KevinMD.com

Consider half life during drug detoxification

Meds

August 30, 2011

A young man on my sobriety-based detox program (only after showing positive for opiates) admitted to heroin-usage, but hedged the matter saying it was “5 days ago.” His implicit presumption was that an isolated episode, days ago — compared to continuous, more recent, heroin-usage — would lessen the likelihood of his getting kicked off the program.

Is his story of “no heroin [ingestion] in the last five days,” likely, the whole …

The expensive progression of pill crushing technology

Gina, RN

Meds

August 29, 2011

We have to crush pills sometimes. Either the patient (through aversion or physical limitation from stroke) can’t swallow whole pills so we crush them and put them in applesauce, or the patient gets their pills through a tube, so we crush them and dissolve them in water.

When I started nursing, we had a mortar and pestle.

Anyway, this is what we used …

The ethics of being on a pharmaceutical advisory board

David B. Nash, MD, MBA

Meds

August 27, 2011

While diligently perusing a stack of unread journals, a piece in the July 25, 2011 issue of Modern Healthcare caught my attention.

Titled “What’s the Agenda?” this special report deftly navigated the murky waters of “physician participation on advisory boards” and managed to present an accurate appraisal of the issues.

Here is a brief recap.

Back in the days before “medical ethics” issues were commonplace, pharmaceutical and medical device manufacturers were accustomed …

Navigating the path of contradictory medical opinions

Ralph Gordon, MD

Conditions

August 24, 2011

With the advancement in healthcare and technology we are able to greatly extend the life expectancy of the population. For the healthcare provider that means that more elderly patients and patients with multiple chronic medical conditions are being admitted to the hospital. Some “complex” patients require a multidisciplinary approach with the involvement of multiple consultants.

As a primary attending physician for the patient you often have to deal with contradictory …

How medical residents should spend their time off

Mary L. Brandt, MD

Education

August 24, 2011

Here’s the scenario. It’s Friday evening. You’ll be back at work on Sunday. You’re sleep deprived because you are a resident. You haven’t spent any quality time with your significant other, friends or family because you haven’t had any real time off. Next week has plenty of call and it would really help if you planned out good food for the week and cooked something. And, by the way, …

It’s possible to have fun during medical school

Eric Lu

Education

August 22, 2011

Before I start second year of medical school, I wanted to take this time to reflect on my first year in medical school and use these lessons to ground me as I begin a new school year.

When people ask me how first year was, my first answer is that it was a lot of fun. That usually comes off as a surprise. Don’t get me wrong, there were definitely …

Practices have failed to analyze the clinical content of their EHR

Ron Sterling

Tech

August 20, 2011

Clinical content refers to the various checklists, documents, and forms that address an area of medicine when using an EHR. For example, a pediatric practice would be interested in documentation tools for a newborn visit. Not all EHRs have clinical content for all areas of medicine. For example, some EHRs have clinical content for internal medicine, but lack the details needed for dermatology or cardiology.

A disturbing number of practices …

MKSAP: 89-year-old woman is evaluated for dizziness

mksap

Conditions

August 20, 2011

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

An 89-year-old woman is evaluated for dizziness that she has had for the past year, mainly while standing and ambulating. The dizziness is described as a sense of unsteadiness. The symptoms can last for minutes to hours, and she has at least 4 to 5 episodes …

What do tonsils do and why would we take them out?

Christopher Johnson, MD

Conditions

August 19, 2011

There are some important new recommendations about tonsillectomy — taking out the tonsils — as a treatment for recurrent strep throats.

Some of us can recall a time when getting your tonsils out was one of the rites of passage of childhood. Usually a related procedure is added — an adenoidectomy, removing the adenoids as well. It’s called a T&A in the medical world, and it’s one of the …

Female doctors and the physician shortage

Darrell E. White, MD

Physician

August 13, 2011

Someone has gone and rained the facts down on what is generally considered a feel–good story in American medicine, the dramatic increase in female doctors in America.

In response to Dr. Herbert Parde’s “The Coming Doctor Shortage” article in the Wall Street Journal, Dr. Curtis Markel pointed out that there is a difference between the raw, gross number of physicians in America, and the effective number of practicing physicians. Not only …

Why doctors should accept protocol medicine

Stephen C. Schimpff, MD

Policy

August 13, 2011

We hear that doctors do not like “protocol medicine” – they do not want to follow a “cookbook” when every patient is different. It is not a good understanding of the issues.

Some years ago when I worked in a branch of he National Cancer Institute and then the University of Maryland Cancer Center, we admitted many patients with acute leukemia. The treatment approach including the necessary special tests to …

What medicine will be like 20 years from now

Aaron J. Stupple, MD

Tech

August 13, 2011

I was asked recently to predict the practice of medicine in 20 years. After stating that any such prediction is massively speculative, I indulged because it is massively fun.

I am persuaded by Clayton Christensen’s arguments in The Innovator’s Prescription that healthcare will go the way of other massively disrupted industries, wherein healthcare will follow the arc of decentralization.

Using the music industry as an example, the arc begins …

6 reasons why doctors won’t call patients back

Mary Pat Whaley

Physician

August 12, 2011

Patients want to know why they can’t get a return call from their doctor’s office – here are six reasons why the calls have increased and physician offices are having trouble meeting the needs of their patients.

1. Medication questions and requests for a prescription change. The average number of retail prescriptions per capita increased from 10.1 in 1999 to 12.6 in 2009 (Kaiser Family Foundation calculations using data from …

How a nephrologist assesses your kidney function

Michael Aaronson, MD

Conditions

August 12, 2011

Doctors use laboratory values to interpret your medical condition. With respect to kidney disease, the BUN and the creatinine help your nephrologist (as well as your internist and family physician) determine if your kidneys are working correctly. These two tests are commonly ordered for many reasons and are invaluable tools to help your doctor assess your condition. Let’s define what BUN (pronounced by spelling out the letters “B”, “U”, …

Women with these 5 pelvic symptoms should call their doctor

Neil Baum, MD

Conditions

August 11, 2011

For most women, a couple of irregular menstrual cycles or an occasional yeast infection are just a part of life — nothing that time or simple treatment won’t cure.

However, there are a few symptoms that warrant a call to the doctor. This article will cover when you should call your doctor for problems “down there”?

1. Pelvic pain. Pain at the time of ovulation is referred to as Mittelschmerz. However, if …

Health reform and the iron triangle of health care

Aaron E. Carroll, MD

Policy

August 11, 2011

When I was in medical school, we had a class on health economics taught by William Kissick. I didn’t pay as close attention as I should have (especially given what I do now). But I remember one thing he stressed. It involved the iron triangle of health care.

There are three aspects of health care systems that are essential: quality, cost, and access (thus the triangle). The problem …

Fever in children: 5 facts you must know

Natasha Burgert, MD

Conditions

August 11, 2011

shutterstock_144663938

A recent issue of Pediatrics includes a new report detailing the need for doctors to improve patient teaching about fever and fever-reducing drugs.

Many parents fear their child getting a fever or have “fever phobia.” I certainly can understand why. Kids can do crazy things when they get fevers. They don’t sleep well, eat poorly, and behave strangely. Some children …

Why the third year is the greatest year of medical school

Robert Centor, MD

Education

August 10, 2011

This post is dedicated to the many 3rd year students whom I have had the privilege to teach over the past 35 years. They continue to inspire me to help them become great physicians. They care.

The third year of medical school is wonderful, but it is a year of great change. Those readers who are physicians will completely understand, and I will try to explain to the non-physicians.

During the third …

Angry Birds: A psychiatrist explains the addicition

Dinah Miller, MD

Tech

August 8, 2011

Joe Frisch is a staff scientist at the SLAC National Accelerator Laboratory at Stanford University. Dr. Frisch writes: “I wonder when we will start seeing really addictive games banned? I don’t know what makes games addictive though. Angry birds is a mystery to me – there is no ongoing story line, you don’t really gain any abilities as the game …

A cream to fight obesity is being ignored

George Lundberg, MD

Meds

August 7, 2011

Do you, or many of your patients, have a little more belly fat around your and their middle than you and they would like? Me, too.

Turns out that there are two decent published studies from reputable places that report that a person may rub a cream on their skin over the fat spots and make the fat go away.

Wow, what a deal.

The first study addresses fat thighs, with each …