Doctors and white coats

Interesting study – most patients seem to want their physicians to wear white coats:

In contrast to doctors, who view white coats as an infection risk, most patients, and especially those older than 70 years, feel that doctors should wear them for easy identification. Further studies are needed to assess whether this affects patients’ perceived quality of care and whether patient education will alter this view.

I find wearing …

Read more…

Smoke free or die

In my home state, where motercyclists can ride without helmets, New Hampshire is becoming one of the last states to ban smoking in restaurants. Tough to be a public health officer here when you do not have the support of the state. As one such officer puts it: “New Hampshire is becoming the ashtray of New England”.

The future of primary care

The New England Journal published a sounding board piece on the future of primary care in the United States. The authors suggest that one paradoxical reason is the increased exposure to primary care in residency training:

But an additional possibility, albeit an apparently paradoxical one, is that the decline is due in part to the successful efforts by medical schools to increase students’ exposure to primary care practice. …

Read more…

New pain guidelines

While I was on vacation, the DEA released guidelines “designed to help doctors prescribe narcotics like Oxycontin and morphine without fear of arrest”.

IM vs oral steroid therapy for asthma

A recent study suggests that a single IM dose of steroid is equivalent as an 8-day tapering course of oral steroid in the setting of relapse rates from acute asthma attacks:

Objective: To compare the efficacy of long-acting IM methylprednisolone to tapering oral methylprednisolone in adult asthmatic patients discharged from the emergency department (ED).

Methods: Randomized, double-blind, placebo-controlled trial of a single IM dose of 160 mg depot …

Read more…

I’m back . . .

. . . from a wonderful vacation and ready to work. Forums will be open later today, and I’ll slowly answer my email.

I went to lovely St. Martin, the culinary capital of the Caribbean. The small fishing village of Grand Case hosts an unbelievable array of fantastic dining – and it surely did not disappoint. Highly recommended to any gourmet …

Read more…

Some interesting reading . . .

. . . while I’m gone:

The dangers of medical advisory board scams.

A poignant story, entitled “It’s not just what we say.”

Another story on the rewards of medicine.

A new addition to the Scutmonkey Comics.

Overlawyered links to some comments on my “Screen me or I’ll sue” story.

Medrants discusses the levels of thinking …

Read more…

Out of the country . . .

. . . and without internet access. Apologies in advance if I don’t respond to emails. Regular blogging will continue when I return and my forums will reopen on August 14th.

Hyperkalemia from the RALES study

The RALES study, published in 1999, concluded that spironolactone reduce mortality in those with severe heart failure (i.e. Class IV failure). Today’s NEJM comes out with a study showing that due to the RALES study, rates of hyperkalemia and mortality from this complication increased. Taking this into account, there were no significant decreases in death from all causes.

The reason for this is that most …

Read more…

Waits for mammograms

A few weeks ago, one of my colleague’s sister from Ireland came over for a visit. The wait for a screening mammogram there was 6 months. She decided to pay out of pocket to have one here. It was booked for her the next day. However, in some parts of the country, the wait times are growing.

A study showing . . .

. . . that triptans do not increase the rate of heart attack and stroke. Reassuring for migraine sufferers.

Any theories . . .

. . . as to what happened to this unfortunate boy? A previously-healthy 13-year old was hiking and saw a bear in the woods. After running away, he went into respiratory distress and collapsed. Would it be possible for the catecholamine release to trigger some sort of arrhythmia?

Fed up with . . .

. . . the inaction of tort reform, two towns in Illinois are taking matters into their own hands.

Other uses of Viagra

Other than erectile dysfunction, Viagra has been studied in the treatment of pulmonary hypertension. Today’s Annals of Internal Medicine presents a small study showing Viagra increased exercise capacity both in normal and high altitudes, suggesting a possible use in managing acute mountain sickness or other conditions caused by low oxygen levels at the alveoli.

The myth of antioxidant supplements

As I have been continually telling my patients, antioxidant supplements do not have the appropriate evidence to support their use. Today, the American Heart Association agreed.

Winning Gmail entry #4

It’s been awhile since I’ve received any submissions for my remaining Gmail invites. I still have 3 more left. Send me any entertaining, medically-related story or article, and I’ll give a Gmail invite to what I find interesting. I give preference to entries that are well-written.

This morning, I received this story from someone who works with the developmentally disabled. An eye-opener to say the …

Read more…

The strain of screening

As screening modalities emerge and grow more expensive (i.e. take the recent studies on screening MRIs for breast cancer in high-risk patients), can our health system handle the strain?

Consider the colorectal cancer screening. We all know that a colonoscopy is one option for colon cancer screening. However, there is no direct data that screening colonoscopies reduce mortality:

The USPSTF found good evidence that …

Read more…

Same issues overseas

Looks like resident physician hours are also an issue in Britain – except their limit is 58 hours a week (way under the 80 hour per week limit in the United States).

On vacation

I’ll be taking a much-anticipated vacation the next 2 weeks. My forums at Med Help International will be closed until August 14th. I’ll continue to blog as interesting things come up, but will be sporadic during the first two weeks of August.

MRIs for breast cancer screening

I was going to talk about it, but Bard-Parker beat me to it. I guess that’s what headlines are for, but people simply read the headline (“Study Finds MRIs Better on Breast Cancer”) and jump to a conclusion. Already had someone ask me for a screening MRI of her breasts this morning. It comes as no surprise that the MRI has the higher sensitivity (i.e. less …

Read more…

1787
pages

✓ Join 150,000+ subscribers
✓ Get KevinMD's most popular stories