Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

Fragmented Care Requires Clarification Of Roles By Each Member Of The Medical Team

Jessie GrumanThe most important thing I learned was that different doctors know different things: I need to ask my internist different questions than I do my oncologist.”

This was not some sweet ingénue recounting the early lessons she learned from a recent encounter with health care.  Nope.  It was a 62-year-old woman whose husband has been struggling with multiple myeloma for the last eight years and who herself has chronic back pain, high blood pressure and high cholesterol and was at the time well into treatment for breast cancer.

Part of me says “Ahem.  Have you been paying attention here?” and another part says “Well of course!  How were you supposed to know this?  Have any of your physicians ever described their scope of expertise or practice to you?”

I can see clinicians rolling their eyes at the very thought of having such a discussion with every patient.  And I can imagine some of us on the receiving end thinking that when raised by a clinician, these topics are disclaimers, an avoidance of accountability and liability.

But all of us – particularly those receive care from more than one doctor – need to have a rudimentary idea of what each clinician we consult knows and does. Why is this clinician referring me to someone else? How will she communicate with that clinician going forward? How and about what does she hope I will communicate with her in the future?

Why does our clinician need to address these questions? Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

Very Few Herbal Remedies Work: Here Are 5 That May Be Useful

Montage of St. John's Wort, African Plum, Horse Chestnut, Red Yeast Rice, and Feverfew

Here at Skeptic North, we’ve often been a sharp critic of those herbal remedies that are unable to withstand the scrutiny of science. Yet nature does indeed house many pharmacologically active compounds, and it stands to reason that some of them will have medicinal value. So today, we’re going to turn the tables and look at 5 herbal remedies that have held up well in repeated studies and are generally regarded as effective.

1)  St. John’s Wort for Depression

If there’s one herbal medicine that consistently gets high marks for effectiveness, it’s St. John’s Wort as a treatment for mild depression. A 2008 Cochrane Review looked at 29 trials totaling over 5000 patients, including 18 comparisons with placebo and 17 comparisons with synthetic standard antidepressants, and found significant effects in both cases. The Natural Medicines Comprehensive Database indicates that St. John’s Wort is likely as effective as both first generation antidepressants (low-dose tricyclics) and the current generation of selective serotonin reuptake inhibitors like Prozac, Zoloft, and Paxil. Read more »

*This blog post was originally published at Skeptic North » Erik Davis*

Why Is Weight Gain Contagious? Monkey See, Monkey Do


One of the big health news stories of 2007 was a study showing that your friends influence the size of your waist (and the rest of your body). Like any study, it raised as many questions as it answered, including why this happens. A new study from Arizona State University looked into that question by testing three pathways by which friends might influence one another’s body size:

  1. Collaboration. Over time, you might start to share the ideas of the people close to you after talking with them about what the proper body size is. Then you might choose your food and exercise habits in order to reach that body size, whether that means eating more food to look like your plus-sized friends, or less food to look like your thin ones.
  2. Peer pressure. You feel bullied into trying to look like your friends and family members. They make you feel bad about your body, so you go about eating and exercising to look like them.
  3. Monkey see, monkey do. You change your habits to mirror those of your friends without necessarily thinking or talking about an ideal body weight. Alexandra Brewis Slade, PhD, one of the Arizona State researchers, gave an example of this pathway that most of us can relate to: You’re at a restaurant with friends and the waiter brings over the dessert menu. Everyone else decides not to order anything, so you pass, too, even though you were dying for a piece of chocolate mousse cake.

All three of these pathways are based on the idea that loved ones share social norms, the implicit cultural beliefs that make some things okay, others not. Read more »

*This blog post was originally published at Harvard Health Blog*

For Shame: Physicians Deny Care To Those Who Are Obese And Pregnant

How does one teach compassion? Either you have it or you don’t. A recent article in the Los Angeles Times made me cringe.  In South Florida, fifteen ob-gyn practices out of 105 polled said that would not take care of a pregnant woman who weighed more than 200 to 250 pounds.  The article goes on to describe two ob-gyn business partners who cited malpractice issues and fear of being sued as a reason for excluding obese women in their practice. So, what’s next? Will pregnant women be denied access to care based on bank accounts or zip codes? Where their children attend school? Whether they own a pet? Where do we draw the proverbial line?

One of my most frustrated moments in clinical practice was dealing with an imaging center who had cancelled my patient’s ultrasound procedure because they were “afraid she was going to break their table.” The patient was excited about her first pregnancy and wanted to do everything in her power to have a healthy baby. The first time I met her, she was almost apologetic about her weight. Most obese patients are. My staff had to locate an imaging center that was not only willing to accept the patient but her Medicaid insurance as well. No one should not have to endure that level of humiliation.

Whether we like it or not, Americans are obese and as physicians, we have done very little to reverse that process. I learned more about nutrition from Weight Watchers® then I did in medical school. Read more »

*This blog post was originally published at Dr. Linda Burke-Galloway*

Internists Not Using Simple Test (Ankle-Brachial Index) For Peripheral Artery Disease

Despite poor awareness and a lack of training on handling peripheral artery disease, internists can and should be able to recognize the symptoms and manage 95% of such cases. Experts advise using the ankle-brachial index as a quick and effective diagnostic method.

Rebecca J. Beyth, ACP Member, demonstrates the ease and quickness of the ankle-brachial index in diagnosing peripheral artery disease. Photo by Eric Zamora/UF News BureauBut internists often don’t. As was reported in ACP Internist‘s previous cover story on the subject, the ankle-brachial index can be a major part of preventing peripheral artery disease, itself a major predictor of strokes and heart attacks, over and above the Framingham risk score.

The ankle-brachial index is the ratio of the ankle to the arm systolic pressure. A ratio of 0.90 or less indicates peripheral artery disease. Its sensitivity is 79% to 95%, and its specificity is 95% to 100%. It takes less than five minutes to perform in the office.

Yet, among the 85 respondents, 36 (42.35%) said “It’s a quick and easy test.” Another 27 (31.76%) thought, “It’s difficult to fit into the standard visit.” The final 22 (25.88%) said, “I don’t use the ABI to screen patients for PAD.” Read more »

*This blog post was originally published at ACP Internist*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

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…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

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

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

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

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »