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A little medical humor

I got a good laugh from a few sarcastic posts lately.  This first one (via Graham) is about the
medicalization of modern life (where every symptom must have a diagnosis):

Consumer: I get
very moody if I don’t eat in the morning. If I don’t eat until 3-4pm I get
headaches, drowsiness and feel nauseous… I think I’ve always had this. Since
I usually eat enough it doesn’t really bother me. I’m 21, male, and a
vegetarian. What do I have?

Physician: You have a condition
known as hunger.

The good news: it is easily treatable

The bad news: there is no permanent cure

This condition can be treated at a specialized clinic, the one you want is
known as a restaurant. This condition can also be treated at home, but you will
need specialized supplies from a grocery store. Most sufferers find that
several treatments per day are necessary.

———

And this conversation was pretty funny (though I can’t for
the life of me find where I read it – sorry I would certainly love to give
attribution here):

Physician: we’re
going to need to get an MRI of your teenager’s head since he had a seizure.

Mom: why are you
going to get an MRI of his head, it was his body that had the seizure!

Have you heard any good jokes lately?

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

The great unveiling

A psychiatric nurse once relayed an observation to me that I
have been pondering for the last decade.
We were working together in an inner city “dementia unit,” populated
with patients with end stage Alzheimer’s, vascular dementias, and brain
disorders of unclear etiology.
Individuals were parked in geri-chairs in institutional hallways, others
were in bed in 4 point restraints for their own protection, still others were
muttering to themselves in wheelchairs.

We were discussing the case of a particularly unpleasant
patient
– he would swing at people as they got near him, trying to hurt them –
scratching, punching, even biting if you got close enough.  His favorite thing was to grab nurses’, or
other female staff’s, breasts or crotches.  He rarely succeeded at this, since most staff
were aware of his tactics, though he sat in his chair nearly motionless, like a
Moray eel in a reef cave, small eyes and snaggle teeth, mouth open slightly at
all times, taking slow deliberate breaths as he waited for an unsuspecting ocean
dweller to wander inadvertently into his reach.

I asked the nurse how she thought he had gotten to be so
rotten.  She replied simply, “When people
get older they become more like themselves.”

That one sentence has fascinated me ever since.  Could it be that as we age (and our minds
lose their ability to maintain the social graces we were taught), we slip into saying
things in an uncensored manner, and behaving the way we truly want to?  Or is the difference between “sweet little
old ladies
” and “mean old biddies” a matter of how much damage there has been
to their frontal lobes?

The scientist in me would like to explain away all agitation
as an organic brain disorder.  But I just
don’t think we can reduce human behavior to neuroanatomy.  The complexity of a lifetime of circumstances
and individual choices – and their interaction with personality – are soul-defining.

Perhaps age brings wisdom and life experience… or maybe it
unveils the truth about who we’ve been all along.  Either way I have a feeling that when the time
draws near for our bodies to give up our souls, we can catch a glimpse of what people
are “made of” in their final words and deeds.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Nutrition standards for foods in schools

Congress recently directed the Centers for Disease Control
(CDC) to undertake a study in partnership with the Institute of Medicine (IOM).  The goal was to establish nutrition guidelines
for government-subsidized nutrition programs in schools nation-wide.  These guidelines are meant to help combat the
growing rates of overweight and obesity in US children.

The standards may surprise you in their restrictiveness – no
beverages with more than 5 calories/serving are permitted (excluding milk or
soy milk) unless the child is involved in rigorous physical activity for more
than 1 hour in duration (then they can have a sports drink such as Gatorade).  No items with more than 35% of calories from
total sugars are permitted, and all bread and cereal items must be whole grain.  There are also restrictions on fat and salt
levels in the food.  Artificially
sweetened drinks and caffeinated beverages are not recommended.  The IOM also calls for removal of all junk
food and soda machines, and replacement with fruit, milk, and healthy snack options.

Reading these guidelines I thought, “Wow, if kids really ate
this way we probably would make a big difference in obesity rates.”

And then I wondered… “But will these kids just go home and
eat a box of oreos and a liter of coke at the end of the school day?  Is it enough to have a healthy food
environment at school, but not at home?
What is the role of parents in this?”

What do you think?
Are the IOM’s recommendations likely to 1) be followed by all schools 2)
make a difference in childrens’ weights?
Is there anything else you’d recommend?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Dr. Val & The Gluten-Free Cooking Spree

What do you get when you confess on your blog to having a
love affair with food and a history of a GI disorder?  You get invited to attend a really cool event,
a sort of Iron Chef meets Scrubs, right here in Washington DC!

Yes my friends, I’ve been invited to participate in a
gluten-free cook off hosted by the National Foundation for Celiac Awareness and
moderated by CNN’s news anchor Heidi Collins.
I’m going to be teamed up with a chef in a gluten-free cooking
contest.  I’m not sure how the chef will
want me to participate – but I’m hoping that I get to do a little more than pot
stirring and taste testing.  There will
be three teams, and 9 healthcare professionals – including 4 docs, 3
pharmacists, 1 nurse, and 1 dietician.
Given hospitals’ reputation for culinary mediocrity, I’m not sure that
we bring any credibility to the contest – but if anyone chokes, we’ll
resuscitate promptly.

The contest is on May 4th in the evening… maybe
you can catch us on a cable channel with a high number?  All proceeds go to Celiac disease research
and awareness programs.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

The cardinal sin of medicine?

An Emergency Medicine physician blogger calls laziness the “cardinal sin of
medicine.”

How did this quality achieve such status?
TrenchDoc explains:

Simple. It is the ONE thing that we as
physicians can control. We cannot prevent patients from smoking and driving
their minivans into light poles. We cannot help that patients have myocardial
infarctions without any symptoms whatsoever. We certainly can not force them to
take medicine or have routine checkups. We CAN however be careful,
double-checking and unassuming diagnosticians. I don’t mean by this that we
should order a whole boatload of tests on each patient… quite the contrary… I
mean we should SPEND THE TIME with the patient to find that one unlikely detail
that is the key to solving the problem.

Honestly though, being lazy, quick and
cheap are the easiest of sins to commit in our vaunted system. We pay
physicians in this country basically upon the number of procedures or the
amount of patients they care for per hour. Eventually, poorly directed
efficiency gives way to poor quality of care and to be honest, I am as guilty
as anyone when it comes to missing important clues from a patient.

In his blog post, TrenchDoc goes on to describe a terrible
case of a mentally disabled woman who fell out of an electric shopping cart at
a Value Mart.  She complained of severe back
pain and got every imaging study under the sun (which showed a normal
spine).  She was discharged from the
Emergency Department, only to be readmitted to another ED weeks later when her
pain was still too great to bear.  This
time she said it was her leg that hurt… take a look at the horrible fracture
she had that was missed at the first ED.

I have argued that one of the major causes of decreased
quality of care is reduced patient-physician interaction time.  We are so pressured to rush through our
history and physical that we often miss the diagnosis, furiously documenting
everything without mentally processing what we’re doing.

I agree with TrenchDoc’s call to spend more time with
patients, though time doesn’t come easily.
How do you think we can help physicians find more time to be with their
patients?

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

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