September 16th, 2010 by Mark Crislip, M.D. in Better Health Network, Opinion, Research
Tags: Accuracy in Diagnosis, CDC Criteria, Centers For Disease Control and Prevention, CFS, Chronic Fatigue Syndrome, Disease Patterns, DNA, Good Diagnosticians, Molecular Biochemistry, Post-Infectious Disease, Psychiatry and Psychology, Science Based Medicine, Xenotropic Murine Leukemia Virus-Related Virus, XMRV
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Humans love to find patterns in the world. Sometimes patterns exist, sometimes they are imaginary. Sometimes you can see a pattern that may be interesting and ignore its significance. As a resident I used to say that anyone who smokes three packs of cigarettes a day has to be schizophrenic. It was meant more as a joke when, in fact, it was later discovered that tobacco helps ameliorate the symptoms of schizophrenia. I need to pay more attention.
Part of my job is to look for patterns as a key to the patients diagnosis. Diseases and pathogens tend to (more or less) cause reproducible signs and symptoms and looking for that pattern is often the most helpful clue towards finding the diagnosis. Of course things are never as easy as one would like, as you have to consider whether you are seeing common manifestations of a common disease, uncommon manifestations of a common disease, common manifestations of a uncommon disease and, the hardest, uncommon manifestations of an uncommon disease. When I have a complex or uncertain cause, I explicitly run through that, and other, litanies so I do not miss a unusual diagnosis.
Chronic fatigue syndrome (CFS) has, at least to my way of thinking, two patterns. I see the occasional CFS patient in clinic and, I hope, pay attention to their disease patterns. I keep in mind I may be seeing a pattern that does not exist, but looking for disease patterns is what doctors are trained to do. Read more »
*This blog post was originally published at Science-Based Medicine*
September 15th, 2010 by RyanDuBosar in Better Health Network, Health Policy, News, Opinion
Tags: ACP Internist, ACP's "Running a Practice", Doctors' Debt, Doctors' Operating Expenses, Dr. Leslie Saltzman, General Medicine, Medical Student Loans, Medicine As A Business, New Doctors, Private Practice Medicine, Solo Practice, Women's Health
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Newly minted MDs face student loans the sizes of mortgages and might go 18 months without an income if they try to start up their own practice. And although in the words of one student, “Medicine shouldn’t be treated like a business,” physicians still have to operate their practices like one.
That’s resulted in one doctor facing a half-million in operating expenses every year in Manhattan. A half-dozen other new physicians describe their first years in practice in these two profiles, while a third details how Leslie Saltzman, ACP Member, took advantage of some resources on hand and guidance from ACP’s “Running a Practice” section to quickly grow her solo practice into a full-service resource for women’s health. (New York Post, Kaiser Health News, ACP Internist)
*This blog post was originally published at ACP Internist*
September 14th, 2010 by Shantanu Nundy, M.D. in Better Health Network, Health Tips, Opinion, Research
Tags: Archives of Internal Medicine, Diabetes, Dietetics, Food and Nutrition, Food Labels, Food Science, Food-Based Approach To Eating, Gary Taubes, General Medicine, Good Calories Bad Calories, Heart Disease, In Defense Of Food, JAMA, Journal of the American Medical Association, Michael Pollan, Nutrient-Based Approach To Food, Nutritional Facts, Obesity, The Science Of Nutrition
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The science of nutrition is changing and not in the way you might expect. After years of “reductionist” thinking — where food has been viewed as the sum of its parts -– a call to treat food as food has been sounded. No more poring over nutrition labels to calculate grams of fat or chasing down the latest go-to chemical –- be it vitamin E, fish oil or omega-3. Instead we are being asked to call a potato a potato and a piece of steak — well, a piece of steak.
If you haven’t heard about this sea change yet, you are not alone. The food science industry that markets “food products” for our consumption has done a good job giving their laboratory creations a semblance of health with phrases like “low fat” and “high in vitamin C.” For our part, the medical community is also to blame. Despite evidence to the contrary, we have been slow to renounce the “fat is bad” mantra or break away from the nutrient-based approach to eating that first swept the country over 30 years ago. Read more »
*This blog post was originally published at BeyondApples.Org*
September 13th, 2010 by DavidHarlow in Better Health Network, Health Policy, News, Opinion
Tags: General Medicine, Healthcare Competition, Healthcare reform, HHS, Hospital Referral Sources, Office of Inspector General, OIG, Pre-Authorizations, Referrals, U.S. Department of Health and Human Services
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The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services released an advisory opinion at the end of last month okaying a hospital’s proposal to provide insurance pre-authorization services free of charge to patients and physicians. This is an issue that has long vexed folks in the imaging world.
Clearly, this is a free service provided to referral sources (to the extent they are obligated by contract with third-party payors to obtain the pre-authorization before referring a patient for an MRI, for example), so why is the OIG okay with it? In their opinion, the OIG blesses the arrangement for four reasons. Read more »
*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*
September 13th, 2010 by Davis Liu, M.D. in Better Health Network, Health Tips, News, Opinion
Tags: Audi, Car Accident, Driver Safety, General Medicine, Motor Vehicle Accidents, Motor Vehicle Safety, New England Patriots, Physical Injury, Primary Care, Public Health, Tom Brady
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New England Patriots NFL quarterback Tom Brady was on his way to practice when he crashed into a minivan which allegedly ran a red light. His Audi S8 car T-boned the other vehicle a few blocks from his home. A relieved New England Patriots owner Bob Kraft noted after the accident:
“[Tom] arched and prepared himself and we’re just lucky with the glass and angles. We have a lot to be thankful for. It was really a miracle…We’re very, very lucky. Patriot Nation is lucky he had his seatbelt on.”
Was it simply luck or good car design and mechanical engineering? Crumple zones and the passenger cage of a car when built for maximum safety decrease injury. Yet, unfortunately, there is significant variability among safety in cars. Brady walked away from the accident for a variety of reasons.
As a future hall of fame quarterback, Brady has lightning fast reflexes when analyzing defensive blitzes and options when throwing the football. Quickly bracing himself for impact may have helped. Wearing a seatbelt definitely helped. What may have helped the most was the type of car he drove. Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
