August 14th, 2011 by ChristopherChangMD in Health Tips, Opinion
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I was informed about this interesting concept on ABC news…
With many aging baby boomers tapping into cosmetic surgery in order to look younger, some are taking it a step further to “sound” younger as well with a “voice lift”.
For some, it’s not right to look 10-20 years younger after a facelift but still sound like 70 years old.
A hoarse voice with aging is not unusual, but a surgical “voice-lift” is not necessarily the first step that should be taken.
First things first… Read more »
*This blog post was originally published at Fauquier ENT Blog*
April 19th, 2011 by Harriet Hall, M.D. in Opinion
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Before we had EBM (evidence-based medicine) we had another kind of EBM: experience-based medicine. Mark Crislip has said that the three most dangerous words in medicine are “In my experience.” I agree wholeheartedly. On the other hand, it would be a mistake to discount experience entirely. Dynamite is dangerous too, but when handled with proper safety precautions it can be very useful in mining, road-building, and other endeavors.
When I was in med school, the professor would say “In my experience, drug A works better than drug B.” and we would take careful notes, follow his lead, and prescribe drug A unquestioningly. That is no longer acceptable. Today we ask for controlled studies that objectively compare drug A to drug B. That doesn’t mean the professor’s observations were entirely useless: experience, like anecdotes, can draw attention to things that are worth evaluating with the scientific method.
We don’t always have the pertinent scientific studies needed to make a clinical decision. When there is no hard evidence, a clinician’s experience may be all we have to go on. Knowing that a patient with disease X got better following treatment Y is a step above having no knowledge at all about X or Y. A small step, but arguably better than no step at all.
Experience is valuable in other ways. First, there’s the “been there, done that” phenomenon. Older doctors have seen more: they may recognize a diagnosis that less experienced doctors simply have never encountered. My dermatology professor in med school told us about a patient who had stumped him: she had an unusual dermatitis of her hands that was worst on her thumb and index finger. His father, also a doctor, asked her if she had geraniums at home. She did. She had been plucking off the dead leaves and was reacting to a chemical in the leaves. The older doctor had seen it before; his son hadn’t. Read more »
*This blog post was originally published at Science-Based Medicine*
April 14th, 2011 by DrWes in True Stories
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It was 11:00 pm when the pager vibrated, then beeped: it was the ER, Hospital #3.
“This is Dr. Fisher returning your page?”
“Thank you Dr. Fisher, just a moment for Dr. Frigamafratz.”
A brief pause, then:
“Wes, I think we’ll need your services. Old guy, found down at the nursing home, brought in unconscious, pulse 25 – hooked him up to an external pacer, he’s back with us now.”
“I’m on my way.”
When I arrived, there was the usual cacophony of activity in the Emergency Room. Someone screaming in one corner. Intercom sounding. Ambulance en route to our location. Breathing treatments underway in Bay 5. Room 10 headed to the CT scanner. Has room 12 got a bed? By comparison my patient was easy: his disposition in the eyes of the ER staff had been made: he was on the Express Track to the EP lab.
There he was, chest twitching. Big forceful jerking. He was a big guy, uttering something with purpose but impossible to understand. Next to him, his wife, just arriving and removing her coat. “Is he going to be okay?”
My head scrambled for an answer. “He’s okay for now,” I think I replied. Read more »
*This blog post was originally published at Dr. Wes*
January 23rd, 2011 by admin in Opinion, True Stories
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This is a guest post by Dr. John Schumann.
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In 2011, the first wave of baby boomers will turn 65 years old. Sixty-five still has currency because that’s the age at which non-disabled Americans are eligible to be covered under the Medicare program (now itself having reached middle age).
As our economy continues to recover (hopefully) from the Great Recession, the entrance of millions of Americans to the Medicare rolls over the next decade and a half will be a formidable planning challenge. Look at this chart to see how the baby boomers population has surged:
So is the promise of healthcare reform (the “PPACA“), which will enlarge Medicaid by an additional 16 million Americans — about half of the projected growth in coverage for those currently uninsured.
A couple of recent patient encounters got me thinking about these phenomena, and how we are very much in historically uncharted territory. Never have we had so many living so well for so long. We have an entire generation of people reaching “seniority” who will continue to want the most out of life, without many guideposts on how to achieve it. Read more »
*This blog post was originally published at ACP Internist*
December 26th, 2010 by Elaine Schattner, M.D. in Better Health Network, News, Opinion, Research
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This evening, when I finished cleaning up the kitchen after our family dinner, I glanced at the current issue of the Economist. The cover features this headline: the Joy of Growing Old (or why life begins at 46). It’s a light read, as this so-influential magazine goes, but nice to contemplate if you’re, say, 50 years old and wondering about the future.
The article’s thesis is this: Although as people move towards old age they lose things they treasure — vitality, mental sharpness and looks — they also gain what people spend their lives pursuing: Happiness.
Fig. 1 (above): “A snapshot of the age distribution of psychological well-being in the United States,” Stone, et al: PNAS, May 2010 (y-axis: “WB” stands for well-being.)
Young adults are generally cheerful, according to the Economist’s mysterious author or authors. Things go downhill until midlife, and then they pick up again. There’s a long discussion in the article on possible reasons for the U-shaped curve of self-reported well-being. Most plausible among the explanations offered, which might be kind of sad except that in reality (as opposed to ideals) I think it’s generally a good thing, is the “death of ambition, birth of acceptance.” The concept is explained: “Maybe people come to accept their strengths and weaknesses, give up hoping to become chief executive or have a picture shown in the royal Academy…” And this yields contentedness. Read more »
*This blog post was originally published at Medical Lessons*
I was informed about this interesting concept on ABC news…
