It’s been a very busy few weeks. Medicine is like that — seldom is “business” steady. Like rainy weeks in the southeast when you think it will never be sunny again, there are weeks when you think everyone’s atria are fibrillating. So there were shocks, and burns, and wires installed. The heart rhythm was rocking, and so were we.
But in all this fury two cases stand out as a reminder that in spite of, not always because of, what we doctors do, the human body can right itself — like it did before their were drugs, procedures, and surgery. (Keep this quiet, though.)
Case 1: A semi-emergent consultation for atrial flutter (AF’s crazy sister) came in. “Something has to be done, Dr. M,” was the message. She was symptomatic and scared (not necessarily in that order), but after a bit of simple doctoring (a pill), the heart rate had slowed and the symptoms abated somewhat. Then after a heavy dose of an AF doctor’s greatest weapon, reassurance and education, we mutually decided on one of my secret treatments for acute AF/AFlutter: A deep breath, a chair, a book, and time. Just in case, though, a cardioversion (shock) was set up for the next morning. I knew that since this was a first episode, that given some time the heart may right itself, without any fury.
Bingo. The text message came the next morning: “Cardioversion cancelled. Patient converted to sinus rhythm right after you saw her yesterday.” (Grin.) Read more »
*This blog post was originally published at Dr John M*
Here’s my column in the August edition of Emergency Medicine News. A person who seems powerless may hold an entire emergency room hostage!
Magic Words: ‘I Have Chest Pain’
Propped in her bed, frail and weak, the little grandma sighed. Her complaints were legion: weakness, poor appetite, poor sleep, joint pain, cough, dry mouth. Her daughter, eyes rolling, was trying to balance three reasonable emotions. She desperately wanted to go home and rest after spending the day in the ER. She truly wanted to avoid her mother’s admission to the hospital, and she was, graciously, sympathetic to the physician who brought the bad news.
‘Mrs. Adkins, I know you feel poorly, and I’m sorry. But I have to say, I can’t find any reason to admit you to the hospital. You’re right as rain. Isn’t that great?’
‘You mean, I’ve been here all this time, and had a gallon of blood drawn, and all them x-rays and a CAT scan, and there ain’t nothing wrong? I can’t believe that. I feel terrible.’ When she said the word terrible, she smacked her lips and looked away. She propped her hands on her lap and intertwined them; and she managed a subtle, but expressive, sniffle. Read more »
*This blog post was originally published at edwinleap.com*
Today I refer you to an excellent post by Peter A. Lipson, M.D., at the blog Science Based Medicine entitled “HuffPo blogger claims skin cancer is conspiracy.”
The post focuses on an article by someone who contends that the link between sunlight and skin cancer is a conspiracy by dermatologists and the cosmetic dermatology industry. Dr. Lipson’s highly insightful analysis about the “interview” process and how doctors must act these days on behalf of their patients concludes:
This article shows a misunderstanding of journalistic ethics, medical ethics, and medical science. It’s a disaster. And it’s no surprise that it’s in the Huffington Post.
While this is a medicine story, my question relates to why an organization with a lot of great front-page news so frequently posts medical articles that are wrong and, sometimes, downright dangerous.
Read the article first, then read Dr. Lipson’s analysis.
Disclosure: I am an occasional contributor to Science Based Medicine but, like all contributors there, receive no compensation.
*This blog post was originally published at Terra Sigillata*