June 28th, 2011 by Dr. Val Jones in Opinion
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I’ve often heard physicians say that “the history is 90% of the diagnosis.” In other words, they can usually determine the underlying cause of a patient’s problem just by listening to their account of how it evolved. The physical exam is merely to confirm the diagnosis, and is often cursory, limited, or ignored.
I believe that the physical exam is far more important than it seems – and I learned this during my recent oral medical specialty board examination. Although I have been sworn to secrecy regarding the content of the test questions, I will share an epiphany that I had during the exam.
The examiners’ job is to describe a patient and then ask the examinee what else she’d like to know and what she’d do next. With each description, I found myself struggling to visualize the patient – wishing I could see their face and hear their tone of their voice as they described their condition. I hadn’t realized that so much of my clinical judgement was based on laying eyes on a patient – I needed to see if they were in pain, if they were straining to breathe, if their skin was pasty or pale, if they were disconnected and potentially drug-seeking, if they were fidgety, if they were articulate, forgetful, or well-groomed. All of these subtle cues were gone. I was left staring at the examiner – who himself couldn’t describe the patient more fully because he was to stick to the script, reading verbatim from a prepared list of signs and symptoms. Read more »
June 28th, 2011 by Berci in News, True Stories
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I’ve recently come across a really controversial story about a cancer patient who blogged and complained about his hospital treatment and has been threatened with legal action by an NHS trust.
Daniel Sencier was worried about delays at Carlisle’s Cumberland Infirmary and had surgery at another hospital. He complained to North Cumbria University Hospital Trust and it came up with an action plan to improve care.
But Mr Sencier, 59, of Penrith, then received a letter threatening legal action. The trust declined to comment.
Mr Sencier, a photography student, had expected an apology but then received a letter saying the trust would consider legal action if his blog contained “unsubstantiated criticism”.
*This blog post was originally published at ScienceRoll*
June 28th, 2011 by Lucy Hornstein, M.D. in True Stories
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I don’t always practice what I preach. Regular mammograms, for instance. Last year I realized I had skipped a few, so I decided to turn my procrastination into an opportunity to reach out to those of my patients guilty of the same thing.
I made arrangements with my hospital to monopolize half their schedule one Saturday morning, put flyers up in my office and talked it up like crazy to every eligible woman I saw. On the appointed day, I brought a whole bunch of bagels, half a dozen spreads (I asked the ladies to bring their own coffee), and we proceeded to have a blast! Or as much fun as you can have getting your boobs squished. Hey; it’s all in the name of early detection.
Last year’s final tally was a bakers dozen (twelve patients plus me), out of which about 5 people were called back for more views (mainly those with old films not readily available from other institutions), 2 benign biopsies were done, and one case of invasive breast cancer was diagnosed and treated. Not bad, I thought. Read more »
*This blog post was originally published at Musings of a Dinosaur*
June 28th, 2011 by Happy Hospitalist in Humor, Opinion
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You ever wonder what doctors really think but are afraid to say out loud? Here’s one example:
“I wish all my patients were on a ventilator”
There’s a reason vented and sedated patients are considered desirable. In addition to the obvious economic benefits of
There are the less talked about, but equally pleasant side effects most hospitalists, ER doctors, cardiologists, gastroenterologists, pulmonologists, surgeons, infectious disease doctors, endocrinologists, psychiatrists, rheumatologists, dermatologists, nurses, respiratory therapists and physical therapists wouldn’t admit, but would agree, without hesitation. As a general rule:
- Patients on ventilators are just faster, easier and more pleasant to take care of. Read more »
*This blog post was originally published at The Happy Hospitalist*
June 28th, 2011 by ThomasFriedenMD in Health Policy, Health Tips
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Note: Yesterday President Obama issued a statement on National HIV Testing Day
Thirty years ago, at the beginning of the HIV/AIDS epidemic, there was no test for HIV, the virus that causes AIDS. For many, there was only the long and worrisome wait for the signs of infection. Once those signs appeared, no treatment for the virus was available. I personally cared for many, many patients in this era, and I am thankful that those days are over. Today, HIV testing is accurate, widely available, and often free—and treatment can help people living with HIV enjoy long, healthy lives, especially when they get diagnosed early.
The good news is that more people are being tested for HIV than ever before. It is estimated that almost 83 million American adults between 18 and 64 have been tested for HIV, as of 2009. That’s an increase of more than 11 million from 2006 when the Centers for Disease Control and Prevention (CDC) recommended that HIV testing become a routine part of medical care for adults and adolescents.
However, more than half of American adults still have never taken an HIV test. That’s why we need to spread that message that HIV testing saves lives and why Read more »
*This blog post was originally published at Centers for Disease Control and Prevention (CDC)*
