Before reaching for tests like EKGs to screen teen athletes, we should first ask ourselves if we’ve taken a careful history:
The new study consisted of Madsen and his fellow researchers sending out surveys to every pediatrician and family practice doctor in Washington State. They received a good response–surveys were returned by 72 percent of pediatricians and 56 percent of family practitioners.
The results were disheartening:
- 28 percent of doctors surveyed failed to always ask if a teen experienced chest pain during exercise.
- 22 percent of doctors surveyed failed to Read more »
*This blog post was originally published at Dr. Wes*
I’ll cut to the chase: I loved this book. Five stars. Two thumbs up.
When I read books, especially psychiatry books that I write about on Shrink Rap, I often read more carefully and sometimes more critically. I was so immersed in reading “Just Like Someone Without Mental Illness Only More So” that I didn’t stop to think, I just went on the journey.
Mark Vonnegut is a pediatrician and the son of my favorite author when I was in junior high school. His memoir is a poignant and candid account of his struggles with, well, life in general, and life with a psychotic illness in particular. Schizophrenia, bipolar disorder — who knows? (I’ll vote for bipolar disorder.) Some illness where he had three episodes in his twenties, then another episode 14 years later.
Thorazine and lithium and megavitamins and psych wards. Xanax and alcohol and how humiliating it is to be psychotic on a stretcher in the ER hallway of the hospital where he works. Divorce and remarriage. First and second families. Childhood as the son of a financially struggling, not-yet-famous eccentric writer, and adulthood as the son of an icon. Vonnegut is a hippy, a mainstream doctor, a middle-aged softball player, then finally a guy who accidentally poisons himself with wild mushrooms. Read more »
*This blog post was originally published at Shrink Rap*
Many times when faced with a clinical dilemma, a parent will turn to me and ask: “What would you do if this were your child?”
When faced with this question, I never quite know what to say. And each time I feel a little on-the-spot. But why is that? Aren’t I comfortable recommending for someone else exactly what I would do for my own child? After all, what have I got to hide?
Here’s the problem: The decisions we make as parents involve our values, tolerance of risk, level of concern and frustration, prior health experience, and religious belief — to name but a few. There’s no way to fully tease those things from the parent sitting across the room. Read more »
*This blog post was originally published at 33 Charts*
I like Dr. Rob, the one with the “distractible mind.” And although I thoroughly agree with the stance he takes in his recent post against cholesterol screening in kids, I must take issue with his opening statement:
I have a unique vantage point when it comes to the issue universal cholesterol screening in children, when compared to most pediatricians. My unique view stems from the fact that I am also an internist who deals with those children after they grow up on KFC Double Downs.
“Unique: existing as the only one or as the sole example; single; solitary in type or characteristics.”
Your med-peds training allows you to follow patients from birth to death (but no obstetrics or gynecology). You can care for all organ systems and all stages of disease (but without as much training in psychiatry). Congratulations! You’ve just (re)invented family practice (except for the above shortcomings). Oh, wait — that’s already a recognized specialty with its own residency programs, boards and everything like that, forty years now.
This misuse of the word “unique” is one of my pet peeves. “Unique?” I don’t think that word means what you think it means. After twenty years in practice, I agree that there probably isn’t much difference between what Dr. Rob does and what I do. After twenty years, I’m not even sure how much relevance remains from our “training.” Still, there remains a great deal of confusion about the very real differences between family practice and med-peds residencies. Read more »
*This blog post was originally published at Musings of a Dinosaur*
Many conservatives are up-in-arms about President Obama’s decision to appoint Don Berwick, a pediatrician and renowned expert in quality improvement and patient safety, to lead the Center for Medicare and Medicaid Services (CMS). They object to Dr. Berwick’s views on a range of issues, and to Obama’s decision to use his office’s authority to appoint Dr. Berwick while the Senate was out on a short Independence Day holiday recess. As a “recess appointment,” Dr. Berwick was able to take office without Senate hearings and confirmation, but he can only serve through the end of the 111th Congress — that is, until the end of 2011 — unless ratified by the Senate.
Berwick, though, also has many supporters. Maggie Mahar articulates the “pro” viewpoint on Dr. Berwick’s appointment in a recent Health Beat post. She observes that two former CMS administrators who served in Republican administrations have commented positively about Dr. Berwick’s qualifications. Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*