db's Medical Rants

Yesterday I cited a NY Times essay on the messiness of patient care – It ain’t always pretty
At the time, I knew that I wanted to comment, but struggled, so I delayed.
Later that day I wrote the piece on clinical judgment. Last night as I pondered these two posts, I realized how interrelated they [...]

Cleaning Up the Mess of Medicine in the Pages of Posterity
As I headed up to the laboratory to deliver our hard-won tubes, it occurred to me that in the event our patient proved to have some unusual infection and we wrote up his case for a medical journal, the last surreal 30 minutes would be [...]

A Medical Mind (the link takes you to his entries – I am commenting on his Dec. 25th post).
The point is, I am sure that a barrier must be crossed to ‘know’ about patients and medicine and science, I am just a little unsure about when that will happen. I know that I have [...]

Many physicians immediately recoil when they hear about the retainer model. They attack the physicians and use derogatory code words like boutique, justice, and two-tiered system.
However, one should always look beyond the surface to understand the good and bad in any situation. Perhaps the retainer model provides some solutions.
For those with AMA [...]

Frequent readers may remember that I love mysteries. I believe that accounts for my love of morning report and CPCs. Many general internists share this love for a genre which closely parallels our field.
For those with access – White coats and fingerprints: diagnostic reasoning in medicine and investigative methods of fictional detectives
Current trends [...]

New Test May Cut Customer Base for Cardiac Implants
Late Wednesday, though, Medicare proposed a plan that could portend new limits on that market. In March, Medicare expects to begin reimbursing doctors for a relatively new type of diagnostic heart test that is currently paid for only in some states in limited situations. Studies show that [...]

Come ye, worship at the shrine of evidence! Evidence will fix medicine.
What do I hear blasphemers? Bah humbug?
Some are challenging the religion of EBM – Evidence Based Medicine proponents need to watch out for their friends and A contrarian view of evidence based medicine
I like some aspects of EBM. [...]

As the end of the year approaches, I usually review my ranting from the current year. I have chosen 10 rants which I think epitomize my thoughts this year. Some themes recur through these rants, I consider these essential themes for the future health of our health care system.
Feel free to suggest other [...]

Gastric Acid–Suppressive Agents Linked to Clostridium difficile Diarrhea
Proton-pump inhibitors (PPIs) and H2-receptor agonists (H2RAs) are associated with increased risk for community-acquired Clostridium difficile–associated disease (CDAD), according to the results of 2 population-based, case-control studies reported in the December 21 issue of JAMA.
“Recent reports suggest an increasing occurrence and severity of C. difficile–associated disease,” write Sandra [...]

In February I linked to a column about a health writer who had had bilateral knee replacement surgery. A health writer gets new knees. This entry has (to date) received 24 comments. Today, in the NY Times, she tells us what happened since then. A Year With My New Knees: Much Pain [...]

A reader sent me this link – You smoke you croak
A SICK dad blasted NHS “bullies” yesterday after a hospital consultant refused to treat him unless he stops smoking.
Ailing Fred Smith, 60, was told he must quit cigs for at least six months before he even gets an appointment.
Fred was referred to the specialist with [...]

As we say in Alabama, “you ain’t gonna believe …”.
Journal Faults a Medical Group in a Dispute Over Independence
The Canadian Medical Association Journal gives readers a mixture of scientific research papers and journalism. Now a dispute about the boundary between the two has led to charges of censorship and the creation of a committee to [...]

General internists often love mystery stories. When I hear about or care for an interesting patient, I look for colleagues to tell. We love trying to solve the puzzle.
Lisa Sanders is a general internist. She regularly tells stories of interesting diagnoses in the New York Times Magazine. Today’s magazine [...]

As I have written this week, I am not disturbed that Dr. Topol lost one of his administrative positions. Administrative positions in academic health centers come with no protection and no guarantees. However, this situation will likely hurt the reputation of the Cleveland Clinic more than it hurts Dr. Topol. Sometimes [...]

Nurses face sexual harassment from patients
Nurse Sarah Andres is so used to male patients calling her “sweetie” or “cutie” — or even asking her for a kiss — that it rarely upsets her anymore.
“I usually chalk it up to they don’t feel good, a lot of them are confused,” said Andres, who has been [...]