Earlier this year, I completed a medical rotation in Africa. It was an amazing, eye-opening experience. While I expected it might be difficult to acquire newer, more expensive medications and procedures, I had anticipated that, given limited resources, there would be some rationale in deciding which medications and procedures would be available. I was deeply mistaken in this assumption. During my time abroad, I watched several patients with heart attacks pass ...

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A recent editorial in the New England Journal of Medicine lauded, albeit cautiously, point-of-care ultrasound that has risen to such an extent that it is now becoming an integral part of medical education. Could the availability of ultrasound revolutionize clinical medicine in much the same way Laennec’s stethoscope broke the acoustic barrier? Certainly this possibility can’t be ruled out. But I am not so sanguine. One thing I’m sure about: Indiscriminate ...

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A respiratory physician who I worked for had an uncanny ability of predicting the diagnoses the admitting junior doctor would fail to consider in patients presenting acutely with difficulty in breathing. He was using a checklist, which he developed after years of observing his housestaff. As a surgical intern I was once praised for my presence of mind in cross matching blood for a patient with a rare blood group who ...

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Supporters of the most recent paper from the Canadian National Breast Screening Study (CNBSS) falsely contend that only radiologists are criticizing this study. This simply is not true. The Canadian study flaws have been well documented for decades. Robert E. Tarone at the National Cancer Institute (who isn't a radiologist) wrote in 1995 that there was a statistically significant excess of advanced cancers that were allocated to the mammography ...

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Schuur and colleagues in JAMA Internal Medicine listed five low value services in the emergency department (ED). Although compilation was not solicited by the American College of Emergency Physicians as part of the Choosing Wisely program, it has its ethos. The list was developed by a technical expert panel after multiple iterations. The list is not only wise but derived from sound methodology. Most importantly, the recommendations are ...

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From MedPage Today:

  1. Preop PET Cuts Lung Cancer Surgery. Routine preoperative PET imaging led to a significant reduction in unnecessary surgery for non-small cell lung cancer (NSCLC).
  2. A Cure for Chlamydia Arthritis? Increased understanding of the biology and survival tactics of Chlamydia trachomatis is suggesting that the post-infectious chronic arthritis experienced by many patients may actually be curable.
  3. Efavirenz Tops Lopinavir in ...

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When first introduced four decades ago, breast cancer screening with mammography was widely regarded as an important tool in the fight against this terrible disease.  It seemed obvious that the earlier it could be diagnosed the more lives could be saved. Aggressive treatment, it was thought, would prevent the cancer from spreading through the body.  A huge amount of research evidence since then has slowly and painfully led to a ...

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Is anyone else frustrated with the business of medicine?  I guess that’s a stupid question.  But really, when you were training to become a physician, what were your goals?  For me, I wanted to have a career that was meaningful, interesting, and at the same time provided a good living for myself and my family.  Growing up, I was always told to strive to become a doctor or a lawyer.  ...

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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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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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