Primary Care

Testosterone and when should low levels be treated in older men

Conditions
August 6, 2010

I’ve been interested in the role of testosterone in physical performance, depression and aging for many years. While at the University of Iowa, I was involved in research to detect testosterone doping, the psychological effects of testosterone and the potential for testosterone to alleviate depression in older men.

One of the difficult questions facing clinicians is when is testosterone too low in older men.

One problem with answering this question is the …

Read more…

How to treat slouching in children

Conditions
July 9, 2010

“I’m worried about my daughter’s posture. What can I do about it other than constantly nagging her to stand up straight?”

You’re probably talking about “kyphosis,” which is the rounded-shoulders, hunched forward kind of posture common in children and many adults. It’s often called “postural kyphosis” because it can be corrected if the child tries to stand straight up. Rarely, there’s a genuine spinal deformity, called Scheuermann’s Kyphosis or Scheuermann’s Disease, …

Read more…

Ranking prestige of medical diseases

Conditions
July 4, 2010

Among medical specialties, some are more prestigious than others. You can generally tell which ones are more prestigious by how well they pay. Surgery and cardiology, for example, rank at the top of the prestige scale. Psychiatry and dermatology are near the bottom.

One can also ask if some diseases are considered more prestigious than others, in the opinion of doctors.

A Norwegian doctor, Dag Album, has been investigating the prestige …

Read more…

Why patients don’t value primary care doctors

Physician
June 30, 2010

“Hey doc, all I need is this referral.”

I’ve been encountering more of this lately. A patient who has not been seen in the office for months to years (well beyond when they were supposed to come back for a follow up visit) walks in and requests a “referral” for a specialist visit but they can’t be bothered with actually being seen and evaluated in the office or to be compliant …

Read more…

8 insomnia tips to help you fall asleep without drugs

Conditions
June 19, 2010

Difficulty with sleep is one of the most common patient complaints presenting to the primary care office.

Chances are, you will suffer from difficulty with insomnia at some point in your lifetime. It can be distressing, and cause difficulty with functioning during your wake hours. The first thing you may want to do is to run to the doctor for a prescription for a medication to help you sleep.

However, you don’t …

Read more…

Primary care doctors at a competitive disadvantage to midlevels

Physician
June 13, 2010

A primary care resident wrote in one of the journals recently about making the limited time she has with each patient matter the most.

How refreshing, I thought when she concluded that time ultimately is an absolute and finite resource. We often feel as if we are battling time as much as we are battling disease, and we sometimes have trouble admitting when we are losing either one of those battles. …

Read more…

Don’t let a doctor make you feel uncomfortable

Physician
June 12, 2010

by Diana E. Lee

One member of my health care team is a migraine specialist in another state. Since we don’t have many opportunities to work together in person, we generally try to pack a lot into my periodic two-day visits.

Last time I was there I had an experience that has left me feeling guilty all these months later.

My doctor, who I respect and admire greatly, asked if I was interested …

Read more…

Wii Sports and Wii Fit Plus exercise equivalents

Conditions
June 11, 2010

Regular exercise has been shown to be helpful in the prevention and management of a variety of clinical neuroscience conditions including: Alzheimer’s disease, Parkinson’s disease, major depression and anxiety disorders. However, motivating people to get involved in a regular exercise program is a significant challenge. Wii Sports and Wii Fit Plus may provide the motivation edge for some patients to start and maintain an exercise program.

The Wii video game system …

Read more…

MRI abuse can be dangerous and expensive for patients

Conditions
June 7, 2010

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 …

Read more…

6 reasons why people commit suicide

Conditions
June 3, 2010

shutterstock_184859519

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 …

Read more…

Your asthma or COPD inhaler is not available, and what to do

Meds
May 28, 2010

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 …

Read more…

How doctors choose which specialists they refer to

Physician
May 28, 2010

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 …

Read more…

Allergy drug recommendations for patients on a budget

Conditions
May 21, 2010

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 …

Read more…

ADVERTISEMENT

Physician assistant not associate: Reasons against a name change

Policy
May 17, 2010

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 …

Read more…

Problem list problems with electronic medical records

Tech
May 4, 2010

In family medicine it has been common to keep a “Problem List” in patients’ paper charts. Usually placed on the left hand side, on top of the Medication List, it has given doctors like me an instant thumbnail sketch before considering the specifics of each patient’s visit for that day.

A typical Problem List would include diagnoses like diabetes, hypertension, high cholesterol or rheumatoid arthritis. It would list prior surgeries, like …

Read more…

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. …

Read more…

ADVERTISEMENT

Internal medicine is dead, will concierge physicians thrive?

Physician
April 29, 2010

by Steven Knope, MD

For the last several years, writers in the New England Journal of Medicine and the Journal of the American Medical Association have authored doomsday editorials about the prognosis of primary care medicine. There has been much discussion about the fact that internists and family practitioners cannot keep pace with rising overheads and falling reimbursement under the traditional third-party payment system.

Paraphrasing a recent …

Read more…

Primary care is burdened by excessive paperwork

Physician
April 28, 2010

by Charles R. D’Agostino, MD

We’ve all seen the headlines –- “Primary Care Physicians Becoming a Scarce Breed”, “Wait Times for Appointments Increasing”, “Primary Care in Crisis” –- and have heard the pundits pontificating on the deteriorating state of primary care.

But rarely do we hear what’s happening from physicians on the front lines, those actually seeing patients. Consequently, with direct access to the primary care trenches, replete with an overworked …

Read more…

Alternative medicine isn’t taught to doctors in medical school

Meds
April 26, 2010

by Crystal Phend

Physicians don’t know much more about complementary and alternative medicine than their patients do, according to a new survey.

Most healthcare professionals who answered an online survey of Drug and Therapeutic Bulletin subscribers said their profession was just as poorly informed about herbal medicines (75.5%) as the general public (86.3%).

And almost half of respondents rated their own knowledge about herbal medicines as “quite” or “very” poor (36.2% and 10.4%, …

Read more…

ADVERTISEMENT

High blood pressure treatment that patients need to know

Conditions
April 21, 2010

When her gynecologist told her she had high blood pressure, Marie had a simple solution: switch doctors. After all, she had gone to him for a different problem, and this was the first time he had ever checked her blood pressure.

“He said, ‘Oh my God, you’re like a bomb waiting to explode.’ I said, ‘I didn’t come here for that, I came here for something else,’” she explained.

Two years later, …

Read more…

93
pages