For decades, malpractice lawyers and insurers have counseled doctors and hospitals to “deny and defend.” Many still warn clients that any admission of fault, or even expression of regret, is likely to invite litigation and imperil careers.
But with providers choking on malpractice costs and consumers demanding action against medical errors, a handful of prominent academic medical centers, like Johns Hopkins and Stanford, are trying a disarming approach.
By promptly disclosing medical errors and offering earnest apologies and fair compensation, they hope to restore integrity to dealings with patients, make it easier to learn from mistakes and dilute anger that often fuels lawsuits.
Malpractice lawyers say that what often transforms a reasonable patient into an indignant plaintiff is less an error than its concealment, and the victim’s concern that it will happen again.
Despite some projections that disclosure would prompt a flood of lawsuits, hospitals are reporting decreases in their caseloads and savings in legal costs. Malpractice premiums have declined in some instances, though market forces may be partly responsible.
Friday, May 30, 2008
Thursday, May 29, 2008
Two monkeys with tiny sensors in their brains have learned to control a prosthetic arm with only their thoughts, using it to reach for and grab food and even to adjust for the size and stickiness of morsels when necessary, scientists reported Wednesday.Joking aside, the technology shows promise for future clinical applications in patients with spinal cord and other neurological injuries:
The report, released online by the journal Nature, is the most striking demonstration to date of brain-machine interface technology, which scientists expect will eventually allow people with spinal cord injuries and other paralyzing conditions to gain more control over their lives. The findings suggest that brain-controlled prosthetics, while not yet practical, are at least technically within reach.While I'm thinking about radiology, its stories like these that give me pause and wonder whether I should have pursued neurology or even neuroscience as a PhD instead. Still, we must always be wary of our future robotic counterparts...
In previous studies, researchers showed that humans who had been paralyzed for years could learn to control a cursor on a computer screen with their brain waves; and that thoughts could move a mechanical arm, and even a robot on a treadmill.
Yet the new experiment demonstrates how quickly the brain can adopt a mechanical appendage as its own, refining movement as it interacts with real objects in real time. The monkeys in the experiment had their own arms gently restrained while they were learning to use the prosthetic one.
Wednesday, May 28, 2008
The crook of your elbow is not just a plain patch of skin. It is a piece of highly coveted real estate, a special ecosystem, a bountiful home to no fewer than six tribes of bacteria. Even after you have washed the skin clean, there are still one million bacteria in every square centimeter.
But panic not. These are not bad bacteria. They are what biologists call commensals, creatures that eat at the same table with people to everyone’s mutual benefit. Though they were not invited to enjoy board and lodging in the skin of your inner elbow, they are giving something of value in return. They are helping to moisturize the skin by processing the raw fats it produces, says Julia A. Segre of the National Human Genome Research Institute.
Dr. Segre and colleagues report their discovery of the six tribes in a paper being published online on Friday in Genome Research. The research is part of the human microbiome project, microbiome meaning the entourage of all microbes that live in people.
I think a microbiome project is a great idea. In medical school, we learn about the most common and/or most virulent bugs, but often on clinics I have noticed pathology reports come back with bugs I have never heard of, and wouldn't know how to categorize without the helpful notes from the pathologist. Having a better understanding of all the 'commensuals' can only help to improve not only medical school education but medical knowledge overall.
Tuesday, May 27, 2008
Jennifer Buettner was taking care of her young niece when the idea struck her. The child had a nagging case of hypochondria, and Ms. Buettner’s mother-in-law, a nurse, instructed her to give the girl a Motrin tablet.
Studies have repeatedly shown that placebos can produce improvements for many problems like depression, pain and high blood pressure, and Ms. Buettner reasoned that she could harness the placebo effect to help her niece. She sent her husband to the drugstore to buy placebo pills. When he came back empty handed, she said, “It was one of those ‘aha!’ moments when everything just clicks.”
Ms. Buettner, 40, who lives in Severna Park, Md., with her husband, 7-month-old son and 22-month-old twins, envisioned a children’s placebo tablet that would empower parents to do something tangible for minor ills and reduce the unnecessary use of antibiotics and other medicines.
With the help of her husband, Dennis, she founded a placebo company, and, without a hint of irony, named it Efficacy Brands. Its chewable, cherry-flavored dextrose tablets, Obecalp, for placebo spelled backward, goes on sale on June 1 at the Efficacy Brands Web site. Bottles of 50 tablets will sell for $5.95. The Buettners have plans for a liquid version, too.
Still, later in the piece, even Dr. Brody admits that the product will likely be quite popular. And why not? We already do many actions to treat things which in reality have no true efficacy. Why not formalize the practice? I think if this catches on, pediatricians should simply address it with parents directly, and tell them when it is appropriate to use placebos and when they must bring their child in to see a physician.
But some experts question the premise behind the tablets. “Placebos are unpredictable,” said Dr. Howard Brody, a medical ethicist and family physician at the University of Texas Medical Branch at Galveston. “Each and every time you give a placebo you see a dramatic response among some people and no response in others.”
He added that there was no way to predict who would respond.
“The idea that we can use a placebo as a general treatment method,” Dr. Brody said, “strikes me as inappropriate.”
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Friday, May 23, 2008
Thursday, May 22, 2008
The therapy, which uses heat from the laser to destroy the tumor’s blood supply and cancer cells, damages surrounding tissue far less than radiation and different types of lasers.
It has been tested in only 28 patients, all at Massachusetts General Hospital in Boston. Yet the initial findings hold promise because the laser was the patients’ only treatment and none have had a recurrence or needed surgery or radiation after a mean follow-up of 27 months, the team’s leader, Dr. Steven M. Zeitels, said in an interview. The longest is more than five years.
Apparently, before the lasers, these types of cancers required surgery and radiation, a much more intensive approach. In the video interview (I think it was on ABC's 20/20), the doctor treated one of Israel's famous comedians who used his voice all the time to perform. The comedian was highly pleased with the results, 3 years out. I wonder what further applications this technique has.
Wednesday, May 21, 2008
The officials had previously identified seven cases of the disease linked to the gastroenterology practice, one of the largest in southern Nevada, and a single case in one of the practice’s sister clinics. The infections were caused, they said, by the reuse of anesthesia syringes among multiple patients.How avoidable, ridiculous, and tragic. These poor people are now victims of a chronic potentially fatal disease all due to someone's negligence and likely cost-cutting measure. No wonder many people out there are skeptical of physicians and how they practice.
Tuesday, May 20, 2008
What do I do to make the patient comfortable when they lie down?Make sure they have a pillow if they are lying down for an extended period. Extend the leg support so that their legs are not dangling off the edge of the bed. It is easy to forget to do this, but it is important to do so your patient feels comfortable.
How do I adjust the angle of the head of the bed?
Most beds have a lever on the right side near the head that allows you to adjust the angle of the head. Simply press it, adjust the head of the bed, release the lever, and the bed should lock in place. Make sure to do this before the patient lies down.
How do I tear the butcher/butter paper neatly?
Most beds have this wax paper on them to keep the bed clean between patients. You should change it after every patient. However, it can be hard to tear at times. A simply way to tear it nicely to lay either the edge of your palm or your whole forearm down where you want to tear to form an edge. Then, simply tear with the other arm quickly in one brisk motion, and you should get a relatively nice tear.
Again, I realize most of this is obvious, but it's very easy to get nervous during the first years of med school when you first start seeing patients and forget about the patient's comfort, so hopefully this will help some of you beginners out there. Got more tips? Feel free to add a comment and mention them.
Monday, May 19, 2008
The doctor found his 20 year-old son in the bathroom sprawled over the toilet. “Not again?” he asked gently. The young man nodded, tears bright in his eyes, as he rose slowly to his feet. He pressed his hand deeply into his own abdomen, as if holding something in place. “It’s getting worse.”
The father was overwhelmed by a sense of helplessness. “Get dressed,” he told his son suddenly. If they rushed to the hospital, maybe they would be lucky enough to catch whatever was causing this pain on an X-ray. The young man had already been imaged a half-dozen times, but never during an attack. But a short time later, as they walked down a quiet hospital hallway, he turned to his father. “I’m sorry, Dad,” he said. “The pain is gone.” As it had so often in the past, the attack ended the way it started — suddenly. The X-ray was normal.
The young man’s father, a gastroenterologist, had been trying to figure out the cause of these terrible episodes for months. He was tormented by the possibility that he might have missed something. It was, he thought, time to send his son to another doctor, and so he called an old friend and internist, Andrew Israel.
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Friday, May 16, 2008
Society is now riven between the memory haves and the memory have-nots. On the one side are these colossal Proustian memory bullies who get 1,800 pages of recollection out of a mere cookie-bite. They traipse around broadcasting their conspicuous displays of recall as if quoting Auden were the Hummer of conversational one-upmanship. On the other side are those of us suffering the normal effects of time, living in the hippocampically challenged community that is one step away from leaving the stove on all day.
This divide produces moments of social combat. Some vaguely familiar person will come up to you in the supermarket. “Stan, it’s so nice to see you!” The smug memory dropper can smell your nominal aphasia and is going to keep first-naming you until you are crushed into submission.
Thursday, May 15, 2008
The book goes beyond merely being a descriptive exposition. Groopman is mainly writing with patients as his intended audience, and he offers some prescriptive advice at the end of the book that endeavours to help patients help their physicians overcome their internal biases.
I highly recommend this book to all medical students, especially those who are having a hard time choosing between different fields. Seeing how different specialists think is very helpful in trying to decide if that is the role one desires to inherit.
Wednesday, May 14, 2008
The Water Hack: A bit of water before bed and half a liter as soon as you get up. The water before bed will serve in the rejuvenation process we mentioned above. While you sleep all your cells will fill up with this fresh water and create an over all well being within your body.
The water in the morning does two things. One is it provides your first dose of water to get your mind and body going. Another function, as told to me by my endocrinology teacher (a very qualified person to say this), is that a dose of water in the morning triggers a cascade of physiological functions that engages your digestive system and causes you to excrete feces. You'll feel nice and light first thing in the morning!
Tuesday, May 13, 2008
University of Florida marketing professors Chris Janiszewski and Dan Uy suspected that something fundamental might be going on, that some characteristic of the opening bid itself might influence the way the brain thinks about value and shapes bidding behavior. In particular, they wanted to see if the degree of precision of the opening bid might be important to how the brain acts at an auction. Or, to put it in more familiar terms: Are we really fooled when storekeepers price something at $19.95 instead of a round 20 bucks?The article does on to describe their experimental set-up, and their explanation of the results:
Why would this happen? As Janiszewski and Uy explain in the February issue of Psychological Science, people appear to create mental measuring sticks that run in increments away from any opening bid, and the size of the increments depends on the opening bid. That is, if we see a $20 toaster, we might wonder whether it is worth $19 or $18 or $21; we are thinking in round numbers. But if the starting point is $19.95, the mental measuring stick would look different. We might still think it is wrongly priced, but in our minds we are thinking about nickels and dimes instead of dollars, so a fair comeback might be $19.75 or $19.50.Check out the article for more details on the experiment and results. I, for one, will never look at a price-tag the same way again.
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Monday, May 12, 2008
... a rare condition in which there is excess sulfhemoglobin (SulfHb) in the blood. The pigment is a greenish derivative of hemoglobin which cannot be converted back to normal, functional hemoglobin. It causes cyanosis even at low blood levels.
Sulfhemoglobinemia is usually drug induced. Drugs associated with sulfhemoglobinemia include acetanilid, phenacetin, nitrates, trinitrotoluene and sulfur compounds (mainly sulphonamides). Another possible cause is occupational exposure to sulfur compounds. The condition generally resolves itself with erythrocyte (red blood cell) turnover, although blood transfusions can be necessary in extreme cases.
The man - a 42-year-old white Canadian - had developed a compartment syndrome (localised tissue/nerve damage due to restricted blood flow) in both lower legs after falling asleep in a sitting position. He was a smoker whose medical history included chronic shoulder pain and migraine, and was taking a number of regular medications, including sumatriptan to treat the migranes.Green blood! Who knew?
Doctors decided he needed urgent fasciotomies (a limb saving procedure in which tissue is cut into to relieve pressure) and he underwent emergency tests, which determined he was mildly tachycardic (rapid heart beat) but had normal blood pressure and his only initial abnormal blood result was an extremely high creatine kinase concentration.
In the operating theatre, multiple attempts to insert a radial arterial catheter yielded dark greenish-black blood, which was immediately sent away for analysis. Meanwhile the catheter was eventually fully inserted, and the man recovered well.
Sulfhaemoglobinaemia, rather than cyanosis, was diagnosed as the cause of the green-black blood.
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Friday, May 09, 2008
Trained in mathematics, chemistry and biology, Dr. Adams left her career as a teacher and bench scientist in 1986 to take care of a son who had been seriously injured in a car accident and was not expected to live. But the young man made a miraculous recovery. After seven weeks, he threw away his crutches and went back to school.
According her husband, Robert, Dr. Adams then decided to abandon science and take up art. She had dabbled with drawing when young, he said in a recent telephone interview, but now she had an intense all-or-nothing drive to paint.
Ravel and Dr. Adams were in the early stages of a rare disease called FTD, or frontotemporal dementia, when they were working, Ravel on “Bolero” and Dr. Adams on her painting of “Bolero,” Dr. Miller said. The disease apparently altered circuits in their brains, changing the connections between the front and back parts and resulting in a torrent of creativity.
“We used to think dementias hit the brain diffusely,” Dr. Miller said. “Nothing was anatomically specific. That is wrong. We now realize that when specific, dominant circuits are injured or disintegrate, they may release or disinhibit activity in other areas. In other words, if one part of the brain is compromised, another part can remodel and become stronger.”
Thursday, May 08, 2008
Jamie Lee Curtis
I remember learning about gender determination on a genetic level, and hearing Jamie Lee Curtis' name mentioned. Why? Because apparently she may be a hermaphrodite. According to Snope though, the reality is undetermined. Based on her movies though, I think she wants us to believe that she is all woman.
I suppose people may argue about how famous he is now, but back in the 80's, I think he was pretty well known. Dudley Moore starred in films such as Arthur and 10. Unfortunately, Dudley Moore died of progressive supranuclear palsy, a degenerative neurological condition that mimics Parkinson's Disease.
The talk show host's battle with the bulge has been legendary. However, perhaps there was a medical condition. Oprah recently revealed that she had been diagnosed with hyperthyroidism which then became hypothyroidism, leaving her overweight and easily fatigued.
The Denver Broncos quarterback was recently diagnosed with Type I Diabetes.
The King of Pop claims his, um, appearance changes are due to a skin condition called vitiligo. How does that explain the hair, the nose, and the bizarre behavior? Anyway, to quote an old joke, Michael Jackson proves that only in America can a black man grow up to be a white woman. Snap.
Wednesday, May 07, 2008
- So you're scrubbed in. Now what? You want to approach the bed, but the room is now a mix of sterile and non-sterile areas. As you approach the bed, try your best to always face anything that is not sterile. If you have your back to something that is not sterile, you are more likely to bump into it.
- Move slowly. Never rush. Always keep your hands tucked into your body, between your nipples and navel.
- Once at the table, find a comfortable place to stand that affords you a good view. This can be hard sometimes.
- Once the patient is draped and sterile, you can relax a bit. Feel free to brace yourself against the patient's body with your hands. Just make sure that your hands are touching only the sterile drapes.
- When you are scrubbed in, you are going to be doing a lot of standing. Maintaining a good posture is key to avoiding back / leg pain later on. To do so, try to stand as straight and symmetrically as possible. Avoid favoring one leg over the other. Do not lock your knees, but rather bend them slightly in order to take stress off of your back. Also, stand with a wide stance to improve your balance.
- Find yourself nodding off? Make sure to look around / look away every few minutes. Try to bend and flex your legs periodically to keep them from hurting.
- Face itchy? Sweating? You CANNOT touch your face mask because it is not sterile. For the most part, you have to just deal with this. However, if it is a severe problem, you can always request the circulating nurse to dab your forehead or adjust your mask.
- Feeling faint? This happens occasionally. If you know it will pass momentarily, just stay calm and focus on your balance. However, if you really know you cannot hold your position, just let the attending (or first assist) know the problem, and ask to scrub out. It is better to scrub out than to fall into the field or onto the floor. Don't be a hero.
Tuesday, May 06, 2008
“I’ve grown up on medication,” my patient Julie told me recently. “I don’t have a sense of who I really am without it.”
At 31, she had been on one antidepressant or another nearly continuously since she was 14. There was little question that she had very serious depression and had survived several suicide attempts. In fact, she credited the medication with saving her life.
But now she was raising an equally fundamental question: how the drugs might have affected her psychological development and core identity.
It is indeed an interesting question. As the author notes, for patients who are on these drugs whil their brains are still developing may not remember a time when they were not on antidepressants. Their sense of who they are is shaped in part by the medications. This can lead to interesting but distressing side effects:
Beyond these concerns, there are other important issues to consider in long-term use of antidepressants, especially in young people. One patient, a woman in her mid-20s, told me that she felt pressured by her boyfriend to have sex more often than she wanted. “I’ve always had a low sex drive,” she said.
For the past eight years she had been taking Zoloft, which like all the antidepressants in its class is known to lower libido and to interfere with sexual performance. She had understandably mistaken the side effect of the drug for her “normal” sexual desire and was shocked when I explained it: “And I thought it was just me!”
Honestly, sometimes I tend to overlook these "common" side effects as medical students are trained to know the rare / more severe reactions. However, hearing this story makes me realize how little we truly know about these medications and their impact on our patients' lives, especially over the long term.
Monday, May 05, 2008
Patient: Roseann Errante, 36, mother-to-be
Doctors: Alan Monheit, obstetric surgeon, and Frank Seifert, heart surgeon, Stony Brook University Hospital
Patient’s husband: Joe Errante
Roseann: At 30 weeks I woke up with chest pains. It was like nothing I’d ever felt. The pains went up to my neck, ears, and head.
Monheit: I was on call when she came in. Her tests looked fine, but with the pain traveling to her neck, we called a cardiologist.
Joe: I was joking with the technicians that we were praying for preeclampsia—which is terrible. But at least we would’ve known what it was. They were looking at the scan and suddenly everyone stopped joking.
Seifert: She had aortic dissection, a tear in the inside wall of the aorta. The aorta is the largest blood vessel in the body. It starts at the heart and goes up to the great vessel, which supplies the brain, then loops around and goes down the back and supplies all the organs. Roseann’s dissection was in the part between the heart and the great vessel. Think of it as a run in a stocking. It could either stay where it was or just keep on going.
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Friday, May 02, 2008
Next she shared the alarming news that American radiologists are losing jobs because X-rays are being sent electronically to India. But the outsourcing of radiology is not precisely what Mrs. Clinton made it out to be; according to Frank Levy, a professor at the Massachusetts Institute of Technology, there is only one company in India that reads American images. The overseas radiologists who read American images are generally American citizens themselves, said Mr. Levy, because doctors who have not passed American boards cannot be insured against malpractice.Oh, Hillary. Stick to the politics, okay? And fine, while this is a threat in the future I suppose, she should be more careful before making such claims since it's easily falsifiable.
Thursday, May 01, 2008
Working closely with William Gruber, the inventor of the View-Master, the three-dimensional viewing system that GAF Corporation popularized as a toy in the 1960s, Dr. Bassett created the 25-volume “Stereoscopic Atlas of Human Anatomy” in 1962. It included some 1,500 pairs of slides, along with line drawings that made the details more discernible. The paired slides could be examined with a View-Master, making the chest cavity look cavernous, and making details of structure and tissue stand out unforgettably.Apparently now, these images will be hosted online by Stanford University. Given the degree of technology and the availability of 3-D CT imaging, I remember thinking that it was strange that I was learning my anatomy from a mix of crude diagrams and detailed but still 2D images. Hopefully efforts like this will lead to medical students of the future learning anatomy in full 3-D.