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Disgusting Parasite Of The Month

Thanks to science writer Carl Zimmer for highlighting this totally disgusting fish parasite. Read the description and check out the photo link if you dare.

“Parasites often choose very particular–and peculiar–places to live. This crustacean invades a fish’s mouth, devours its tongue, and takes the tongue’s place. It then acts like a tongue; the fish can use it to grip and swallow prey.”

The fish’s version of “has the cat got your tongue?”

In the mood for more creepy stuff? Check out my previous posts:

Spider bite


Rabid bat bite

Total body warts

Poisonous snake in ICUThis post originally appeared on Dr. Val’s blog at

"Don’t Get Sick In July" Revisited

As newly minted physicians begin their residency training and clinical care responsibilities on July 1, hospitalized patients might expect a bumpy transition. At least, that’s been the urban legend – “don’t get sick in July!” But is that really true? Are patients at higher risk for medical errors at teaching hospitals in July?

Some say, “no” and some say “yes.” I’m in the “yes” category, and some research suggests that medication error rates do in fact increase in the month of July. In the “no” category we have Jerome Groopman, renowned Harvard physician and author of “How Doctors Think.” He simply says, “Today, most hospitals closely watch over interns.”

This is what I wrote in a previous blog post:

There are many ways that an intern can make mistakes, without ordering a single test or procedure, and under the full scrutiny of red tape regulations and documentation practices.

When an intern fails to recognize a life threatening condition and chooses to do nothing, or to let the patient wait for an extended period of time before alerting his or her team to the issue, serious harm can befall that patient.  And that harm is not caused by inexperienced procedural technique, or ordering the wrong medicine – it’s caused by doing nothing.  This “doing nothing” is the most insidious of intern errors – and it is not remedied by any form of hospital quality improvement initiatives.  It is the risk that a hospital takes by having inexperienced physicians in the position of first responders.  Interns gather large amounts of information about patients and then create a summary report for their supervisors.  The supervisors (more senior residents) don’t have time to fact check every single case, and must rely on the intern’s priority hierarchy for delivering care.

But many hours pass between the time an intern examines a patient and when a supervising physician checks back in with that patient.  And within that period of time, many conditions can deteriorate substantially, resulting in the loss of precious intervention time.

Dr. Groopman describes an experience from his own life in which a surgical intern (in July) correctly diagnosed his son with an intussusception

(twisted bowel) but then incorrectly determined that the baby could wait to go to the O.R.  Of course, untreated intussusceptions are nearly always fatal, and each minute that passes without intervention can increase the risk of death.

And so, in my opinion, it is in fact more dangerous to be admitted to a teaching hospital in July, but not necessarily for the reasons that people assume (procedures performed by inexperienced physicians or drug errors – though those mistakes can be made as well). Rather, it is because interns don’t have the clinical experience to know how to prioritize their to-do lists or when to notify a superior about a patient’s health issue.  Timing is critically important in quality care delivery – and that variable is not controlled by our current intern oversight system.

Now that I’ve completely terrified you – I will offer you a word of advice: designate a patient advocate for your loved one (or yourself) if you have to be in the hospital as an inpatient (especially in July).  If you can, find someone who is knowledgeable about medicine – and who knows how to navigate the hospital system.  A nurse, social worker, or physician are great choices.  That person will help you ensure that concerns are prioritized appropriately when your intern doesn’t yet fully appreciate the dangers behind certain signs symptoms.  If you have no advocate, then befriend staff members who are particularly caring and experienced.  Be very nice to them – but don’t be afraid to insist on being examined by the intern’s supervisor if you really are concerned.  Unfair as it may seem, sometimes the most vocal patients get the best care.

This post originally appeared on Dr. Val’s blog at

Saving Face: Kiddies and Kitties

I read a touching story at the BBC news center about a young woman with Alpert’s Syndrome. This rare syndrome is present in only 1 in 170,000 births. It results in facial disfigurement and mitten-like hands.

The physical defects of Apert’s syndrome were first described by Fredrick Apert in 1942. These characteristics include: A tower-shaped skull due to craniosynostosis (premature fusion of the sutures of the skull)—an underdeveloped mid-face leading to recessed cheekbones and prominent eyes, malocclusion (Faulty contact between the upper and lower teeth when the jaw is closed) and limb abnormalities such as webbing of the middle digits of the hands and feet.

Bones of the fingers and toes are fused in Alpert’s infants giving a “mitten-like” appearance of their hands. Children with Apert’s syndrome can have unusual speech characteristics such as hyponasal resonance due to an under-developed mid face, small nose and long soft palate and, sometimes, cleft palate.

What struck me about the girl’s story was how she described how it felt to be teased growing up, and how the worst part of the teasing was that no one stuck up for her. I’ve seen kids do this kind of thing before, and I can imagine how painful it is when no one has the courage to go to bat for you. I’ve often wondered how “doing nothing” to defend a little one might be just as bad as actively harrassing them. I’d encourage parents to teach their children not to tease others, and beyond that, to come to the defense of those being teased. I bet this will do a lot of psychological good for the victims.

The good news in this case is that the girl has had some very successful reconstructive surgery and has a fairly normal life. The teen is even thinking about boyfriends, and preparing for college. Many thanks to the surgeons who did such a wonderful job.

And coincidentally, the Happy Hospitalist brought this story to my attention: a 4 month old kitten was in a horrible accident that resulted in her losing the front half of her face. Veterinarians were able to save her life, though she remains quite deformed. I am told that the kitty is not in any pain, and is enjoying her life as a therapy pet. She brings hope to those recovering in the hospital from surgeries and serious illnesses. I suppose they see her as a loving animal who is cheerfully going about her kitty business, without giving much thought to her previous injury.

These stories of hope are made possible by the surgeons and veterinarians who devote their lives to saving face. In so doing, they provide the rest of us with valuable lessons, and new friends of exemplary courage.This post originally appeared on Dr. Val’s blog at

Diagnosis Without Physician Input: Russian Roulette Online

I realize how incredibly tempting it is to reduce medicine to a series of algorithms. Wouldn’t it be nice if we didn’t need to see a doctor to diagnose our ills? Wouldn’t it be great if our computer could tell us what’s wrong, and prescribe next steps for us? Wouldn’t it save money if we could triage peoples’ medical needs without human intervention?

Unfortunately, we’re not there yet. A friend of mine posted a link (on Twitter) to an online triage tool called “FreeMD.” The tool describes itself this way:

FreeMD® is an electronic doctor that conducts an interview, analyzes symptoms, and provides expert advice — for free.

So I decided to try it out. I imagined that I was a hypothetical patient – a woman in her mid thirties who had had abdominal surgery in the past and was now experiencing mild to moderate abdominal pain. My imaginary patient has abdominal adhesions from the surgery, which is causing her to have bowel pain – which could become an obstruction and surgical emergency.

I answered all the questions posed by the free MD and he responded that he had determined the most likely cause of my pain: tubal pregnancy or threatened abortion.

This response was offered even after I indicated that I was not pregnant. What would the average consumer think of seeing “threatened abortion” as a potential diagnosis for their abdominal pain? Would they know that this was the medical term for miscarriage or would their mind race to abortion clinics and ominous threats?

The problem with this tool is that it cannot take into account all the subtle co-morbidities and nuanced historical information necessary to return an accurate result. In fact, no online tool can replace a healthcare provider’s evaluation of a patient. Attempting to do so is like playing Russian Roulette with your health. Maybe you’ll get lucky and happen upon the correct diagnosis and treatment, but maybe you’ll be horribly misled and suffer irreperable harm.

Of course, companies like freeMD contain disclaimers about the service not being a substitute for a physician’s oversight. But the reality is that people are using the service to make decisions about when and if to see a professional for further evaluation. As a concerned physician, I worry about patients being misled about their health. I want patients to be empowered and to learn all they can about their disease or condition – but self-diagnosis, even with the aid of an algorithm, is fraught with danger.

My bottom line: computers will replace physicians when robots replace spouses. Similar satisfaction rates will come from either replacement option. People know instinctively that a good doctor is critical in managing their health – why else would there be so many physician rating tools, including the one here at Revolution Health? Why would Castle Connolly bother to publish their yearly “America’s Top Doctors” reports? This is not about paternalism – it’s an acknowledgement of the incredible complexity of human beings. And in this case my friends, it takes one (doctor) to know one (patient).This post originally appeared on Dr. Val’s blog at

Weird Stuff From Around The Blogosphere

I had every intention of publishing my follow up Disney post today… but I’m afraid it’s not quite ready for prime time. So queue the musical interlude and enjoy some weird stuff from around the medical blogosphere…

Dr. Deb highlights a new fashion trend: high heel baby shoes.  Join the discussion at her blog – do the shoes represent an inappropriate sexualization of infants, or is it just good fun that’s lost on the babies? You decide.

Medgadget presents the prosthetic solution to two-legged dogdom. This little puppy is getting around nicely thanks to a custom front end with wheels. The Ostrovsky brothers dub this “unbearably cute.”

Dr. Dino is surrounded by blooming cacti. Who knew that such flora existed in the northeast?

Dr. Joe, the part-time anesthesiologist, has found two amusing websites - the first will turn your name into an Ikea-style furniture label, the second is an audio survey regarding what makes noises annoying. As in, “Hey, do you wanna hear the most annoying sound in the world?”

And if you got that last reference – then you’re telling me there’s a chance… A chance you liked these links.

And on a more serious note, I’m going to interview Dr. Nancy Nielsen, new President of the American Medical Association, on Medicare cuts this week. So stay tuned for more of my unique blend of news, humor, touching stories, and high level interviews.This post originally appeared on Dr. Val’s blog at

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

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Eat To Save Your Life: Another Half-True Diet Book

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