PalMD

Google doesn’t care about your health. See me instead.

PalMD

Physician

July 20, 2015

I love that patients have so many more tools to learn about their health. Between Google, TV, magazines and the thousand-word warning that comes with every prescription, it’s almost like you don’t need a doctor. This is especially true if you do the two most important things for your health: eat less and exercise more.

Except it’s not really that simple. There’s a reason it takes at least seven years to …

From one doctor to another: “I don’t think we’re ever getting out of here.”

PalMD

Physician

May 18, 2015

shutterstock_112271348

Scene: Medical office, 9 a.m., waiting room full, chairs in hall full

Players: 2 nurses, 1 clerk, 2 doctors, lots of patients

Doc 1: “Hey, what’s up? I’m sitting on my ass here, and there’s a room full of patients waiting.”

Nurse 1: “Hold on Doc, I’m almost done checking one in.”

“So, Mrs. Smith, do you feel safe in your own home?”

Patient 1: “It’s …

Witness to a patient, losing her life in front of us

PalMD

Physician

December 15, 2014

She arrived by ambulance in the middle of the night, awake, alert, and bleeding like crazy. We’d gotten a call earlier in the evening that she was on her way from a small hospital about forty miles to the north. We were the big city hospital, and an attending physician had agreed to have her transferred for a life-saving procedure, in this case a shunt that might stop her bleeding.

People …

The conundrum of communication and uncompensated care

PalMD

Physician

April 16, 2014

Going to the doctor starts as a disconcerting experience: Getting naked, physically and emotionally; talking about your weight, your smoking, your divorce. You count on your doctor’s ear and her discretion. Often enough, a patient will apologize for taking my time or for crying or whatever. I remind them that this is what the exam room is for, this is what they pay me for.

How far does this special relationship …

Doctors don’t get investigated for being quacks

PalMD

Physician

February 27, 2013

A doctor in our area was recently indicted for allegedly running a “pill mill”. According to local news reports, patients were recruited to come in and ask for narcotics and the doctor received massive cash payments to write the prescriptions. After the guy was nabbed, his patients (the real ones and the others) spread out in the community looking for new doctors to take care of them (or to write …

Let’s solve our most pressing healthcare problems first

PalMD

Policy

January 24, 2013

“He’s dead, Jim.”

So here’s my beef. At the recent Forbes Healthcare Summit there was a lot of focus on speakers and vendors offering very cool new tech, from future “Tricorders” that can diagnose multiple diseases, is non-invasive, and hand-held; personal genomics, where data from your own genome is cheap and easy to get and can be integrated with clinical knowledge to produce better care; targeted therapies for various diseases, …

How drugs are promoted isn’t a freedom of speech issue

PalMD

Meds

December 31, 2012

I learned of a disturbing decision from the Court of Appeals for the Second Circuit. In an insane ruling, two of judges determined that a drug rep promoting “off-label” uses for a drug was exercising his freedom of speech. Let’s stroll to the back of a typical doctor’s office to see how this plays out.

Of all the ways pharmaceutical companies …

Hold your disgust: A nuanced look at paternalism in medicine

PalMD

Physician

December 3, 2012

Over at his blog Gene Expression, Razib Khan expressed his disgust with the paternalism of the medical profession. His disgust was not misplaced, but he did bypass some of the subtleties.

Razib, a respected science blogger, ran smack into a frightening piece in Time. In it, doctors discuss whether and how much genetic information should be given to parents about their kids. The doctors featured evaluated a child’s …

If pilots worked like doctors, the sky would rain planes

PalMD

Physician

November 20, 2012

“This note was produced using [mega-brand] medical dictation software. While every effort has been made to insure accuracy, errors may still exist.”

Really? What kind of doctor would admit in a medical chart to being too lazy or incompetent to produce an accurate record?

A lot of them. Dictations are easy to read if you are willing to confound legibility and accuracy. Dictation software is relatively cheap, and with the continued profusion …

Selling a cure based on imaginary evidence is immoral

PalMD

Meds

November 9, 2012

In the ongoing battle to gain from our society’s scientific illiteracy, Dr. Oz has nocked another arrow. This time, he as the cure for all fatigue. I hope he’s got this right because this is one of the most common and most difficult problems to treat.

Fatigue is a tough one. Everyone has experienced fatigue at some point, and as a physician, part of my job is to figure …

Why I want to ration your health care

PalMD

Policy

October 9, 2012

I want to ration your health care. Well, I don’t want to do it personally, and not to you specifically. And that’s the problem. Policies on the individual and societal levels feel very different. We are not culturally prepared for “rational” rationing. We’re happy to do it irrationally; if you don’t have insurance, you’re probably not going to get proton beam therapy for your prostate cancer. Someone might be willing …

Read more…

Why I want to ration your health care

Women in medicine: A front line perspective

PalMD

Physician

July 9, 2012

Think about your own experiences—you’re at a party or a restaurant, and someone you’re with says something obviously racist. You cringe, but given the setting, you can’t decide how to react; after a pause, you probably decide to say something. Now imagine you’re at meeting for work, and a senior partner says something racist. You want to say something, and you even know that under some circumstances there are laws …

A doctor resolves to cut his heart attack risk

PalMD

Physician

December 13, 2011

I have a 5% chance of having a heart attack in the next 10 years. That’s not so high, but it’s higher than I want it. Most of that risk is due to my cholesterol and my age. I can’t do anything about the latter, but the former is under my complete control. Cholesterol medications can improve my cholesterol significantly. So can proper diet and exercise. That’s not true of everyone; …

HIV is devastating poor and minority communities

PalMD

Conditions

August 13, 2011

The HIV pandemic in the US has developed a stable appearance over the last few years, and that appearance is notably non-white and non-wealthy. When the pandemic was discovered nearly thirty years ago, it was—in the US—primarily a disease of gay men. In Africa, the disease is everyone’s. Women make up significantly more than half of HIV cases in Africa, and tens of thousands of children are infected during …

Omega 3 fatty acids and the prevention of heart disease

PalMD

Meds

May 25, 2011

Omega-3 fatty acids (more properly called “n-3 fatty acids”) are a group of naturally occurring fat molecules.

They are found mainly in fish and other marine-derived oils, but some can also be extracted from plants. Omega-3′s are currently very popular, but the evidence for their usefulness isn’t so clear. A recent study failed to show any benefit in preventing dementia. A new study out …

Prevention of disease and monitoring of chronic diseases in a yearly physical

PalMD

Physician

March 11, 2011

When I go to the doctor for my yearly physical (OK, not quite yearly, but…) he puts me through the ringer. He asks me dozens of questions, follows up with more questions, and does a (thorough!) physical exam. Then he takes some blood, and sometimes runs some other tests. The big question is “why”? What are …

Disconnect between knowledge of STIs and behaviors to reduce risk

PalMD

Conditions

January 9, 2011

In my opinion, people are often too embarrassed to see their doctor about sexually transmitted infections (STIs)—in my opinion.

“In my opinion” is one of the most dangerous phrases in science. But when in comes to attitudes toward STIs, the data are scarce. STI’s are very much a “behavior”-based disease, so knowing what attitudes prevail can help us design effective prevention strategies. Attitudes toward HIV have been …

Making the decision to go to medical school

PalMD

Education

November 13, 2010

First, this piece is not a how-to guide for getting into medical school.

But I use this ploy for good, and not for evil. Through conversations with a number of non-medical colleagues, I’ve been forced to think a bit more about premedical and medical education. A letter from a reader (which is presented in a highly altered version below) made me decide to more thoroughly and …

The story of vitamin D and its association with other diseases

PalMD

Conditions

September 27, 2010

Vitamin D is a fascinating molecule with a fascinating story.

Historically, “vitamins” were defined as chemicals that humans required from their environment that were “vital” to human health. These chemicals were needed only in very small amounts to prevent disease; an absence of a particular vitamin in the diet led to a specific deficiency disease: vitamin C, scurvy; thiamine, beri beri. Other vitamin deficiencies were found …

Is placebo a therapy, like surgery or medication?

PalMD

Conditions

August 23, 2010

The New England Journal of Medicine recently published a troubling article on acupuncture, which was ably deconstructed by Dr. Mark Crislip. This incident has reignited a discussion of what, exactly, “placebo” is.

A common argument is that placebo is like any other intervention, something that can be intentionally harnessed for the benefit of patients. This is both true and overly simplistic.

First, we must review what “placebo” is. …

PalMD

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