by RH+, MD
About 3 weeks after my son was born I read this post and I was extremely jealous as I read about the author’s extended leave. As I began to consider my “maternity leave” I realized that I could quite possibly have a truly unique situation on my hands.
I work in private practice and my husband is an amazing stay at home Dad. We had been waiting to …
How this OB/GYN handled her unexpected maternity leave
Not being much of a soccer aficionado, I have nevertheless been captivated by some of the games in the 2010 World Cup Soccer. Probably has something to do with my being South African!
While I hear many Americans bemoan the slow pace of the televised game (“boring!”), the low scores (“where’s the action?”) and the vuvuzelas (“irritating!”), I have been struck by lessons these matches have offered up for entrepreneurial physician …
World Cup soccer lessons that doctors can use
A couple of months ago, a Baltimore reporter called to get my take on a scandal at St. Joseph’s Hospital in Towson, an upscale suburb.
A rainmaker cardiologist there, Dr. Mark Midei, had been accused of placing more than 500 stents in patients who didn’t need them, justifying the procedures by purposely misreading cath films. In several of the cases, Midei allegedly read a 90 percent coronary stenosis when the actual …
Mark Midei and the failure of peer review
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 …
The grief men face when their wives undergo mastectomies
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old woman is evaluated in the emergency department for difficulty seeing out of her left eye.
The symptoms were first present upon awakening 45 minutes earlier. She describes her vision as “looking through a dark veil.” Her right eye is unaffected. There is …
MKSAP: 68-year-old woman with difficulty seeing out of her left eye
As a young medical student I remember the arrival of the first video arcade games very clearly: Asteroids, Space Invaders and Pacman.
I spent whatever spare cash I had on them, never playing long enough to be any good, or rich enough to get any better. When I bought my first computer in my late-twenties, I relived my excitement with the newest computer games, spending a disproportionate amount of time long …
Tomorrow’s surgeons are today’s video gamers
Social and language issues dominate most of the discussion about the features of autism spectrum disorder (ASD).
A neglected area of study are the physical feature characteristics that have been known to be associated with ASD. Unlike some of the diagnostic physical changes in disorders such as Down Syndrome, physical features found in ASD are often subtle and missed by most clinicians.
Ozgen and colleagues from the Netherlands, UCLA and the UK …
Physical features of autism spectrum disorder (ASD)
In Journal Watch AIDS Clinical Care, we published a simple case: Clinically stable HIV+ gay man, on HIV treatment; anal pap comes back with “atypical squamous cells of undetermined significance” (ASCUS).
What to do with this result? Two experts weighed in, Howard Libman and Joel Gallant. In Howard’s thoughtful response, he acknowledges the limitations of the data thus far, but said he would refer the patient for high-resolution anoscopy (HRA) and …
Anal cancer screening in HIV+ men
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 …
Ranking prestige of medical diseases
by Kristina Fiore
Drinking coffee and alcohol, smoking, and lack of physical activity all appear to be associated with migraine and tension-type headaches in teenagers, researchers found.
High consumption of cocktails appeared to put students at the greatest risk for these headaches, increasing the odds almost three-and-a-half-fold, Astrid Milde-Busch, PhD, of Ludwig Maximilians University Munich in Germany, and colleagues reported online in the journal Headache.
“Rather unexpectedly, recommendations to increase fluid intake as …
Drinking and smoking associated with migraine headaches
It’s worth your while to browse through Sid Schwab’s sampler one rainy Saturday afternoon when you get a chance.
The old man can write. I was reading through a couple of his old posts the other day when I stumbled upon this one. It’s a shorter post (for him) but very powerful and moving.
He describes what it’s like to enter an abdominal cavity of a patient, with all its …
Surgeons need to reconnect with patients after an operation
Just last week I saw a full-page ad in the newspaper for a series of medical screening tests — EKG, echocardiogram, aortic ultrasound, and the like (all interpreted by “certified doctors”) — that a person could arrange for oneself or a loved one.
We newspaper readers were told we could arrange to have these tests performed without a doctor’s order as …
A cardiologist discusses screening for vascular disease
I recently visited my cardiologist. It was a routine follow up after a heart attack a year ago. I enjoy our relationship. As a token of my regard, I came bearing a gift. It was a copy of my book Obama, Doctors, and Health Reform.
I knew he had qualms about Obamacare. He expressed doubts about the health reform bill’s merits. The bill will roll out over the next ten years. …
Why Obamacare scares this cardiologist
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by Michael Smith
Administering high concentrations of supplemental oxygen during resuscitation after cardiac arrest is associated with increased inhospital mortality, researchers said.
So-called blood hyperoxia resulting from being given pure oxygen after cardiac arrest was associated with an 80% increase in the risk of death, compared with patients whose blood gases were normal on admission to the intensive care unit (ICU), according to Stephen Trzeciak, MD, of Cooper University Hospital in Camden, …
Supplemental oxygen during cardiac arrest resuscitation
Obesity is a huge healthcare problem in the United States.
It has reached the proportions of an epidemic and continues to get worse. Multiple medical problems including heart disease, hypertension, diabetes, sleep apnea and cancer are closely associated with obesity. The patients with extreme obesity can reach a body weight of five, six or seven hundred pounds and even higher. Riddled with chronic medical conditions, these patients often end up in …
Obese patients present challenges in the ICU
This is a painful story to write.
A close friend of mine, in his 40’s, had a persistent light cough for many months. Finally, when he had an X-ray taken, it showed a large tumor on his lungs. He was diagnosed with stage 4 lung cancer. As a non-smoker and strapping, physically fit man, he was shocked, as you can imagine.
He went to his non-Boston-based medical practice, and he was told …
Clinical trial conflict of interest for doctors
Why do dentists prescribe antibiotic prophylaxis so often?
Because they can.
Why am I dissing my dental colleagues? Because I can.
Perhaps, this is a simple case of dental envy, since their profession remains within secure borders far beyond the health care reform line of fire. Consider these dental incidentals:
• Not a syllable in the ~2000 page health care reform law that affects dentists. Every filling is still worth its weight in gold
• …
C. Diff and how dentists overuse antibiotics
Malpractice and heart catheterization have been in the news recently.
A spicy concoction for sure. An epidemiological study published in an online subsidiary of Circulation addresses the role of three major medical issues facing cardiologists today: malpractice, heart catheterization, and medical costs.
It is hard to get more controversial.
Heart catheterization, the invasive assessment of the coronary artery lumen, has always been a hot-potato topic. The “percent-normal” was the buzz word when I …
Heart catheterization worries that every cardiologist face
by RH+, MD
More than anything in life I wanted to be a family practitioner (FP).
Going into medical school there was little doubt in my mind that this was my chosen path. I chose a school that had a significant focus on primary care and was president of the Family Practice Club my second year. I had shadowed several FPs and truly enjoyed the continuity of care that went into FP.
When …
Why a doctor chose OB over family practice
by Chris Emery
Single and childless surgical residents in the U.S. are more likely to pursue specialized surgical fellowships, and a majority of surgical residents believe a successful career depends upon specialty surgical training, a new survey found.
Of residents who responded to the survey, 28.7% believed general surgery is becoming an obsolete career path (30.1% of men and 25.9% of women, P=0.004), and 55.1% believed specialty training is necessary for career …
Residents who specialize in surgery are influenced by family
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