7 top medical comments, May 17th, 2009

Here are some of the more interesting comments readers have left recently.

1. Anonymous on whether IV sedation is overused:
I think it depends on the patient and on the procedure. For my colonoscopy, I did prefer the sedation. It wasn’t something that I cared to remember.

But I’ve also had a core needle biopsy of an abdominal tumor. The tumor was right underneath the fascia, so pretty close to the surface. There was one nurse who really wanted to sedate me but the doctor let me choose. I chose not to and it was fine. I got some local anesthetic and the whole thing was over within 15 minutes. It wasn’t an uncomfortable or unpleasant experience and I was happy to be able to go home that much sooner.

2. Chris on violent behavior and the media:
Tying the violent actions of people like the Columbine killers to the media they consume is the height of ridiculousness.

Here’s the far more likely explanation: People who are violent (for whatever reason) are simply attracted to violent movies, television and video games. End of story.

And I won’t believe a study naming violent media as the cause of violent actions until there’s also an explanation as to why 99.99% of the consumers of violent media seem to be immune to its apparent call to violence.

3. Anonymous on doctors using Wikipedia as a medical resource:
This is shocking to me as an internist. Using Wikipedia is an abdication of duty when there are so much better sources of data out there (even if more expensive or less user friendly). To the commenter who mentioned UpToDate not being free – consider it a cost of doing business, then, to have a reliable source of information, whether it be a Harrison’s tome or an online database.

But Wikipedia? With no quality control, and as mentioned in the article, easily manipulated? It’s an abdication of duty to use a sub-par information source in the care of patients.

4. Roger on Scrubs being the most accurate medical show on television:
While the show might hit the right emotional notes at times, it’s medicine is nearly as unrealistic as House. To me, the most realistic show was ER. Sure, it compounded the cases in such a way as to be unlikely to occur at any one hospital, if you can imagine the show as a series of highlights about life in the ER, it was the closest to being realistic.

5. Aaron B. Hicks on the FDA targeting Cheerios:
General Mills is a big target. The FDA had to know that issuing a warning for Cheerios would make big news. In a way, their warning might serve as deterrent to the claims made by other producers in the food and dietary supplement industries.

6. Anonymous on the second coming of capitation:
It will work this time the same way it did last time. At first it will cut costs by eliminating the easy fat. They the overseers will demand more cuts and more cuts and more cuts until eventually they are effectively demanding factitious medical care at which point, if the docs have a shred of professionalism left, it will collapse.

7. Anonymous on the how the physical exam affects the doctor-patient relationship:
I keep hearing this but am wondering what the solution is. I admit that my physical exam has become much more hastened and therefore more sloppy. But the last time I spent the time to assess a murmur with all the associated maneuvers, it took 15 minutes by itself. With all the anger expressed by patients about waiting for the doctor and wanting to bill the doctor for running late, what are we to do? I would really like some ideas on how to listen fully, do a thorough physical exam and explain the condition in detail all in 15 minutes. And address other chronic issues at the same time. Please help.

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