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Latest Posts

Migraine With A Visual Aura: It Might Be Scintillating Scotoma

Nothing like experiencing a medical condition first-hand to really help a doctor understand it from the patient’s point of view. After all these years, I had my first (and hopefully last) scintillating scotoma while sitting on the couch playing “words with friends” on my ipad and watching TV. A scotoma is a partial loss of vision in a normal visual field. Scintillate is flashing, sparkles. Put them together and you have moving, flashing sparkles with a blind spot in your eyes.

This visual aura was first described in the 19th century by a Dr. Hubert Airy who had migraine headaches. The visual sparks and flashes are in a zig-zag pattern and they can precede a migraine headache or occur without any pain. The scotoma affects both eyes and closing one or the other does not make it go away. Sometimes Read more »

*This blog post was originally published at EverythingHealth*

Drug Seekers And Pain Complaints In The ER: How To Know What’s Real

The first seven patients I saw today were in the ED for:

  • Dental Pain (ongoing for three years)
  • Back Pain (third visit in one month, 18 in 2006)
  • Migraine Headache (six visits in a month, and second ED visit in 18 hours)
  • Back Pain (this one was legit)
  • Chronic Recurrent Abdominal Pain (ran out of Oxycontin and doctor “out of town”)
  • “Cyclic Vomiting Syndrome” (in which only narcotics stop the vomiting)
  • Oxycontin withdrawal

Sometimes I wonder why I bother. I occasionally wish my job demanded something more than a valid DEA license, and decision-making skills beyond “yes narcs” and “no narcs.” It just drains the carpe right out of your diem to start the day off in a series of ugly little dogfights over drugs with people whom, to put it charitably, you have concerns about the validity of their reported pain. Read more »

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

Why It Takes Time To Get Pain Medicine In The ER



Three days.

Out of pain medication and vomiting so you wouldn’t keep it down, anyway.


Emergency department.


You’re in luck -  no one in triage!

A bed opens up, the nurse takes you straight to a room.

Gown, blanket.


Two minutes later you send your cousin out to ask how long it will be until you get your pain med.

Excuse me? Read more »

*This blog post was originally published at Emergiblog*

Dodged One: Meningitis Discovered By Trusting One’s Instincts

Saw a nine-year old with a headache today.  His dad brought him in, and explained that all the men in his family get migraines; he figured this was his son’s first one.  The kid seemed perfectly well, with a positive Cheetos sign and my gut instinct was that I would discharge him with no work-up.  But when I flexed his neck fully, he winced. Read more »

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

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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