by Marianna Rakovitsky, RPh
Recently, I have talked about the concerns with the use of NSAIDs and their effects on the heart. All medications carry a risk of adverse effects. NSAIDs are usually very effective in controlling pain especially muscle and bone pain, but they also carry a potential risk of side effects such as stomach and kidney problems, increased risk of bleeding and adverse effects …
Alternatives to NSAIDs, pros and cons
An excerpt from The Color of Atmosphere: One Doctor’s Journey In and Out of Medicine (Chelsea Green Publishing, 2011).
We all make mistakes. To err is human—unless you are a doctor. This is a lesson that began in med school. If something went wrong, someone else was to blame. Attending physicians blamed the residents, who blamed the interns, who blamed whomever else was within range—med student, nurse, patient. We gave …
The threat of malpractice means doctors cannot acknowledge their fallibility
I usually work two or three shifts a month at a small, rural hospital about two hours from where I live. Why? Mainly, the small hospital is less than ten miles from my childhood home, where my widowed father still resides, and thus provides me an opportunity to catch up with Dad as well as four of my siblings and their families, all who live within five miles of Dad.
I …
Treating a patient in a small town versus a big city
Chronic cough is a common condition that’s seen by many doctors, and in most cases, after a thorough history and exam, an answer can usually be found. However, just because a physician followed all the accepted guidelines and evidence based medicine principles to successfully address and treat a condition, it doesn’t mean that it was the right thing to do. Let me explain.
A 49 year old healthy woman presented to …
Laryngopharyngeal reflux disease and a complex case or chronic cough
The other day, I happened to be talking to Mark, a sales representative from one of the pharmaceutical companies. He’s the type of rep that many doctors don’t mind seeing – someone who is careful of your time, is happy to hunt down the answers to questions that come up on the medications his company makes, and brings by useful information about new drugs that seem to be practice-appropriate. He …
FDA regulation and non-approved use of drugs
The following is a brief list of some of the things I think have been useful and worth their money in my first two years of med school:
1. Large, widescreen computer monitor. The volume of information required to internalize during the preclinical years of medical school can’t be compiled and organized on paper. You would end up with bookshelves filled with those gigantic 4″ binders. Therefore, almost everything happens on …
Useful things to buy during medical school
A common complaint about modern medicine is the depersonalization of the patient and the loss of compassion.
So let’s take a look at compassion.
Compassion is derived from the Latin “cum” (together with) and “patior” (suffer). From the perspective of clinicians, compassion is defined by two concurrent emotions: (1) a feeling of deep sympathy and sorrow for another who is stricken by medical misfortune accompanied by (2) a strong desire to relieve that …
Depersonalization of the patient and the loss of compassion
An excerpt from White Coat, Black Hat.
by Carl Elliott
Many of us have a relatively simple, commonsense view of the way that drug development and marketing work.
People get diseases; scientists develop drugs to treat those diseases; and marketers sell the drugs by showing that the drugs work better than their competitors. Sometimes, however, this pattern works in reverse. Drug company scientists develop a drug …
Create a disease to market a new drug
One of my best friends in med school was an O.B. nurse. Though she has moved almost all the way across the country and I haven’t seen her since I was in school, we’re still in touch and expect to be seeing each other at last in a couple of months.
By some coincidence one of my best friends now is also an O.B. nurse. I’ll call her Ziva (yes, I …
Can a doctor and a nurse be friends in the OR?
The New York Times has jumped all over a couple of recent scientific articles asserting that certified registered nurse anesthetists (CRNA’s) provide equivalent care as MD anesthesiologists. Already, it is legal in 15 states for CRNA’s to dispense anesthesia without the overarching supervision of a physician.
Furthermore, a study from the Lewin Group in California has demonstrated that CRNA-only models of anesthesia provision are far more cost effective that …
How MD anesthesiologists have become victims of their own excellence
Many doctors roll their eyes whenever patients bring in a stack of research they printed out, stemming from a Google search of their symptoms.
A piece by Zachary Meisel in TIME.com describes a familiar scenario:
The medical intern started her presentation with an eye roll. “The patient in Room 3 had some blood in the toilet bowl this morning and is …
Patients Google their symptoms, doctors need to deal with it
Either as a patient or as a physician there’s a very high chance that you’ve ever got your hands on a simple blood test.
These range from very basic ones to complex ones with multiple pages and are substantial to any cinlical evaluation. Blood tests are probably one of the most performed tests in a clinical environment with direct patient contact. Also, if you’ve ever seen a typical blood test from …
Your blood test and the need for better designed results
by Phil Baumann, RN
What assets do physicians nurse practitioners have which they can share online? It’s knowledge.
With today’s technologies, medicine and nursing care online are obviously limited – perhaps in the future we’ll have technologies which more robustly extend traditional care.
When patients seek information online, they’re usually looking for answers to questions. Now they may be seeking answers from different sources, but if they could find …
Quora in health and medicine, what doctors and nurses need to know
Many people are already aware that marijuana is now legal in some states in the US with a medical prescription.
What many people may not realize is that cocaine is also used in medical care, especially in the ENT world.
Cocaine is one of the most potent anesthetic and vasoconstrictor. These two characteristics make it an ideal medication for use during sinus surgery as well as any nasal procedure where bleeding and …
How cocaine can be used in sinus surgery
Hold onto your hats. I am about to enter dangerous territory. I am about to suggest maybe doctors should profit from dispensing medications from their office to offset declining reimbursements and rising expenses by using prescriptions as a source of ancillary revenues.
Why dangerous? For a number of reasons.
One, physicians still grapple with the perception that it is improper for a physician to make money from …
Why doctors should profit from dispensing medications
by Tayson DeLengocky, DO
There has been a growing public interest in complementary and alternative medicine (CAM) in recent years. Osteopathic manipulative therapy, a form of physical manipulation of the body for improvement of health and body function, has been designated as complementary and alternative medicine (CAM) by the National Institutes of Health (NIH).
According to data reported in 2007 by the National Institutes of Health’s National Center for Complementary and Alternative …
Alternative medicine and osteopathic medical education
I was sitting on one of the hospital’s nursing units having a difficult telephone conversation. Anyone working nearby could have easily discerned the situation from my end of the call.
Patient’s family member wants to keep aggressive care going for a comatose, terminally ill family member against the best advice of the medical team.
Having never had to make such a decision in my own life, I am left to imagine how …
Kind and thoughtful words from a fellow physician colleague
by Joyce Graff
Medical dramas can play powerful roles in increasing awareness of rare diseases, but it’s critical that the diseases are portrayed accurately. Mischaracterizations by the popular media of medical conditions, particularly rare ones, can be very demeaning to people afflicted with those conditions, and can affect how people look at them in the workplace or at school.
The TV show, Grey’s Anatomy recently broadcast the first …
Mischaracterizations by the popular media of medical conditions
How many times have I been asked by the trauma surgeons to see a trauma patient for respiratory failure? The reason for intubation and ventilatory support – being combative and non-cooperative.
Intubating, sedating and sometimes even paralyzing a combative patient is an established practice. Combative patients are dangerous to themselves and to the medical staff. Clinical and radiological evaluation of these patients is difficult as well. Asking “What is hurting, Sir” …
Intubating the combative patient
During my training at Hennepin County Medical Center (HCMC) in Minneapolis, MN, my mentor would use the following teaching pearl during rounds: “When you hear hoofbeats, think of horses not zebras!” He would also frequently use: “If it looks like a duck, swims like a duck, and quacks like a duck, then it probably is a duck.” What did my mentor, the Sage of HCMC, mean by this?
From Wikipedia: “Zebra …
Common things are common, except when the diagnosis is rare
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