"Patients assume doctors are omnipotent and they know everything there is to know about the universe."
Today, respected medical medical journal Annals of Internal Medicine published a short, anonymous account called "Our Family Secrets" of two different sexual assaults (or, in the journal's words, situations with "overtones" of sexual assault) by surgeons on their unconscious patients. (trigger warning for sexual assault and misogyny) [more inside]
"House calls, which accounted for 40% of all doctor visits in 1930, dwindled to less than 1% by 1980 as physicians found it far more efficient to see 20 or 30 patients a day in an office than just a handful in their homes. But in-home care is starting to be seen as cost-efficient again—particularly for the most expensive patients." [SLWSJ]
Nebraska became the 20th state to adopt a law that makes it possible for nurses in a variety of medical fields with most advanced degrees to practice without a doctor’s oversight. Maryland’s governor signed a similar bill into law this month, and eight more states are considering such legislation, according to the American Association of Nurse Practitioners. Now nurses in Nebraska with a master’s degree or better, known as nurse practitioners, no longer have to get a signed agreement from a doctor to be able to do what their state license allows — order and interpret diagnostic tests, prescribe medications and administer treatments.
I am in my first month of nursing school. It is the early 70s and this is a three-year program, hospital-based, all practical training. It is my first day in my first ward...A remembrance, by English professor and disability studies scholar, Janet Lyon.
On Breaking One's Neck. Dr. Arnold Relman, former Editor in Chief of the New England Journal of Medicine, gives a first-hand account of a catastrophic accident, intensive care, and rehabilitation--as a patient. I am a senior physician with over six decades of experience who has observed his share of critical illness--but only from the doctor's perspective. That changed suddenly and disastrously on the morning of June 27, 2013, ten days after my ninetieth birthday, when I fell down the stairs in my home, broke my neck, and very nearly died. Since then, I have made an astonishing recovery, in the course of which I learned how it feels to be a helpless patient close to death. I also learned some things about the US medical care system that I had never fully appreciated, even though this is a subject that I have studied and written about for many years.
The Nazi Anatomists. "How the corpses of Hitler's victims are still haunting modern science—and American abortion politics."
The Course of Their Lives. While much in medicine has changed over the last century, the defining course of a first year medical student's education is still 'Gross Anatomy.' This is their hands-on tour of a donated cadaver -- an actual human body -- and is an experience which cannot be replicated by computer models. When Milwaukee Journal Sentinel reporter Mark Johnson came up with the idea of following a med school gross anatomy class for a feature story, his editor challenged him to make it different. So he chose to intertwine the students' stories with that of Geraldine 'Nana' Fotsch, a living future donor, as sort of a stand-in for the cadaver. (Via. This four-part series contains descriptions of a human dissection. Some may find it disturbing.) [more inside]
In 2011, the CIA reportedly hired a doctor in Pakistan to conduct espionage while giving vaccinations to children. In response, Pakistan expelled Save the Children from the country. The New England Journal of Medicine comments on military operations masquerading as humanitarian relief. [more inside]
Groundbreaking Surgery for Girl Born Without Windpipe: [New York Times] — Using plastic fibers and human cells, doctors have built and implanted a windpipe in a 2 ½-year-old girl — the youngest person ever to receive a bioengineered organ.
You're about to be the base doctor at Halley Research Station in Antarctica for a year. For ten months, no one gets in or out. Fourteen lives are in your hands, including your own. What do you put in your medical kit? And how do your choices differ from those of your predecessors (Eric Marshall and Edward Wilson) a century ago?
"Guardian 24/7 combines best-in-breed technology with protocols designed to serve the President of the United States, offering unprecedented medical attention to a demanding audience. Thanks to Guardian, your medical care can finally look like the rest of your life[...]. Our innovative ReadyRoom™ strategy places essential equipment, medications and supplies where you live, move and work. Yet everything is hidden away until needed. [...]Before Guardian, this kind of medical protection was only available to one person. But now, presidential-level care can be yours — on your schedule and your terms." Don't miss the embedded video. This appears to be in earnest.
As Doctors Use More Devices, Potential for Distraction Grows — Do too many digital devices distract doctors from their daily rounds and endanger patients?
It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little.How Doctors Die.
The Phantom Menace of Sleep Deprived Doctors: Young doctors are no longer working long, stupor-inducing hours. So why aren’t hospitals any safer?
Do doctors violate the 2nd Amendment when they ask their patients if they own guns? May the government force doctors to stop asking that without violating the 1st Amendment?
"As Hannah Montana once said..." A Med School commencement speech about what it means to be called a Doctor. [more inside]
We've all seen Harry Potter fan art before. But Constantine Michael also offers up Inglorious Basterds, The Royal Tenenbaums, The Doctors, and Mad Men. [Via.]
Shadofax at MovingMeat has an interesting writeup about two WSJ articles on the AMA's RUC and warring specialities. [more inside]
The New Abortion Providers: an in-depth look at the re-institutionalization of abortion training in U.S. teaching hospitals, from the New York Times Magazine.
The healthcare debate explained on the back of 4 napkins. Napkin 1: The health care equation. Napkin 2: It's not about health care. Napkin 3: The plans on the table. Napkin 4: What's it mean to me?
A simple question shows how complex the issue is. Chris at "Cynical C" asks his fellow citizens where they get thier health care (insurance) from and the incredible diversity of the current options and situations is immediately apparent. Quite spontaneously (but surely not unexpectedly), the question of "How much does it cost you?" becomes an essential part of the answers. Outsiders opine and tell stories and commiserate. [more inside]
In December 2003, Brent Cambron gave himself his first injection of morphine. Save for the fact that he was sticking the needle into his own skin, the motion was familiar--almost rote. Over the course of the previous 17 months, as an anesthesia resident at Boston's Beth Israel Deaconess Medical Center, Cambron had given hundreds of injections.- Going Under by Jason Zengerle of The New Republic [print version] is heartbreaking article about the high rates of drug addiction among anesthesiologists. It tells the story of Brent Cambron and his spiral into addiction. His live was also sensitively chronicled in The Boston Globe by Keith O'Brien in Something, anything to stop the pain [print version]. [more inside]
You may remember Stan Brock from as the British anaconda wrangler from Mutual of Omaha's Wild Kingdom (top right video). These days he runs Remote Area Medical, a volunteer airborne relief corps that brings medical, dental, and educational assistance to remote areas of the world. Every year, they go to remote Appalachian Virginia, a one day drive from Washington DC, for a 3 day event at the fairgrounds.
"AngryJournalist.com, an increasingly popular site that consists of nothing but rants from pissed-off reporters, is now the most accurate summation extant of journalism as an industry," (via Gawker). It's spawned a marvelously less popular HappyJournalist.com, and what appears to be an unrelated copycat called AngryResident.com, for "for every doctor-in-training tired of suffering in silence."
Self-Diagnosis: Five anonymous doctors frankly discuss their patients, other doctors, American healthcare, and the inevitable mistakes doctors make, including mistakes they've personally made that jeopardized their patients' lives.
What's the Trouble? - "How Doctors Think"
The Surgery of Love. Dr. James C. Burt was an Ohio gynecologist who circumcised over 2000 women without their consent over a period of 22 years. He didn’t operate in secret, and actually published a book about it in 1975, which he called “The Surgery of Love”. He claimed that female genitalia were "structurally inadequate" for intercourse, and that by removing their clitoral hoods and "realigning" the vagina, he could turn women into ”horny little mice” (PDF). His surgeries often left women with sexual dysfunction, infection and the need for corrective surgery. But although other doctors in the area knew about him, they dismissed the problems with a laugh: “Oh, I see Jim Burt got hold of you.” At least 10 women who tried to sue Burt had their cases dismissed when no doctors would testify against him, and when one doctor finally reported Burt to the state medical board after treating one of his victims, he was ostracized by the local medical community for breaking rank. But the lawsuits, and their attendant publicity, finally caused the Ohio State Medical Board to pressure Burt into voluntarily surrendering his license in 1989. Further attempts to sue were dismissed because of statutes of limitation and a 1987 law giving hospitals immunity from certain lawsuits. James Burt retired to a comfortable life in Florida, making no apology.
Inside Surgery, Dr. Lisa Marcucci's surgical blog, will give you a lovely preview of exactly what they'll be doing to your guts, from gallbladder surgery to appendectomy, artery plaque removal, hemorrhoid removal, and more. Supplement the text with this extensive collection of surgical videos (NSFW), and you'll be ready to operate -- or, at least, to understand what'll go on during your operation.
Coverage with Evidence Development. Never heard of it? Me neither, until today. It's what they call this idea: if you want to be covered by Medicare, you're forced to participate in medical research. The AMA approves (article abstract only). So much for informed consent.
"Doctor, it hurts when I do that." Doctors and patients agree - doctors are lousy when it comes to recognizing, diagnosing and treating pain. The AMA developed this free Continuing Medical Education tool (requires Flash) to help docs learn and understand how to deal with pain - but other folks, folks who are now in pain or might someday be in pain, might find it quite interesting as well. All docs in California have to complete this seminar or a similar one by the end of 2006 to get relicensed; the hope is that this will help the docs and the patients who have to deal with pain on a daily basis.
The new lies about women's health (image slightly NSFW) according to Glamour. More on why every egg is sacred to the Bush administration. [via Wired's Sex Drive Daily]
There are lots of doctors who blog. Among them, two recent entries were particularly notable: a heavy one about a grieving 15 year old father and a light one about child cancer survivors.
Never, ever leave flashlights, shampoo bottles, beer bottles or any long, circular object on the floor because someday you will fall on it and it will somehow, work its way up your rectum. And other important life lessons learned by student doctors from their emergency room rotations.
Doctors suing patients Are you angry and upset because of what a doctor did or did not do during a medical procedure? Did you express your anger online? Now doctors are suing patients for expressing their anger online.
Communication Breakdown is a problem that often prevents doctors from treating immigrant patients effectively. Language and cultural barriers prevent patients from understanding doctors instructions, sharing their symptoms of illness, and even from being examined by the doctor in cases where religious beliefs prohibit contact with someone of the opposite gender.
Have you ever been under anesthesia? Doctors are being warned about a bizarre but threatening phenomenon - that patients under anesthesia can experience vivid sexual dreams they believe are real.
"Family Values, My Ass!" That article in the Lexington Herald-Leader inspired me to look up the Nation article it referred to. Now I'm beginning to see why many women won't go to "evangelical Christian" MDs: this guy Hager (previously brought up on MetaFilter in 2003, in fact twice, and then again in 2004) is strongly anti-abortion -- so pro-conception that he tried to keep the "morning-after pill" known as "Plan B" away from women -- but he's apparently pro- sodomy and pro-rape. It almost sounds like fiction.
Fitness to Practice is a collection of songs written and performed by Amateur Transplants, two practicing doctors from the UK. The album consists of original songs as well as witty parodies of songs originally performed by among others Tom Lehrer and The Jam (mp3 links). The lyrics contain a lot of medical in-jokes, but the humour is broad enough to appeal to everyone.
Conscientious Objector Policy Act would allow Michigander doctors and health care providers to refuse treatment on moral, ethical or religious grounds. Yet another OMG MORALZ OMG sort of bill. But wait, what are morals? And does Nicole Kidman figure into this somehow?
Is there a bell curve for doctors? How hard would it be to evaluate the performance of doctors and should this information be publicly accessible?
Conscience Clauses and Health Care --"Yes, we need to respect individual freedom of religion. But at what point does it cross the line of not providing essential medical care? At what point is it malpractice?" she asked. "If someone's beliefs interfere with practicing their profession, perhaps they should do something else." The Protection of Conscience Project feels differently: Protection of Conscience Laws are needed because powerful interests are inclined to force health care workers and others to participate, directly or indirectly, in morally controversial procedures, while NARAL says: ... Many of these clauses go far beyond respecting individuals' beliefs to the point of harming women by not providing them with full information or access to medical treatment. Medicine, not ideology, should determine medical decisions.
Doctors refuse laywers. So your last client managed to get restitution from that quack who left the clamp in her abdomen, just in time to pay for your daughter's delivery. Good luck finding an OB. Or perhaps your husband works for a law firm. Good luck with that nursing job. Maybe you're a neurosurgeon making less take-home than your insurance premiums. What are you going to say to the next ambulance chaser with migrane trouble? The war between the two solitudes could start racking up a real body-count.
"The Conscientious Objector Policy Act" just passed the Michigan Assembly, and awaits voting in the state Senate. The bill legalizes the right for a doctor, or any health provider, to deny treatment based on "ethical, moral, or religious grounds." In addition to the obvious notion of restricting abortion, in the most extreme example the bill technically allows doctors to deny treatment to gays simply for believing that homosexuality is immoral.
The war on drugs is unfairly targeting doctors who prescribe legal pain medication to their patients who suffer from chronic pain, according to a spokeswoman of the Association of American Physicians and Surgeons. She was speaking at a press conference of patient and physician advocacy groups, sponsored by the Pain Relief Network, in support of Dr. William Hurwitz. Dr. Hurwitz has been indicted and imprisoned for prescribing high doses of opioid pain relievers, as have other pain-management doctors. But these crackdowns may end up doing more harm than good to patients in chronic pain. [More inside.]
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