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How Psychiatrists Approach Wrist-Cutting Cries For Help

When Roy and I were on Talk of the Nation this past week, a called phoned in to ask about her sister. The question was about care in the Emergency Room/Department, so it was a perfect Roy question and he fielded it. I’ve been playing with it since, and wanted to talk more about this particular scenario, because the scenario was very common, and the question was more complicated than it seems.

From the transcript of the show:

ANN (Caller): Hi, thank you very much. I would like to ask Dr. Roy (oh, I gave him his blog name here) a question: My sister was admitted to emergency when she cut her wrists, and the doctor on call pulled me aside and said, do you think she was trying to kill herself?

And I said – because my sister is very intelligent – I said, if my sister really wanted to kill herself, she would have done it. I think she’s asking for help.

And so he said – and so he had her see the psychiatrist who was on call, or on duty. And she spoke with him for a while. And he sent her home, saying: Well, if you need me, I’m here.

What I would like to ask Dr. Roy is, what protocol was going on there? Why did they allow that to happen? And what would you change, if you could? Read more »

*This blog post was originally published at Shrink Rap*

You’ve Heard Of Kidney Stones, But Did You Know You Could Get A Salivary Gland Stone?

The Doctors TV show actually produced a great (and accurate) segment on a relatively new procedure called sialendoscopy. This procedure allows a surgeon to remove a stone that may be blocking your spit gland from draining saliva into the mouth. This is analogous to a kidney stone which blocks urine from draining from the kidney into the bladder resulting in painful swelling of the kidney (causing flank pain).

How does a person know if they have a salivary gland blockage due to a stone? There is a painful swelling located right in front and/or below the ear if the parotid gland is affected, or under the jawbone if the submandibular gland is blocked.


If the blockage persists long enough, it may lead to an infection of the gland itself (sialadenitis). Read more »

*This blog post was originally published at Fauquier ENT Blog*

How A Gynecologist Thinks About Lung Cancer

Out of the Shadows: Women and Lung CancerA new report on lung cancer in women has been published by the Women’s Health Policy and Advocacy Program at Brigham and Women’s Hospital.

Called “Out of the Shadows,” the report seeks to raise awareness about lung cancer, currently the leading cause of cancer death in women, and more importantly, to increase funding for research for its prevention, detection and treatment. (Thanks to Booster Shots, the LA Times‘ fabulous health blog, for highlighting the report.) I encourage you to read the report, which is well written and comprehensive. Read more »

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

The Mammogram Debate: Two Doctors Discuss Why It’s So Complicated

Dr. Avrum Bluming is a medical oncologist and clinical professor of medicine at the University of Southern California. He is also a dear friend, scientist, and careful analyzer of data. I asked him to help me understand the current mammogram guidelines debate, and what women (now faced with conflicting recommendations) should do about breast cancer screening. Please listen to his fascinating discussion captured here:

[audio:https://getbetterhealth.com/wp-content/uploads/2009/11/mammogrambluming.mp3]

What I learned is that the guidelines must be tailored to each woman’s unique situation. The variables that must be considered are incredibly complex, as breast cancer risk factors include everything from when and if one has given birth, to a history of smoking, drinking, overweight, breast cancer in the family and even the age of your parents when you were born. Beyond risk factors, new research suggests that some breast cancers spontaneously resolve without treatment, but our technology is not advanced enough to distinguish those from others that will go on to become life-threatening tumors – so we treat all cancers the same. Read more »

Man Dies Of Internal Bleeding After Rattlesnake Bites His Finger

In a recent issue of Wilderness & Environmental Medicine (Volume 20, Number 2, 2009), Anne-Michelle Ruha and Steven Curry have written an article entitled “Recombinant Factor VIIa for Treatment of Gastrointestinal Hemorrhage Following Rattlesnake Envenomation.” This is a “case report,” meaning that this is a description of a particular medical event, rather than a study.

To open the piece, the authors observe that North American rattlesnakes possess venom with properties that can cause severe physiological effects, such as low platelet count and, on occasion. bleeding. In this report, we learn about a 44 year old man who was bitten on the index finger by an unidentified (unknown for this case) species of rattlesnake. The victim developed massive gastrointestinal bleeding that was treated eventually with a product known as recombinant factor VIIa. His initial clinical presentation included an altered level of consciousness, profoundly low blood pressure (shock), sweating, and vomiting of bright red blood. Read more »

This post, Man Dies Of Internal Bleeding After Rattlesnake Bites His Finger, was originally published on Healthine.com by Paul Auerbach, M.D..

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

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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?

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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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