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

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 …

False assumptions and clinical errors in modern medical practice

George Lundberg, MD and Clifton Meador, MD

Physician

September 18, 2011

Here are 22 false assumptions, practice failures, and everyday clinical errors that we believe are common in modern medical practice:

1. Lack of appreciation of the phenomenon of physician persuasion and its hidden power. The placebo effect is scientific, potent, and worthy of use.

2. Lack of understanding of the power of prevalence or pretest probability in the diagnostic process, leading to frequent false positives and “overdiagnosis” of nonexistent diseases.

3. Lack …

How your physician is like a chef

Stewart Segal, MD

Physician

September 17, 2011

I wear lots of hats. Over the years, I have developed analogies for most of the things I do and for the things I want my patients to do. Analogies help people conceptualize the complexities of medicine in a way that makes sense.

Today, I had my chef’s hat on. I was actually treating a young chef and found myself talking about food and medicine. There is a direct correlation. My …

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How your physician is like a chef

When not to use a physician recruiter

Bo Claypool

Physician

September 11, 2011

As a physician recruiter of prominence, a number of times during any given week I get a fair number of calls from physicians in training who, honestly, should not be calling me whatsoever and I am very frank in telling them this. The call normally starts something like this:

“Hi Bo, my name is Dr. Doe. I am finishing up my dermatology residency and I want to be there in …

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When not to use a physician recruiter

The graveyard hidden in a surgeon’s mind

bongi, MD

Physician

September 9, 2011

This is a difficult story to tell but if I am to be true to the complete experience of a surgeon, I do need to tell it.

One of my seniors used to say that every surgeon has a graveyard hidden away somewhere in the dark recesses of his mind. He went on to say it was unfortunately normal, so long as you remember all the names engraved on the tombstones. …

Human capital makes doctors special

Douglas Perednia, MD

Physician

September 9, 2011

If you’ve ever been sick, especially with anything serious, you quickly realize that doctors, nurses and their ilk are an unusual and precious resource.

First you have to find smart people with personalities willing and able to put up with a lot of guff in the service of their fellow man. Then they have to be willing to (usually borrow, and) spend tens or hundreds of thousands of dollars for …

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Human capital makes doctors special

The specialty that makes doctors rich and happy

Paul Sax, MD

Physician

September 8, 2011

A long time ago, I was very close to becoming a cardiologist. Really.

Even though my fascination with ID and microbiology started in medical school — and believe me, not much fascinated me in medical school — the fact that all the top residents in my program were going into cardiology made me feel that somehow I should be doing this too. Plus, the guy who was Chief …

How a doctor reviews cases for both plaintiff and defense attorneys

Charles A. Pilcher, MD

Physician

September 7, 2011

Early in my career, a local defense attorney working with my hospital would occasionally ask me to review a case in which another physician client of her firm was the defendant. As Medical Director of Evergreen Hospital Emergency Department, I was comfortable with hospital records, knowing where to look in a record for information – both recorded and not recorded – that either helps or hurts a case. I found …

Phil Mickelson’s psoriatic arthritis explained

Michele R. Berman, MD

Conditions

September 6, 2011

Golfer Phil Mickelson has had a rough year and a half. First, his wife and mother are diagnosed with breast cancer, and then he has a health scare of his own. Last year, after the US Open, Mickelson began to experience some troublesome symptoms.

In an interview with Extra’s AJ Calloway, Mickelson opened up about what was going on: “After the U.S. Open last year, I wasn’t able to …