If you haven’t seen this before, you must check out TBTAM’s photo of a man’s message to his wife (taped on the refrigerator). He had answered the phone and taken down this message for her…
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“Someone from the Gyna Colleges called. They said the Pabst beer is normal. I didn’t even know you liked beer.”
— Rick
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
I’ve been reading Mindy Roberts’ hilarious book: Mommy Confidential: Adventures From The Wonderbelly of Motherhood. I particularly enjoy the moments she captures about her son, Will. I thought I’d share some excerpts with you to give you a good chuckle:
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Today at Jake’s 6th birthday party, Will rushed up to me saying, “Mommy! There’s a dead squirrel over there! Hurry mommy, before he goes to heaven!”
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Will is obsessed with size differentials among animals and the relative strengths and weaknesses of each as they relate to other predators. He wants to know exactly how big everything is so that he can determine how many predators it takes to bring down each type of prey. Among the factors are: height, weight, speed, habitat, how far it can jump, whether it can rear up, whether it can swim, and how sharp the teeth are. Usually he wants to know if, say, 20 wolves can take on 10 tigers, but this morning’s question took the cake. “Daddy, can 10 monkeys take down a zebra?”
You can find Mindy’s book at her website.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
Have you ever been singled out in a lecture and picked on? Or maybe at a comedy club? It’s somehow awkward when everyone is looking at you, and you can’t really defend yourself. That happened to me yesterday in a lecture about how email can transform medical practices. My friend Joe Scherger was talking about the beauty of asynchronous communication, and how much time it saves – when out of the blue, he said that Blackberries defeated the whole purpose of emailing, and that people who used them lead unbalanced lives. He then pointed at me and said, “See my friend Val Jones, there? She uses a Blackberry all the time!”
All eyes fixed on me with a sort of half pity, half “tisk, tisk” expression.
“She answers all her emails within minutes… She never unplugs.”
I shrugged and smiled sheepishly. Soon the conversation turned to other subjects, and I resisted the urge to pull my Blackberry out of my bag to check my emails.
Today I heard that Intel instituted email-free Fridays as a means to force their engineers to talk to others face-to-face. Apparently, the company was worried that interpersonal skills were being lost, and that people were not developing normal working relationships because of the artificial distance created by email-only communication.
“Well, at least I’m not alone,” I thought as I read the news story. “This is a serious problem across the country.”
There has been recent debate in the psychiatric community about whether or not video games could be considered an addiction (just as drugs and alcohol can be). Some have proposed that it be added to the DSM-V due out in 2012, others have said that compulsive video game playing is a sign of other underlying pathology (such as depression or social anxiety) but not a true addiction.
But the bottom line is that overuse of the Internet can disrupt a person’s time available for meaningful interpersonal relationships, be they with a spouse, a parent, a relative, or a friend. When your husband is sitting in the same room with you and has to get your attention by IM-ing or emailing you, you know there’s a problem.
And there doesn’t seem to be much of a break in sight – with Facebook, MySpace, Linked-In, YouTube, Pownce, Twitter, GTalk, blogs, podcasts, discussion boards, chat rooms, forums, etc. available as 24-7 forms of entertainment and communication, and companies like Intel trying to forbid this kind of stuff at least 1 day per week, Blackberries are the least of our worries. I wonder if these programs are like junk food for the brain? Will we soon suffer from cerebral obesity?
I’m afraid that I recognize that there is a problem, but I’m not sure what the solution is. “Just say no” to email doesn’t work for me… I like the fast-paced interactivity and connection I get from these activities. Maybe there’s a positive feedback loop at work, though – we spend a lot of time involved in online activities and become more isolated and lonely in our personal lives. In the end we become more and more engaged with the Internet to fill the emotional gap that we’re actually creating by overusing it.
I’ll ask my husband what he thinks… perhaps I’ll send him an email about it tonight.
What do you think?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
Well, I had a great time at the Revolution Health booth at the AAFP meeting today. Hundreds of people stopped by for a chat and to get to know what Revolution Health is about. I handed out golf towels (well, they were little white hand towels that I used to give out as gym towels, but with the doctor audience I changed the pitch to golf. How cliche of me. Ha!) Some of the notable guests included:
Bob Rakel, MD – author of my most favorite medical textbook in the world: Saunders Manual of Medical Practice
David Rakel, MD – Bob’s son, and the author of my second most favorite medical textbook: Integrative Medicine
Len Fromer, MD – past president of the California Academy of Family Physicians. His wife is an actor – and we had a great chat about how we both miss New York City.
John Pfenninger, MD – author of the coolest book for outpatient medical procedures
Todd Dicus, JD – deputy executive VP of the AAFP and a really friendly lawyer.
Marianne Walters, MD – an urgent care physician in California who taught me that surfers’ wet suits are like Petri dishes for MRSA (a really nasty bacterium). Ew.
Allan Harmer, ThM – from the Christian Medical Association, who told me that the story of how he accidentally attended a medical conference about HIV and ended up involved in medical groups for the rest of his career (even with no previous medical training).
Joe Scherger, MD – the hardest working man on the Revolution Health expert team. He gave a lecture about how to use email and online help as an integral part of one’s medical practice – and the audience was riveted.
Tomorrow’s going to be fun, I can just tell. And the best part is that I can wear sneakers with my business suits – all the family physicians are doing it themselves! I’ve never seen more Birkenstocks in one place before… I think Michelle Au might have been right about family docs – see her cartoon.
See you tomorrow at Revolution Rounds.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
A dear friend of mine sent me a panicked, cryptic email late on a Friday night: “call me immediately” (followed by her cell phone). As a doctor, I usually know that these kinds of requests are triggered my medical emergencies, so I anxiously picked up the phone and called my friend, hoping that I wasn’t going to hear some alarming story about a tragic accident.
And low and behold the story was this: “I got home from work late and picked up the mail. There was a letter in there from the radiologist’s office. It said that my mammogram was abnormal. Do you think I have breast cancer? Am I going to die?”
Remaining calm, I asked what sort of abnormality was described. She read the letter to me over the phone:
“Dear [patient],
Your recent mammogram and/or breast ultrasound examination showed a finding that requires additional studies. This does not mean that you have cancer, but that an area needs further evaluation. Your doctor has received the report of your examination. Please call us at XXX to schedule the additional examinations.”
I knew immediately that this was a form letter (heck the letter didn’t even distinguish between whether or not my friend had had a mammogram or an ultrasound) and it made me angry that it had frightened her unnecessarily. I knew that as many as 40% of women who have mammograms have some sort of “finding” that requires further testing. Usually it’s because the films are too dark or too light, the breasts are particularly large or dense, or there is some cyst, calcification, lymph node, or shadow that the radiologist picks up. And in a litigious society, a hint of anything out of the ordinary must be reported as an abnormal “finding” until proven otherwise.
I did my very best to reassure my friend – to tell her that if the radiologist were truly concerned about what he or she saw on the mammogram s/he would have called the physician who ordered the test right away. Receiving a vague letter like this is reassuring, because it’s an indication of a low index of suspicion for a malignancy. I also told my friend that if a true mass were found on the mammogram, that a biopsy of that mass still has an 80% chance of being normal tissue.
But even though I did my very best to reassure her, my poor friend didn’t sleep well that night, and worried all weekend until she could speak to her physician on Monday. As I thought about her experience, and the unnecessary fright that she was given… I began to wonder about how common this experience must be. How many other women out there have lived through such anxiety?
Personally, I think that women who get mammograms should be warned up front that there is a high chance that the radiologist will find something “abnormal” on the test, and that these abnormalities usually turn out to be any number of typical breast characteristics. They should be told not to worry when they receive a letter about the abnormality, but come back for further testing in the rare event that the finding is concerning.
I decided to do a little research about this phenomenon (women receiving scary letters out of the blue about their mammogram results) and interviewed Dr. Iffath Hoskins (Senior Vice President, Chairman and Residency Director in the Department of Obstetrics and Gynecology at Lutheran Medical Center in Brooklyn, N.Y.) about her experiences.
Please listen to the audio file for the full conversation. I will summarize her opinions here:
Q: How common are abnormal mammograms?
Mammograms are considered “abnormal” in some way in up to 40% of cases.
Q: What sorts of things are picked up as abnormal without being true pathology?
Overlapping tissues in women with larger or heavier breasts, fibrocystic breast tissue, calcium deposits or the radiologist doesn’t have the last mammogram to compare the new one to and sees some potential densities.
Q: What happens next when a woman has an abnormal mammogram?
It may take a week or two for the patient to get scheduled for follow up tests. Usually the physician will choose to either repeat the mammogram with targeted views of the area in question, request a breast ultrasound, biopsy the mass, or remove the concerning portion of the breast tissue surgically.
Q: When would a physician choose a biopsy?
A biopsy is indicated if the mammogram and follow up tests all are consistent with the appearance of a concerning lesion. Sometimes the physician will do a biopsy on a lump if a woman says that it’s unusual, new, or tender and the mammogram result is equivocal.
Q: What percent of biopsies confirm a malignancy?
It varies from physician to physician because some have a lower threshold for performing biopsies (so therefore the percent of biopsies that are malignant is lower). But on average only 10% of biopsies pick up an actual cancer.
Q: What does a radiologist do when he or she finds an abnormality on a mammogram?
First of all, the patient must be notified of the abnormality. Secondly, the radiologist reports the abnormality to the referring physician, usually by fax. They do it either in batches, or one at a time. If the person reading the film has a serious concern about the breast tissue – or if it appears to have the characteristics of a malignancy, the radiologist will personally call the referring physician right away.
Q: What advice would you give to a woman who receives a letter in the mail indicating that she’s had an abnormal finding on her mammogram?
Please try not to be concerned yet. Wait for the doctor to fully evaluate the mammogram and do further testing before you make any assumptions about the diagnosis. Although it’s almost impossible not to feel anxious, you must understand that the vast majority of “abnormal findings” on a mammogram are NOT cancer.
Listen to the full interview here.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
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