May 3rd, 2009 by EvanFalchukJD in Better Health Network, True Stories
Tags: Arterio-Venous Malformation, AVM, Evan Falchuk, Misdiagnosis, Neurology, Neurosurgery, Spinal Cord, Surgery, Tumor
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My younger brother is an executive producer of the show “Nip/Tuck” and an executive producer of soon-to-air Fox show “Glee.“ Last year, he almost died.
It started when he woke up one day with numbness on one side of his body.
His doctor ordered an MRI. It found bad news: a tumor in his spinal cord, high up in his neck. He was referred to a neurosurgeon.
The plan was straightforward, but dangerous. First, radiation. Then, his spinal cord would be carefully cut open to remove the tumor. He was told he could end up paralyzed, or dead. Concerned, he called me, and we started a case at Best Doctors.
One of our nurses took a history, and we collected his records. Two internists spent hours reviewing them. The records noted our family history of a kind of malformed blood vessel. Our grandfather had hundreds of them in his brain when he died at 101, and our father has dozens of them in his. I have one in my brain, too. This was in my brother’s charts, but none of his doctors had mentioned it.
An expert in these malformations told us a special imaging study should be done to rule this out as a cause of the problem. Best Doctors gave that advice to my brother and his doctors. They agreed.
The test showed this was precisely what he had.
Quickly, the plan changed. He still needed surgery — if the malformation bled, it could also paralyze or kill him. But there would be no radiation, which might have caused the very bleeding we feared. Even if that didn’t happen, the surgeons were prepared to operate on a tumor. They would have been surprised to find a delicate malformation there instead.
In the end, his surgery went well. He is having a good recovery and is busy with his new show. But his case is a constant reminder of how important it is to have the right diagnosis, and how easy it is for things to go wrong.
Even in Hollywood.
May 3rd, 2009 by KevinMD in Better Health Network
Tags: Electronic Medical Records, EMR, Family Medicine, Health IT, Internal Medicine, KevinMD, Medical Errors, PHR, Primary Care, Technology
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Bolstered by the stimulus, there’s no doubt that there’s a significant push for doctors and hospitals to adopt digital medical records.
I’ve written before how we’re essentially throwing money at Windows 95 technology, but now, as an article from BusinessWeek points out, there’s a real danger in moving too fast.
Somewhat under-publicized were the incompatibilities with older systems in the Geisinger Health System, which after spending $35 million on software, noticed a spike medication errors that required another $2 million to fix.
Or what happened at the University of Pennsylvania, which found medication errors stemming from software designed to prevent mistakes.
Worse, there is no national database tracking the errors that are caused from electronic medical records. Because most of the programs are not open-source, confidentiality agreements meant to protect proprietary technology also serve to hide mistakes.
Ideally, these issues need to be resolved before throwing more money into bad technology. But, because of the intuitive notion that technology automatically improves health care, no one seems to be advocating a more cautious route which may, in actuality, better serve patients.
***
Better Health Editor’s Note: Please read this post for more in-depth coverage of how difficult it is to transfer health records electronically.
May 2nd, 2009 by Jon LaPook, M.D. in Better Health Network, Video
Tags: CDC, Dr. Jon LaPook, H1N1 Flu, Influenza, Mexican Flu, Recommendations, Swine Flu
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Yesterday I visited the Centers for Disease Control in Atlanta and was taken inside the command center, where almost 100 staffers have been working around the clock to monitor and stem the current outbreak of flu.
I first spoke to Toby Crafton, the manager of the command center, who oversees the day-to-day operations. He and his team have been preparing for a possible pandemic of flu or another infectious illness for years. I also spoke to Michael Shaw, PhD, who heads up the virology labs that are studying the H1N1 virus causing the current outbreak. He’s spent a career learning the laboratory techniques that are so urgently needed right now. The third person I spoke to was Dr. Richard Besser, Acting Director of the CDC, who has been working at the agency for 13 years and is an extensively published expert in infectious diseases.
I mentioned that last week I had received an email notification from the New York City Department of Health (NYCDOH) about how I should be managing my patients with flu-like symptoms. The advice was actually not intuitively obvious to me. For example, the Department of Health said that for patients with mild illness, treatment with anti-viral meds like Tamiflu and Relenza was only recommended for patients who also had underlying conditions that increased their risk for complications due to influenza. Dr. Besser pointed out that it was especially important right now for physicians to stay up to date with the recommendations being made by public health officials. Doctors can contact their local department of health and sign up for the same type of email notification that I received.
This brings us to the main point of today’s blog post. Many of us – patients and physicians alike – have been thinking about the influenza virus for about a week. Public health officials like the teams at the CDC and the NYCDOH have been thinking about it for years. Physicians, me included, are used to practicing medicine based on “clinical judgment.” We understand that medicine is an art and not a science, that there are many different ways to approach a problem, that there’s often no clear “right” or “wrong.” We are also used to doing things “our way”, whatever that way is. But this is not a time for doing things “our way” if it’s at significant odds with strong recommendations being made by public health officials. There are recommendations that may seem logical – like prescribing medication for somebody with mild flu symptoms “just in case” that nevertheless go against the judgment of people who have trained for years to think about how to deal with an epidemic.
What if you’re a physician who strongly disagrees with a suggestion of public officials? Then challenge that recommendation publicly. Bring the discussion to light; maybe you’re right. While this is no time to go rogue, doctors have an obligation to think carefully and independently and to challenge recommendations that seem illogical. But don’t silently do things your own way.
Watch CBS Videos Online
April 30th, 2009 by KevinMD in Better Health Network
Tags: electrocution, Family Medicine, KevinMD, Primary Care, Urination, Urology
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Why yes, you can.
From a German collection of 30 illustrations showing how you can die from electrocution. Uplifting.
(via kottke.org)
*This post was originally published at KevinMD.*
April 29th, 2009 by Paul Auerbach, M.D. in Better Health Network, Health Tips
Tags: Addiction Medicine, Alcohol, Beer, Dr. Paul Auerbach, Drinking, Psychiatry, Swimming
3 Comments »
In continuing with the theme of getting ready for the beach and water sports this summer, let’s consider what to do about substance abuse. There is no controversy whatsoever about the fact that persons under the influence of alcohol or any other mind-altering substance have a higher incidence of accidents. In fact, ingestion of alcohol figures prominently as a statistic in falls, drownings, motor vehicle accidents and virtually every variety of activity that has ever been studied. The issue, then, is not whether or not alcohol contributes to illness and injury, but to what extent we are able to control its use by reason and, when necessary, prohibition.
Im June of 2008, Solana Beach, California banned alcohol consumption on its beaches for at least a year. This ban continues. Here is what appears on the city’s website:
Alcoholic Beverages – Alcohol is banned at all beach areas in Solana Beach. Alcohol is also prohibited in the parking lot, community center, viewpoint or any other public place adjacent to the beach. Glass is prohibited as well.
There are similar rules at, among others, Torrey Pines State Beach, Cardiff, San Elijo, South Carlsbad and Carlsbad state beaches.
City officials made this move proactively, to avoid the sorts of tragedies and social problems that have intermittently plagued “wet” beaches. Recognizing that judgment is often an irrelevant factor when it comes to drinking alcohol, they made a strong and, in my opinion, laudable move. Like it or not, judgment is impaired by drinking alcohol, so the concept of “responsible drinking” is an oxymoron when water sports and potentially hazardous surf conditions coexist with beer, wine, and liquor. Of course, the same is true for certain prescription drugs and illicit drugs.
Needless to say, civil libertarians and numerous other individuals are opposed to mandated prohibitions. They cite lack of observation of problems, principles of freedom and personal rights, and even the loss of romanticism. The issue obviously has two sides.
From a safety perspective, it’s a no-brainer. There’s no benefit to drinking alcohol and entering the ocean. It can never make you safer, and can only make you less safe. Even if you are able to drink alcohol at the beach and safely dispose of your metal cans and glass bottles, not litter, not be rowdy or obnoxious, and keep your drinking to yourself, the moment you dip a toe, you are a greater risk to yourself and to the lifeguards and other rescuers entrusted to protect you. You may not believe that to be the case, but the stories and statistics don’t support you. Having pulled intoxicated victims from the water, treated them at the scene, stitched their heads and set their broken bones in the emergency department, and having had to tell their families and friends that they are dead (while knowing that none of this would have ever happened had the victims been sober), I am offering well-intentioned advice. Not every city will mandate that you leave your beer cooler at home when you head to the beach. When you need to be the one to decide, choose wisely.
Preview the Annual Meeting of the Wilderness Medical Society, which will be held in Snowmass, Colorado July 24-29, 2009.
Join me from January 24 to February 2, 2010 for an exciting dive and wilderness medicine CME adventure aboard the Nautilus Explorer to Socorro Island, Mexico to benefit the Wilderness Medical Society.
photo courtesy of www.aquaticsafetygroup.com
*This post, Alcohol At The Beach, was originally published on Healthline.com by Paul S. Auerbach, MD, MS.*
