Steve Jobs received a new liver, and the ethics surrounding his transplant

Conditions
June 22, 2009

Orac, a general surgeon who blogs at Respectful Insolence, writes the most comprehensive entry I’ve seen thus far on Apple’s Steve Jobs’ liver transplant.

For those interested in the medicine behind the transplant, go and read his post in its entirety. I’d like to highlight some of the potentially questionable ethics surrounding the case.

For one, there is the question why Mr. …

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Steve Jobs received a new liver, and the ethics surrounding his transplant

How much time do doctors spend on paperwork?

Physician
May 29, 2009

A common complaint is that doctors these days are spending more time doing clerical tasks.

Examples include filling out pre-authorization forms, talking to health plans for pre-certifications on imaging studies, and spending time jumping through bureaucratic hoops. Generally, you do not need a medical degree to do these tasks.

Bob Doherty points to a study that gives some numbers to back up the claims. Primary care doctors spend about 3.5 …

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How much time do doctors spend on paperwork?

Can you really kill a man by gluing his anus shut?

Potpourri
May 9, 2009

A recently reported method of torturing gay men in Iraq sounds horrifying.

Andrew Sullivan points to an article that spares no graphic details: “. . . anti-gay Shiite death squads are sealing their anuses with a powerful glue, then inducing diarrhea, which leads to a painful and agonizing death.”

But, can someone really die from this novel form of torture?

Emergency physician Shadowfax has his doubts. …

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Can you really kill a man by gluing his anus shut?

Nighthawks, dayhawks, and the demise of the American radiologist

Physician
March 29, 2009

More hospitals are resorting to so-called “dayhawk” radiology services to read their x-rays.

It’s modeled after the “nighthawk” model, where radiologists (via Shadowfax), in some cases as far away as India, remotely read films in the middle of the night.

Now, the phenomenon is happening during business hours as well, which according to radiologist Giles W. L. Boland, means that “some radiologists can no longer assume long-term …

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Nighthawks, dayhawks, and the demise of the American radiologist

Should the MCAT grant extra time for students with learning disabilities?

Education
March 22, 2009

A recent California court denied extra time for aspiring medical students with dyslexia and attention deficit disorder when taking the MCAT.

The body that administers the test has to straddle a delicate line, in granting extra time to a broadening definition of the disabled student versus maintaining the overall fairness and integrity of the high stakes test.

Despite the ruling, three of the four plaintiffs have gone …

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Should the MCAT grant extra time for students with learning disabilities?

Did the Canadian health system fail Natasha Richardson?

Physician
March 20, 2009

Would Natasha Richardson be alive today if she had gone skiing in the United States instead?

I don’t think it would have made a difference.

To recap the tragedy, Ms. Richardson died from an epidural bleed, after she fell while skiing. Her presentation was somewhat classic, with the well-described “lucid” period before she deteriorated.

According to Canada’s Globe and Mail, “ambulance workers were not …

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Did the Canadian health system fail Natasha Richardson?

Why do I need a rectal exam, and what can doctors find with the gloved finger?

Conditions
March 6, 2009

Have you ever wondered why doctors have to perform a digital rectal exam?

Well, look no further, as primary care doctor Rob Lamberts gives us the answers discerning readers demand.

Simply by looking at the rectum, which by the way, indeed “takes some getting used to,” can lead to significant diagnostic findings. Furthermore, does tight sphincter tone matter? And should you be worried about the large hands …

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Why do I need a rectal exam, and what can doctors find with the gloved finger?

Relative value units, and how the RVU payment system doesn’t allow doctors to practice good medicine

Policy
March 5, 2009

For those who don’t know, every piece of work that a doctor performs is quantified and measured.

The base unit of physician work is known as the relative value unit (RVU). Most physician salaries are determined by the amount of RVUs a doctor produces in a given year, and in most cases, can range between$35 and $45 per RVU in primary care, depending on geographic location and …

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Relative value units, and how the RVU payment system doesn’t allow doctors to practice good medicine

Ways you can die from having sex

Potpourri
February 17, 2009

Cosmo Magazine, that bastion of reliable medical advice, declares, “An orgasm almost killed her.”

Intrigued, gynecologist Amy Tuteur reads further, and finds its about case where a woman developed stroke-like symptoms after intercourse, and was diagnosed with an embolic stroke.

The patient was taking the birth control pill, which can raise the risk of blood clots. In this case, it was also combined with the presence of …

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Ways you can die from having sex

Her hands and feet amputated, a Brazilian model dies from Pseudomonas aeruginosa sepsis. What happened?

Uncategorized
January 25, 2009

Mariana Bridi da Costa, a 20-year old Brazilian model, tragically died early Saturday morning from Pseudomonas aeruginosa urosepsis.

How can this happen?

Miss Bridi da Costa initially presented on December 30th, and was diagnosed with kidney stones. An ultrasound, plain film, or CT scan likely would have been done to confirm the diagnosis. I assume that a urinalysis was also performed, and if …

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Her hands and feet amputated, a Brazilian model dies from Pseudomonas aeruginosa sepsis. What happened?

What do doctors look for when they examine the abdomen?

Uncategorized
January 16, 2009

A primary care doctor guides us through the abdominal physical exam.

He deciphers the much-written notation of “Abd: Soft, NT, Normal BS, no HSM or masses*,” and explains what physicians look for when they poke, prod, percuss, and listen to when examining a patient’s belly.

You’d be surprised at some of the things we find simply by pressing on the abdomen.

* For those who need translation, …

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What do doctors look for when they examine the abdomen?

Jett Travolta’s seizure and death, was Scientology a factor?

Uncategorized
January 3, 2009

Jett Travolta tragically passed away yesterday, after being found unconscious in his hotel room by his caretaker. There is speculation that he had a seizure and hit his head on a bathtub.

Travolta apparently had a long history of medical problems, including Kawasaki disease, which is a vasculitis that primarily affects children. It is one of the most common causes of acquired heart disease in children, and …

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Jett Travolta’s seizure and death, was Scientology a factor?

Why too many CT and MRI scans can be dangerous for patients

Uncategorized
December 9, 2008

This is an important article to read.

Many of the incentives today encourage doctors to order more advanced imaging scans, like CTs and MRIs. This expensive practice is invariably caused by this common scenario, as “patients who are in pain often demand scans hoping to find out what is wrong, doctors are tempted to offer scans to those patients, and then, once a scan is done, it …

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Why too many CT and MRI scans can be dangerous for patients

Is there a place for a part-time medical residency?

Education
November 25, 2008

Doctors in training often do so in their prime family-rearing years.

A few pediatric residencies are offering part-time residency options, designed for those who also want to raise their own families. Proponents argue that residents can not only get more rest, but also avoid depression, which affected almost a quarter of pediatrics residents.

Combined with the talk of further limiting work hours down to 56 …

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Is there a place for a part-time medical residency?

Sharpie for surgery

Uncategorized
October 25, 2008

Surgeons use markers to identify the right body part for procedures. Unfortunately, they care become contaminated with bacteria which can lead to surgical site infections.

Enter the Sharpie: “As it turns out, the ink used in a Sharpie pen has an alcohol base, making it an unexpected germ fighter.”

Who knew? The Sharpie is probably also many times cheaper than the single-use “sterile” pen used …

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Sharpie for surgery

Tom Brady and his knee infection

Uncategorized
October 23, 2008

New England Patriots quarterback Tom Brady recently underwent repair of his anterior cruciate ligament at the Kerlan-Jobe Orthopaedic Clinic in Los Angeles. His doctor was Neal S. ElAttrache, who’s a renowned orthopedic surgeon and former team physician of an NFL team.

Unfortunately, his post-op course has been complicated by an infection. On his website, TomBrady.com, he acknowledged this and said that the original procedure was …

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Tom Brady and his knee infection

Are MRI results accurate?

Uncategorized
October 14, 2008

Most physicians and patients think that the MRI scan is one of the more sensitive and comprehensive diagnostic tests.

However, there is significant variability in reading and performing the scans, which makes having it done at a reputable institution more imperative:

Magnetic resonance machines, though, vary enormously, and not just in the strength of their magnets. Even more important, radiologists say, is the quality of the imaging …

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Are MRI results accurate?

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