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Latest Posts

Dealing With Cyclic Vomiting Syndrome Given How Little Is Known About The Condition

I have been working as an ER doctor for over a decade, and in that time I have come to recognize that there are certain complaints, and certain patients who bear these complaints, that are very challenging to take care of. I’m trying to be diplomatic here. What I really mean is that there are certain presentations that just make you cringe, drain the life force out of you, and make you wish you’d listened to mother and gone into investment banking instead. Among these, perhaps most prominently, is that of the patient with cyclic vomiting syndrome.

The diagnosis of cyclic vomiting syndrome, or CVS, is something which is only in recent years applied to adult patients.  Previously, it was only described in the pediatric population. It has generally been defined as a disease in which patients will have intermittent severe and prolonged episodes of intractable vomiting separated by asymptomatic intervals, over a period of years, for which no other adequate medical explanation can be found, and for which other causes have been ruled out.

That is not much in the way of good literature about this disease entity, which is surprising, because it is something that I see in the emergency department fairly regularly, and something with which nearly all emergency providers are quite familiar. These patients are familiar to us in part because we see them again and again, in part because they are memorable because they are so challenging to take care of.

Some things about the cyclic vomiting patient that pose particular challenges: Read more »

*This blog post was originally published at Movin' Meat*

The State Of Drug-Seeking In America: Nothing Should Hurt

101-homepage-merthiolate

This might sting a little…

When I was a child, I was often painted orange with Merthiolate.  My grandmother, like every good grandmother, kept a bottle handy at all times.  Merthiolate was an antiseptic, containing Mercury, that was marketed for cuts and scrapes.

A fall on the gravel, a slide on the pavement, a run through the briar patch and you’d be sitting on the kitchen table while grandma colored you orange with the magical elixir, which incidentally burned like fire!

On a recent emergency department shift, we were colluding about the general state of drug-seeking in America, which has been enabled by our ‘nothing should hurt’ ideology.   One of my dear friends, Nurse Nancy, had a realization; an epiphany, really. Read more »

*This blog post was originally published at edwinleap.com*

What Some Patients Will Do For Drugs: A Strange Phone Call Late At Night

9:00 pm:

Hello. It’s Mrs. Mumbledimumbler; I need the doctor to call me right away. My hip is driving me crazy. Please call me.

I listen to the message three times so I can sort of make out the name. The problem is that even though I think I can understand it, I don’t recognize it at all. But I call her because she said she needed me to call her right away.

Hello. I need you to call me in some tramadol right away.

“What was your name again?”

She repeats it clearly enough for me to confirm that I really don’t recognize it.

“Have I ever seen you in the office?”

No.

Let me get this straight: it’s 9:00 at night and your hip is hurting, so you call a doctor who’s a complete stranger and insist that they call you in a powerful painkiller without ever having seen you, taken your medical history, or examined you? I don’t think so.

“Um, I’m sorry ma’am, but I really can’t do that unless you’re an established patient in my office.”

Oh, okay; never mind.

I suppose I should count my lucky stars that she didn’t want vicodin.

*This blog post was originally published at Musings of a Dinosaur*

The Lesbian And The Lipstick

red-lipstick.jpgThe woman in bed six informed me immediately on my arrival and introduction that she was a lesbian. I don’t know why it mattered because she was there for a scald injury on her arm, and I hadn’t inquired about it. In fact, I hadn’t even begun my history before she made her announcement in a somewhat belligerent tone.

So…ooookaaay. I tried not to let this non sequitur throw me too much off my stride, and I went through the brief history necessary for a minor injury such as she had.

As an aside, this self-proclaimed lesbian was quite feminine. She was well-dressed for the hour of the evening and quite pretty in her own sort of way. She even had a choker of pearls on, along with earrings, lipstick, and well-coiffed hair.

I asked a few questions, though, and was surprised at the frankly-aggressive tone of her responses. Nothing too blatant, nothing that I could call her on, but quite definite. And her story seemed to not quite add up. Read more »

*This blog post was originally published at Movin' Meat*

Insurance Or Not, The Patients Nobody Wants To See

In the practice of medicine, as in any human endeavor, we encounter a wide variety of human beings. While thinking about this recently, in light of the passage of the healthcare reform act, I realized something startling that supporters of the bill may not realize: There are some patients that nobody wants to see.

This uncomfortable truth exists irrespective of the presence or absence of insurance. Sometimes physicians are accused of dismissing or avoiding certain patients on the basis of their finances alone. While that problem exists (and I have seen it), a great many of the patients who can’t find (or keep) a doctor simply aren’t much fun to be around, much less to treat. Read more »

*This blog post was originally published at edwinleap.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…

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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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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…

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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…

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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…

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