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Women in medicine

Even though the gender gap in medicine is closing quickly (about 50% of medical students are female), young female physicians in practice are often viewed with suspicion.  Dr. Michelle Au, an anesthesiologist and graduate of my alma mater, is regularly asked if she’s “a real doctor” or if she’s the nurse or a student of some sort.  This week she blogged about her experiences, and there was a large volume of interesting responses.

I myself have had a rough time of it in the past (now I guess I look old enough to “be a real doctor”), and was routinely assumed to be a nurse, physical therapist, or even pharmaceutical rep.  I actually wasn’t that offended by being miscast – mostly because I took it as a compliment not to look like a doctor.  Although it’s somewhat unclear what a real doctor is supposed to look like, I have a feeling he’s older, balding, and paunchy.

But one day I was a little annoyed when my age and gender was equated with incompetence, which crosses the line for me.  Here’s how the conversation went between me and the parents of a toddler with a small cut on his forehead:

Me: “Hi, Mr. and Mrs. X, I’m Dr. Jones.  I see that Johnny bumped his head and will need a few stitches.” [Enter long history and physical discussion here].

Mrs. X: “Are YOU going to put in the stitches?” She asked nervously, scanning the ED for other physician suturing candidates.

Me: “Yes, I assure you I will be very careful.  I’ve sutured many similar lacerations.”

Mr. X: “Yeah, but don’t you think he needs a plastic surgeon?”

Me: Looking at the small cut that only required 2 or 3 sutures.  “I understand that you want the best possible cosmetic outcome for your son, but I assure you that this cut is so small that the plastic surgeon wouldn’t close it any differently than I would.”

Mrs. X: Spotting a tall, male intern fiddling with some bandages on a supply cart.  “Well, can’t he do it?”

Me: Viewing the clumsy medicine intern.  “Well, yes, he could.  Shall I ask Dr. Big Hands if he can come and suture your son’s forehead?  He’s never closed a lac before and has been dying to try one.”

Mrs. X: Um… Well, maybe you should just do it.

Outcome: I did a beautiful, delicate job of closing the small laceration, and the parents watched in awe as I used the tiniest needle and thread to create a seamless finish.

Mr. X: Thanks for your help.  You did a really great job.

Have any of you readers had similar experiences?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Honesty: a new policy for drug companies?

I was struck by two different news stories today – one in the New York Times, and the other in the Washington Post.  Although the topics were different, the underlying theme was unified: drug companies (particularly Glaxo Smith Kline?) are coming clean with research data and marketing messages.  Sure, it might have taken a law suit by Eliot Spitzer to shine a light on the common practice of witholding negative research information from scientists… and it also may have taken a costly failure of an over-hyped diet pill by a competitor drug company to cause GSK to take the honest marketing track with Alli… But I like this new honesty, however we got to it.

Did you know that drug companies spend billions of dollars to research the safety and effectiveness of their drugs, but then are under no obligation to share what they learn with the general scientific community?  No, they share what they want to – generally the studies that show the largest effect or the greatest safety profile.  But now, physicians have been given access to the raw data collected in all the trials (showing benefit, no benefit, or harm) conducted by GSK.  And they’re having a field day!  A new study published in the New England Journal of Medicine is based on an analysis of GSK’s research, where they have found that Avandia (a popular diabetes drug) may put people at higher risk for heart attacks and heart related death.

Now here’s the devil in the details (as Dr. Charles rightly points out): the potential harm has been blown way out of proportion – the media has been citing “a 43% increase in heart attacks/myocardial infarctions and a 64%
increase in death from cardiovascular causes” when another way of stating what the authors found is that 86/14,371 patients or 0.598% of the patients taking Avandia had a heart attack, while 72/11,634 or 0.619% of people
not taking Avandia also had a heart attack.  Gee… which sound bite seems more scary?

Honestly, I feel worried for the general public who are now (with the new full disclosure of drug company data) sure to be victims of an onslaught of media hype around all sorts of small differences found in research studies.  Believe me, it’s important to sift through all this data to look for early signs of potential drug related health risks – but I think we should be careful before we terrify our patients with scary statistics.

Maybe in the midst of all this new honesty – we can have medical bloggers like Dr. Charles and the Revolution Health team help patients get to the bottom of things without having to have a PhD in biostatistics.  We need a voice of reason to translate research data for public consumption.  I’ll do my part – but since there are ~6000 research studies published per day in this world… I need some back up.  Any takers?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

The right balance for good health

I realize that my last post has probably left you wondering what on earth bulldozers and ballerinas have to do with medicine.  Well, let me lead you down my little mental garden path here and explain.

The dancing event took place right next to the National Academy of Sciences, where the Institute of Medicine (IOM) holds its regular meetings.  It was all the more humorous to see these bulldozers (with rose petal-filled buckets) participating in this awkward dance – right in front of the hallowed halls of medicine’s most prestigious scientific body.  As I thought about what the IOM stands for – the pursuit of truth through objective scientific analysis – and what these ballerinas were up to (reveling in the whimsy of life) it struck me that good medicine might actually combine the two.

Clearly, there are aspects of a healthy life that cannot be well defined by science.  Love, peace, and joyfulness are all nourishing to the mind and body – but quantifying them is rather difficult.  The things that grandma taught us – get your beauty rest, be kind to others, get lots of fresh air, marry a loving man (or woman) – are great medicine, and should be the foundation for a life in balance.

However, the science of medicine is also critically important.  The media thrives on exaggeration and controversy.  If there were a mountain of sand in front of us, and we had the choice to move it with a bulldozer or a teaspoon – the media would have us convinced that the spoon was equally effective.  And this is why we are constantly misled about treatments – we hear about efficacy, but we don’t hear about the relative effectiveness compared to other therapies.  So cinnamon, for example, is touted as a great new treatment for diabetes, when in fact it is only a teaspoon compared to the bulldozer of insulin.

And so I guess I would summarize my musings this way: good health is a dance near the IOM, with bulldozers instead of teaspoons.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Bulldozers and ballerinas

“Bulldozers and Ballerinas” is the whimsical name of the event I attended this past weekend.  A dance troupe decided to pair themselves with some small bulldozers (propane powered) to do some interpretive work to the tune of Tchaikovsky’s Swan Lake.  There were about 8 dancers and two bulldozers on a city street closed off to traffic.  Large speakers blasted the classical music, as construction worker gear-clad ballerinas danced around the moving bulldozers.  This was about as funny as a Monster Truck rally hosted by Luciano Pavarotti.  I watched with  amusement and enjoyed the humor of the contrasts.

In my next post I’ll explain the connection between bulldozers and medicine.

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

Sun Therapy for Tuberculosis?

I was interested to see this news piece about how Vitamin D may improve the body’s ability to fight off Tuberculosis.  Vitamin D is found in some foods, but can also be created in your body when it’s exposed to UV light.  In the 1940’s Tuberculosis sanitoriums used “heliotherapy” (sun exposure) as a modality to treat TB.  I had often wondered about the utility of such treatments – with this photo etched in my mind.  And now it seems that they had it right.

Of course, we don’t know how many of those patients developed skin cancers later in life…  (Always a trade off, isn’t there?)  In the US, milk and orange juice are fortified with Vitamin D – however in Britain they have no such requirement and they are seeing an increase in TB cases.  “Got Milk?” only works if it’s “Got Vitamin D Fortified Milk?” I guess…This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

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