Last night was clear with full moonshine and the owls were busy hunting on our farm, calling back and forth to each other, comparing notes on where to find prey.Thankfully they were not calling my name. At least I don't think so, nevertheless their hoots haunted me.A coastal tribal legend has it that if you hear an owl call your name, your death is imminent. I've had no recent brushes ...
Emily Gibson, MD
The possibility of zebras in primary care
It is critical for physicians to share unusual patient diagnoses that present to clinic with routine type symptoms. In a hospital setting, these are cases for discussion and debate at Grand Rounds. In a primary care setting, we do case reviews when we can with informal sharing for the purpose of teaching and learning. The bottom line, whether in a formal academic setting, or an informal setting around the lunch ...
Handshakes during viral outbreaks
Suffice to say, as a physician, I’m not germ phobic. If I were, I wouldn’t work as a health care provider in the “culture media” of an ambulatory care clinic. I certainly respect the pathogens I come in contact with daily, along with the host who harbors them. For the most part, the virus and the patient know I don’t have much effective artillery to fight back with and my ...
A real doctor will first do no harm
I’m really miserable and need that 5 day antibiotic to get better faster.Ninety eight percent of the time it is a viral infection and will resolve without antibiotics.But I can’t breathe and I can’t sleep.You can use salt water rinses and decongestant nose spray.But my face feels like there is a blown up balloon inside.Try applying a warm towel to your face.And I’m feverish and having sweats at night.Your temp ...
Who to blame in fatal medication overdoses
There was news of yet another high profile death from an uncertain cause in a star with addiction history. Media accounts included reference to the "27 club" -- a lengthy list of famous artists who have perished by their own hand, often unintentionally, at the age of twenty seven.The reality is that too many fatal overdoses responsible for the deaths of the famous and not-so-famous are from medications ...
Hidden meanings behind the chief complaint
Any primary care clinic has a schedule that lists the appointments of the day in incremental time slots. There is a column for the name of the patient, the patient's age, and always there is a place for the reason for the visit--the "chief complaint" according to medical parlance.A quick review of the "chief complaints" for the day gives the physician a sense of how clinic will flow. There are the seemingly "quick" concerns, ...
Reasons why your doctor is running late
It may not be rabbit season or duck season but it definitely seems to be doctor season.Physicians are lined up squarely in the gun sights of the media, government agencies and legislators, our health care industry employers and coworkers, not to mention our own dissatisfied patients, all happily acquiring hunting licenses in order to trade off taking aim. It’s not enough any more to wear a bullet proof white coat. ...
The unintended consequences of medical marijuana
It was 1978 and I was a third year medical student when my friend was slowly dying of metastatic breast cancer.Her deteriorating cervical spine, riddled with tumor, was stabilized by a metal halo drilled into her skull and attached to a scaffolding-like contraption resting on her shoulders. Vomiting while immobilized in a halo became a form of medieval torture. During her third round of chemotherapy, her nausea was so ...
Adult ADHD and academic performance in college
‘Twas the week before finals and all through the dorm, few students were sleeping, since Adderall is the norm …What is the state of academic performance and achievement in the age of adult ADHD?Recent media publications feature "neuro-enhancement" sought by college students and stressed professionals through the use of prescribed and non-prescribed medications, particularly stimulants, to guarantee focus, concentration ...
The patient is a partner in their illness management and health maintenance
Sixty five years ago my maternal grandmother, having experiencing months of fatigue, abdominal discomfort and weight loss, underwent exploratory abdominal surgery, the only truly diagnostic tool available at the time.One brief look by the surgeon told him everything he needed to know: her liver and omentum were riddled with tumor, clearly advanced, with the primary source unknown and ultimately unimportant. He quickly closed her up and went to speak with ...
The war on pubic hair must end
I must have missed the declaration of war on pubic hair.It must have happened sometime in the last decade because the amount of time, energy, money and emotion both genders spend on abolishing every hair from their genitals is astronomical. The genital hair removal industry, including medical professionals who advertise their specialty services to those seeking the "clean and bare" look, is exponentially growing.But why pick on the lowly pubic ...
Vaccination and the killers of yesterday now overcome by modern medicine
It’s only been a little over fifty years since vaccinations became routine for the childhood killers like polio, measles, mumps and whooping cough. People my age and older had no choice but to suffer through childhood infectious diseases given how effectively and quickly they spread through a community.Most of us survived, subsequently blessed with life long natural immunity. Some did not survive. ...
Mental illness in the college student
Along with millions of Americans, I've tried to comprehend the tragic shootings in Tucson, reaching deep within myself to find compassion for a young man who has forever changed the world for himself and so many others through his actions.For those of us who assess, diagnose and treat college students struggling with mental illness while trying to succeed in their academic pursuits, the events leading up to his impulsive killings ...
