Why do I need a rectal exam, and what can doctors find with the gloved finger?

Have you ever wondered why doctors have to perform a digital rectal exam?

Well, look no further, as primary care doctor Rob Lamberts gives us the answers discerning readers demand.

Simply by looking at the rectum, which by the way, indeed “takes some getting used to,” can lead to significant diagnostic findings. Furthermore, does tight sphincter tone matter? And should you be worried about the large hands …

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Relative value units, and how the RVU payment system doesn’t allow doctors to practice good medicine

For those who don’t know, every piece of work that a doctor performs is quantified and measured.

The base unit of physician work is known as the relative value unit (RVU). Most physician salaries are determined by the amount of RVUs a doctor produces in a given year, and in most cases, can range between$35 and $45 per RVU in primary care, depending on geographic location and …

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Laborists, and how rising malpractice premiums and the physician payment system are fueling the rise of hospital-only obstetricians

Meet the obstetric version of hospitalists, known as laborists.

Faced with rising malpractice premiums, and the increasing financial pressure to see more patients in the office, more obstetrician/gynecologists are ceasing to deliver babies. In fact, according to Massachusetts’ largest malpractice carrier, more than half of the OB/GYN’s they cover have dropped obstetrics.

It’s no wonder, as “an obstetrician-gynecologist in Massachusetts generally pays between $75,000 and $100,000 …

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Ways you can die from having sex

Cosmo Magazine, that bastion of reliable medical advice, declares, “An orgasm almost killed her.”

Intrigued, gynecologist Amy Tuteur reads further, and finds its about case where a woman developed stroke-like symptoms after intercourse, and was diagnosed with an embolic stroke.

The patient was taking the birth control pill, which can raise the risk of blood clots. In this case, it was also combined with the presence of …

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Does masturbation really cause prostate cancer?

A small study garnered significant media attention last week, with headlines blaring an association between masturbation and prostate cancer.

Before anyone gets really worried, obstetrician-gynecologist Amy Tuteur takes a closer look at the data, and is not impressed.

The retrospective, case-control study actually didn’t reveal any significant initial findings, so the authors kept manipulating the variables until they saw a possible association.

Dr. Tuteur believes that …

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How many babies can one woman carry?

That’s a question I was asked more than once, in light of this week’s story about the birth of octuplets.

For the answer, I’ll refer to this article in Slate. The largest reported number of fetuses in a single womb is 15.

The limit is not so much the number of fetuses, but the combined size and weight. As Christopher Beam explains, “once the total …

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Does the President need blood stored in his limousine?

Apparently, the Presidential limousine has a compartment that stores pre-crossmatched blood, just in case.

How necessary is this, considering the fact that a designated emergency department will never be far off for the President?

And in case the unforeseen happens, is transfusing blood in the field the best option for fluid resuscitation, rather than simply giving intravenous saline or crystalloid?

If anything, emergency physician Shadowfax writes, …

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Her hands and feet amputated, a Brazilian model dies from Pseudomonas aeruginosa sepsis. What happened?

Mariana Bridi da Costa, a 20-year old Brazilian model, tragically died early Saturday morning from Pseudomonas aeruginosa urosepsis.

How can this happen?

Miss Bridi da Costa initially presented on December 30th, and was diagnosed with kidney stones. An ultrasound, plain film, or CT scan likely would have been done to confirm the diagnosis. I assume that a urinalysis was also performed, and if …

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Is The Dark Knight’s Two-Face a realistic depiction of third-degree burns?

The answer is no.

Patient-blogger Duncan Cross takes exception to the cavalier treatment director Christopher Nolan gives to third-degree burns in Aaron Eckhart’s super-villain.

“There is no way that eye would have survived intact, much less be able to function without a lid and tear ducts,” he writes.

And his refusal of pain medications in the film? “The idea that someone could suffer Dent’s injuries, …

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Colonoscopy by primary care doctors, is it time to start joining the proceduralists?

As mid-level providers are starting to take over primary care, can generalist doctors start doing specialist procedures?

If they’re smart, they’ll try. Better to take advantage of a specialist-favoring physician payment system, rather than wait for things to change.

Colonoscopies are among the more lucrative of procedures, and signs are pointing to a shortage of gastroenterologists in the coming years to perform them.

MedPage Today

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What do doctors look for when they examine the abdomen?

A primary care doctor guides us through the abdominal physical exam.

He deciphers the much-written notation of “Abd: Soft, NT, Normal BS, no HSM or masses*,” and explains what physicians look for when they poke, prod, percuss, and listen to when examining a patient’s belly.

You’d be surprised at some of the things we find simply by pressing on the abdomen.

* For those who need translation, …

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Are there too many hospitals?

Should hospitals be run more like fire departments?

“Each neighborhood has its own firehouse,” says #1 Dinosaur, adding that “because the training is generally similar from one company to another, you don’t have huge, expensive advertising campaigns touting the superiority of the Main Street Fire Company over the one on Church Street.”

Calling it “the ultimate in capitation,” he envisions hospitals to be funded like police and …

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Jett Travolta’s seizure and death, was Scientology a factor?

Jett Travolta tragically passed away yesterday, after being found unconscious in his hotel room by his caretaker. There is speculation that he had a seizure and hit his head on a bathtub.

Travolta apparently had a long history of medical problems, including Kawasaki disease, which is a vasculitis that primarily affects children. It is one of the most common causes of acquired heart disease in children, and …

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Can you be too aggressive in silencing disruptive doctors?

What if a doctor wanted to speak up to promote better patient care?

It can be difficult under the new Joint Commission guidelines, which casts a wide definition of what a “disruptive physician” means, giving examples like “reluctance or refusal to answer questions, return phone calls or pages; condescending language or voice intonation; and impatience with questions.”

Like any profession, some doctors are indeed jerks. But Doug …

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Can Good Samaritans be sued for providing medical help?

A controversial ruling in California is making people think twice before stopping to help.

California’s Supreme Court has ruled that “the state’s ‘Good Samaritan’ law providing tort immunity for rescuers applies only to medical personnel providing medical help at an emergency scene, and not to civilians.”

But are physicians really protected? This doctor cites colleagues who are “afraid to stop at the scene of an …

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When primary care refuses to accept Medicare

It’s never a problem, until it affects you.

Baby Boomers are going to be Medicare beneficiaries within the next few years, and some are finding out how difficult it is to find a primary care doctor.

Nationwide, about 30 percent of Medicare patients had difficulty finding a primary care physician during the past year.

As one patient puts it, “I must have made 12 calls before …

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Is there a place for a part-time medical residency?

Doctors in training often do so in their prime family-rearing years.

A few pediatric residencies are offering part-time residency options, designed for those who also want to raise their own families. Proponents argue that residents can not only get more rest, but also avoid depression, which affected almost a quarter of pediatrics residents.

Combined with the talk of further limiting work hours down to 56 …

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How Hurricane Ike destroyed a medical center

Last month’s hurricane hit the University of Texas Medical Branch at Galveston particularly hard, with the institution suffering $700 million in damage:

It cannot begin to take on patients, open up wings and generate revenue until it repairs critical operations like its blood bank, pharmacy, kitchens and radiology department, but it lacks the millions needed for the repairs, and so far the federal and state governments have not come through …

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