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The Dangers of Practicing Medicine Without Context Print E-mail
Written by A Country Doctor Writes   
Friday, 08 February 2019 13:32
We once had a locum provider who spent a great deal of time reviewing each patient's record before each visit. He would then enter the room and proceed to "clean up" medication and problem lists. Everything he did was done without eliciting the back story from the patient or the record. All he looked at was the data, never the narrative. Patients were often bewildered, saying "he changed my medicines without even talking to me." It may sound great to only act on the facts, but real medicine is a lot messier than that. Sometimes we prescribe medications for more than one purpose: Amitriptyline may not be the theoretically best drug for neuropathy, but if the patient also has trouble sleeping and a history of migraines, it could solve three problems at once. And propranolol could be used for migraines, tremors, palpitations and stage fright. It may not be the best beta blocker for the average 70 kg male, but there aren't many of those around.
Last Updated on Friday, 08 February 2019 13:35
MOC: When you play the game and they change the rules Print E-mail
Written by XRAYVSN, MD | KevinMD   
Tuesday, 29 January 2019 17:58
I think one of the biggest frustrations I have as a doctor is being at the mercy of people who either have no medical training or are so detached from medicine that they have lost touch with those on the front line. The American Board of Radiology (ABR) essentially governs over radiologists who typically need the important board-certified designation to find a place of employment. I have always played by the rules dictated by the ABR and have toed the line with whatever rules/mandates have come from high above. However, it seems like playing by the rules is indeed not enough as this particular board appears to continually change its stance on multiple issues.

Last Updated on Monday, 18 March 2019 16:56
Hospital Faces Lawsuit for Failing to Honor DNR Print E-mail
Written by KevinMD   
Wednesday, 26 December 2018 14:35
A New Mexico woman, suffering from Dercum's disease (adiposis dolorosa) which causes painful fatty tumors, is suing a Santa Fe hospital and an emergency physician claiming she was the victim of two negligent acts in 2016. One, according to the Albuquerque Journal, she told hospital personnel she was allergic to Dilaudid but went into cardiac arrest after receiving an injection of the drug. Two, despite the presence of a lawfully executed "do not resuscitate" (DNR) advance directive, she was successfully resuscitated and now faces continued pain and medical bills. The staff had been aware of her DNR order and had even issued her a purple bracelet labeled "DNR." However since the cardiac arrest was allegedly caused by an allergic reaction to Dilaudid, the staff may have felt her problem was not related to her illness and would likely result in a successful resuscitation.

Last Updated on Wednesday, 26 December 2018 14:38
Did Merck circumvent its duty to warn on 'Fosamax fractures'? Print E-mail
Written by Suzanne Robotti | STAT First Opinion   
Tuesday, 18 December 2018 18:39
How would you feel if you were harmed by a medicine you took as prescribed and then learned that the drug company wasn't liable - even though it knew about the risk and didn't tell you or your doctor? This is exactly what has happened in the case of Fosamax (alendronate), a drug used to treat bone-thinning osteoporosis and osteopenia. After it was approved by the Food and Drug Administration and women across the country began taking the drug, the FDA and its maker, Merck, started receiving reports about spontaneous fractures of the thigh bone among women taking the drug. These fractures, dubbed "Fosamax fractures," happen with no warning and usually require surgery. Although they are a rare side effect of the drug, millions of women have taken the drug. While the true number of Fosamax fractures isn't known, about 500 women have sued Merck for failing to warn them about the risk of this painful and possibly debilitating side effect. These lawsuits are at the heart of a case, Merck, Sharp & Dohme Corp. v. Doris Albrecht, et al., that will be argued before the U.S. Supreme Court on Jan. 7, 2019.
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Last Updated on Tuesday, 18 December 2018 18:43
Money will be lost in health care. This is true no matter how we describe it. Print E-mail
Written by Edwin Leap, MD | KevinMD   
Tuesday, 04 December 2018 17:33
Does anyone in medicine, particularly emergency medicine, understand why we lose money? Why we have to push those metrics so hard to capture every dime? I mean, we're  constantly reminded that satisfaction scores, and time-stamps and time to door, time to needle, time to discharge, reduced "left without being seen" scores are connected to the money we make. Medicine now is far less about the wonder of the body, the ravages of disease, the delight of the diagnosis and the thrill of healing. Medicine, now, is clicks and time-stamps, clipboards and strategies, through-put, input, out-put, put-out, burned out.

Last Updated on Tuesday, 04 December 2018 17:53
Are Vertical Desks Overrated? Print E-mail
Written by Aaron Carroll, MD, MS | The Incidental Economist   
Friday, 23 November 2018 14:08
We know that physical activity is good for us, and that being sedentary is not. Some have extrapolated this to mean that sitting, in general, is something to be avoided, even at work. Perhaps as a result, standing desks have become trendy and are promoted by some health officials as well as  some countries. Research, however, suggests that warnings about sitting at work are overblown, and that standing desks are overrated as a way to improve health.
Dr. David Rempel, a professor of medicine at the University of California, San Francisco, who has  written on this issue, said, "Well-meaning safety professionals and some office furniture manufacturers are pushing sit-stand workstations as a way of improving cardiovascular health - but there is no scientific evidence to support this recommendation."

Last Updated on Friday, 23 November 2018 14:15
Patient Satisfaction: Who is Rating the Ratings? Print E-mail
Written by Skeptical Scalpel via KevinMD   
Wednesday, 07 November 2018 00:00
Everything is being rated these days. But who is rating the ratings? As a public service, I have been blogging about the shortcomings of various rating systems since 2010. Two recent papers on this topic are worthy of review.

In a randomized controlled study, investigators from the University Hospital of M√ľnster, Germany found that medical students who were provided cookies during academic course sessions rated the experience significantly higher than students who did not receive cookies....

<Meanwhile> A research letter from the Cleveland Clinic published in JAMA Internal Medicine looked at over 8,400 patient encounters for respiratory tract infections involving 85 telemedicine doctors and found 66% resulted in an antibiotic being prescribed. The estimated prevalence of bacterial acute respiratory tract infections in outpatients is low. A substantial number of the antibiotics prescribed by telemedicine physicians were probably unnecessary. Physicians received 5-star ratings from 91% of patients who were prescribed antibiotics and 86% of those who received a non-antibiotic drug prescription. When no drugs were prescribed, 72% of patients gave 5-star ratings, a significant difference.

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Last Updated on Friday, 09 November 2018 14:14
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