I walked into Room 35 to find a three year-old lying on the hospital cot. Her father sat alongside her bed, whispering softly to her. The patient appeared quite tired, wiped-out even, and if it weren’t for her complacent eyes tracking my every move, I would have thought she might be sleeping.
She was visiting our ER because, after a few days of cough and congestion, she had developed a fever. …
Treating a child with fever and leukemia
If you have spent anytime with a palliative care team in a hospital you will know of their efforts to essentially blacklist Demerol (meperidine) from use in the hospital.
Some hospitals have removed it or restricted it from the formulary all together. In medical culture, Demerol has been a go to opioid peri-OR and mostly favored by surgeons. The drug has been purported to be less likely to cause billiary spasm, …
Demerol used to treat shivering in patients
by Todd Neale
The recent stroke suffered by Delaware’s attorney general Beau Biden, who is 41, has highlighted the fact that people of all ages are vulnerable, despite seemingly good health.
A statement from Timothy Gardner, MD, medical director of the Center for Heart and Vascular Surgery at Christiana Care Health System in Newark, Del., where Biden was initially treated, said he had suffered a “mild stroke,” although it remains unknown whether …
Causes of stroke in young adults
With healthcare reform dominating the news recently, MRI and other imaging tests have become the (misguided) targets of many critics.
Although MRI makes up only one-half of one percent of total healthcare expenditures, it is easy to demonize since the average healthcare consumer can understand imaging much easier than the diagnosis related groups (DRGs), hospital facility fees or insurance contracts that have a much greater impact on the cost of health …
Clinical judgment and when neurologists should order an MRI
What is “MRI Abuse”? This is when the health care provider orders MRIs (Magnetic Resonance Imaging) in excess or for the wrong reasons. There are many causes of MRI abusive behavior but most evolve out of a significant misunderstanding of how to properly utilize this diagnostic tool. MRI imaging has a high sensitivity to detect anatomic abnormalities, does not expose the patient to high doses of radiation like a CAT …
MRI abuse can be dangerous and expensive for patients
Though I’ve never lost a friend or family member to suicide, I have lost a patient.
I have known a number of people left behind by the suicide of people close to them, however. Given how much losing my patient affected me, I’ve only been able to guess at the devastation these people have experienced. Pain mixed with guilt, anger, and regret …
6 reasons why people commit suicide
If a person tries to commit suicide, could that be considered as a statement that this person wishes to die and does not want aggressive treatment to save his or her life?
Not from a legal standpoint, and not if you are living in the United States.
A middle-aged man with a long standing history of depression decides to end his life. He puts a large caliber gun straight to his forehead …
Patients who attempt suicide and withdrawal of medical care
I believe in the peak oil theory.
Think about it, in a closed system nothing is infinite. Since oil is a product of millions of years of decay, unless we use it at the same rate that is it produced, we will run out. I do not have a crystal ball any more than anyone else I know, so I will not hang my hat on when, but will commit to …
How the oil shortage will affect hospitals and healthcare
As reported in MedPage Today, the FDA announced the end for CFC-propelled inhalers. Of the seven inhalers with deadlines for removal, only three are still being made:
Flunisolide (Aerobid Inhaler System) on June 30, 2011
Albuterol and ipratropium combination (Combivent Inhalation Aerosol) on Dec. 31, 2013
Pirbuterol (Maxair Autohaler) on Dec. 31, 2013
The reason for this is because CFC’s are harmful for the environment, and the newer inhalers have to be replaced with …
Your asthma or COPD inhaler is not available, and what to do
There is an aspect of professional sports that I greatly admire. This transcends the athleticism and skill of the athletes, the work ethic, coaching expertise, teamwork and the thrill of the game. This is one of the only institutions that is a pure meritocracy. The philosophy is simple and not blurred by arguments for diversity or massaging the qualifications for admission to serve another agenda. Coaches, managers and owners want …
How doctors choose which specialists they refer to
by an anonymous medical student
As of today, I am one month from adding those long sought-after and hard-earned initials to my name, M.D.. I matched at my number one choice in a very competitive “lifestyle specialty,” have a fabulous husband who has helped me through the emotional turmoil that is medical school, and two young boys who make me laugh and smile every day. I sit here, where …
A medical student chooses dermatology because of family
Ahhh spring.
The lovely blooms unfurling. The trees budding.
It’s enough to make a girl get tears in her eyes.
And sneezes in her nose.
And itching on her face.
Yes, it’s allergy season again — but what can you do to make yourself more comfortable without emptying your wallet?
1. Avoidance. Close the windows. Make someone else cut the grass. Stay inside. (Yes, I hate this one too- let’s move on.)
2. Neti pot or other nasal saline rinsing. LOVE …
Allergy drug recommendations for patients on a budget
by Ryan DuBosar
“House, M.D.,” is the least realistic medical drama on television. That doesn’t bother Lisa Sanders, ACP Member, one of the show’s technical advisors.
The lead character, Gregory House, MD, verbally abuses patients, goes overboard ordering tests and above all, he’s “a jerk,” Dr. Sanders said. But after all, it’s television, and the former CBS news producer turned med student turned Yale professor understands the difference between reality and good …
House, M.D. physician technical advisor interview
In reference to the seemingly “simple” name change being proposed for Physician Assistants to Physician Associates, I take great exception to the commentary offered by Dr. Zilberberg in her recent article entitled, Physician assistant name change rubs doctors the wrong way.
She states: “Physicians have been only too successful at becoming the final word in health, at the exclusion of all others.”
Physicians are the highest and most extensively trained group …
Physician assistant not associate: Reasons against a name change
by Tricia Pil, MD
This is the true story of a hospitalization as told from three points of view: first, the recollections of the patient (who happens to be a physician); second, events as recorded in the medical charts by doctors and nurses; and third, the version put forth by the hospital.
FRIDAY
Patient:
It is fall 2005, and I am nine months pregnant. A healthy 33-year-old pediatrician, I am a longtime patient of …
Patient wants an apology, not money, after medical malpractice
Generally, I find my practice works best when I get paid in dollars. They’re convenient. They can be transmitted electronically between bank accounts. Mary and Annie like them. I can spend them by swiping a credit card.
But, in a remarkable effort to win the “Let’s See How Stupid I Can Sound” award, a Nevada candidate for U.S. Senate has proposed ditching the idea of paying doctors in money, and going …
Bartering and whether doctors should be paid with chickens
The role of autopsy in the medical profession is difficult to overestimate. Western medicine takes its roots from comparative studies between patient’s symptoms and the findings on autopsy.
Participation in an autopsy was one of the most valuable lessons from medical school and residency. If you participated in the patient’s care, there is no greater educational tool than witnessing the postmortem exam. It is especially true if the cause of death …
Declining autopsy rate, and how that impacts doctors
One of the biggest emergency room problems is contacting patients after they leave.
Patients sometimes leave false contact information — which makes it difficult for the emergency room staff should problems arise after the visit.
The issue was illustrated in a piece from msnbc.com. Many times, results like blood cultures or x-ray findings take time to return. And if there’s something that needs to be acted upon, contacting the …
False patient contact information worsens emergency care
An excerpt from How to Survive a Medical Malpractice Lawsuit: The Physician’s Roadmap for Success.
by Ilene R. Brenner, MD
The most important part of your case is upon you: the pretrial deposition. If you do a poor job, you can ruin your case and make a defensible lawsuit become indefensible.
So what is a deposition? It is the sworn testimony of a witness taken before trial, in a location …
Medical malpractice deposition survival tips for doctors
by David Edelman, MD
Heartburn and acid reflux disease are common problems affecting women of all ages. The problem develops when acid in the stomach backs up into the esophagus. There is a muscle known as the diaphragm that separates the chest from the abdominal cavity. When you eat or drink, the food goes from the mouth down the esophagus, through the diaphragm and into the stomach. …
Hiatal hernia in women can present with heartburn
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