Poland’s syndrome is a congenital disorder. The classic ipsilateral features of Poland syndrome include the following: absence of sternal head of the pectoralis major, hypoplasia and/or aplasia of breast or nipple, deficiency of subcutaneous fat and axillary hair, abnormalities of rib cage, and upper extremity anomalies. These upper extremity anomalies include short upper arm, forearm, or fingers (brachysymphalangism). (photo credit)
Additional features of Poland syndrome include the following: hypoplasia or aplasia of serratus, external oblique, pectoralis minor, latissimus dorsi, infraspinatus, and supraspinatus muscles; total absence of anterolateral ribs and herniation of lung; and symphalangism with syndactyly and hypoplasia or aplasia of the middle phalanges. (photo credit)
The name of this condition pays homage to Dr. Alfred Poland of Guy’s Hospital, who in 1841 described a case of these two deformities during the autopsy of a 27-year-old convict, but as this article points out he wasn’t the first to recognize the syndrome.
If you enjoy medical history, then you will enjoy this article. It explores the historical literature to reveal the progression of knowledge about this syndrome. Here is a quick summary of different investigators who contributed to the understanding of Poland’s syndrome. The article goes into more detail of each.
1826
Lallemand is first to describe the absence of the pectoralis.
1835
Bell is the first to record the absence of the pectoralis
1839
Forlep is first to describe the paired absence of the pectoralis and ipsilateral syndactyly
1841
Poland is the second to describe the paired absence of the pectoralis and ipsilateral syndactyly
1895
Thomson is the first to document an understanding that the deformities accompanied one another
1900
Furst is the first to propose that the anomalies constituted a syndrome
1902
Bing is the first to present a case series of patients with the syndrome
1940
Brown and McDowell are the first to document a thorough review of the syndrome
1962
Clarkson is the first to propose the name “Poland’s Syndactyly” for the syndrome
As the authors conclude:
Honoring physicians for notable achievements in the form of eponyms can be viewed as a harmless way to bring a little bit of warmth to an otherwise cold world of facts. The least we can do, though, is to recognize the contributions of those who endeavored to shape our current understanding of disease.
Perhaps if history took another course, Poland’s syndrome would instead be called Frolep’s syndrome or Furst’s syndrome. Or perhaps it might simply have been called pectoral-aplasia-dysdactylia syndrome
[This post was written by Charlie Baker, President and CEO of Harvard Pilgrim Health Care, Inc., one of New England’s leading non-profit health plans.]
I heard this idea promoted at a luncheon I was at last week — that the best way to fix health care in the U.S. would be to move to a “Medicare-For-All” system. Needless to say, I find this odd — since I think many of the things people hate most about our existing system — too procedure driven, doesn’t support primary care and prevention, favors technology over face-to-face interaction, doesn’t support multi-disciplinary approaches to care delivery, etc. — derive from the rules of the game set up and enforced by…Medicare!!! Yikes!
But aside from that, the two things I always hear about why it’s a good idea are — Medicare has lower Administrative costs than private health plans and they’re a ”better” payer than the private plans. Hmmm…Let’s take the first one. What I’ve heard before is that Medicare only spends 4% of its money on a per beneficiary basis on administration, while the plans spend 14% per member on administration — a big difference. This is interesting, but misleading.
Medicare beneficiaries are over the age of 65. They spend almost three times as much money on health care as a typical private plan member — most of whom are under the age of 65. If the Medicare member typically spends $800 per month on health care, and 4% of that is spent on administration, that’s $32 a month on administration. If the private health plan member typically spends $300 per month on health care, and 14% of that is spent on administration, that’s $42 a month — a much smaller difference. But we’re not done yet. Medicare is part of the federal government, so its capital costs (buildings, IT, etc.) and benefit costs (health insurance for its employees and retirees (!), pension benefits, etc.) are funded somewhere else in the federal budget, not in the Medicare administrative budget.
Private plans have to pay for these items themselves. That’s worth about $5-6 per member per month, and needs to come out of the health plan number for a fair comparison. Now we’re almost even. And finally, Medicare doesn’t actually process and pay claims for all of its beneficiaries. It contracts with health plans around the country to do much of this for them. That’s not in their administrative number, either — and it is, needless to say, in the private health plan number.
People push and pull these numbers all the time, and there may be “some” difference between Medicare and the private health plans on administrative spending as a percent of total spending. But it’s not huge, if you try to compare apples to apples.
On the payment issue, the numbers I’ve seen suggest that nationwide, private plans — on average — pay somewhere between 120 and 125 percent of what Medicare pays for hospital and physician services. In other words, private plans pay MORE than Medicare pays, not less! If people want Medicare For All, they need to be prepared to either dramatically raise Medicare rates and payment — and therefore, Medicare costs — by a lot of money — 20 to 25% by this estimate — or kick the bejeebers out of the physician and hospital communities and make them eat the difference.
Being with the wrong doctor can have grave consequences – literally. As a practicing physician, I’m the first to admit that no doctor is perfect, especially me. I’m in a field that is eternally humbling, with my next mistake potentially hiding just around the corner. The stakes are enormous and the number of tasks I must juggle often daunting. From my point of view, I’m trying my best. But from the patient’s point of view, that may not be enough. So how do you know when it’s time to call it quits with your doctor? Here are ten reasons to make you think twice about continuing with the status quo:
1) You feel your doctor isn’t listening to you.
Listening isn’t waiting to speak. One of my favorite and most beloved teachers, Dr. Alfred Markowitz, once told me, “If you let patients talk long enough, they’ll actually tell you what’s the matter.” Studies show that, on average, doctors let patients talk for 18-23 seconds before interrupting. Patients are allowed to finish their opening statement of concerns about 25 percent of the time.
You want a physician who not only is willing to hear what you’re saying but who’s intrigued by interpreting nuances of words and body language, who notices when you hesitate a millisecond before answering a question that’s hit a hidden sore spot. Don’t be shy about confronting a doctor who isn’t listening. And leave if your concerns aren’t addressed.
2) Your doctor can’t communicate effectively with you.
Your doctor not only needs to be a great listener but has to be able to explain things to you in a way that you can understand. You’ll know it when you don’t hear it.
3) The doctor isn’t taking you seriously.
This is a deal breaker. It may happen if your doctor jumps to a conclusion about the cause of your symptoms before considering other possibilities. Even if you’re a hypochondriac, your hypochondria needs to be seriously addressed. And even hypochondriacs get real illnesses.
4) You have a problem with the office staff.
Office personnel represent the doctor. If they’re unfriendly or unkind then you’re starting off on the wrong foot. And it gets worse if they’re inefficient. Messages must be given to the doctor, insurance forms filed, tests properly scheduled and results reported. Last week, a survey of primary care practices found that patients were not told of abnormal results an average of 7 percent of the time.
5) You’re kept waiting too long.
Doctors can be delayed by unpredictable medical emergencies. But if it happens consistently then the doctor is probably scheduling inefficiently. A clue you’ve been in the waiting room too long: if you pass completely through menopause while waiting to discuss your hot flashes.
6) It takes too long to get an appointment.
Routine annual visits can be scheduled months in advance but new problems and ongoing medical complaints need to be addressed in a timely fashion.
7) The doctor’s too busy.
This may develop over time, as the practice grows. If messages are going unreturned, insist on talking to the doctor. If the problem continues or the doctor always seems to be in a hurry then you may need to find somebody else.
8) Your doctor gets annoyed by questions.
This may be a reflection of other problems listed above such as the doctor being too busy or not taking you seriously. Whatever the cause, it’s unacceptable. Not only are patients entitled to careful consideration of questions, those questions may provide doctors with important clues. “Why do I get a stomach ache every time I eat a slice of toast?” may lead to the diagnosis of celiac disease, a condition in which gluten – a component of wheat, rye, and barley – is toxic to the body. If a doctor doesn’t immediately know the answer, a perfectly good response is, “I don’t know but I’ll research it and get back to you.”
9) Your doctor is too arrogant.
God save us from the brilliant doctors. You probably need to be a B+ student to be smart enough to learn everything you need to be a great doctor. But you also need to be A+ in empathy, listening, carefulness, keeping an open mind, logic, and common sense. Doctors who think they are brilliant scare the heck out of me. I’ve seen them make huge mistakes as they take short cuts or rely on their instincts without seeking help from others or adequately listening to their patients.
10) It just doesn’t feel right.
As with any relationship, sometimes you can’t put it into words but you just know it’s wrong. Don’t fight your instincts.
For this week’s episode of CBS Doc Dot Com, I visit the Mount Sinai School of Medicine in New York City and speak to Erica Friedman, the director of the Morchand Center, where budding doctors are schooled on bedside manner by treating actors pretending to be patients.
I went to a great grand rounds the other day about osteoporosis and learned that all teenage girls should be taking about 1,500 mg of calcium with Vitamin D a day in addition to a multivitamin. Three glasses of milk provide about 1,200 mgs, but most teens are not drinking that much milk. Dark green vegetables are another good source of calcium.Exercise and weight-bearing activity is also important in the prevention of osteoporosis.
Calcium is a mineral that gives strength to your bones. Calcium is also necessary for many of your body’s functions, such as blood clotting and nerve and muscle function. During the teenage years (particularly ages 11-15), your bones are developing quickly and are storing calcium so that your skeleton will be strong later in life. Nearly half of all bone is formed during these years.
Women develop most of their bone strength before they are between 25 and 35. After that, bone is broken down faster than it is created, leading to a small loss of bone mass every year. For women, bone loss accelerates during menopause, but slows again around age 60.
There are specific risk factors for osteoporosis that teens should know:
Being white;
Having irregular periods;
Doing little or no exercise;
Not getting enough calcium in your diet; Being below a normal weight;
Having a family history of osteoporosis;
Smoking; and
Drinking large amounts of alcohol.
Osteoporosis can be prevented, but teens need to start early.
Being the first group of parents to have to have to parent an all digital generation of kids, it’s no wonder our brains go on overload trying to sort out not only how to use all things digital but keep our developing kids safe and thriving in their ever digital lives.
I talked about these issues today on Fox25 Boston and highlighted the new social media and sexting tips out from the American Academy of Pediatrics in honor of Internet safety month. Here’s the clip of the segment with all the details:
To remember the key points of the new AAP tips, I came up with the mnemonic “TECH”:
T: talk to your kids about their technology use and what they think of technology and the issues they hear about online.
E: educate yourself about the technology your kids are using, your kids about the issues, and your community about the need for youth education programs in schools as support for the issues
C: check your kids online profiles and logs often, and sometimes without warning
H: have a family tech use plan and follow-through when violations occur.
We know how to parent off line. We know how to create consequences when curfews are broken and expectations for social rules and proper behavior are not met. What we have to do now is modify our already great parenting skills to the online world. These tips are the first step!
Plus, keep in mind, you are not alone. Not only are all the parents around you in the same boat but you have experts like me here to help answer your questions about the high tech lives of kids.
I had a great chat after the segment with many FoxNews25 viewers and will post what we talked about soon so everyone can benefit. In the meantime, if you have questions about your own “Networked Family” or a story to share from your own “Networked Family” archives, email me at ideas@pediatricsnow.com.
*This blog post was originally published at Dr. Gwenn Is In*
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