March 5, 2017

$20 and an Algorithm Could Save Your Teen From a Heart Attack

Baseline EKGs are considered poor predictors of heart attacks. This article in The Wall Street Journal says they are not, if coupled with the Seattle criteria.

https://www.wsj.com/articles/20-and-an-algorithm-could-save-your-teen-from-a-heart-attack-1488585696

March 2, 2017

Patients from away

Every year I get at least half a dozen new patients who are “from away”, as we say in Maine. Obviously, I’m “from away” myself. I chose to come here after once driving up from Massachusetts, where I had been an exchange student, and seeing the untouched vastness and the slower pace of life in rural Maine.

Until a few years ago, these new patients were all people who had fallen in love with Maine by vacationing here, or they had come here because of job opportunities.

Lately, I have puzzled over why some of my new patients have chosen to move here; many of them have serious health problems and disabilities, they have never visited Maine before (or seen a Maine winter) and they don’t know a soul here.

A few have hinted about the lower cost of living, and I didn’t really think very hard about that until I saw an article in the Wall Street Journal about a baby boomer in California who moved to an Iowa town of 700 just to be able to survive on the resources she had left to live out her life on.

https://www.wsj.com/articles/with-15-left-in-the-bank-a-baby-boomer-makes-peace-with-less-1487259894

February 24, 2017

Deep brain stimulation for refractory anorexia nervosa: The Lancet Psychiatry

Anorexia Nervosa, a disease I first saw treated with behavioral therapy in medical school on the OB/GYN ward at Uppsala Akademiska Hospital, appears to respond to Deep Brain Stimulation.

http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(17)30076-7/fulltext

February 14, 2017

Back Pain? No Drugs!

The American College of Physicians has issued their new guidelines on how to treat low back pain without sciatica. No more “pain is the fifth vital sign”, and no more opioids.

http://annals.org/aim/article/2603228/noninvasive-treatments-acute-subacute-chronic-low-back-pain-clinical-practice

February 13, 2017

The Root of Physician Disengagement

Richard Gunderman is a wise and prolific writer, radiologist and professor of many disciplines. He writes eloquently in NEJM Catalyst:

What Is Medicine For?

The core problem, then, isn’t managerial. It isn’t even ethical. It’s ontological, pertaining to the most fundamental question of all: what in medicine is most real?

Recent efforts to convert medicine from a relationship-centered profession to an efficiency-focused production process have shifted the focus of attention……describing…a health care culture seriously out of step with what matters most in patient care. This imbalance inevitably erodes the engagement of health professionals.

http://catalyst.nejm.org/poor-care-root-physician-disengagement/

October 6, 2016

Is Infertility Hereditary?

I have, in my entire life, made up only one joke worthy of standup comedy. It is perhaps similar to Stephen Wright’s “I live on a one-way, dead end street”.

It goes “Is infertility hereditary?”

Of course, there is some serious thought behind it. More serious than I thought, it turns out:

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Sons born with fertility treatment ‘inherit problems’

Boys born to fathers who needed help conceiving grow up to have poorer sperm quality than peers conceived without help, a study has found.

http://www.bbc.co.uk/news/health-37563250

April 23, 2016

Top 100

A Country Doctor Writes is one of the top 100 healthcare blogs on eVisit’s 2016 list. They write:

This blog is a great read from a small-town doctor who’s been practicing on the same families for generations. The posts feature “progress notes,” highlighting interesting and unusual cases, along with touching stories of being the doctor for such a close-knit community.

Top 100 Healthcare Blogs: 2016 Edition

January 31, 2016

Expert Advice, But Not in Spelling

Here’s a headline from this week’s Medical Economics. The article points out that our office notes are scrutinized for lazy documentation cliches that don’t reflect the amount or complexity of work to justify our charges.

What’s that expression about throwing rocks from a glass house?

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January 23, 2016

Single Dose Propranolol and Reexposure to Phobia or PTSD Triggers Brings Cure

After one round of treatment, the arachnophobes held the spiders in their bare hands.

http://www.nytimes.com/2016/01/24/opinion/sunday/a-drug-to-cure-fear.html?smprod=nytcore-ipad&smid=nytcore-ipad-share

December 20, 2015

When Hospital Paperwork Crowds Out Hospital Care

A FRIEND was recently hospitalized after a bicycle accident. At one point a nursing student, together with a more senior nurse, rolled a computer on wheels into the room and asked my friend to rate her pain on a scale of 1 to 10.
She mumbled, “4 to 5.” The student put 5 into the computer — and then they left, without further inquiring about, or relieving, my friend’s pain.

http://www.nytimes.com/2015/12/20/opinion/sunday/when-hospital-paperwork-crowds-out-hospital-care.html?smprod=nytcore-ipad&smid=nytcore-ipad-share