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

Latest Posts

Sex selection: just because we can doesn’t mean we should

As I read the opinion piece in the New York Times about fertility clinics that permit parents to choose the sex of their baby before pregnancy, I was suddenly aware that I had strong feelings about this. As I tried to analyze my indignation, I realized that my emotions came from a place beyond mere reason.

Although technically, this issue could be reduced to a matter of sperm sorting – we all know it’s much more than that. Choosing the sex of your unborn child wanders into an unexplainably uncomfortable territory – swirling unconscious feelings about the value of human life, sexual equality, and the pain of sexism that many have experienced. We have heard the horrible stories about female babies being selectively aborted, or left to die in the elements in India and China, and we wonder if choosing the sex of a baby is somehow part of the same phenomenon.

Why should it matter which sex the baby is? Why is “family balance” cited as a reason to sex select? Perhaps the balance comes from the makeup of the individual personalities in a family, or maybe from parents who plan for the right number of children, not the gender of them.

Personally, I cannot support the practice of sex selection for anything other than sex-linked genetic disease prevention (and even this makes me feel a little uncomfortable, frankly).

I’m curious to know if men and women are equally disturbed by the practice of sex selection… What do you think?

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

Should US physicians learn Spanish?

Last night I was having dinner at Charlie Palmer Steak and entered into a conversation (in Spanish) with one of the wait staff. He was surprised when I ordered in Spanish and we had a friendly conversation about the merits of whole grain bread. He asked me why I spoke Spanish. I answered simply, “porque soy doctora” – because I’m a doctor.

Dr. Richard Reece’s recent blog post tackles the issue of language barriers in the healthcare system. He gives some good advice for cross-cultural communications, reminds us that 25% of US physicians are foreign born, and quotes the inscription on the statue of liberty as the reason why Americans should remember to welcome foreigners. However, he also encourages immigrants to learn English and frowns upon illegal immigration.

As for me, I learned Spanish because I was worried that I’d harm a patient by misunderstanding what they were trying to communicate. Of course we try to have an interpreter at the bedside at all times, but in reality it just doesn’t happen consistently. Learning Spanish was my way of practicing safer medicine.

Now it is frustrating that some patients (at least in NYC) seem to feel as if their doctor is obliged to learn Spanish. They sometimes have an attitude of entitlement that I find hard to swallow. I try to put myself in their shoes, but honestly if I were ill in a foreign country I wouldn’t assume that it was my right to receive care in English.

Still, for me, learning Spanish was a wonderful thing. There is a certain caring that I can communicate, and a certain warmth and appreciation that I feel from my patients as they encourage me – that even though I make mistakes with my grammar, they can still understand my meaning quite well. We laugh a lot at the words I find to describe things – and it generally provides a lighter tone to the interaction. Laughter is good medicine, and if my version of Spanish brings laughter to others – then so much the better!

Do you think US healthcare professionals should make an effort to learn Spanish?

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

Nurses escape death penalty

Makes being a nurse in the US seem like a cake walk, right?

“The son of Libyan leader Moammar Gadaffi said five Bulgarian nurses and a Palestinian doctor condemned to death by a Libyan court had received unjust verdicts and that they would not be executed, a Bulgarian newspaper reported on Monday.

A Libyan court last month convicted the five Bulgarian nurses and a Palestinian doctor of intentionally infecting more than 400 Libyan children with HIV, despite scientific evidence that the youngsters had the virus before the medical workers arrived in Libya. It sentenced all the medical personnel to death.

‘The original files were manipulated and there were many mistakes, but it was the fault of the police officers and investigators who handled the case at the initial stage.’”

As I was thinking about how these relief workers were “ambushed” I imagined that the parents of the HIV positive children were looking for a scapegoat – there is a lot of stigma associated with HIV, and in a country where mere finger pointing can result in the death penalty… taking care of those infected with the virus can be more deadly than the virus itself.

The article also hinted that if it weren’t for the Bulgarian embassy publicizing the unjust executions, they would have occurred without a second thought.

Let’s hear it for the healthcare workers out there who put their lives in harms way to treat the innocent and helpless.  Do you know of other examples?


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

Mice take one for the human team… again

Gone are the days of Beaver Cleaver – and apparently the days of Mickey & Minnie mouse are numbered as well.

In this new study, humans give LSD to the little rodents:

“Of course, we don’t know what the mice experience when they are treated with these drugs,” Sealfon said. “But we do know that there is a head twitch response in the mice that provides a good correlation with drugs that are known to be hallucinogenic in humans.”

So um… why are we doing this?

The Onion spoofed animal research very nicely, picturing an obesity study lab rat nestled among snickers bars and M&Ms.

And in another recent study, we gave mad cow disease to our furry friends:

“As expected… at 9 weeks of age they developed sponginess in the brain tissue, all the mice developed behavior and memory problems, for example they stopped burrowing.”

Hey, I have an idea for a new study – let’s see what mice infected with mad cow disease do if we also give them LSD?

I feel a bit sad for the tiny critters, don’t you?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Wrong diagnosis: physician instinct may harm or help?

A member of our editorial team kindly brought me some blog fodder last week – a recent article from the New Yorker. It was an inflammatory piece, describing four types of errors that doctors make in diagnosing patients:

  1. Representativeness error – when a physician fails to consider diagnoses that contradict their mental templates of a disease. E.g. thin, fit, young male with chest pain – unlikely to have heart attack, but did have one.
  2. Availability error – the tendency to judge the likelihood of an event by the ease with which relevant examples come to mind. E.g. a patient coming to the ER in the middle of a flu epidemic, with flu-like symptoms was diagnosed with flu but actually had aspirin poisoning.
  3. Confirmation bias – confirming what one expects to find by selectively accepting or ignoring information. E.g. “sub-clinical pneumonia” diagnosis given even though lungs are clear.
  4. Affective error – the tendency to make decisions based on what physicians wish were true. E.g. nice young patient has mild fever – physician presumes it’s a typical post-op fever rather than early sepsis.

Although these biases (I wouldn’t really call them “errors”) are indeed real, I thought the author went a little too far, finishing his article with a scathing quote from a Canadian physician:

“The implicit assumption in medicine is that we know how to think. But we don’t.”

Ouch.

I have mixed feelings about this – for as many examples they can think of that demonstrate how physicians got the wrong diagnosis, I can also think of examples of physicians getting the right diagnosis against all odds.

Consider the middle aged woman who came to the ER with a headache – one sharp physician had a “gut feeling” that this headache was not typical, and resisted the protocol to do a head CT to rule out a sub-arachnoid hemorrhage and send her home. Instead he got blood tests that revealed the underlying diagnosis: advanced leukemia. Her blood was so thick with dividing leukemia cells that it was causing her to have a headache. She underwent immediate dialysis and survived what could have killed her.

Or what about the man who complained of chronic sinusitis? Instead of giving him an antibiotic with outpatient follow up, one physician took a detailed history and realized that this man had been having sinus pain since a recent fall from a ladder (while using a nail gun) at a construction site. The doc got a head X-ray and found a nail lodged in his sinus! During the fall the nail gun had shot a nail into the corner of his eye, leaving no entrance wound. Because of the jarring nature of the fall, the man didn’t even realize he had been shot. The man had an ENT surgeon remove the nail, and she also cleaned out what could have become a life threatening abscess.

The truth is that doctors (like anyone else) are vulnerable to making false assumptions about people – and that we would all benefit from using a software program that would automatically generate a large differential diagnosis to consider each time we see a patient (just to keep other possibilities in the forefront of our minds). However, if you ask patients if they’d rather be treated by a machine or a human being – I’m sure the majority would choose the latter. I think we can all agree that instinct and judgment still have value in this information age. The trick is to marry accurate information with good instincts without ordering every single test in the book to rule out rare diagnoses on everyone! That’s a tough balance to achieve.

Do you know of any examples of a physician making an unexpected diagnosis based on gut instincts?  I’d love to hear about it.

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

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 »

Commented - Most Popular Articles