The next part of this continuing series. I'm sure that many can relate to this story. A reader writes:

A 30-year old woman comes into her PCP's office with a complaint of chest pain for the past couple weeks. It is described as sharp and pricking along the left sternal border. It hurts when you press on it and does not radiate. It does not change with ...

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One has to remember that "the first drug geared towards blacks" is really not a new medication
This is simply repackaged hydralazine and a nitrate, which was used before the ace-inhibitor era for heart failure. More has been written about this previously.

A physician lost a case for $2.6 million for following instructions
"Alexander Mitchell, 16, of Conway, N.H., died after swallowing nearly 300 aspirin pills. Alexander, a student at Proctor Academy in Andover, was depressed over a relationship.

The Mitchells alleged that Christopher Occhino, a visiting doctor filling in at Franklin Hospital, did not order their son transferred to Dartmouth-Hitchcock Medical Center soon enough for more specialized treatment. Occhino now ...

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retired doc wonders if there will be general internists in the future
"Tremendous growth and development of the subspecialist domains of expertise has changed the landscape. Cardiologists are now called in to treat coronary syndromes, pulmonary docs for respiratory failure, etc etc. Oncologists take care of the cancers, kidney doctors the ESRD cases and it is the rheumatologists now giving the disease modifying treatments for rheumatoid arthritis. In short, ...

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More defensive medicine: Malpractice fears leads to mammography overreads
"An article in the July issue of Radiology suggests that this anxiety may be the reason for the large number of false positives and recalls in the United States.

Dr. Joann Elmore of the University of Washington medical school, said that this caution does not necessarily make women safer and does increase their anxiety about breast cancer.
...

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More "dirt" on Dr. Death
"India-born surgeon Jayant Patel, dubbed 'Dr Death', refused to wash his hands between operations and was responsible for a high rate of complications among renal unit patients at the Australian hospital where he worked, an inquiry has heard."

The BMJ suggests ways to re-invent office practice
"If we can change the financing so that doctors are paid by the patient instead of by the visit, or if health plans would begin to reimburse for on-line and group care, all kinds of new care models could be supported. The key insight is the willingness to abandon the individual doctor-patient visit as the standard unit of care. The Internet ...

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Antibiotics do not help healthy individuals with bronchitis
"In the study, coughing lasted an average of 11 days after patients saw their doctors, whether they got antibiotics or not. Other symptoms, such as phlegm and shortness of breath, were reduced by less than a day for people treated with amoxicillin or erythromycin."

The abstract can be found here.

A patient punches a doctor for trying to do a physical exam for a hip injury
"Winston seemed to think Dhananjayan would X-ray his leg. When the doctor explained that a physical examination was required first, Winston flew into a rage and accused the doctor of 'wanting to touch his sexual organs,' the police said."

No balls: The AMA can't make up its mind about DTC advertising, so it plays it safe and votes for further study

Overseas Trained Doctors (OTDs) are facing racial abuse in Australia in light of the continuing Dr. Death scandal
A follow-up to this story.

Why is it so difficult to e-mail your doctor?
Liability and reimbursement are two big reasons.

A drug rep took a physician to a strip club
"About four evenings a week, L.J. Twyner, a Newton physician, enjoys dinner paid for by drug companies. Other perks have included trips to bars and in at least one instance a visit to a club featuring nude dancers."

Wyeth is cutting back on drug rep visits to physician offices
"Wyeth spokesman Doug Petkus said his company is cutting back on repeat visits to the same general practitioners and internists because of the costs and also the growing unwillingness of busy doctors to endure so many sales calls."

Grand rounds 1:39 is up
Everybody's favorite blogging surgeon is hosting this week. Come get the weekly best of the medical blogosphere.

Some are facing difficult decisions about removing their recalled heart defibrillators
"Each assessment on surgery, doctors say, will be a personal one, based on a patient's age and health, how dependent the patient is on the device and the patient's attitudes toward risk."

"Dr. Patel screamed at patient's wife not to cry."
The NY Times writes about Australia's Dr. Death.

Bristol-Myers Squibb is the first major drug firm to forgo advertising new drugs to consumers in a product's first year on the market
I applaud the move. Not quite a ban on DTC advertising, but it's a start.

Medical residents are on strike in a hospital in India, leading to a standstill
"Two more patients died and more than two dozen patients sought discharge from the King George's Medical University, as junior doctor's strike entered the second day on Tuesday.

The hospital wore a deserted look as patients started leaving the hospital for private nursing homes and other government hospitals. In the general body meeting held during ...

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A neurosurgeon quits brain surgery to do hair transplants
"'Basically I was working over 100 hours a week just to pay a malpractice premium (of) about $135,000 a year,' he says.

He was reimbursed between 25 and 40 percent of his surgical fees, and his income had already plummeted 60 percent.

Now, Dr. Ballon says he's operating on the same place, but he just doesn't go as deep. ...

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