mean we would only be following half of medicine. The art of …

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What happened to the art of medicine?

Doctors are reluctant to have end of life conversations

Manoj Jain, MD, MPH

Physician

November 2, 2011

My 64-year-old patient with terminal cancer and less than six months to live wanted to go to Oregon. He was contemplating assisted suicide, which is legal there. “My life has been long and good,” he said. “I believe it is my right. I want the ability to say it’s too much, I can’t do it anymore. A person should have a dignified quality of life.”

Another one of my patients, an …

How alternative medicine may have killed Steve Jobs

Michele R. Berman, MD

Conditions

October 30, 2011

When they first discovered the tumor in his pancreas in October 2003, his doctors told him an immediate operation was necessary, and could lead to a cure.

As first reported by Peter Elkind in 2008, Jobs decided to think different, declined surgery, and explored alternative medicine treatments for his disease.

Nine months later, in July 2004, the tumor had grown. Only then would he allow his doctors to operate.

Would Steve Jobs be alive today had he consented to surgery when they first discovered …

How a medical student uses an iPad for patient care and education

Alex Chamessian

Tech

October 23, 2011

iPads have been introduced into medical education mostly during the pre-clinical years. I’d like to share my experience using an iPad during my clinical year. I’ve found it to be exceedingly useful and versatile.

I have an entire medical library in my pocket. With the touch of a button I can pull up essential texts such as Harrison’s Principles of Internal Medicine or William’s Endocrinology. I get these books and …

The problem with round the clock hospitalist coverage

Bradley Flansbaum, DO

Physician

October 21, 2011

Two recent articles, one from the New York Times, the other from The Hospitalist, initiated some 24/7 staffing issue rumination on my behalf. It stems originally from a recent op-ed by Lucian Leape: “Given the accrediting council’s reluctance to act, the federal government needs to get tougher. If we are serious about curbing the tide of injuries stemming from medical errors, Medicare should make its funding of graduate medical education …

Makes you want to pull your hair out: Treating trichotillomania

Edwin Suddleson, MD

Conditions

October 21, 2011

One of the saddest, but more treatable, causes of hair loss in patients is trichotillomania, the impulse control disorder in which a person repeatedly pulls out hair from their body for non-cosmetic reasons. While some people have never even heard of trichotillomania, according to the Trichotillomania Learning Center, as many as ten million Americans (or 4% of the U.S. population) suffer from the disorder.

According to the Diagnositic and Statistical Manual …

Why radiology is the cornerstone of any hospital

Paul Dorio, MD

Physician

October 19, 2011

Radiology is the cornerstone of any hospital. An efficient, high-quality, well-run radiology department increases patient satisfaction as a result of its ability to improve patient care. Over time, a well-run radiology department adds significant patient volumes to the hospital, which, of course, favorably enhances the hospital’s bottom line. Regardless of whether the hospital is not-for-profit or for-profit, a smooth-sailing radiology department vastly increases the profitability of the hospital. The …

tPA is the standard of care for stroke but with significant risks

Charles A. Pilcher, MD

Conditions

October 17, 2011

Under current guidelines from the American Stroke Association, tissue plasminogen activator (tPA, commonly known as a “clot buster” drug) should be administered within 3-4.5 hours of “last seen normal” – and 1 hour of patient arrival – to potentially ameliorate a new onset stroke. (“Last seen normal” means exactly what it says. A patient who went to bet at 10 PM and awoke with slurred speech at 6 AM was …

The decision not to become a surgeon

Jim deMaine, MD

Physician

October 12, 2011

Every medical student goes though a process of elimination when deciding what kind of doctor they want to become. We hear the old saying, “Internists know everything and do nothing; Surgeons know nothing and do everything; Psychiatrists know nothing and do nothing; Pathologists know everything and do everything but it’s too late.” We hear that pediatricians wear bow ties, are short, and love to laugh and play; that surgeons …

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The decision not to become a surgeon

The life of a medical resident in Mexico

Cesar Lucio, MD

Education

October 12, 2011

The average week for a medical resident training in Mexico can easily exceed 90 work hours. Mexico is a country that takes pride in offering full health coverage for 100 million citizens. This is a new policy and free public medical care is being pushed to the limit. The situation is simple, the work load in outpatient clinics, operating rooms, the wards and emergency rooms across the country is …

Three major cognitive errors physicians make

Jerome Groopman, MD and Pamela Hartzband, MD

Physician

October 9, 2011

As physicians, we all dread missing a diagnosis: indigestion that turns out to be angina, back pain that signals an aortic aneurysm, migraine that proves to be a brain tumor. Although it is only an estimate, several studies in the medical literature indicate that misdiagnosis occurs in 15% to 20% of all cases, and in half of these, there is serious harm to the patient.

Researchers have found that the vast …

Health related questions about plastic

Avril Swan, MD

Conditions

October 4, 2011

Susan Freinkel is the author of the new book, Plastic: A Toxic Love Story.

She was kind enough to answer some health related questions about plastic based on her research for her book.

Is all plastic toxic?

There are lots of different kinds of plastic and some may pose more of a health hazard than others. The two experts are most worried about are:

Polycarbonate, a hard, clear plastic …

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Health related questions about plastic

The decision to pursue a rare illness

Jerome Groopman, MD and Pamela Hartzband, MD

Conditions

October 1, 2011

Patricia Daly, FACP, of Warren Memorial Hospital in Front Royal, Va., told us about the case of a 49-year-old man who presented with marked weight loss. A year prior, the patient had weighed about 220 pounds and intentionally put himself on a diet, but after losing 45 pounds, he developed poor appetite and early satiety.

He continued to lose weight to a nadir of 143 pounds. He found it increasingly difficult …

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The decision to pursue a rare illness

Honesty between doctors and patients goes both ways

Stewart Segal, MD

Physician

September 28, 2011

Yesterday, someone asked me, “Can I be perfectly honest with you?” I wanted to reply, “No, just be dishonest, I like it better that way!” “Can I be” implies that, in past conversations, my patient has been dishonest. Dishonesty is a relationship breaker. Dishonesty leads to distrust and if I cannot trust what a patient is telling me, I cannot be effective; the doctor-patient relationship is terminated.

Am I being too …

Why medicine is not health

Anonymous

Meds

September 26, 2011

Being a physician certainly biases how I view the world around me. I can’t help but think in terms of problem-solving and healing. But have you noticed how medicalized our society has become? The other night watching television, we watched at least four drug commercials and one health insurance commercial — during a half-hour show! I believe we are in the middle of the medicalization of America, and I don’t …

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Why medicine is not health

Why do doctors cling to continuous fetal heart monitoring?

Alexander Friedman, MD

Physician

September 25, 2011

My patient needed to be delivered. She had just developed eclampsia, a potentially fatal disease that afflicts women in the second half of pregnancy. She had suffered a seizure and dangerously high blood pressure, and was at risk for far worse, including a stroke. No one knows why this condition arises, but delivery sure clears it up in a hurry.

So we gave medication to start labor, and the nurses placed …

Do doctors have a moral obligation to serve?

James Logan, MD

Physician

September 23, 2011

Since it strikes at the very core of what this blog is all about, I couldn’t pass up the opportunity to comment on Dr. Karen Sibert’s recent op-ed piece in the New York Times.

She argues that, especially given the current shortage of primary care doctors in this country, being part of the medical profession confers one with the moral obligation to serve and, as such, conflicting …

ADHD and the lack of quality sleep

Steven Y. Park, MD

Conditions

September 19, 2011

As the new school year begins, it’s only natural that there’s more awareness about learning and behavior issues. One of the most controversial topics that came up frequently is ADHD, or Attention Deficit Hyperactivity Disorder. It’s thought that 2-4% of children have this condition, and a shocking 50% of children with this condition are on some form of prescription medication. Not only is it seen in children, but adults …

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ADHD and the lack of quality sleep

When professional courtesy could get physicians in trouble

Deniza Gertsberg, Esq

Physician

September 18, 2011

More likely than not, a physician or a dentist has at one point provided discounted or free healthcare services to some patients by waiving all or part of a fee or the copayment and/or coinsurance obligations as a “professional courtesy.” According to the Office of Inspector General’s (OIG) Compliance Program For Individual and Small Group Physician Practices guidelines, however, this practice may expose a physician to an investigation.

To be sure, not all professional courtesy discounts or free …

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