January 19th, 2011 by StevenWilkinsMPH in Better Health Network, Health Tips
Tags: Accurate Diagnosis, Diagnostic Technology, Doctor-Patient Communication, Doctor-Patient Interaction, Doctors' Diagnosis, Doctors' Diagnostic Skills, Dr. Robert Cantor, Dr. William Osler, Driving Up Healthcare Costs, Empowered Patients, General Medicine, Hands-On Diagnostic Skills, Hands-On Diagnostician, History and Physical, How To Talk To Your Doctor, Listening To Patients, Mind The Gap, Overtesting, Patient Empowerment, Patient Examination, Patient-Centered Medicine, Steven Wilkins MPH, Test-Centered Medicine, Too Many Tests, Too Much Testing, Unnecessary Risks, Why Doctors Should Listen
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We’ve all been there. It often starts with some kind of recurring pain or dull ache. We don’t know what’s causing the pain or ache. During the light of day we tell ourselves that it’s nothing. But at 3:00am when the pain wakes you, worry sets in: “Maybe I have cancer or heart disease or some other life-ending ailment.” The next day you make an appointment to see your doctor.
So now you’re sitting in the exam room explaining this scenario to your doctor. Based on your previous experience, what’s the first thing your doctor would do?
A. Order a battery of tests and schedule a follow-up appointment.
B. Put you in a patient gown and conduct a thorough physical examination, including asking you detailed questions about your complaint before ordering any tests.
If you answered “A,” you have a lot of company. A recent post by Robert Centor, M.D., reminded me of yet another disturbing trend in the doctor-patient interaction. The post, entitled “Many doctors order tests rather than do a history and physical,” talks about how physicians today rely more on technology for diagnosing patients than their own “hands-on” diagnostic skills — a good patient history and physical exam, for example.
Prior to the technology revolution in medicine over the last 20 years, physician training taught doctors how to diagnose patients using with a comprehensive history and physical exam. More physicians today are practicing “test-centered medicine rather than patient-centered medicine.” Medical schools focus on teaching doctors to “click as many buttons on the computer order set as we possibly can in order to cover every life-threatening diagnosis.” The problem is that medicine is still an imperfect science, and technology is not a good substitute for an experienced, hands-on diagnostician. Read more »
*This blog post was originally published at Mind The Gap*
January 18th, 2011 by PJSkerrett in Better Health Network, Health Tips
Tags: Acute Coronary Syndrome, Blood Clot, Blood Flow, Blood Pressure, Cardiology, Chest Pain, Cold Weather, Harvard Health Blog, Harvard Health Publications, Harvard Heart Letter, Harvard Medical School, Harvard University, Heart Attack, Heart Health, Myocardial Infarction, Outdoor Safety, PJ Skerrett, Safe Shoveling, Shortness of Breath, Snow Shoveling, Winter Safety
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After shoveling the heavy, 18-inch layer of snow that fell overnight on my sidewalk and driveway, my back hurt, my left shoulder ached, and I was tired. Was my body warning me I was having a heart attack, or were these just the aftermath of a morning spent toiling with a shovel? Now that I’m of an AARP age, it’s a question I shouldn’t ignore.
Snow shoveling is a known trigger for heart attacks. Emergency rooms in the snowbelt gear up for extra cases when enough of the white stuff has fallen to force folks out of their homes armed with shovels or snow blowers.
What’s the connection? Many people who shovel snow rarely exercise. Picking up a shovel and moving hundreds of pounds of snow, particularly after doing nothing physical for several months, can put a big strain on the heart. Pushing a heavy snowblower can do the same thing. Cold weather is another contributor because it can boost blood pressure, interrupt blood flow to part of the heart, and make blood more likely to form clots.
When a clot forms inside a coronary artery (a vessel that nourishes the heart), it can completely block blood flow to part of the heart. Cut off from their supply of life-sustaining oxygen and nutrients, heart muscle cells begin to shut down, and then die. This is what doctors call a myocardial infarction or acute coronary syndrome. The rest of us call it a heart attack.
The so-called classic signs of a heart attack are a squeezing pain in the chest, shortness of breath, pain that radiates up to the left shoulder and down the left arm, or a cold sweat. Other signs that are equally common include jaw pain, lower back pain, unexplained fatigue or nausea, and anxiety. Read more »
*This blog post was originally published at Harvard Health Blog*
January 17th, 2011 by Glenn Laffel, M.D., Ph.D. in Health Tips, Research
Tags: CA 125 Biomarker Testing, Dr. Glenn Laffel, Dr. Laura Havrilesky, Duke University Medical Center, Gynecology, Markov Model, National Institutes of Health, NIH, Oncology, Ovarian Cancer Mortality, Ovarian Cancer Prevention, Ovarian Cancer Screening, Pizaazz, Preventive Health, Preventive Medicine, Reproductive Health, Routine Ovarian Cancer Screening, Screening Tests, Transvaginal Ultrasound, Women's Health
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Cancer of the ovary is a particularly nasty disease. It often remains asymptomatic until it has reached an advanced, incurable stage, and scientists have been unable to develop an effective screening test for the disease like the ones in widespread use for cancers of the breast and cervix.
The dismal status of ovarian cancer screening was underscored a year ago when an NIH-sponsored study showed that over 70 percent of cancers detected by transvaginal ultrasound and CA 125 biomarker testing — the two best ovarian screening tests we’ve got — had reached stage III or IV at the time the patients screened positive. That’s about what happens when women aren’t screened at all.
That wasn’t the worst of it, however. In just the first year of that screening program, positive test results obligated 566 surgical procedures which uncovered only 18 cancers. That’s an awful lot of unnecessary surgery and associated morbidity right there. Things were no better on the false-negative side of things. Overall, 89 cases of ovarian cancer were diagnosed during the NIH study, and a third of them had been missed by both screening modalities.
What’s new?
The NIH study didn’t evaluate the impact of screening on ovarian cancer mortality, but a recent study by Laura Havrilesky and colleagues at Duke did indeed address the point. Sadly, the results were abysmal. Read more »
*This blog post was originally published at Pizaazz*
January 14th, 2011 by admin in Health Tips, News, Video
Tags: Accidental Overdose, Acetaminophen, APAP, Chronic Pain, Dr. Mary Lynn McPherson, Drug Safety, FDA, Food and Drug Administration, Liver Damage, Liver Failure, Liver Transplant, Medication Safety, Opioid Pain Relievers, Over-The-Counter Medications, Pain Medication, Pain Relievers, Painkillers, Patient Safety, Pharmacology, Pharmacotherapy, Prescription Pain Medication, Public Health, Regular-Strength Tylenol, Team-Based Patient Care, Uncontrolled Pain, University of Maryland, Your Pharmacist
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This is a guest post from Dr. Mary Lynn McPherson.
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FDA Restricts Acetaminophen In Popular Pain Medications
The Food and Drug Administration (FDA) made an announcement yesterday that affects one of the most common pain medications on the market, and as a consequence may affect countless numbers of the 75 million Americans who experience chronic pain (for perspective, that’s more than the number of people suffering from cancer, heart disease and diabetes combined.) The FDA has asked manufacturers of popular prescription pain medications like Vicodin or Percocet to limit the amount of acetaminophen (also known as Tylenol, or APAP) used in these drugs to no more than 325 milligrams per tablet — the equivalent of one regular-strength Tylenol tablet.
The move came because research has shown that acetaminophen can cause liver damage when taken in higher than recommended doses. The problem is that many over-the-counter medications ALSO contain acetaminophen, and patients may take one or more of these common products (like Tylenol) to reduce their fever or get rid of a headache along with their prescription pain relievers.
Before you know it, you could be taking more than the maximum daily dose of acetaminophen which is 4,000 milligrams. I go out of my way to advise people I work with of this warning, but not everyone takes time to talk to the pharmacist and not all pharmacists make themselves readily available. That is why it is critically important that you talk to your pharmacist to make sure that you are not taking more than this amount. The pharmacist is the last stop between you and medication misuse — you could be taking a medication that contains acetaminophen and not even know it. Read more »
January 13th, 2011 by RamonaBatesMD in Health Tips, Research
Tags: Archives of Dermatology, Dr. Joel Hillhouse, Dr. Ramona Bates, East Tennessee State University, Indoor Tanning, Maternal Influence, Mother-Daughter Relationship, Oncology, Personal Appearance, Preventive Health, Preventive Medicine, Skin Cancer Prevention, Skin Cancer Risk, Skin Damage, Suture For A Living, Tanning Beds, Teen Health, Teenage Girls, UV Rays, Young Women
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Not all maternal influence on daughter behavior is good. Take for example the influence of the unhealthy use of indoor tanning beds as presented in a recent Archives of Dermatology article (full reference below) which “investigated whether indoor tanning with one’s mother the first time would influence frequency of tanning later in life and whether it was associated with age of initiation.”
Joel Hillhouse, Ph.D., of East Tennessee State University-Johnson City and colleagues published a study the May 2010 issue of the Archives of Dermatology which looked at which health-based intervention worked best in reducing skin cancer risks. They found that “emphasizing the appearance-damaging effects of UV light, both indoor and outdoor, to young patients who are tanning is important no matter what their pathological tanning behavior status.”
For this study, Hillhouse and colleagues randomly selected a total of 800 female students who were then sent a screening questionnaire on their indoor tanning history. Those who reported ever indoor tanning (n = 252) were invited to participate in the study and offered an incentive ($5). A total of 227 (mean age, 21.33 years; age range, 18-30 years) agreed, signed informed consent documents, and completed assessments.
One of the questions asked who accompanied the participant the first time they indoor tanned (i.e. tanned alone, with friend, with mother, or other). Read more »
*This blog post was originally published at Suture for a Living*
