March 16th, 2011 by Davis Liu, M.D. in Health Tips, Opinion
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Colon cancer screening has a particular personal interest for me — one of my colleagues in residency training had her father die of colon cancer when she was a teenager.
No one should lose a loved one to a disease that, when caught early, is often treatable. But for both men and women, colon cancer is the third most common cancer behind lung cancer and prostate cancer in men, and behind lung cancer and breast cancer in women, it’s the second most lethal.
The problem is that patients are often confused about which test is the right one. Is it simply a stool test? Flexible sigmoidoscopy? Colonoscopy? Virtual colonoscopy? Isn’t there just a blood test that can be done? (No.)
In simple terms, this is what you need to know:
All men and women age 50 and older should be screened for colon cancer. Even if you feel healthy and well and have no family history, it must be done. Note that Oprah’s doctor, Dr. Oz, arguably a very health-conscious individual learned that he had a colon polyp at age 50 after a screening test. Left undetected, it could have cut his life short. This wake-up call caused him to abort his original second season premier on weight loss and instead show the country why colon cancer screening matters. He admitted that if it wasn’t for the show and the need to demonstrate the importance of screening to America, he would have delayed having any test done.
The least invasive test is a stool test. If it is to screen for colon cancer, then the test is done at home and NOT in the doctor’s office. Either the fecal occult blood test (FOBT) or the fecal immunochemical test (FIT) are available to screen for unseen microscopic blood that could be a sign of a colon polyp or cancer. Research shows that when a stool test is done annually, the risk of dying from colon cancer can fall by 15 to 33 percent. If you don’t want any fiber optic cameras in your rectum and lower colon, this is the test for you. You must do it annually.
The next two tests are similar but often confused: The flexible sigmoidoscopy and the colonoscopy. Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
March 10th, 2011 by Shantanu Nundy, M.D. in Health Tips, Research
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What is the leading cause of death in the United States? Heart disease? Cancer? No, it’s smoking. Smoking? Yes, depending on how you ask the question.
In the early 90s, McGinnis and Foege turned the age-old question of what people die of on its head by asking not what diseases people die of but rather what the causes of these are. Instead of chalking up the death of an older man to say lung cancer, they sought to understand the proximate cause of death, which in the case of lung cancer is largely smoking. Using published data, the researchers performed a simple but profound calculation — they multiplied the mortality rates of leading diseases by the cause-attributable fraction, that proportion of a disease that can be attributed to a particular cause (for example, in lung cancer 90 percent of deaths in men and 80 percent of deaths in women are attributable to smoking). Published in JAMA in 1993, their landmark study became a call to action for the public health community.
When looked at the conventional way, using data from the 2004 update of the original study, heart disease, cancer, and stroke are the leading causes of death, respectively. This accounting may help us understand the nation’s burden of illness, but does little to tell us how to prevent these diseases and improve health. Through the lens of McGinnis and Foege we get the actual causes of death (e.g., the major external modifiable factors that contribute to death). This analysis shows that the number one cause of death in America is tobacco use, followed closely by poor diet and lack of physical activity, and then alcohol consumption. Read more »
*This blog post was originally published at BeyondApples.Org*
March 6th, 2011 by Edwin Leap, M.D. in Opinion, True Stories
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Here’s my column in the March issue of Emergency Medicine News.
Second Opinion: Be Smarter Than Your Brain
“Everyone is a drug seeker. Why does everyone want to be on disability? I’m so tired of lies. Great, another lousy shift. I wonder who will die tonight? I’m so sick of suffering. I’m so weary of misery and loss. I hope this never happens to my family. I’ll probably get sued. Being sued nearly drove me crazy. This job never gets easier, only harder. I have to find something else to do; I can’t go on this way. I think I’m going crazy. I don’t have any more compassion. People hate me now.”
These are only a few of the wonderful thoughts that float through the minds of emergency physicians these days. Sure, not every physician has them. But I know our specialty, I know our colleagues, I hear from doctors around the country and I see that fear, frustration and anxiety are common themes.
Older physicians fantasize about career changes, and younger ones are often blind-sided by the hard realities of practice outside of their training programs (where their work-hours and staffing do not necessarily reflect the world beyond).
We are crushed by regulations and overwhelmed by holding patients, often put in situations where we are set squarely between the devil and the deep blue sea. “Spend more time with your patients; see them faster. Don’t let the ‘psychiatric hold’ patient escape; why are you using so much staff on psychiatric patients? See chest pain immediately; why didn’t you see the board member’s ankle injury as fast as the chest pain?”
In all of this mess of emergency medicine, we often find ourselves frustrated and bitter. But is it only because of our situations? They are admittedly daunting. But is our unhappiness merely the result of the things imposed on us? Or could it be more complex than that? Lately, I have come to wonder if our thoughts are perhaps worse enemies than even lawsuits, regulations, or satisfaction scores. Read more »
*This blog post was originally published at edwinleap.com*
March 4th, 2011 by Bryan Vartabedian, M.D. in Opinion, True Stories
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This week a reporter cornered me on the issue of professional behavior in the social space. How is it defined? I didn’t have an answer. But it’s something that I think about.
Perhaps there isn’t much to think about. As a “representative” of my hospital and a physician to the children in my community, how I behave in public isn’t any different than a decade ago. Social media is just another public space. Sometimes it’s easy to forget that we’re in public. When I’m wrapped up in a Twitter thread it’s easy to forget that the world is watching. But the solution is simple: Always remember that the world is watching.
On Twitter I think and behave as I do in public: Very much myself but considerate of those around me. I always think about how I might be perceived.
Here’s a better question, online or off: What is professional behavior? I have a pediatrician friend who, along with the rest of his staff, wears polo shirts and khaki shorts in the summer. The kids love it. One of my buttoned-down colleagues suggested that this type of dress is “unprofessional.” Or take a handful of physicians and ask them to review a year of my blog posts and my Twitter feed. I can assure you that some will identify elements that they find “unprofessional.” I believe I keep things above board.
This is all so subjective.
The reporter was also interested in how I separate my professional and personal identities in the online space. I’m not sure the two can be properly divided. The line is increasingly smudged. I try to keep Facebook as something of a personal space. I think it was Charlene Li who suggested that she only “friends” people she knows well enough to have over for dinner. That’s evolving as my rule as well. But independent of how I define “well enough,” Facebook is still a public space. My comments and photos can be copied to just about anywhere.
Social media has not forced the need for new standards of physician conduct. We just need to be smarter than we were before. Everyone’s watching.
*This blog post was originally published at 33 Charts*
March 3rd, 2011 by StevenWilkinsMPH in Opinion, True Stories
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We hear about stories like this all time: An elderly person falls and breaks something — a hip, a wrist, or an arm. Soon what once was a healthy, independent senior begins an inexorable downhill slide. Such is the case of my 89-year-old mother who recently fell and broke her wrist.
Turns out that 30 percent of people age 65 and older fall each year. Predictably, seniors with the following risk factors are more prone to falls:
- Using sedatives
- Cognitive impairment
- Problems walking
- Urinary tract infection
- Eye problems
- Balance issues
Similarly, when a person does fall, a cascading series of predictable clinical events occurs. It even has a name: “Post-fall syndrome.” This syndrome is characterized by things like fear of falling again, increased immobility, loss of muscle and control, lack of sleep, nutritional deficits, and so on. Seniors susceptible to falls also have higher rates of hospitalization and institutionalization.
What strikes me about falls among the elderly is that they are seemingly predictable events. And once a fall does occur, the consequences seem pretty predictable as well — enter post-fall syndrome. So if falls and their consequences are so predictable, why aren’t primary care physicians more proactive in terms of:
- Preventing falls?
- Treating post-fall syndrome?
In the case of my mother, her primary care physician and orthopedist were both very diligent at treating her episodic needs (i.e. her pain and broken bones). But little attention, if any, was given to assessing her long-term needs, such as nutrition, inability to do anything with her left hand (she’s left-handed), sensitivity to new medications (she never took drugs because they make her loopy), gait analysis, and depression counseling. Read more »
*This blog post was originally published at Mind The Gap*
