Quote of the Day
Family physicians are the pluripotential stem cells of American health care. -Dr. Wanda Filer
Well said.
Dr. Filer (I get to call her Wanda because I’m special; also, she’s really nice) did hands-down one of the best talks I’ve ever heard on the long term effects of childhood trauma, which probably affects more than a third of my patients, and I don’t even know it. (Look for upcoming post on asking established patients — some of them decades-long — new patient questions.) She is also the President-elect of the American Academy of Family Physicians, which means that even though I ju...
Source: Musings of a Dinosaur - March 21, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Happy π Day
Bonus points for recognizing this:
Not only is today pi day (3/14), it’s uber pi day: 3/14/15. (Also note the time of this post.)
There are many ways of celebrating pi day, many of which include consuming lots of circular foods. This makes sense (as pi is the ratio of the diameter of a circle to its circumference, for the nerd-impaired.)
Many people also like to get together and play games (hence the double entendre of the above cookie design), which doesn’t really make much sense.
It’s irrational.
Like pi.
(Source: Musings of a Dinosaur)
Source: Musings of a Dinosaur - March 14, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Food Miscellaneous Source Type: blogs
Explaining the Unexpected
Incidentaloma: a cutesy term for an unexpected finding on an imaging or lab study unrelated to the study’s original purpose.
Known more formally as an “incidental finding”, they are a huge source of wasted time, money, effort, anxiety, and medical resources spent tracking down exactly what they are. Because lawsuit!
I found myself trying to explain this concept to a patient the other day, and came up with this:
It’s something completely unrelated that’s photobombing your xray.
Isn’t that exactly it? (Source: Musings of a Dinosaur)
Source: Musings of a Dinosaur - March 13, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Shortage of Logic, Not Doctors
In news to absolutely no one with an iota of common sense, the purported physician shortage isn’t actually one of numbers, but rather a problem of distribution. Per this article by Lenny Bernstein in the Washington Post:
[C]ritics of doctor shortage projections have argued for years that the problem is actually poor distribution of physicians, with too many clustered in urban and affluent areas and too few in poor and rural areas.
Doctors prefer to live in affluent urban areas instead of rural poor ones. This is a surprise…why? Doctors are people. There are more people in urban and suburban areas than in rural ...
Source: Musings of a Dinosaur - March 8, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Crowd Sourced Suckers
“What do you think of this?” writes a friend:
…[A]n untraditional approach to medical diagnosis that is helping solve the country’s most difficult medical mysteries and creating real miracles.
This is the description of something called CrowdMed, the latest version of getting doctors to provide services for free. Thus my short answer about what I think of it: not much.
To be fair, and because I had a few minutes of free time, I went and checked it out. Patients submit questions about their medical condition(s), accompanied by varying levels of supporting detail, and “medical detectives”...
Source: Musings of a Dinosaur - February 27, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
In the News Again
Yesterday’s Philadelphia Inquirer Health section’s Medical Mystery, by yours truly.
I’ve been busy. I think they’re going to print another one of mine next week as well. (Source: Musings of a Dinosaur)
Source: Musings of a Dinosaur - February 16, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Aspirin and Altruism
I have a patient in his mid-60s with multiple risk factors for cardiovascular disease. He has hypertension and hyperlipidemia controlled with medication. He’s got mild, diet-controlled diabetes, and his father dropped dead of a heart attack at age 51. At least he doesn’t smoke.
This is a patient who should clearly be taking low dose aspirin daily for cardiovascular prophylaxis. But:
For the last 20 years, ever since his wife was diagnosed with breast cancer, he has been a platelet donor. Every month without fail, he goes to donate. Even after his wife passed away, he’s kept it up. Month in, month out.
Asp...
Source: Musings of a Dinosaur - February 12, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Told You So
For several years now I have been advising my patients that, based on my admittedly anecdotal but fairly extensive experience, dietary cholesterol is no big deal.
“What?” my patients would cry with incredulity. “What kind of doctor are you, saying that eggs aren’t bad for us?”
My response has generally been that your blood cholesterol levels have far more to do with how you pick your parents than how you pick your food. Cholesterol you eat is metabolized by the liver, which then synthesizes the stuff that winds up in the blood. And that liver metabolism is genetically programmed. Sure, being s...
Source: Musings of a Dinosaur - February 12, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
New Treatment for Obesity???
There’s some really fascinating research coming down the pike about the role bacteria in our gut (our so-called microbiome) play in our overall health. Rapidly becoming mainstream is the idea of “fecal transplants” to cure resistant gut infections with a particularly nasty germ called clostridium difficile (or C. diff to its friends — er, to those who know it well).
Now there’s a case report of a patient who was cured of her C. diff infection with a fecal transplant from an overweight donor, who is now packing on the pounds. While we need to be cautious about that whole correlation-causation t...
Source: Musings of a Dinosaur - February 5, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Down the Rabbit Hole of “Quality” We Go
Oy:
The Obama administration on Monday announced an ambitious goal to overhaul the way doctors are paid, tying their fees more closely to the quality of care rather than the quantity.
Holy crap: they’re really doing it. Or trying to do it. Who the hell knows what they’re trying to do? Not “them”, that’s for sure.
The United States government via the Department of Health and Human Services is going to start trying to pay for “Quality of Care” without ever defining what that means!
Doctors practice medicine, an art and a skill that sometimes involves procedures and sometimes invol...
Source: Musings of a Dinosaur - January 28, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Bemoaning the Anti-Vaxers; Welcome to my World
Surprise! (NOT) There’s a new measles epidemic centered on California’s Disneyland, primarily because of non-vaccinated children. What is not so much surprising as it is interesting (and gratifying) is the way the mass media has by and large come down against the antivaccine movement responsible for the carnage.
More amusing is listening to long-time med bloggers sound off:
I do not have personal experience with the anti-vaxxers. My colleagues in other states tell me that many of these fools are well-educated. Obviously they are anti-science. I believe that many such vaccine deniers believe that diet and supple...
Source: Musings of a Dinosaur - January 26, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Busy Day
I was very busy yesterday. In addition to the Philly Inquirer piece, I also spoke with the lovely Taunya English at WHYY.
Yesterday I was in the paper. Today I’m on the radio.
Have a listen. (Source: Musings of a Dinosaur)
Source: Musings of a Dinosaur - January 23, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Nice Picture
It’s kind of amazing how a big colorful picture can dominate a news story even when it has precious little to do with the subject at hand. To wit, this image:
now graces the top of page A3 in today’s Philadelphia Inquirer, illustrating an article headlined:
Paid more, doctors saw more Medicaid patients, Penn study finds
In other news: Water is wet.
Pardon my snark. I suppose demonstrating things that are intuitively obvious can be useful at times. Especially when dealing with the government, which includes large numbers of people who refuse to believe just about anything that hasn’t passed across their...
Source: Musings of a Dinosaur - January 22, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
So Much Easier
I saw a patient the other day who was finally sober, again, after several relapses. She was working the program and doing very well indeed. She mentioned that she had gone to a yoga class, and then made the following comment:
It’s so much easier when I’m sober.
Which got us thinking about all kinds of other things that are easier when you’re sober:
Working: Much easier to get to work in the morning when you’re not hung over.
Laundry: Instead of getting so discouraged looking at the pile that you just have a drink.
Driving: without worrying about getting pulled over for DUI.
Yoga: and walking, swimm...
Source: Musings of a Dinosaur - January 20, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Is it the Food, or is it the Fast?
Exciting recent research about the benefits of restricting eating to a certain window of time during the day: it works. On mice, at least. Granted you can’t extrapolate directly to humans, yet it supports my empiric observations that people who eat at night (technically, “when they’re supposed to be sleeping”; mice are nocturnal, so in the study, they were restricted to eating at night, corresponding to “when they’re supposed to”) find it very difficult, if not impossible, to lose weight.
Yet I find myself wondering whether it’s the restricted eating period, or the enforced ...
Source: Musings of a Dinosaur - January 19, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
