It seems lately that questions of medical ethics are coming up more and more in the news, things like the rights of patients to make decisions, definitions of futile care, and end of life care. The way to look at these things is not in a vacuum. All of us may have our own opinions about right and wrong, but the field of medical ethics is actually one that has ...

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I have been thinking a lot about cancer screening tests. It seems that there has been a constant stream of articles about screening in both the lay press and professional journals -- as well as the inevitable stories in the lay press about the reports in professional journals -- but this is more personal. I have had two recent experiences that ...

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Sometimes, we play a little politics on this blog.  I am a student of current events and enjoy following the dysfunction and absurdities in American politics.  To paraphrase the legendary former British prime minister, "never has so little been done by so many to benefit so few." Readers know how skeptical I am about medical dogma.  When I was an intern a quarter century ago, I didn’t grasp why routine measurement ...

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I gotta say, the daily commute has been feeling a bit hairy lately. Seems like I’m passing accidents more frequently. Watching a bit more weaving. I can’t be sure that it’s all related to distracted driving, but sure seems like a lot of it is. Every day I witness drivers looking down at phones at stoplights, missing the change to green. I even saw a smartphone mounted to one car’s driver side dash and the driver scrolling through websites ...

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The BMJ recently published the latest results from the Canadian National Breast Screening Study (CNBSS). A brief summary of the CNBSS: Women were randomly assigned to annual mammography or breast exams and then the outcomes tracked. The results in the BMJ: mammography did not improve survival. This is a very interesting study and when I first started working on this post I wanted to delve more into the science of ...

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Mr. Heim Stillear, at 70-years-old, seems older and less intelligent to his family, since he was hospitalized for a stroke about two months ago. They come to the appointment with him and help him into the exam chair. When I ask Heim what is going on with him, the long pause before his strained answer begins makes his family uncomfortable. His daughter interjects, “We are having a very difficult time understanding ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 32-year-old woman is evaluated following a diagnosis of chronic fatigue syndrome. She has a several-year history of chronic disabling fatigue, unrefreshing sleep, muscle and joint pain, and headache. A comprehensive evaluation has not identified any other medical condition, and a screen for depression is normal. Her only medications are multiple vitamins and ...

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Recently I reviewed my son's high school essay on To Kill A Mockingbird. I was surprised and pleased to rediscover, or perhaps discover for the first time now that I was viewing it from the perspective of over 50 years of life experience, the profound wisdom of the book. In one of the novel's most famous quotes, Atticus tell his daughter Scout, "you never really understand a person until you consider things ...

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Why doctors commit suicide I’ve been a doctor for twenty years. I’ve not lost a single patient to suicide. I’ve lost only colleagues, friends, lovers -- all male physicians -- to suicide. Why? Here’s what I know: A physician’s greatest joy is the patient relationship. Assembly-line medicine undermines the patient-physician relationship. Most doctors are burned out, overworked, or exhausted. Many doctors spend little time with their families. Workaholics are admired in medicine. Medicine values ...

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Two big studies have been published in the last few weeks, both of which have confirmed previous data: home birth is not as safe as hospital birth. These studies show that having a baby at home increases the risk of your baby dying by about 4 times. That really is a big increased risk -- especially considering that most home births are supposedly low-risk pregnancies. Those babies should be less likely ...

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