The story where the woman had to dial 911 from the ER to receive care seems to be getting a lot of play here. The ensuing forum is bringing out more "complaints" against this hospital - it seems that people do not understand that the reason why ERs are so overcrowded is beyond the physicians' control. There are many reasons for this (too many uninsured, poor access to ...

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I trained in Boston so I periodically keep tabs on the medical scene there. In the same vein of the previous entry I wrote today, comes this story from the Boston Globe.

. . . new patients in Boston wait an average 37 days to see a cardiologist, 45 days to see an obstetrician-gynecologist, and 50 days to see a dermatologist "” the longest waits ...

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Apparently, some patients are taking action against the long ER waits. From The Bostonchannel.com comes this story of 2 patients. One was a young girl who waited six hours before being seen. It turned out she had appendicities and when she was operated on, the "doctor said she was a mess when he opened her up".

The other case was a 39-yo female who ...

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. . . from yesterday - certainly looks like a cholesteatoma to me. The patient was sent to an ENT physician. Here is some more information from Medline Plus:

Cholesteatoma can be a congenital defect, but it more commonly occurs as a complication of chronic ear infection. Long-term inflammation and malfunction of the eustachian tube leads to chronic negative pressure in the middle ear. ...

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Following-up on Galen's entry on Canadian vs US health care, comes an article from the Globe and Mail that discusses a study comparing satisfaction with both systems:

Americans are more enthusiastic about their free-market health-care system than Canadians are about their publicly funded medicare system, but Canadians' care needs are actually better met than those of their U.S. counterparts.

The main beef with the system in the U.S. ...

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35-yo female came in today with right-sided ear pain. Here is what I found on otoscopic exam. Any ideas?

(Disclaimer: Any pictures shown are not of the patient. All identifying features, including race, age, gender and ethnicity have been modified significantly or fictionalized.)

They sure don't have this kind of food at the hospitals where I work at.

Here's something interesting I came across from Internal Medicine News Online. It discusses whether the media overplays and overpublicizes clinical studies. Some excerpts:

. . . most studies cannot stand alone. "Rarely is a study conclusive enough or broad enough to establish public policy or direct individual action by itself," . . .

. . . Although they might be suitable for journal publication, very few ...

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Interesting article from the NY Times investigating communication between physicians and patients. Here are some excerpts:

. . . Two decades ago, in 1984, researchers showed that on average, patients were interrupted 18 seconds into explaining their problems. Fewer than 2 percent got to finish their explanations.

. . . Research shows that only 15 percent of patients fully understand what their doctors tell them, and that ...

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Harvard Medical School is planning a medical campus in the United Arab Emirates. Some interesting points:

. . . there are enormous hurdles to fostering US-style health care in a region where medicine is so spotty that the 100 million Persian Gulf residents spend $25 billion a year getting treatment elsewhere, according to Dubai Healthcare City officials. Many medical school students enroll straight out of high school and ...

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Here is a nice article from the Boston Globe that investigates some of the issues of importing medications from Canada.

As a follow-up to what I wrote last week, it seems like the new Medicare cards are slow to take off. And why not? On one hand, you have a dizzying, confusing array of Medicare cards - on the other, you have Canada, which gives you better savings. The choice seems pretty clear. It confounds me how the government can so poorly implement a simple ...

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Here's a nice joke from the BMJ:

For those of you who watch what you eat and drink, and worry about heart disease, here is the truth"”according to a joke currently doing the rounds. The Japanese eat very little fat, while people in Mexico eat lots. Both groups suffer fewer heart attacks than the British or Americans. Africans drink very little red wine, while the Italians drink large ...

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In the article, Why do doctors use treatments that do not work?, several interesting points were made. It is making a case that we need to continually rely on the evidence, and less on empiricism. This is why it is so frustrating when I hear stories where EBM is tossed around like a "dirty word" and when physicians are making treatment decisions that are evidence-bereft.


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IBS is one of the more frustrating diseases to treat. Increased fiber intake, antispasmodic agents, and Zelnorm (for constipation predominant disease) are among the treament choices. However, in many cases, these treatments aren't enough and many patients unfortunately remain symptommatic. In the GI forum that I moderate, there are many who report refractory IBS symptoms.

Today comes a study from the American ...

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We all know that one reason for rising health costs is that newer technologies are more expensive. For one small example, consider the evolution from sigmoidoscopies to colonoscopies. The medical director Patient Care writes that sigmoidoscopies have virtually ceased once colonoscopies became a covered benefit under both Medicare and private insurance. Consider the charge for a sigmoidoscopy is several hundred dollars compared to over $3000 for a ...

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Inevitable

It was only a matter of time that this would happen.

AP:
A businessman has sued the promoters of the Atkins Diet, saying the low-carb, high-fat meal plan clogged his arteries and nearly killed him.

Scutmonkey comics

I got a good laugh from Michelle Au's scutmonkey comics. Very funny, very true. I particularly like the 12 types of med students.

Medpundit and DB has chimed in on the mainstream coverage of the deficiencies of PSA screening for prostate cancer that was discussed here on Tuesday and Wednesday.

Medpundit writes:
Beware of organizations made up of hospitals and urologists who call for lower thresholds for treatment. They have much to gain from the increased number of biopsies such lower thresholds would produce. Unfortunately, it's far from clear ...

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The FDA approved rifaximin, a non-absorbed antibiotic that remains within the body's gastrointestinal system, for traveller's diarrhea. This is in contrast to most other antibiotics which are spread throughout the body. Cipro or Bactrim are medications that are currently used.

A review article has suggested that this therapy may become the treatment of choice once routinely available.

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