Skip to main content


Showing posts from December, 2007

2008 Resolutions for Patients and Doctors

#1 Doctor: Resolve to let patient speak without interruption and describe their symptoms.
Patient: Resolve to focus on the problem I am seeing the doctor about and not come with a list of 10 complaints for a 15 minute visit.

#2 Doctor: Resolve to keep a pleasant tone of voice when answering night and weekend calls from the answering service or nurses.
Patient: Resolve to get my prescriptions filled during office hours, not forget my medications while traveling and to use nights and weekend phone calls for emergencies only.

#3 Doctor: Resolve to exercise a minimum of 4 times a week for better health.
Patient: Ditto

#4 Doctor: Resolve to train my staff and model excellent customer service for patients.
Patient: Resolve to understand that getting an instant referral, prescription, note for jury duty, letter to my insurance from the doctor is not my god-given right and I will stop bitching.

#5 Doctor: Resolve to give at least one compliment a day to …

Patients Who Google

I read an article in Time Magazine from a Dr. Haig who couldn't tolerate a patient who "googled" him, her health conditions and treatments. It made me stop and think about patients who "google". They often send me articles they have discovered about their illness or bring information they have downloaded. Many times the information is not exactly evidence based nor well researched. There are a plethora of experts with "Doctor" in front of their name that tout research that was published in an obscure journal. Other times it is anecdotal or advertisements. The internet can be a wonderful thing but one needs the ability to sift through the junk. When it comes to health, that is my role.

Despite the fact that there is very little a patient can bring me that I don't already know...I don't disdain the effort. An involved patient is one I can work with. I try to show respect for whatever product or treatment they are asking about but I don…

Giving Thanks

The darkness has settled in on this Christmas Day and the dishes are almost done. Wrapping paper is in the recycle can, the dog and cat are sleeping and everything is peaceful. For this and many things, I give thanks:

That my family is relatively well and my son's strept throat (or could it be mononucleosis?) has turned the corner.That I am a physician and can actually treat these illnesses on holidays without bothering another doctor.That we are warm and have a nice home and a full refrigerator...something 3/4 of the world's population does not have.That my mom is still alive and has a good man to spend her life with.That I am a physician and can offer a healing touch to others.That my husband is a great partner and loving person.That I live in a place with trees, the ocean, mountains and beauty.That I am blessed with fantastic and interesting friends.That we have great garbage pickup. I can't imagine life without it.That Steve Jobs invented the ipod.That my patient got b…

Track Santa's Progress Across the World

It is almost Christmas Eve and that means Santa will be starting his 'round the world magic ride. How does he do it? We can't always explain the magic of Christmas but with modern technology we can track Santa via Norad space stations. So if you have children or are just a child at heart, don't forget to Track Santa.
You can begin on Christmas Eve!

Bad Habits

With the New Year looming, I always start getting more introspective. There is something about starting a new year that makes me think "change" is possible and I can be fresh and new.

Marshall Goldsmith has written a book called "What Got You Here Won't Get You There" with some simple tips for successful people. His premise is that simple bad habits keep us all from achieving what we could in life and we are often unaware of what we do. It applies to home and family as well as the workplace. Here are a few that may sound familiar:
Passing JudgementMaking destructive commentsStarting sentences with "no", "but" or "however". These terms are progress stoppers.
Failing to give recognitionClinging to the pastFailing to express gratitudeNot being able to say "I'm sorry"Making excuses - not owing up to our own actions
Goal obsession - getting so caught up that we don't focus on what is important.Goldsmith says you can&…

Answer-Quiz #5

The answer is #3 - Ehlers Danlos Syndrome. This rare genetic condition causes hypermobility and extreme extension of joints due to abnormalities in collagen synthesis and connective tissue. Like many medical conditions, it was named after two doctors from Denmark and France who discovered it at the turn of the century. Thanks for playing.

Medical Quiz-How Smart Are You #5

I saw Cirque du Soleil this week. It is a wonderful acrobatic extravaganza and one act had three beautiful girls who did amazing, flexible things with their bodies that looked absolutely unreal.
I am sure they had this condition. Can you name it? Click on the image for a closer look.
Answer will be posted tomorrow.

Superbugs and Farming


A recent issue of JAMA addressed the issue of antibiotic resistance and the effect of farm practices on creating resistant "superbugs". This topic has been reported on for decades but more and more scientific evidence is emerging that cannot be refuted. Now researchers have found, in two distinct studies of humans, that bacteria are developing resistance to antibiotics on poultry farms and that these resistant bacteria are colonizing humans. The studies showed that the mutated strains of bacteria were identical in the animals and the humans who ingested the food.

Farmers have been feeding antibiotics to pigs, chickens and cattle for the past 50 years. Seventy percent of antibiotics used in the U.S. are given to food animals because they grow up 5% faster and use less feed if they are given antibiotics. This is not done to treat disease.

Bacteria are very adept at evolving genes that allow them to live, despite our amazing arra…

Hearing Aids - Surprise! You're on your own.

I learned something yesterday from a patient (and friend) that was a surprise to me! I did not know that hearing aids are generally excluded from insurance coverage and Medicare (insurance for Americans over 65) also does not cover hearing aids. I argued "No, that can't be true" but, sure young friend who suffered sudden hearing loss was correct. She should know as she had experienced the need to price compare and get the best deal at Costco.

Do any readers find this shocking? Hearing aids cost hundreds of dollars up to $2500. One study found that 55% of senior citizens not using hearing aids found cost to be the barrier. What about children that are hearing impaired?

Hearing aids are not a luxury. I've never known anyone to "fake" deafness just so they could wear an aid. Even the many hypochondriacs that doctors treat don't use lack of hearing to go from doctor to doctor or get lots of expensive tests. If you have hearing loss, it is ea…

The Uninsured - Everyones Concern

It's election time (the longest election in history)! Today's post will be a primer in who are the Uninsured in America that we hear so much about.

45 Million people under age 65 lacked health insurance. (Over age 65, Medicare kicks in and Medicare is government sponsored. If you are a billionaire, you get Medicare too)
Eight out of 10 (8/10) came from working families and 70% worked FULL TIME.59% have gone without health coverage for 2 years or more.Minorities ( translate: "lower income") make up the uninsured. (1/3 Hispanic, 1/4 Native American, 21% African American, 18% Asian American, 13% white).79% of the uninsured are American Citizens.Having insurance improves health overall and could reduce mortality for uninsured by 10-15%. I'm sure most American readers of EverythingHealth have health insurance of some type and wonder why 45 million don't? Are they lazy? Are they irresponsible?

61% of Americans get their health insurance from their employers and th…

Answer to Quiz #4

The answer is #5 - Calcinosis. These lumpy bumps are soft tissue calcium and phosphate deposits due to chronic renal failure. The parathyroid glands help regulate calcium in the body and these bumps resolved after she had her parathyroids removed. (NEJM)

How Smart Are You? Medical Quiz #4

Click on the image for a better look. (this is a wrist) The answer will be posted tomorrow.

Kids Fail Physical Fitness Test

The California Department of Education reports that more than two in three California public school students failed to meet State physical fitness standards. They measured over a million fifth, seventh and ninth graders in six areas:
Cardiovascular endurance
Body fat percentageAbdominal strength and enduranceTrunk strength and flexibilityUpper body strength and enduranceOverall flexibilityThere is a little good news here...compared to 2006, the scores increased 2% for fifth graders (to 27.1%), 1% for seventh graders (30.9%) and 3% for ninth graders (30.1%)

These numbers are a bit of a shock when you see them in black and white. California has great weather, lots of open space and, I thought, a more health minded population. Could it be the video games and TV? Is it lack of physical education in schools? The report didn't discuss the reasons but the results speak for themselves. Get these kids outside doing activities or we are going to be faced with a very unhealthy adult popu…

Physicians Roles at Guantanamo Bay

Hundreds of prisoners at Guantanamo Bay, Cuba have gone on hunger strikes to protest their indefinite detention without legal process and inhumane treatment. When this happens, 6-point restraints have been and are still being used to immobilize prisoners and nasogastric tubes are inserted for force feedings.

Force feeding of competent prisoners who have refused food is a violation of the Geneva Conventions, International human rights law and medical ethics. The World Medical Association has recently updated the Declaration of Malta with guidelines on care of hunger strikers. They have stated that if the hunger striker is not being coerced, either by other prisoners, officials or outside influences, forcing treatment on competent people is wrong.

"Forced feeding contrary to an informed and voluntary refusal is unjustified...Forcible feeding is never ethically acceptable. Even if intended to benefit, feeding accompanied by threats, coercion, force or use of physical restraints …

It's Flu Season - Why in Winter?

The New York Times ran a great article about a study that answers an age old question. Why does the flu (influenza) season always happen in the winter? We seldom see flu in Summer or even the Fall. In the tropics flu doesn't even exist.

There have been hypothesis that it was from overcrowding in schools and homes, or in the winter people are stuck inside and can pass the germs. But people are crowded in the Summer too and travel on vacations in planes and we don't see influenza.

A clever researcher, Dr. Palese from Mt. Sinai School of Medicine in New York conducted studies on guinea pigs and found that the flu virus thrives and is passed through the air at low temperatures. At 41˚the animals passed the virus more readily and longer than at 68˚. The virus was passed at low humidity but not at all at 80% humidity.

Since you really can't do anything about the weather, the best way to prevent flu is to get a flu shot or move to the tropics. Mom was almost right when she s…

Wonder Where the Money Goes in Healthcare?

Here is the answer:
Breaking News: UnitedHealth Group’s former chairman and chief executive officer, William McGuire, M.D., will forfeit more than $400 million under agreements reached with the company and the Securities and Exchange Commission over an options backdating scandal, on top of $200 million he has already relinquished.

Answer to Quiz #3

The answer is # 5 Dupuyten's contracture

The flexion contractures of Dupuytren's involves the flexor tendons of the hands and creates a contracture that is not painful. The cause is unknown and treatment is surgical release of the tendons.

Medical Quiz - How Smart Are you #3?

This middle aged man comes to the office wondering what is wrong with his hands. He has no pain. What is the diagnosis? (Click on image for a close up view)
Answer will be give tomorrow.

New Changes in Dental Prophylaxis

The American Heart Association has published the new recommendations that will spare thousands of patients from loading up on antibiotics before a trip to the dentist. For decades certain patients have been taking antibiotics for protection before dental procedures but now the rules have changed.

Infective endocarditis is a rare but life threatening condition that was thought to be prevented by patients taking antibiotics before dental procedures. I never knew that there was no scientific evidence on which to base those recommendations, but there wasn't. Doctors were taught to prescribe five days of antibiotics to certain "at risk" patients and in 1997 it was changed to a single dose of antibiotics. Many doctors still gave several doses despite the lack of evidence.

The new guidelines are a huge change from current practice. The only people who are recommended to receive the SINGLE DOSE of antibiotic are:
Patients with prosthetic heart valvesPeople with prior infec…

RBRVS-For Primary Care No Good Work Goes Unpunished

The results are in - Medical Residents are not choosing to enter the Generalist fields of medicine in the United States. With current trends, less than 10% of those training in Internal Medicine will work as general internists. Compare this with JAMAs report that all European countries have a broad Generalist foundation comprising 70-80% of practicing physicians. The consequences of our failing primary care infrastructure will be higher costs, greater inefficiencies, lower quality, more uninsured and inability to get care even if you have insurance. If you think we have problems with financing health care now, you don't even want to see what is coming in the future!

In the U.S., current reimbursement substantially favors procedures and technical interventions and offers financial advantages for expensive care. This applies to all medical services, both hospital and physician. Hospitals are quietly closing routine care services all across the country in favor of specialt…