Cancer. Just the word is scary. Actually, that’s the problem. Once you say that word, the average American will do anything — ANYTHING! — to just get it out of my body!!! Whether or not they have it, whatever the actual numerical chances of their ever developing it, no chance for detecting or treating it should ever be neglected. EVER! Ask any Med-mal lawyer. Better, ask any twelve average people off the street (i.e., the ones who are going to wind up on a jury). “The doctor didn’t do every possible test/procedure, and now the patient has CANCER? String him up!”
Hence we have the new guidelines for PSA testing. (Given that many patients with prostate cancer have normal PSAs and lots of patients with high PSAs don’t have prostate cancer, it doesn’t seem semantically correct to call it “prostate cancer screening”.) Surprise! Turns out that not only does PSA testing not save lives, but that urologists don’t really care. Certainly not enough to stop recommending PSAs to just about everyone they can get their hands on.
Nor do breast surgeons have any intention of modifying their recommendations, not only in light of new understandings of the limitations of mammography, but even as Read more »
*This blog post was originally published at Musings of a Dinosaur*
Atul Gawande says that we’re used to doctors working like “cowboys” – rugged individualists who are responsible for making sure your care gets done right. We don’t need cowboys, he says. We need “pit crews” – teams of doctors working together toward a common goal, with each playing their own role.
It’s an appealing idea. Pit crew-like teams work, and work well, in trauma units across the country.
But there’s a problem: if you haven’t just been airlifted to a hospital after a horrible accident, you’re not going to be treated by a pit crew. You’re going to be on your own, shuffled from one 15-minute specialist visit to the next, likely with no one person in charge of your care.
Dr. Gawande knows this, and he picks a heck of an example of the problem: Read more »
*This blog post was originally published at BestDoctors.com: See First Blog*
Both in the United States and around the globe there is a mismatch between needed medical care and the doctors who can provide it. Most physicians are located in urban areas where there are hospitals, teaching schools, lab and Xray and specialists to deal with most every medical condition. Rural areas in the United States lack these resources and patients either do without, or must travel far to be seen. In developing countries there may be no services at all for hundreds of miles. That is where telehealth can play a huge role in bringing medicine to the people.
The “In-touch” robot is one technology that can work all over the world. Through a simple lap-top computer a doctor can Read more »
*This blog post was originally published at EverythingHealth*
A hard thing about being an ER doctor is that I know a little, sometimes very little, about a lot of things. When I am faced with a particular condition, I often need to call the specialist for that organ, who knows way way more about it than I ever will, and they all think I’m an idiot because I don’t know as much about their organ as they do. There’s a huge asymmetry of knowledge, and it can create some tension and conflict.
I’m OK with it, because I can ignore their condescension and I am secure with what I do know, and its limits. But sometimes I get perplexing instructions from the specialists. The emergency medicine dogma can be overbroad and a little hidebound and what the specialists will do in the real world often radically diverges from what the Emergency Medicine textbooks say to do. It’s often an interesting learning opportunity for me, especially when it’s a condition I don’t encounter that much. But I also have to work to maintain a flexible and open-minded attitude when I call a consultant and my side of the conversation consists of “Really? I didn’t know you did that for this…” You need to know and trust your colleagues in other specialties, and know when to call BS on them and push to do something else, which is really hard to do when you are talking to someone who is so much more of an expert than you are.
So I saw this guy recently, an urban hipster who was perhaps a bit too old to be riding his longboard on the hilly streets of our fair town. He didn’t seem to be too good at it, judging by the collection of crusted abrasions and aging ecchymoses he was sporting. He had been falling a lot recently — we only get about a month of sun here, so I guess he was making the most of the summer weather practicing his new hobby. He had a variety of complaints from Read more »
*This blog post was originally published at Movin' Meat*
I think a lot about the slow, certain dissolution of medicine as we know it. Mental health issues crowd emergency departments, as few mental health clinics are available. Psychiatrists are in short supply. Drug abuse overwhelms the medical system, with either patients seeking pills or patients families hoping to get them off of pills.
Persons with little interest in their own health continue to smoke and drink, use Meth and eat poorly. Disability claims are skyrocketing as younger and younger individuals confabulate their misery in hopes of attaining a check, paid for by someone else.
The poor, with genuine medical problems, have increasing difficulty finding care as jobs, and insurance, fade away. Politicians, eager to be re-elected, eager to be loved, promise Read more »
*This blog post was originally published at edwinleap.com*