September 29th, 2010 by Lucy Hornstein, M.D. in Better Health Network, Health Policy, Health Tips, News, Opinion, Quackery Exposed, Research
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There’s been a movement afoot for several years now to quantify pain as the so-called “Fifth Vital Sign.” It all started as a well-intentioned effort to raise the level of awareness of inadequate pain control in many patients, but has gotten way out of hand. The problem is that the word “sign” has a specific meaning in medicine that, by definition, cannot be applied to pain.
When you hear us medicos talk about “signs and symptoms” of a disease, it turns out that they are not the same thing. “Symptoms” are things the patient experiences subjectively. “Signs” are things that can be observed objectively by another person.
Headache is a symptom; cough is a sign. Itching is a symptom; scratch marks over a blistery linear rash are a sign. Vertigo, the hallucination of movement, is a symptom; nystagmus, the eye twitching that goes with inner ear abnormalities that can cause vertigo, is a sign. If someone other than the patient can’t see, hear, palpate, percuss, or measure it, it’s a symptom. Anything that can be perceived by someone else is a sign. Read more »
*This blog post was originally published at Musings of a Dinosaur*
August 16th, 2010 by KevinMD in Better Health Network, Health Policy, Opinion
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I’ve written previously that many doctors are finding the physical exam obsolete, and are favoring more technologically-advanced, and expensive, tests. In fact, I alluded to traditional physical exam advocates as “arguing for staying with a horse and buggy when cars are rapidly becoming available.”
In a recent piece from the New York Times, internist Danielle Ofri says we need to look past the lack of evidence supporting the physical exam. The benefits of touching the patient, and listening to his heart and lungs, cannot be quantitatively measured:
Does the physical exam serve any other purpose? The doctor-patient relationship is fundamentally different from, say, the accountant-client relationship. The laying on of hands sets medical practitioners apart from their counterparts in the business world. Despite the inroads of evidence-based medicine, M.R.I.s, angiograms and PET scanners, there is clearly something special, perhaps even healing, about touch. There is a warmth of connection that supersedes anything intellectual, and that connection goes both ways in the doctor-patient relationship.
Great point. Read more »
*This blog post was originally published at KevinMD.com*
August 14th, 2010 by DrRob in Better Health Network, Humor
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Dear American Academy of Pediatrics,
I think there is a mistake. Kids have recently started coming into the office with forms for sports physicals, and the form is different. See below:
Someone added stuff to the form! Not only do we have to continue the inexplicable obsession with the hernia check (for maximum humiliation of boys, we try to use only female examiners for this), there’s a bunch of new stuff. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
August 6th, 2010 by DrRob in Better Health Network, Humor, Medical Art, Opinion
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It’s time we get away from all of the serious nonsense and back to something I am far more comfortable with: Taking otherwise-useful information and twisting it into utter nonsense. Yes, it’s time to journey back to the wonderful world of the physical exam.
My ongoing mission is to explore the human body from my unique (albeit moderately unstable) perspective. For an overview of my previous posts on the physical exam see this post which features Dick Chaney on a Segway (reason enough to click on the link). Please visit a psychiatry blog to aid in recovery once you have done so.
My most recent post in this fine series covered the topic of psychics and about the examination of the hand. It was mainly about psychics examining the hand, but I did slip in a little doctor stuff to keep the cops off of me. But then I got a call from the department of homeland security and they said that if I didn’t shape up, I’d no longer be able to use the picture of Dick Cheney on the Segway. It’s hard to resist such harsh tactics. Read more »
*This blog post was originally published at Musings of a Distractible Mind*
June 22nd, 2010 by Davis Liu, M.D. in Better Health Network, Health Policy, News, Opinion
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Boston Celtics basketball player Kendrick Perkins injured his knee during the NBA Finals against the Lakers when he landed awkwardly. Unable to weightbear, he left Game 6 not to return for the following pivotal Game 7.
Based on his mechanism of injury and his physical examination, his trainer reported that he tore his medial collateral ligament (MCL) as well as the posterior cruciate ligament (PCL). More amazingly, this was done without the help of a MRI. Since Perkins was unable to play the final game, there was no urgent medical need to expedite the test, as regardless of the result his season was already done.
How do doctors know what’s wrong without X-ray vision or an imaging test? (Note that Perkins did get a X-ray, but X-rays generally don’t show ligament injuries.) Is it guessing? Read more »
*This blog post was originally published at Saving Money and Surviving the Healthcare Crisis*
