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Internists Not Using Simple Test (Ankle-Brachial Index) For Peripheral Artery Disease

Despite poor awareness and a lack of training on handling peripheral artery disease, internists can and should be able to recognize the symptoms and manage 95% of such cases. Experts advise using the ankle-brachial index as a quick and effective diagnostic method.

Rebecca J. Beyth, ACP Member, demonstrates the ease and quickness of the ankle-brachial index in diagnosing peripheral artery disease. Photo by Eric Zamora/UF News BureauBut internists often don’t. As was reported in ACP Internist‘s previous cover story on the subject, the ankle-brachial index can be a major part of preventing peripheral artery disease, itself a major predictor of strokes and heart attacks, over and above the Framingham risk score.

The ankle-brachial index is the ratio of the ankle to the arm systolic pressure. A ratio of 0.90 or less indicates peripheral artery disease. Its sensitivity is 79% to 95%, and its specificity is 95% to 100%. It takes less than five minutes to perform in the office.

Yet, among the 85 respondents, 36 (42.35%) said “It’s a quick and easy test.” Another 27 (31.76%) thought, “It’s difficult to fit into the standard visit.” The final 22 (25.88%) said, “I don’t use the ABI to screen patients for PAD.” Read more »

*This blog post was originally published at ACP Internist*

Why Double Mastectomies Are Popular: Watchful Waiting Is Too Difficult?

The rise of prophylactic double mastectomy in women with increased risk of breast cancer has been a topic of recent discussion. In particular, this trend has been observed amongst women with the diagnosis of unilateral carcinoma in situ, or pre-invasive breast cancer. While it has been known that in women with genetic cancer syndromes, including BRCA1 and BRCA2, double mastectomy reduces risk, the efficacy of the approach is uncertain in women with other risk profiles, yet more women and surgeons seem to be doing it.

Knowing when to test, treat and act is part of art of medical practice. The ability to convey this information effectively is also an art. Both patients and doctors may have a hard time embracing watchful waiting with respect to many forms of cancer and pre-cancer. In the case of cancer of the cervix, it is known that infection with human papillomavirus (HPV) is causative in cancer development. However, only a small percentage of those infected actually go on to get cancer. Low grade dysplasia, a condition that is early in the cervical cancer development continuum, frequently spontaneously resolves without treatment. Fortunately, in the case of cervical cancer, there is now a vaccine to prevent high risk HPV infection.

“Watchful waiting” has been most discussed as a treatment strategy for prostate cancer. Read more »

*This blog post was originally published at ACP Internist*

Some Physicians Fear Airport Scanner Radiation, Despite Evidence

In preparation of Internal Medicine 2011 in San Diego this week, the unavoidable choice to make isn’t which sessions to attend, but even before arriving: Will you pass through the airport’s security scanners, or opt for the pat down?

Physicians themselves are split on the issue, with some physicians opting out of repeat scanning in favor of the pat down search.

“I do whatever I can to avoid the scanner,” one physician told CNN. Other physicians interviewed were split on the issue one way or another. But as a frequent flier, this doctor was concerned about the cumulative effect. “This is a total body scan–not a dental or chest X-ray. Total body radiation is not something I find very comforting based on my medical knowledge.” Read more »

*This blog post was originally published at ACP Internist*

Why You Should Still See Your Doctor When You’re Not Sick

Patient Power logoExperts say over 100,000 lives a year could be saved in the United States if patients focused more on preventive medicine. What is preventive medicine? What can you do in your everyday life that may make a long-term difference?

On this Patient Power program, you will hear from two board certified internists from the UW Medicine Neighborhood Clinics in Western Washington. They will discuss how having an ongoing relationship with a primary care physician who you check in with regularly –- even when you’re well –- gives you the best chance at staying healthy.

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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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