October 7th, 2010 by Jennifer Shine Dyer, M.D. in Better Health Network, Health Tips, Opinion, True Stories
Tags: Basal Rate, Blood Sugar Control, Blood Sugar Levels, Bolus, CGM, Chronic Disease Management, Continuous Glucose Monitor, Diabetes Management, Disease Pathology, Dr. Jennifer Shine Dyer, Insulin Pump Site, Insulin Pumps, Insulin Sensors, Lack Of Vanity, Lessons For Doctors, Living With Diabetes, Medical Lessons
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As doctors, sometimes the biggest lessons that we learn about disease pathology are those that we learn from the people that have that disease. Diabetes is one such disease.
I recently gave a show-and-tell lecture about insulin pumps to the new interns and residents as well as the 3rd-year medical students on their pediatric clerkship with the inpatient endocrine service. We discussed different types of pumps (point A on the picture) and they got to push the buttons and send a bolus or change a basal rate. They also looked at real time CGM (Continuous Glucose Monitors, points C and D on the picture) sensors used to check glucoses levels every five minutes. Read more »
October 7th, 2010 by Harriet Hall, M.D. in Better Health Network, Book Reviews, Health Tips, Opinion
Tags: Acupuncture, CAM, Chiropractic, Common Health Problems, Complementary And Alternative Medicine, Dietary Supplement, Dr. Harriet Hall, Energy Medicine, Evidence-Based, Herbal Remedies, Home Reference Book, Homeopathy, Mayo Clinic Book of Home Remedies, Quackademic Medicine, Science Based Medicine, Woo-Free
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I write a lot of critical articles. It’s nice to be able to write a positive one for a change. I received a prepublication proof of The Mayo Clinic Book of Home Remedies: What to Do for the Most Common Health Problems. It is due to be released on October 26 and can be pre-ordered from Amazon.com. Since “quackademic” medicine is infiltrating our best institutions and organizations, I wasn’t sure I could trust even the prestigious Mayo Clinic. I was expecting some questionable recommendations for complementary and alternative medicine (CAM) treatments, but I found nothing in the book that I could seriously object to.
It is organized alphabetically, starting with acne and airplane ear and progressing through bedbugs, boils and bronchitis, dandruff, depression and diabetes to warts, wrinkles and wrist pain. Each entry consists of (1) a description of the problem and its symptoms, (2) treatments you can try at home, and (3) when to seek professional medical help. It concludes with a short section on emergency medicine that covers anaphylaxis, bleeding, burns, CPR, choking, fracture, heart attack, poisoning, seizure, shock and stroke.
Nowhere does it mention acupuncture, chiropractic, energy medicine, or homeopathy. It gives good, clear guidance about when a health problem should not be treated with home remedies. Its recommendations about diet and exercise are solid. It doesn’t recommend anything that can’t be supported by published studies and common sense. When it recommends herbal remedies and dietary supplements, it is cautious about what it claims. For instance, glucosamine and chondroitin are listed for osteoarthritis, but they point out that further study is required and they say “because the supplements may help and appear to be safe, it may not hurt to give them a try.” Not exactly a strong recommendation. Read more »
*This blog post was originally published at Science-Based Medicine*
October 6th, 2010 by StevenWilkinsMPH in Better Health Network, Health Tips, Research, True Stories
Tags: Family Medicine, Healthcare Outcomes, Journal of General Internal Medicine, Mind The Gap, Patient Disagreement, Patient Happiness, Patient Preferences, Patient Satisfaction, Patient-Centered Approach, Patient-Centered Care, Patient-Centered Medicine, Patient-Centeredness, Patients' Health Goals, Physician-Patient Agreement, Primary Care, Provider-Centered Medicine, Steven Wilkins MPH, Unhappy Patients, When Patients And Doctors Disagree
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A 69-year-old woman who swims in my master program came back to the pool after a total knee replacement. I asked her how she was doing. She said she is still in a lot of pain because of her physical therapy. She said that her physical therapist was disappointed that she still was still unable to achieve full flexion of 120 degrees. Why 120 degrees? Did you set that goal I asked her? “No,” she said, “the therapist did.”
She went on to tell how she already had more range of motion in her knee than she did before the surgery. My friend was quite satisfied with her progress and wanted to stop physical therapy. The pain from the PT was worse than anything she had experienced before the knee replacement. I knew she and her 80-year-old boy friend were going on a cruise and she didn’t want to still be hobbling around.
It turns out that patients and physicians disagree on quite a few things. We hear a lot about patient-centered care. You know, that’s where the provider is supposed to consider the patient’s needs, preferences, and perspective when diagnosing and treating health problems. But medicine is still very provider-centered. Read more »
*This blog post was originally published at Mind The Gap*
October 6th, 2010 by AlanDappenMD in Better Health Network, Health Tips, Opinion, True Stories
Tags: DocTalker Family Medicine, Dr. Alan Dappen, General Medicine, Health and Wellness, Integrating Wellness, Internal Medicine, MDHQ EHR, Patient-Centered Care, Patient-Centered Medicine, Patient-Centeredness, Practicing Wellness, Primary Care
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I often am asked how I incorporate wellness in our family medical practice, and I must admit that I’ve mixed feelings when it comes to the question because it implies that I’m not already trying to practice wellness simply by practicing medicine. I feel that the two are synonymous.
To those who want to know more about wellness and primary care, here’s my approach:
• I never try to sell anyone on a “wellness” program.
• I follow specific guidelines on certain chronic illnesses, mostly adhering to evidence-based guidelines and not expert opinion or opinion by committee.
• I offer the best advice I can to patients and try to guide them in the right direction when I feel they are taking pathways that worry me and that could be harmful (e.g. like using megavitamin and nutrient therapies or colonics, to name a few).
• I try to be as cost effective as possible when it comes to treatment.
• I see our patients once a year to comply with the legal definition of “face-to-face visits,” but not because scientific evidence substantiates this time honored ritual as “wellness.”
• I use calendar reminders in our electronic health record, MD-HQ to set up needed labs like cholesterol or Hgba1C or to schedule flu shots based on guidelines.
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October 6th, 2010 by Dinah Miller, M.D. in Better Health Network, Health Tips, Opinion
Tags: Ability To Practice Medicine, Bipolar Disorder, Bipolar Doctor, Doctor's Ability, Doctor's Personal Life, Doctor's Well-Being, Dr. Dinah Miller, Emotional Health, Emotional Well-Being, Mental Health, Personal Illness, Physician Health, Practicing Medicine, Psychiatric Disorder, Psychiatry and Psychology, Psychological Challenge, Psychological Disturbances, Psychological Health, Shrink Rap
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“I have bipolar disorder. Can I be a doctor?” One of our readers asked this. It’s one of those questions to which there is no real answer.
Being a doctor takes a long time, it requires reliability, diligence, and a willingness to learn things you may not want to learn (organic chem anyone?) and do things you may not want to do. It requires endurance and passion. You need to be tolerant of many things: Arrogant supervisors, irritable colleagues, sick people who may not be charming and who may, in their distress, be downright nasty. You have to tolerate a militaristic order and be willing to work with a system that may be very difficult, wrong, and demand your obedience in ways that may be uncomfortable. (Oh, I am so happy to no longer be a medical student or a resident in training.)
So can you do it with bipolar disorder? Can you do it with diabetes? Can you do it with attention deficit problems? Can you do it if you’re disorganized or ugly? Read more »
*This blog post was originally published at Shrink Rap*
