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Twitter-Assisted Diagnosis

I have many reasons to use Twitter. One of them is that it’s quite easy to get feedback from doctors who also use Twitter for communication. Now one of my stories was featured in the New York Times.

Some people are even using Twitter for more urgent questions. Bertalan Meskó, a medical student at the University of Debrecen in Hungary, wrote a post about a patient with mysterious symptoms: “Strange case today in internal medicine rotation. 16 years old boy with acute pancreatitis (for the 6th! time). Any ideas?”

Within hours, specialists worldwide had responded, suggesting gallstones, lupus or growths on the pancreas. One of the suggestions helped the doctors with a diagnosis.

“It would have been impossible to find that specialist through e-mail, because we had no idea who to contact,” Mr. Meskó said.

*This blog post was originally published at ScienceRoll*

Drugs To Prevent Cancer? The NYT Misses The Devil In The Details

In yet another article addressing the war on cancer, The New York Times today tackles cancer prevention, focusing on alternative and mainstream Pharma products marketed to reduce the risk for cancer.

While author Gina Kolata seems to have done her homework when it comes to the failure of alternative medicine to prevent cancer, she has missed the story completely when it comes to telling why the medical profession and patients may have failed to embrace Big Pharma’s push to use their drugs to prevent breast and prostate cancer. Of course, that’s not surprising since almost exclusively, the experts she interviewed were those who conducted the clinical trials of these drugs. Read more »

*This blog post was originally published at The Blog that Ate Manhattan*

The President is Wrong About Second Opinions

The New York Times interviews President Obama about health care:

I’m a pretty well-educated layperson when it comes to medical care; I know how to ask good questions of my doctor.  But ultimately he is the guy with the medical degree.  So, if he tells me, You know what, you’ve got such-and-such, I don’t go around arguing with him or go online to see if I can find a better opinion than his.

It’s shockingly bad advice.

Numerous studies show that patients get the wrong diagnosis as much as 20% of the time, and get the wrong treatment half of the time.  Thirty-five percent of doctors and 42% of patients report errors in their own care or that of a family member.  Studies show that most errors happen because of a failure to analyze the patient’s problem correctly.  Experts, like Dr. Jerome Groopman from Harvard, say that doctors, strapped for time and dealing with complicated problems, easily fall prey to cognitive pitfalls that create poor quality.

Ask questions, be skeptical, disrupt your doctor’s thought process.  Make sure the decisions about your care are right.

Above all, remember it is you, the patient, that are in charge, not the “guy with the medical degree.”

(h/t @epatientDave via twitter)

*This blog post was originally published at See First Blog*

Unexpected Consequences: Wyeth Law Suit Could Limit Patient Access To Medications

Photo of Bert Rein

Bert Rein

On November 3, 2008 the US Supreme Court will hear opening arguments in the Wyeth vs. Levine case. This highly publicized lawsuit has been discussed by the New York Times and the Journal of the American Medical Association and will likely be the most important case during the upcoming Supreme Court term. However, neither source has fully explained the unexpected consequences to the consumer if Wyeth loses.

To get to the bottom of the issue, I interviewed Bert Rein, attorney for Wyeth. Bert has conducted interviews with NPR and the three major TV news networks. Please enjoy this exclusive podcast interview here at Getting Better with Dr. Val, or read my summary of our conversation below.

Dr.Val: Bert, please summarize for our listeners what has happened so far in the Wyeth vs. Levine case.

Rein: Ms. Levine is a guitarist who suffers from migraine headaches and associated nausea. One day she sought pain management therapy at a clinic in northeast Vermont – the same clinic where she regularly received care.  They elected to treat her with a combination of demerol (for pain) and phenergan (for nausea). They delivered the drugs intramuscularly, but several hours later Ms. Levine returned, complaining of an unrelieved migraine headache.

The clinic’s physician realized that the drugs would be more potent if they were injected intra-venously so he asked the PA (physician assistant) to give another dose of the drugs through Ms. Levine’s vein. Unfortunately, the PA inserted a butterfly needle (rather than the usual heplock for an IV) into what she thought was Ms. Levine’s vein, and delivered the phenergan into or near a punctured artery. Phenergan’s label clearly states that the drug can cause tissue necrosis if it comes in contact with arterial blood. Ms. Levine experienced a necrotic reaction to the medication which resulted in the eventual amputation of her arm. She sued the clinic for negligence and was awarded $700,000 dollars in a cash settlement.

Ms. Levine then brought a separate lawsuit against Wyeth, claiming that the phenergan label did not offer sufficient instructions about how to administer it safely, though the risks of necrosis from arterial blood exposure to phenergan are well known and labeled in capital letters as a warning on the drug’s label. Read more »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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