Dr. Charles describes a patient with a Holiday Heart Syndrome.

Non-medical readers can see what this "high-speed and disorganized rhythm of the heart" looks like here.

How Doctors Think

BMJ reviews the book How Doctors Think: Clinical Judgment and the Practice of Medicine.

The reviewer rightfully points out that "doctors do not really think that medicine functions as a science with "invariable replicability and rule like precision."

NEJM published a study about the Feasibility of Treating Prehypertension with an Angiotensin-Receptor Blocker:

"Treatment of prehypertension with candesartan .... reduced the risk of incident hypertension during the study period. Thus, treatment of prehypertension appears to be feasible."

California Medicine Man is not so sure if this is a good idea.

Dr. Taraneh Razavi writes occasional posts on the official Google blog and recently decided to start one on her own: Dr. Razavi's Good to Know Info.

Funny enough, the team members of her blog are:

A Googler
Eric (Schmidt, Google CEO?)
GooglePR (the Public Relations Department?)

Are the team member there just to help or to keep a close eye on the blogging doctor?


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Visiting bloggers

I happy to say that two distinguished guest-bloggers will be filling in for the next little while. Please welcome Ves Dimov, M.D. from Clinical Cases and Images, as well as the always provocative and controversial editor of This Makes Me Sick.

I appreciate your continued readership, I especially thank the guest bloggers for keeping Kevin, M.D. fresh in my absence.

A pediatrician laments, no one ever talks about defensive medicine. I'll have to invite Dr. Orr to read this blog:

Orr says physicians have to practice "defensive medicine" to protect themselves against being sued. Having that as a premise means doctors will order more expensive testing even if they don't think it is necessary.

"Malpractice also put the healer at odds with the person coming to be healed," ...

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Medical malpractice in China. A man spends seven years teaching himself medicine so he can prove a hospital caused his son's disability.

Some drug reps go over the line:

A weekly offer of coffee and bagels in exchange for two prescriptions a week was the last straw for Physician Assistant Carolyn Finocchiaco.

That was the recent pitch of one pharmaceutical drug seller to Finocchiaco, the associate clinical director of cholesterol management at Catholic Medical Center.

"She was back a week later and said, 'Hey, you didn't add those two ...

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Hooray single-payer: "The family of a 57-year-old Meath Park woman says it will take at least three months before their mother gets to see a Saskatchewan oncologist who can tell her if her cancer is treatable or fatal."

Want a provider to spend lots of time with you? You'll find it with medical students.

WSJ - turning to other industries to cut physician waiting times:

Portland, Ore., physician Chuck Kilo, whose GreenField Health Systems helps restructure medical practices, and is assisting with the program, says that too many doctors' appointments take up valuable office time with follow-up that could be accomplished with phone calls and email.
Sounds good in theory - one barrier is that phone calls and emails are not reimbursed. Another ...

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Why it's important to have advance directives:

Hazel Wagner has been in Allegan General Hospital'Â’s critical-care unit, where she has been kept alive by a feeding tube and ventilator. She suffered a heart-attack and has failing kidneys and dementia . . .

. . . Court documents filed by Drozdowski say Wagner has "no chance of meaningful recovery," but the hospital continues to provide costly care, and if she ...

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Using a "pre-flight" checklist before surgery:

Before a surgery starts, everyone in the operating room says their name, what instruments they'll need and what their role will be. The team then double-checks the patient's name, procedure, and, critically, which body part will be operated on.

60 percent of patients in the UK support high physician wages:

Becky from Tunbridge Wells said: "GPs do one of the most worthwhile jobs in the country. We should be rewarding people who go into services such as the NHS and police, not questioning this," she said.

"I would rather pay GPs than the leeches that bleed us all dry - MPs, solicitors, estate agents, then you get the ...

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A reporter is banned from a hospital. (via the Houston Chronicle's MedBlog)

A phony doctor was going door-to-door giving women breast exams:

People are often annoyed at door-to-door sales people, but they were downright offended at what one man was offering to women who answered his knock. Police say the man went door-to-door carrying a doctor's bag and offering free breast examinations, and actually got two women to take him up on his offer.

Ezra argues for lower physicians' salary in exchange for subsidizing medical education:

Doctors, to some extent, work for the public good. Why shouldn't the country subsidize their education -- particularly if they go into high-need specialties or work in inadequately served areas -- but lower their pay? Or at least allow for many more nurse practitioners?
(via over my med body!)

Maria with absurdity in the ER. Hilarious.

Followup to the man who lit himself on fire at the hospital:

Philip Hoe, 60, is believed to have sneaked out of a ward and on to a fire escape stairwell to get around a smoking ban.

It is believed that as he lit the cigarette it ignited fumes from a paraffin and kerosene wax cream used on large areas of his body.

The reality of a high Medicaid population:

In my practice, and I believe in many other practices in the area, 90 percent of the clientele is Medicaid. Therefore, in order to generate the income of a normal patient load elsewhere, we have to see double. In other words I have to see 60 patients to make the income of 30 patients.

Doctors outside of the border area who do ...

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