MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'being a doctor'. Sat, 03 Sep 2011 02:48:11 +0100 http://www.medworm.com/index.php?rid=4281311&cid=t_100416_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-a-doctor-is-spent%2F2010.12.22 “I need you to do me a favor,” my nurse asked me at the end of our day on Friday. “Sure,” I answered. “What do you want?” “Please have a better week next week,” she said with a pained expression. “I don’t think I can handle another one like this week.” It was a bad week. There was cancer, there was anxiety, there were family fights, there were very sick children. It’s not that it’s unusual to see tough things (I am a doctor), but the grouping of them had all of us trudging home drained of energy. Spent. I think this is one of the toughest thing about being a doctor (and nurse, by my nurse’s question): The spending of emotional reserves. I’m not physically active at work, yet I come home tired. I don’t have to be busy to feel drained. It’s not the pati... Better Health blogs http://www.medworm.com/rss/comments.php?id=4281311 Wed, 22 Dec 2010 23:00:40 +0100 4281311 http://www.medworm.com/index.php?rid=4175694&cid=t_100416_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdr-patient-doctors-and-self-care%2F2010.11.17 I did a little “self care” earlier this week. I did it by not caring for myself. I went to the doctor. I was sitting in the waiting area for my appointment and saw the mother of one of my patients. “Why are you here?” she asked. “I have a doctor’s appointment,” I replied. She got a curious look on her face, asking: “Don’t you doctors just take care of yourselves? I thought that was what doctors did.” We do take care of ourselves. In fact, we do it far more often than we should. Being your own doctor allows for a lot of denial. When you spend your day advocating healthy lifestyles after you had trouble finding pants that would fit in the morning, denial is necessary. “Do as I say, not as I do.” I realize that this is hypocrisy — that is why I was ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4175694 Wed, 17 Nov 2010 19:00:34 +0100 4175694 http://www.medworm.com/index.php?rid=3033589&cid=t_100416_88_f&fid=34729&url=http%3A%2F%2Fallscrubbedup.blogspot.com%2F2009%2F11%2Faustralian-doctors.html Recently reported by The Daily Maverick...The Australian Medical Association ran an advertisement in newspapers offering a bounty of A$3,000 (just over R20,000) to anyone who persuades a foreign doctor to work in that country.We're short 2500 doctors in this bloody country. Oz should leave ours alone! (Source: All Scrubbed Up) All Scrubbed Up blogs http://www.medworm.com/rss/comments.php?id=3033589 Thu, 26 Nov 2009 16:55:00 +0100 3033589 http://www.medworm.com/index.php?rid=2943788&cid=t_100416_88_f&fid=34729&url=http%3A%2F%2Fallscrubbedup.blogspot.com%2F2009%2F10%2Fyour-medical-records-belong-to-you.html I've been engaging a lot recently with the notion of an electronic health record. For those of you who don't know, this is usually an online version of collated data to do with your health. Simply - your pathology, your doc notes, all the hospital visits, illnesses and drug usage are kept in one secure place. You can access it and most of the time, so can a healthcare provider.For those of you that are not in tune with the medical world - this is something you have to know about as it is the backbone of the Obama administration. By having an electronic health record, there is a saving on administration as well as all the good things a centralised database brings. eg. Less duplication of tests and better management of healthcare.Discovery Health in South Africa is launching one next year. I... All Scrubbed Up blogs http://www.medworm.com/rss/comments.php?id=2943788 Fri, 30 Oct 2009 06:44:00 +0100 2943788 http://www.medworm.com/index.php?rid=2113354&cid=t_100416_88_f&fid=34729&url=http%3A%2F%2Fallscrubbedup.blogspot.com%2F2009%2F01%2Fmedical-quackery-cyberchondriacs.html Stumbled across an old, but interesting post. Excerpt below:"Experts warn there is a great deal of false and misleading information on the Internet. That’s true – I learned the hard way that eating a bucket of chocolate pudding doesn’t alleviate a headache. But, for me, the outright quackery was far less damaging than the cold, hard, accurate facts. There is no more devastating statistic than a Survival Rate. That number rattles around your brain like it’s the solution to an equation that could save your life. You massage it, you toy with it… “If 75.2% survive, that means 24.8% don’t… and if 24.8% don’t that means almost 1 in 4…” There’s no better, darker way to learn math."All to often in practice you get patients who come in and tell YOU what they have. They Googl... All Scrubbed Up blogs http://www.medworm.com/rss/comments.php?id=2113354 Mon, 19 Jan 2009 06:10:00 +0100 2113354 http://www.medworm.com/index.php?rid=2010979&cid=t_100416_88_f&fid=34729&url=http%3A%2F%2Fallscrubbedup.blogspot.com%2F2008%2F12%2Fguest-post-trusting-your-doctor-is-it.html This article is contributed by Sarah Scrafford, who regularly writes on the topic of Radiology Technician Schools. She invites your questions, comments and freelancing job inquiries at her email address: sarah.scrafford25@gmail.com. (Source: All Scrubbed Up) All Scrubbed Up blogs http://www.medworm.com/rss/comments.php?id=2010979 Wed, 03 Dec 2008 15:29:00 +0100 2010979 http://www.medworm.com/index.php?rid=1454253&cid=t_100416_88_f&fid=34729&url=http%3A%2F%2Fallscrubbedup.blogspot.com%2F2008%2F05%2Fwho-do-you-let-die.html Interesting article on Yahoo Answers.Who should MDs let die in a pandemic? Report offers answersBy LINDSEY TANNER, AP Medical Writer Mon May 5, 12:14 AM ETDoctors know some patients needing lifesaving care won't get it in a flu pandemic or other disaster. The gut-wrenching dilemma will be deciding who to let die.Now, an influential group of physicians has drafted a grimly specific list of recommendations for which patients wouldn't be treated. They include the very elderly, seriously hurt trauma victims, severely burned patients and those with severe dementia.The suggested list was compiled by a task force whose members come from prestigious universities, medical groups, the military and government agencies. They include the Department of Homeland Security, the Centers for Disease Control ... All Scrubbed Up blogs http://www.medworm.com/rss/comments.php?id=1454253 Tue, 20 May 2008 06:29:00 +0100 1454253 http://www.medworm.com/index.php?rid=1382281&cid=t_100416_88_f&fid=34729&url=http%3A%2F%2Fallscrubbedup.blogspot.com%2F2008%2F04%2Fmodernising-medical-world.html In the wake of the official Google Health launch (check it out - looks interesting). Got some comment from SA Doc on modernising the medical world...I used to work in a practise that was - for lack of a better word - archaic. You've heard of paperless offices. Now try a paper-filled practice. Everything was done in the old fashioned method of pen to paper - the invoices, the patient notes, even the list indicating the link between family name and file number. Email? Email who? The only computer visible (under the masses of paper) is an old 486 running Windows 3.1. I actually had to relearn how to use that OS.No matter how I tried to convince the partners to modernise they could not see the advantage. The idea that you could access any information from complete, LEGIBLE patient notes with a... All Scrubbed Up blogs http://www.medworm.com/rss/comments.php?id=1382281 Fri, 18 Apr 2008 08:51:00 +0100 1382281 http://www.medworm.com/index.php?rid=1258065&cid=t_100416_88_f&fid=34729&url=http%3A%2F%2Fallscrubbedup.blogspot.com%2F2008%2F02%2Fmedical-confessions.html Har. Har. Pretty funny read...Ever wondered if doctors are frightened of catching what you've got? What their notes really mean? Or how to get round their receptionist? We asked five doctors to spill the beansCheck it out here. (Source: All Scrubbed Up) All Scrubbed Up blogs http://www.medworm.com/rss/comments.php?id=1258065 Tue, 26 Feb 2008 15:57:00 +0100 1258065 http://www.medworm.com/index.php?rid=889610&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F09%2F21%2Fmind-your-xs-zs%2F We doctors are always looking for ways to do things faster.  A prime example of this is our signatures.  I once calculated that I sign my name a total of 200 times per day.  Signing my name as a "squiggle" takes me a total of one second.  If I sign my name neatly so it [...] (Source: Musings of a Distractible Mind) Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=889610 Fri, 21 Sep 2007 08:08:40 +0100 889610 http://www.medworm.com/index.php?rid=885356&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F09%2F19%2F10-things-you-hate-to-hear-when-you-walk-into-an-exam-room%2F “I hope you are better than the last 4 doctors I’ve seen.” “Could you start my 2-Year old on ADHD medicine? He won’t do anything I say.” “She made me come.” (Pointing to his wife) Any sentence ending in the word “discharge.” “Do you have any air freshener?” “I wanted an antibiotic, but your staff said I had [...] (Source: Musings of a Distractible Mind) Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=885356 Wed, 19 Sep 2007 16:07:12 +0100 885356 http://www.medworm.com/index.php?rid=880159&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F09%2F18%2Fdeaths-door%2F Sometimes things are too obvious to notice. I am not sure why, but it has taken over twenty years in the medical profession to realize this blazingly obvious fact: one of the main differences between us in the healthcare field and people of most other professions is that we face death in our jobs. I have just discovered a delightful blogger from South Africa named Bongi, who posts on the blog other things amanzi. In a recent post he discusses becoming disillusioned when a senior resident over him reassures a patient that “everything will be fine” when in fact the patient is clearly going to die. he had boerhaave syndrome, a tearing of the esophagus, usually into the left hemithorax, associated with overeating and drinking which in turn causes discoordinated vomiting and voila! ... Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=880159 Tue, 18 Sep 2007 08:27:31 +0100 880159 http://www.medworm.com/index.php?rid=870400&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F09%2F13%2Fthe-unscientific-practice-of-medicine%2F I tip my hat to likes of Orac, Sandy, and Robert Centor.  They don’t shy away from a debate or a contraversial topic; in fact, they seem to greet it with open arms.  This takes a frame of mind that I find difficult to hold for very long - one that thoroughly examines the details of issues and comes up with a defendable position.  I think this type of debate and scrutiny of issues is very important in that it attacks dogma and challenges assumptions, forcing us to make sure evidence is good for the things we are doing.  But if I spend much time doing this, I find myself reaching for the Tylenol. In a recent post in his blog, Centor challenges the dogma of getting the hemoglobin A1c down below 7.0, questioning whether the benefit of getting diabetics to that level i... Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=870400 Fri, 14 Sep 2007 03:34:14 +0100 870400 http://www.medworm.com/index.php?rid=867287&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F09%2F12%2Fhow-not-to-call-your-mothers-doctor%2F Rant sequence activated: 10,9,8,7,6,5,4,3,2,1…. I got a call today from the daughter of a patient. The overhead page in the office was “Doctor Call on line 2,” so I picked up quickly and answered it. The doctor on the phone did not identify herself as such, but I knew her to be the daughter of one of my patients. She then proceeded to critique my care of her mother and question whether certain tests had been done. She was very aggressive in asking why a specific test had not been ordered and strongly implied that I had been negligent in my care in not ordering this test. Looking through the patient’s chart, I could go through the list of complaints over time, and this “chronic severe problem” that I was presented with was only complained about on occasio... Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=867287 Thu, 13 Sep 2007 01:42:55 +0100 867287 http://www.medworm.com/index.php?rid=861790&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F09%2F10%2F10-reasons-to-not-like-pediatrics%2F Obviously I favor the positives against the negatives here, but I have many colleagues who feel otherwise.  Plus, there are things that make me glad that I also see adults.  So here are the negatives: The smell in the room after the 2-year-old has squatted behind the exam table. Splinters.  I hate splinters.  Taking them out of a squirming kid is like threading a needle on a 4-wheeler. Parents threatening their kids with shots if they don’t behave.  I don’t give shots to be mean. Strong stale cigarette smoke smell walking into a room of an infant whose parents smoke.  Do they really think it doesn’t harm the child? The child who ran out of the exam room, out of the the office, and into the parking lot of a nursing home while I chased him.&nb... Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=861790 Tue, 11 Sep 2007 03:32:01 +0100 861790 http://www.medworm.com/index.php?rid=853446&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F09%2F09%2Fteens-and-suicide%2F As sited on Shrink Rap (and seconded by Dr. Smak), the suicide rate has gone up in the past year.  As many know, there has been a “Black Box” label on SSRI’s for suicide in teenagers and young adults.  This has basically handcuffed primary care physicians in taking care of depressed teens, resulting in a 22% drop in prescription of SSRI’s in that age group.  This reminded me of a post I posted last year on Trusted.MD.  ******* I had a tough situation in the office yesterday. One of my patients is a 17-year old who went to the ER on Sunday for shortness of breath.  They said she had a panic attack and should follow-up with me as soon as possible.   When I saw her, she was clearly distressed, but not to the point of needing to be h... Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=853446 Sun, 09 Sep 2007 22:02:36 +0100 853446 http://www.medworm.com/index.php?rid=848314&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F09%2F07%2Ftop-10-good-things-about-pediatrics%2F This is the first of two posts. The second will be: 10 bad things about pediatrics. The toothless grin of a 4-month-old child when you walk into the room Dealing with mostly healthy patients There are very few 30-minute visits There are lots of 5-minute visits A long pediatric problem list will be 4 problems long Resilient little bodies recover quickly and fully Being able to tickle someone at work and not get arrested Having your Scooby-Doo voice be an absolute asset Always having an easy audience for your silly jokes I get paid to hold cute babies! (Source: Musings of a Distractible Mind) Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=848314 Fri, 07 Sep 2007 08:40:35 +0100 848314 http://www.medworm.com/index.php?rid=845735&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F09%2F06%2Freasonable-doubt%2F When I posted recently on my approach to lipids in pediatrics, I got into a debate with one of my commenters regarding the merits of statin therapy.  I am never against having a dogma challenged, and lipid lowering through statin therapy is quickly becoming a medical dogma.  If a dogma cannot be challenged, it is no longer scientific. One of the misconceptions of the general public about science is that we use science to come to definitive answers.  The process of science is to draw a conclusion through a finite number of observations to allow us to predict the behavior of things.  We use our senses and use tools to aid our senses in finding as much information about an object, process, or circumstance as possible and use reasoning to draw conclusions.  There is no... Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=845735 Thu, 06 Sep 2007 06:39:38 +0100 845735 http://www.medworm.com/index.php?rid=838803&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F09%2F04%2Fphysical-exam-eye-eye%2F Though it seems a small part, the eye exam is a very important part of the routine of the exam.  Often in the doctor’s notes you will read: Eyes: PERRLA, EOMI, Anicteric This translates: Pupils Equal, Round, Reactive to Light and Accommodation, no yellowing of the eyes. Pupil Exam No, this is not the kind of pupil exam I am referring to. If you hold up a light to a person’s eye, the pupil will get smaller.  That is what is meant by reactive to light.  In certain circumstances, they don’t react to light as well:  A person on narcotics will have their pupils very small.  If someone is comatose and has constricted pupils, chances are good it is an opioid overdose. A person who has had a seizure or who a head injury may have very sluggish reactions ... Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=838803 Tue, 04 Sep 2007 05:58:03 +0100 838803 http://www.medworm.com/index.php?rid=816648&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F08%2F22%2Fscanman-i-need-you%2F This report tells me very little except that she probably has arthritis, which may or may not be of significant importance depending on what he means by mild and moderate. My guess is that this guy doesn’t want to be liable for the interpretation.  He feels that he will just let the doctor reading the report form their own interpretation.  It drives me crazy when I get one of these reports.  I really don’t care about Anterolisthesis or Ligamenta Flava.  I just need to know: does she need to go to neurosurgery or not? AAARGGHH! (Source: Musings of a Distractible Mind) Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=816648 Wed, 22 Aug 2007 16:52:04 +0100 816648 http://www.medworm.com/index.php?rid=815161&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F08%2F22%2Fgrumpy%2F A Conspiracy. That is what seemed to be going on.  Fifteen-minute visits become half-hour visits.  Lots of questions are thrown at me.  Patient after patient was complicated - either medically or emotionally. I had not walked into the day irritated, but the conspiracy that my patients were engaged in was doing its best to make me that way.  They did not accept my explanations, but instead wanted me to explain the same thing about ten different ways, only to go home and “think about it.”  Just as I finally got through with one patient, I walked into another room to the words “I am glad you are here.”  Ominous words that said that this next visit wouldn’t fit the time allotted either. They were not being unreasonable (well, mostly n... Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=815161 Wed, 22 Aug 2007 12:40:17 +0100 815161 http://www.medworm.com/index.php?rid=808632&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F08%2F19%2Fphysical-exam%2F I think that most patients feel that the most important part of a doctor visit is the physical exam. It is when we actually lay hands on the patient and “find out what is wrong.” In the flow of the visit it seems to be the climax of data-gathering. We first ask questions, then we assess whether the hypotheses we put forth are really true. Actually, I see the physical as ten, maybe twenty percent of my decision making. Most of it comes from the history - the questions I ask before the visit. I know that when I am seeing the patient, I am seeing them at one moment in time. The history, on the other hand, covers all the time leading up to today’s visit. Many conditions are intermittent, or are difficult to tell anything on exam, so the exam gives very little additional infor... Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=808632 Sun, 19 Aug 2007 23:22:02 +0100 808632 http://www.medworm.com/index.php?rid=801378&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F08%2F15%2Fpowerless%2F “I just keep gaining weight.  I exercise an hour every afternoon and I just keep gaining weight.” She looked down as she sat in her chair across from me in the exam room. “It gets so that I don’t want to go to parties; I don’t want to go out with friends.” She looked up, her eyes moist, betraying the shame that she held; the contempt which she had toward herself. I felt a huge amount of sympathy.  This is a battle I fight as well.  I have gone on various diets with varying success.  The Atkins Diet made me lose over 30 pounds and forever feel mixed emotion when I see cheese or bacon.  Weight watchers was successful as long as I stuck to the plan.  Patients are quick to point out to their doctor if they feel he has gained or ... Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=801378 Wed, 15 Aug 2007 14:07:10 +0100 801378 http://www.medworm.com/index.php?rid=792837&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F08%2F10%2Faugust-is-hell%2F Today the high will be 104.  Thankfully, I spend most of my day in an air-conditioned office and don’t bear the brunt of it (like Mrs. Dr. Rob does - more on that later). But despite the similarity of the Southern climate to that of the fiery abode of demons, that is not what I mean by saying August is hell.  I am actually talking about the insanity that is August for a pediatric office. School starts next Monday for most of the state of Georgia (some actually started this past Monday).  South Carolina starts the following week.  This means that all children entering public school for the first time need to have up-to-date immunizations and a 3231 form for the state of Georgia. The 3231 form was changed this year (for the first time in over 10 years) to include ... Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=792837 Fri, 10 Aug 2007 13:40:50 +0100 792837 http://www.medworm.com/index.php?rid=781337&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F08%2F05%2Fhospitalists-a-deal-with-the-devil%2F I am a Med/Peds physician.  That means that my training was in both internal medicine and pediatrics.  I do basically what a family physician does (a little more pediatrics, and less procedures and well-woman care).  My internal medicine residency training was mostly inpatient in nature.  We spent most of our time on the wards in the hospital, often taking care of intensive care patients.  I never spent much time taking care of patients in the outpatient setting, with a half-day each week alternating between adult and pediatric clinics.  So by the time I was done with residency, I was very comfortable in taking care of inpatients - even ICU patients - but with relatively little experience taking care of patients in the office. I quickly adjusted, however, wit... Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=781337 Mon, 06 Aug 2007 03:11:40 +0100 781337 http://www.medworm.com/index.php?rid=779974&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F08%2F04%2Fthe-hand-of-the-beholder%2F One of the most difficult conversations you can have as a physician is to have to inform new parents that their child has a “birth defect.”  As I stated in a previous post, I like to tell parents that their child is “perfect” whenever I can, but the feeling of knowing there is something wrong with a child when the parents don’t yet know is one all pediatricians would gladly avoid. One of the more common problems we see in newborns is polydactyly, a condition where a child has an extra digit on the hand or (less commonly) the foot.  It most commonly happens in the location pictured on the right - just lateral to the 5th digit.  The extra digit is usually non-functional, and smaller digits can often be removed before ... Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=779974 Sat, 04 Aug 2007 14:30:47 +0100 779974 http://www.medworm.com/index.php?rid=764699&cid=t_100416_88_f&fid=34729&url=http%3A%2F%2Fallscrubbedup.blogspot.com%2F2007%2F07%2Fis-depression-on-rise.html GP's tend to deal with a lot of depression and anxiety (and I'm not talking about our own... who tends to us? Another question. Another post).Is there more depression and anxiety in the 21st century or are we just getting better at recognising it?The middle of the 20th century saw the rise in early recognition and treatment of psychiatric illnesses. In fact, most of the stigmas surrounding psychiatry, psychologists and psychological drugs were put to bed in the late 70's and early 80's. The rise of Freud and Mommy-consoling. They were heady days.Back to the present – something is definitely up. It feels like at least 1 out of every 3 patients I see is on some type of an antidepressant or mood stabiliser. I used to have a professor who joked that lithium should be put into the water. Quic... All Scrubbed Up blogs http://www.medworm.com/rss/comments.php?id=764699 Sun, 29 Jul 2007 09:12:00 +0100 764699 http://www.medworm.com/index.php?rid=757947&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F07%2F25%2Fperfect-words%2F I had a mother tell me yesterday, “Dr. Rob, I remember so clearly when you walked in to my hospital room when my daughter was born 10 years ago. You said ‘I just want you to know that your daughter looks perfect.‘ I was just so happy that everything was OK, but you said that she was perfect!” While I don’t remember that specific situation, I have always chosen my words carefully when I talk to patients/parents. This comes from when Mrs. Dr. Rob commented to me after she took our first child to a visit to the pediatrician. “He told me that J was really cute!” she had told me. “He sees lots of children, but I think he really felt he was really cute.” I saw how much those words meant to my wife, so I decided to regularly use words like tha... Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=757947 Wed, 25 Jul 2007 22:45:19 +0100 757947 http://www.medworm.com/index.php?rid=751689&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F07%2F23%2Fto-my-patients%2F Dear Patient: I am writing this to set the record straight.  Coming to the doctor is often an awkward thing.  Many people don’t want the spotlight focused on them, and so react unnecessarily to things that happen in the office.  Let me give you some tips that may help the office visits go better in the future. There are no “stupid reasons” to come in to see me.  People are constantly apologetic for coming in when they are not sure there is something serious going on.  Why should you apologize?  The best-case scenario is that everything is fine and that you are over-reacting.  The worst-case scenario is that something serious is going on and you are sitting at home.  There are things that you just can’t figure out without my h... Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=751689 Mon, 23 Jul 2007 16:20:59 +0100 751689 http://www.medworm.com/index.php?rid=747658&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F07%2F20%2Fa-day-in-the-office-with-emr%2F The headline read: Electronic Health Records Don’t Lift Care. Balderdash! That’s like saying that cars don’t improve transportation compared to walking. Now, certainly if people don’t know how to drive, cars are not much use to them, but there is no way I would ever go back to practicing without my EMR. I couldn’t do it in good conscience. To show why this is the case, let me go through my day today for you (this is not made up). 8:00 AM - Arrive in office, Log on to EMR. Check Schedule. Look over unfinished work on desktop. Look over labs from patients in office yesterday that came through interface. Any abnormal results are flagged and put on the top of my list. Gentleman with wt loss and abdominal pain whose labs were OK, although sugar is up. I’ll ad... Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=747658 Sat, 21 Jul 2007 03:28:00 +0100 747658 http://www.medworm.com/index.php?rid=735519&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F07%2F15%2Fmaking-patients-angry%2F I was talking today with a specialist friend (yes I do have them) today and we were talking about a patient of mine whom he had angered. He is one of the gentler people I know, so when I got the irate call from the patient about his care, I had a good idea what was up. He had refused to give her a pain medication and felt “like he didn’t care.” In talking with him, he had taken her pain very seriously, but feels (as I do) that people should only be getting narcotics from one source. Since it is a common ploy of the “drug seeker” to go to different doctors for narcotics, we generally try to make sure only one of us is prescribing them. I would have done the same thing, and appreciate his conscientious approach. He was somewhat apologetic about making her mad, b... Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=735519 Sun, 15 Jul 2007 22:15:17 +0100 735519 http://www.medworm.com/index.php?rid=729830&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F07%2F12%2Fjoi-de-vivre%2F  I must admit, there have been many days in the past year when I resented work.  Life often seems like a hamster wheel - the harder you run, the more tired you get, but you never get ahead.  Fighting with insurance companies, dealing with difficult patients, worrying in the face of disease, sadness, death, I am both physically and emotionally drained at times.  The buzz of my alarm in the morning is often a disheartening sound.  It’s not that I don’t love what I do.  I feel very privileged to be able to make a real difference in people’s lives - that is what keeps me coming back for more.  Despite all of the battles, I do make a good income and get to use my talents in doing so.  I really couldn’t see myself doing much else.&n... Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=729830 Thu, 12 Jul 2007 12:40:05 +0100 729830 http://www.medworm.com/index.php?rid=687662&cid=t_100416_88_f&fid=34729&url=http%3A%2F%2Fallscrubbedup.blogspot.com%2F2007%2F06%2Ftaste-of-medicine.html Medicines have always inherited the somewhat unfair rep of being so vile tasting, that not even hungry dogs would go close. Why? Safety? Maybe I am a doctor that likes to taste things before I prescribe them to kids (need to know if there’s a chance they’lll take it - or I’ve lost the battle before it has even begun – and Mom has gotta force feed).I’m here to reassure you. They’re not all that bad. Kerry, a previous commentor on the nose suction wonderment is right is right though, pharmaceutical companies really need to think about the taste of syrups before they make them for kids. If it’s going to taste KAK - make them in suppositories! And deal with the consequences.But since we won’t be getting a horde of bum tablets from the pharmaceutical companies any time soon, her... All Scrubbed Up blogs http://www.medworm.com/rss/comments.php?id=687662 Thu, 21 Jun 2007 14:57:00 +0100 687662 http://www.medworm.com/index.php?rid=675469&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F06%2F07%2Ftrust%2F In our last meeting, my partner brought to the table a dietary supplement that he thinks has a fair amount of scientific merit. He has started recommending these to some of his patients and has even started taking them himself. Since he is not one to jump on bandwagons, his recommendation bears a good amount of weight in my eyes. I will probably look into it myself. This supplement, however, is not sold in stores but instead through a local distributor. Additionally, our recommendation of the patient to get the supplement could result in a “commission” payment from the distributor. But there is no way we would let that happen. A few years back, some colleagues in town started selling another dietary supplement. They were convinced that this combination of vitamins and fiber wo... Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=675469 Fri, 08 Jun 2007 01:10:40 +0100 675469 http://www.medworm.com/index.php?rid=658544&cid=t_100416_88_f&fid=34729&url=http%3A%2F%2Fallscrubbedup.blogspot.com%2F2007%2F06%2Fmed-student-dissecting-kit-buy-now.html I'll never understand these bloody med students. They're quite serious about selling you the following piece of hardware. And I say hardware because, well, you kind of expect this to come out in a movie like SAW.Feast your eyes on the cold steel available for just under $30!AMA-approved anatomy dissection kit for first year medical students!The American Medical Association (AMA), America�s most prestigious medical organization, worked in conjunction with DR Instruments, professors, and medical students to design this kit for first year medical students. The 10GSM kit contains the most widely used dissection tools for first year anatomy classes. DR Instruments offers over 125 dissection tools including a wide range of dissection kits for medical school anatomy classes. To purchase additio... All Scrubbed Up blogs http://www.medworm.com/rss/comments.php?id=658544 Mon, 04 Jun 2007 19:49:00 +0100 658544 http://www.medworm.com/index.php?rid=650915&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F05%2F30%2Fjury-duty%2F I am doing my civic duty this week. For reasons not clear to me, being a physician is seen as a positive by lawyers when choosing a jury.  Hence, I have been going to court for the past few days and hearing a case. Since the trial is ongoing, I can’t write anything about it (not that you would want to know), but I can say that the trial is the least interesting part of the whole process.  The most interesting thing to me is the interaction between the various members of a jury.  There is not many places where such a diverse slice of society is sitting together in a room.  The rich, poor, educated, uneducated, employed, and unemployed are all together and are forced to talk and interact.  We have an elderly white woman who likes soap operas, a single woman wh... Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=650915 Wed, 30 May 2007 20:37:52 +0100 650915 http://www.medworm.com/index.php?rid=637988&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F05%2F24%2Fthoughts-on-avandia%2F When you read headlines like “Link found between diabetes drug and heart attack risks,” give a sympathetic thought  toward offices like mine. A recent article in the New England Journal of Medicine raised this possibility for the drug Avandia.  The study, done by Dr. Steven Nissen of the Cleveland Clinic, is a meta-analysis of previous studies done on the drug.  From MedPage Today: CLEVELAND, May 21 — A meta-analysis of data from 42 clinical trials found a 43% increase in relative risk of myocardial infarction among type 2 diabetics treated with rosiglitazone (Avandia). The odds ratio for MI was 1.43 (95% confidence interval 1.03-1.98, P=0.03), said Steven E. Nissen, M.D., of the Cleveland Clinic, lead author of the meta-analysis, which was released on... Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=637988 Thu, 24 May 2007 17:24:15 +0100 637988 http://www.medworm.com/index.php?rid=620188&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F05%2F17%2Fi-am-a-blogger-i-am-a-doctor%2F Big happenings in the world of medical blogs. First Barbados Butterfly disappears.  Then Fat doctor is “exposed” by a coworker (or cow-orker, as Dogbert would say).  Finally my dear friend Flea goes AWOL.  You all know the story (if you at all read medblogs). I understand the situation with Flea (I think).  He is in the middle of a lawsuit, and has actually blogged about details of the suit.  I suspect his lawyer (or Mrs. Flea) saw the fact that this is risky.  Should the contents of his blog become part of the court proceedings, his statements could become a liability.  I hope that once his suit is done (and he has won, hopefully), he will once again be part of the medblog community.  He is sorely missed. The other two instances are hard... Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=620188 Fri, 18 May 2007 01:24:14 +0100 620188 http://www.medworm.com/index.php?rid=611099&cid=t_100416_88_f&fid=34729&url=http%3A%2F%2Fallscrubbedup.blogspot.com%2F2007%2F05%2Fperianal-what.html Had to drain a perianal abscess. Standard stuff in a government hospital, but in private practice, it's a rarity. I had forgotten how ABSOLUTELY awful they are.Imagine the smell of a rotten goose egg, mixed with 2 day old vomit, mixed with baby poo... That's about the introduction.AND I kept a straight face and held down the gag reflex. I am a GOD. (Source: All Scrubbed Up) All Scrubbed Up blogs http://www.medworm.com/rss/comments.php?id=611099 Thu, 10 May 2007 18:35:00 +0100 611099 http://www.medworm.com/index.php?rid=538852&cid=t_100416_88_f&fid=34729&url=http%3A%2F%2Fallscrubbedup.blogspot.com%2F2007%2F04%2Fhow-you-start-career-in-medicine.html Dear SA Doc,Living with a doctor is a trying, gruesome experience. And while it has its pharmaceutical benefits - it remains a puzzling past time. Just why, why did you put up with 6 years of studying, 2 years of community service and then sick people (30 times a day) for the rest of your working life.Perhaps this will help. Got it off Diane's blog.SA Doc replies:"Sane. Very hardworking. Nice Attitude. Hate Adults. Oh shit... I should be in Paediatrics."Try it out - which part of this bizarre career would you end up in? SA Doc obviously needs a change :) (Source: All Scrubbed Up) All Scrubbed Up blogs http://www.medworm.com/rss/comments.php?id=538852 Thu, 12 Apr 2007 05:40:00 +0100 538852 http://www.medworm.com/index.php?rid=524322&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F04%2F05%2Fmusings-for-45-spiral-fracture%2F Overhead page at the office. ER. Infant from out of town presents with fussiness and perceived arm pain. X-Ray reveals mid-shaft spiral fracture of the humerus. Spiral fractures are caused by twisting of the limb with a fair amount of torsion. A very high percentage of these turn out to be abuse. There is a chance this could be innocent, but that chance is not real large. They seem like nice people. They usually do. No “smoking gun” story of what happened. Now the job is to just wait until we can send the child home with someone we know is safe. I try not to judge, since I don’t know really what happened. Besides, I am just supposed to take care of the child. Leave judgment to judges. I do my best to be polite and helpful to the family, yet I measure all of my words and ... Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=524322 Fri, 06 Apr 2007 02:47:20 +0100 524322 http://www.medworm.com/index.php?rid=518727&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F04%2F03%2Flessons-in-perseverance%2F I wanted to quit. He wanted to quit. Yet we were 2 miles from our destination.  It was raining, windy, and cold.  I could see in his heavy steps that this was no longer a fun time with Dad.  It was no longer the romantic idea of “roughing it” in the wilderness; it was now just a sinking feeling in the chest and the push to reach our destination.  He was driven by the desire to be wearing dry clothes and be sitting in a warm and dry car. I have to admit, my 40-something feet were aching and heavy as well.  I was fighting my own battle with discouragement as it seemed that our goal was coming a lot slower than I would like.  I knew I could not show my frustration with my pain, so I tried to encourage him. “You know,” I said, trying to be ... Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=518727 Tue, 03 Apr 2007 22:04:27 +0100 518727 http://www.medworm.com/index.php?rid=510483&cid=t_100416_88_f&fid=34729&url=http%3A%2F%2Fallscrubbedup.blogspot.com%2F2007%2F03%2Fdoctors-are-underpaid.html If a job is measured on skill required vs. ability to muck things up... we are getting the right ass-end of remuneration. People can die if we make mistakes.Take this example. First, we study for SIX YEARS! Then work a compulsory term in government for 2 years (at a calm, relaxed 90 hours per week). That's 8 years we could have been earning tom.A GP earns medical aid rates for a patient. That's R180 per consultation (if you get paid). 30 patients a day (fully booked). So that's an income of R108 000 per month. Whoah there big daddy - you think that sounds good?Practice Overheads: Nurses, receptionist, premises, office costs, disposable items (gloves, swabs, needles etc.).Practice Equipment: An ECG machine costs R35000. And we can't survive on just that.Medical Licenses: HPCSA registration... All Scrubbed Up blogs http://www.medworm.com/rss/comments.php?id=510483 Thu, 29 Mar 2007 18:46:00 +0100 510483 http://www.medworm.com/index.php?rid=482519&cid=t_100416_88_f&fid=34729&url=http%3A%2F%2Fallscrubbedup.blogspot.com%2F2007%2F03%2Fwhy-south-african-doctors-are-hardcore.html With much amusement, I noticed that TB (tuberculosis) was number 6 on that Wikipedia Watch-Out-For-This list we've been talking about.In South Africa, TB (next to HIV) is the highest prevalent infectious disease. Even as a first year fledgling, we were taught it's TB, TB, TB until proven otherwise. I can diagnose it in my sleep. Even interns (especially interns because they deal with the crap) treat this shit for breakfast.AND. We don't wear masks everytime we deal with patients. Our immune systems are THAT hardcore. American medicine might think that foolhardy. We just call each other Chuck and carry on with business. (Source: All Scrubbed Up) All Scrubbed Up blogs http://www.medworm.com/rss/comments.php?id=482519 Mon, 19 Mar 2007 14:35:00 +0100 482519 http://www.medworm.com/index.php?rid=467849&cid=t_100416_88_f&fid=34729&url=http%3A%2F%2Fallscrubbedup.blogspot.com%2F2007%2F03%2Fdoctors-drivethru.html What a week. You think MY job is glamorous?60 Itchy Throats50 Snotty Noses30 Episodes of Gastro10 Depression CasesZERO Rare Tropical Diseases.And a patridge with a swollen knee.ER is a but a dream right now. I'm going to start a doctor's drivethru. State your 5 main symptoms. Answer 3 easy questions. 40% of patients get Combo Script 1 (Nose spray Deluxe, no cheese, side order paracetomol). 40% get Combo Script 2 (Super Size Probiotics with the Anti-Spasmodic special). Only 20% get to sit down and order off the menu.I'm going to bed. (Source: All Scrubbed Up) All Scrubbed Up blogs http://www.medworm.com/rss/comments.php?id=467849 Fri, 09 Mar 2007 17:15:00 +0100 467849 http://www.medworm.com/index.php?rid=478790&cid=t_100416_123_f&fid=34879&url=http%3A%2F%2Fdistractiblemind.ambulatorycomputing.com%2F2007%2F03%2F08%2Fi-hate-immunizations%2F Start Rant OK, now that I caught your attention, I need to explain (before some of the wacky folks who visit Flea start thinking I am in their camp). First off, aside from germ theory, sterile technique, and public sanitation, I think immunizations have saved more lives and improved the quality of more people’s lives than nearly any other scientific discovery. Second off, I do not think there is any merit to the whole thimerosal/MMR/autism “debate.” I think vaccines are safe and should be used whenever possible. So why say I hate immunizations? It is the business side of being a doctor that hates them, not the medical side. Immunizations: Are the largest line-item on our budget apart from staff salaries. Have incredibly small margins of profit, so any rejection, failure... Musings of a Distractible Mind blogs http://www.medworm.com/rss/comments.php?id=478790 Thu, 08 Mar 2007 23:32:04 +0100 478790