August 7, 2018

Doxycycline for Young Children (after tick bite)?

I always wondered if a single dose of doxycycline after a tick bite would be all that risky for children under 8 as far as tooth staining goes. Well, I missed this two year old information from The Medical Letter:

“Lyme disease, unlike Rocky Mountain spotted fever, is seldom fatal and can be treated with antibiotics other than doxycycline. A single dose of doxycycline is recommended for prophylaxis after a tick bite. Given the CDC’s statement about its safety, it would seem reasonable to use doxycycline for prophylaxis in all age groups. When longer treatment courses (10, 14, or 28 days) are recommended for the various clinical manifestations of Lyme disease in children <8 years old, alternative antibiotics generally could be used instead.”

July 29, 2018

AAFP Updates Its PSA Screening Recommendation

“The AAFP and USPSTF recommendations on the topic share similarities, but whereas the UPSTF statement is rather ambiguous about whether it recommends screening for men ages 55-69, the AAFP clearly states that it does not recommend routine PSA-based prostate cancer screening.”

The article continues:

“it’s estimated that after 13 years, of 1,000 men ages 55-69 who were screened for prostate cancer, 100 will be diagnosed with the disease.

“As the result of early treatment, 1.3 men will avoid dying of prostate cancer, while five men will die of prostate cancer despite treatment,” the recommendation said. “It is also estimated that screening will result in three fewer cases of metastatic prostate cancer.”

Additionally, the Academy said that although the mortality benefit of prostate cancer screening results from early treatment, it is the treatment of prostate cancer that causes the most serious harms.

“These potential harms are particularly concerning given the high rate of overdiagnosis associated with prostate cancer screening,” the recommendation noted. “Overdiagnosis involves the diagnosis of asymptomatic cancer that never would have resulted in symptoms or death.”

July 26, 2018

Med-Psych Physicians in the Hospital | Psychiatric Times

You can be double Boarded in Internal Medicine and Psychiatry. But the vignette in this article would have been equally well addressed by a generalist who had his eyes, ears and heart open:

“How should we effectively care for the medically complicated patient with psychiatric issues in the hospital? There is not a simple answer to this question, but I write this piece to simply raise awareness of a potential part of the solution: the dually-trained Med/Psych physician.”

July 17, 2018

Treat the Brain to Lessen the Pain

We have successfully helped many of our chronic pain patients reduce their need for opioid medications through our in-house cognitive pain management program. JAMA Neurology just published an article about a similar program with similar results:

July 10, 2018

“Work For Us and Have No Say”

A promoted post keeps appearing in my LinkedIn feed. At first I just ignored it, but tonight I looked at it for a minute and thought to myself: What kind of doctor in today’s climate of time pressures and professional burnout wants to sign up for a job where you are told, “you see the patients and we’ll take care of everything else, including HOW you take care of your patients”?

I would think effective job ads for physicians today would say something like, “come work with us and we’ll value your input into everything our organization does”.

Anyway, I might have a spot for a well qualified family doc of the latter inclination.

July 7, 2018

Mini Quiz: Panic Disorder | Psychiatric Times

Benzodiazepines may have a long-term tolerability edge over the SSRIs, SNRIs, and TCAs, as they do not cause weight gain or sexual dysfunction. Generally, high-potency, shorter half-life benzodiazepines are preferable because of their more predictable pharmacokinetics and simpler metabolism. Regular dosing (vs PRN) is recommended to achieve optimal anxiolysis. >
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July 7, 2018

Primary Care and the Opioid-Overdose Crisis — Buprenorphine Myths and Realities | NEJM

“In part, the overdose crisis is an epidemic of poor access to care. One of the tragic ironies is that with well-established medical treatment, opioid use disorder can have an excellent prognosis. Decades of research have demonstrated the efficacy of medications such as methadone and buprenorphine in improving remission rates and reducing both medical complications and the likelihood of overdose death.1 Unfortunately, treatment capacity is lacking: nearly 80% of Americans with opioid use disorder don’t receive treatment.2 Although access to office-based addiction treatment has increased since federal approval of buprenorphine, data from the Drug Enforcement Administration (DEA) reveal that annual growth in buprenorphine distribution has been slowing, rather than accelerating to meet demand (see graph). To have any hope of stemming the overdose tide, we have to make it easier to obtain buprenorphine than to get heroin and fentanyl.”

July 7, 2018

Don’t Tell Me Doctor Salaries are Driving Healthcare Costs

The second major healthcare blog that reblogged some of my posts, after KevinMD, was The Healthcare Blog. I’m still appearing on both. And while I sometimes enjoy them very much, I don’t always agree with the posts I read on either one of those blogs.

Today I watched a video post by Matthew Holt, the founder of THCB. He is a master of brief, snappy commentary in video format, but this one bothered me a little. He implied, in a talk recorded in Finland, that the cause of high healthcare costs in the United States is that doctors want a Mercedes and a five bedroom house. I think that’s small potatoes compared to healthcare executives’ and healthcare investors’ eight figure payouts, which are enough to pay for jets and yachts:

July 4, 2018

The Loss of a Sense of Control as a Major Contributor to Physician Burnout

The current issue of JAMA Psychiatry points out that resilience training and mindfulness are strategies to decrease physician burnout only when it comes to dealing with unchangeable circumstances. The most important solution is to give physicians more control and influence about how we should work and how our practices and organizations should evolve.

July 1, 2018

BBC News: Seeing the same doctor over time ‘lowers death rates’

“The benefits applied to visits to GPs and specialists and were seen across different cultures and health systems.University of Exeter researchers said the human aspect of medical practice was “potentially life-saving” but had been neglected.
GPs’ leaders said they recognised the value of patients seeing “their own” doctor.
Because of intense workforce pressures, however, this could mean waiting even longer for an appointment, the Royal College of GPs said.”

Seeing the same doctor over time ‘lowers death rates’_102243589_gettyimages-689956326.jpgContinuity of care really is a matter of life and death, a review of studies suggests.