The grief men face when their wives undergo mastectomies

Conditions
July 8, 2010

I have given anesthesia for a lot of breast surgery. I don’t think I’ll ever get used to the fog of pain and sorrow surrounding a double mastectomy.

All surgery is invasive in some way. Amputations, in particular, have a horror all their own; the idea that destroying someone – cutting off a body part, violating a coherent whole – should be necessary in order to save a life is almost …

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The grief men face when their wives undergo mastectomies

Kidney stone pain, as experienced by a man and a woman

Conditions
July 5, 2010

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As a typical guy, there are several painful illnesses that can hit our brotherhood in an instant. No warning was given. No “Get out of jail free” pass, either. Just cruising along, having another fine, healthy day, and bam! — suddenly, you are lying on the floor in severe distress.

The most feared? A testicular torsion. It can happen spontaneously. It can …

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Kidney stone pain, as experienced by a man and a woman

Can chest pain patients be evaluated in the ER waiting room?

Physician
June 12, 2010

by John Gever

Emergency department patients with chest pain may safely be evaluated in the waiting room when necessary, researchers said.

Among 303 patients triaged to waiting-room evaluation in a prospective study, no acute coronary syndromes were missed and adverse event rates overall were lower than among 804 patients who were assessed in conventional monitored beds, reported Frank Scheuermeyer, MD, of St. Paul’s Hospital in Vancouver, British Columbia, and colleagues online in …

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Can chest pain patients be evaluated in the ER waiting room?

Treating a child with fever and leukemia

Conditions
June 10, 2010

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. …

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Treating a child with fever and leukemia

Causes of stroke in young adults

Conditions
June 9, 2010

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 …

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Causes of stroke in young adults

Patients who attempt suicide and withdrawal of medical care

Conditions
June 2, 2010

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 …

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Patients who attempt suicide and withdrawal of medical care

How the oil shortage will affect hospitals and healthcare

Physician
May 31, 2010

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 …

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How the oil shortage will affect hospitals and healthcare

Patient wants an apology, not money, after medical malpractice

Physician
May 16, 2010

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 …

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Patient wants an apology, not money, after medical malpractice

Declining autopsy rate, and how that impacts doctors

Conditions
May 12, 2010

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 …

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Declining autopsy rate, and how that impacts doctors

False patient contact information worsens emergency care

Physician
May 10, 2010

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 …

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False patient contact information worsens emergency care

Avoiding the ER and arranging a direct admit is not easy

Physician
May 4, 2010

Are emergency departments solely responsible for the bulk of unnecessary tests?

Most would like to believe so, but emergency physician Edwin Leap says that’s not the case.

He cites an instance involving a primary care doctor and hospitalist:

Local physician, who does not admit to the hospital, sees patient in the office. Patient has uncontrolled hypertension and is having some chest pain and shortness of breath. Local physician contacts hospitalist. …

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Avoiding the ER and arranging a direct admit is not easy

Aneurysm as a cause of the Bret Michaels brain hemorrhage

Conditions
April 26, 2010

Bret Michaels continues to be monitored in the intensive care unit after suffering a subarachnoid hemorrhage.

bret michaels According to his road manager, “further testing this week will help locate the source of the bleeding.”

What exactly does that entail?

As I mentioned previously, aneurysms are responsible for the majority of brain bleeds. Finding that source is critical. Angiography, or …

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Aneurysm as a cause of the Bret Michaels brain hemorrhage

Psychiatric patients detained in the ER

Physician
April 22, 2010

Our state of South Carolina is a delight. From wonderful people to beautiful landscapes, from a vibrant Southern culture to excellent food like shrimp and grits, it’s a place I’m thrilled to live. But we do lack a few things. And one of the most striking is adequate mental health care.

The state budget, like so many state budgets, has been trimming anything and everything. And of course, mental health coverage …

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Psychiatric patients detained in the ER

President Obama should have had colonoscopy without sedation

Conditions
April 19, 2010

by Michael Kirsch, MD

Does anyone out there know why President Obama underwent a virtual  ‘colonscopy’ (VC) instead of a conventional colonoscopy earlier this year?

In my gastroenterology practice, we do not offer colon cancer screening to 48-year-old individuals, unless special risk factors are present. Of course, maintaining the president’s health is in the national interest, so I understand why professional screening guidelines might not apply to him. For …

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President Obama should have had colonoscopy without sedation

Medicine residency survival tips during pregnancy

Education
April 8, 2010

by Dr. Whoo, MD

Q. I just found out last week that I’ll be a new mom in November, making me an official mother in medicine! I’ve been reading the blog for a while, because I love hearing what all of you have to say about your lives. Here’s my question: What tips would you give for surviving residency while pregnant, especially 30-hour calls (without caffeine)?

— From a future mom and …

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Medicine residency survival tips during pregnancy

Radiology tests, and how to find their price

Conditions
March 30, 2010

I am often asked how we get the prices for the radiology imaging tests, such as MRI’s and mammograms, or ultrasounds. Most people assume that my day job as a doc gives me some sort of special access to this info. But that’s just not the case. Anyone can find out testing prices.

However, over the last year, those of us working at LesliesList.org have gotten more experienced and better at …

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Radiology tests, and how to find their price

Using CT scans to diagnose chest pain in the ER

Physician
March 6, 2010

During residency, there was always a case of misdiagnosed chest pain to discuss in conference.  Incorrectly sending a patient home and missing the diagnosis of cardiac chest pain was an infrequent, but repetitively observed, phenomenon.

So as to tread carefully with words, it is sufficient to say that even now, chest pain triage remains a vexing problem.

Chest pain diagnosis is like appendicitis; there are always small numbers of unusual cases in …

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Using CT scans to diagnose chest pain in the ER

When doctors can’t figure out what’s wrong with a patient

Conditions
February 10, 2010

Part one of a series.

The first patient I ever saw as a first year resident came in with a litany of complaints, not one of which I remember today except for one—he had headaches. The reason I remember he had headaches isn’t because I spent so much time discussing them but rather the opposite: at the time I knew next to nothing about headaches and somehow managed to end the …

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When doctors can’t figure out what’s wrong with a patient

Why the Mayo Clinic is refusing to see Medicare patients

Policy
January 25, 2010

Medicare, the government insurance company for everyone over age 65 (and for the disabled), pays fees to primary care physicians that guarantee bankruptcy.

Additionally, 70 percent of hospitals in the United States lose money on Medicare patients. That’s right, for every patient over age 65, it costs the hospital more to deliver care than the government reimburses. That is why Mayo Clinic has said it will not accept Medicare payments for …

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Why the Mayo Clinic is refusing to see Medicare patients

Why doctors in the United States order so many CT scans and MRI tests

Conditions
January 13, 2010

It’s commonly thought that health care in the United States is heavily dependent on diagnostic testing.

But how do we compare with the rest of the world? Perhaps these graphs, courtesy of the New York Times can provide a stark illustration.

Here’s the data regarding CT scans, showing the number of tests per 1,000 people. Guess which country’s on top:

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Why doctors in the United States order so many CT scans and MRI tests

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