Little Black Bag

Why Primary Care Is Important

2010-03-09T21:00:37-05:00

Thanks to Solo Doc for this Post.

The 7 Doctors and the Patient

Once upon a time, there were six doctors in a hospital. One day the admission clerk told them, "Hey, there is a patient in the hospital today."

They had no idea why the patient was in the hospital. They decided, "Even though we have no old chart, let us go and examine the patient anyway." All of them went to where the patient was. Every one of them touched the patient.

"Hey, this is atopic dermatitis," said the first doctor who touched his skin, for he was a dermatologist.

"Oh, no! it is acute lumbago," said the second doctor who touched the back, for he was an orthopedic surgeon.

"Oh, no! it is paroxysmal tachycardia," said the third doctor who touched the chest of the patient, for he was a cardiologist.

"It is temporomandibular joint syndrome" said the fourth doctor who touched the jaw of the patient, for he was an otolaryngologist.

"It is spastic colitis," said the fifth doctor who touched the belly of the patient, for he was a gastroenterologist.

"No, it's lacrimal duct obstruction," said the sixth doctor who touched a tear from the eye of the patient, for he was a ophthalmologist.

They began to argue about the patient and every one of them insisted that he was right. It looked like they were getting agitated.

A seventh doctor was passing by and she saw this. She stopped and asked them, "What is the matter?" They said, "We cannot agree on the patient's diagnosis." Each one of them told what he thought the patient had.

The seventh doctor took a good look at the patient and said, "I know this man. This is Joe, and he is having an acute stress reaction because he just lost his job and his wife is being treated for breast cancer." And she shook his hand, offered some reassurance and made Joe feel better, for she was his family doctor.

Swine Flu is here... and will probably be around for awhile.

2009-04-26T21:45:00-05:00

For all that are interested, here is a great little google map that shows all the reported and suspected cases of Swine Flu in the world.

Remember: lots of hand washing!

I will post more about this as it emerges.

Google Swine Flu Incidence Map

A Personal Hero of Mine.

2009-02-27T21:01:10-05:00

Not only is this a fascinating read but it is a remarkable TRUE story.

Tea had the pleasure of working with Dr Catena in Kenya. Since that experience and after hearing her stories about the remarkable skill and determination that Dr Catena has I am humbled beyond belief.

I count him as one of my Heros.

Dr Tom Catena- An American Family Doctor in Sudan

Telemedicine or McMedicine?

2009-01-11T00:00:00-05:00

This CNN report shows how telemedicine is beginning to expand into retail medicine. Here in Florida there are state laws that will not allow this kind of "telemedicine."

I certainly think that telemedicine is an important area of medicine and has a role... somewhere. But in retail stores?!?!?

I cant imagine that this can POSSBILY be equal care to an actual doctor visit. I think time will show this.

Smells of more McMedicine to me. I guess we are all going to get what we want to pay for.

Telemedicine Clinics in Walmart

Just for Morbid Curiosity

2009-01-02T00:00:00-05:00

For anyone who is just morbidly curious, I found this interesting list of Self Surgery. That's right.... all people how have operated on themselves. Now that takes guts....

Top 10 Incredible Self Surgeries

Google Flu Trends

2008-12-03T22:27:13-05:00

The CDC worked with Google to help develop this Google Trends map. It uses search trends on google to help predict Flu activity across the country. Amazingly.... it seems to have some validity due to the shear number of people using google.

Take a Look.

Google Flu Trends Map

When will the public and the government understand...

2008-11-30T22:04:00-05:00

When will people understand. The primary care if the heart of a good medical system and amazingly... it is the most cost effective. we can not continue to run primary care practices into the ground and expect ANY meaningful reform in our health care system.

Mass. Health Care Reform Reveals Doctor Shortage

most interesting point about this article is that you can give people all the insurance they need, but it is worthless if you do not pay your doctors well enough to stay in practice. just something to think about.

Why are Medical Bills so Confusing?

2008-02-20T00:00:00-05:00

I think this New York Times article does a nice job of showing how insurance companies use an "illogical" system to pay for healthcare services. Of course, as long as it is saving them money and they can continue to turn a nice quarterly profit, why should they change?

Health Plans Put Onus on Insured

Flu Epidemic in the Making for 2008?

2008-02-11T00:00:00-05:00

Well, it's official. The CDC released surveillance results last week of the 2008 Flu season which suggests that we are heading for an epidemic this year.

The 08 Flu season has gotten off to a slow start but in the last couple of weeks has fired back with a vengeance.
The problem seems to be that this years vaccine is not a good match for 2 of the 3 circulating strains of Flu. Therefore, offering less protection from the illness.
The good news (so far) is that the number of deaths and hospitalizations related to the flu has been low.

Be on the look out and remember to WASH YOUR HANDS(a lot!)

CDC-2007-2008 Influenza Season Week 5, ending February 2, 2008

Universal Healthcare in San Francisco

2008-01-29T00:00:00-05:00

For anyone interested in San Francisco's efforts to promote intracity Universal Healthcare, this is the best article I have seen to date explaining the process.

Golden Gate to Health Care for All? San Francisco's New Universal-Access Program

Mitchell H. Katz, M.D.
Certainly a aggressive and "brave" program. I actually applaud their efforts. However, fear what it will mean for the cities economic health. It will be interesting to see how this plays out over the next few years. I'm also interested to know what will happen the first time the program is sued for malpractice.
Good luck San Francisco.

Why Is Paying Attention, So Hard To Do?

2008-01-22T00:00:00-05:00

This is a really fun experiment showing how often we don't pay attention to our environment.

One of the comments on the page suggested that the men be replaced with women. now that would be very interesting....

Change Blindness Video

Zetia Goes Down in Flames

2008-01-14T00:00:00-05:00

A few years back, Zetia came on the market and was going "help reduce cholesterol" for patients who were not at goal despite high doses of Statin therapy. In a brilliant marketing move, the drug companies combined Zetia with Zocor to produce Vytorin, and they put lots and lots of commercials on TV.
Im all for combination drugs. It's always better to take fewer pills but this one is turning out to be a bust.

I was a resident when Zetia came on the market and I remember a teacher who made the comment to me,"sure it lowers cholesterol... but will that actually translate into decreased heart disease?" That always stuck with me and I was determined to avoid the drug until I saw real proof that it improved heart disease. Well, now i'm very happy I was suspicious.

It turns out that Zetia not only did not improve heart disease, it may have actually made atherosclerosis worse. Another unfortunate blow for Merck.

Cholesterol Drug Has No Benefit in Trial

And then of course... will we ever learn? Doomed to repeat history? only time will tell for new drugs.

Genzyme Wins Cholesterol Drug Deal

Just a Little Nostalgia...

2008-01-08T00:00:00-05:00

If you have never heard this before, or it has been awhile. I encourage you to listen again.

Advice isn't worth much. But Mr Baz Luhrmann is right about it being nostalgic.
his song still makes me feel good about human spirit and the common goals we all share.

Looking For A Little Support?

2007-12-31T00:00:00-05:00

I recently found this Site and Thought I would share....

it is a site dedicated to putting like minded people together to form specific support groups. Great idea.
If your looking to talk to someone about a special problem, then give them a try.

dailystrength.org

YouTube for Your Health

2007-12-31T00:00:00-05:00

Finally today....

Just wanted to share one more site I recently found.

icyou.com

Some interesting videos on many different health topics.
Good stuff, but as always, remember that the information is not "validated" and is not guaranteed to be factual.
Watch, Enjoy, and be suspicious. :)

Need Help Understanding Healthcare Coverage?

2007-12-31T00:00:00-05:00

Getting even basic health insurance coverage has become quite cumbersome.

I will be honest... I'm a health care professional and I hardly understand the whole mess.

I can only hope that this sight can help some people understand the system and their options.
Another Argument for a single payer system?

Foundation for Health Coverage Education

Beware of YouTube & Wikipedia

2007-12-06T00:00:00-05:00

I should not act surprised to hear that people are beginning to look to YouTube and Wikipedia as "reliable" sources of information, but honestly, I'm shocked and even disgusted by it.
I even hear that college students are even using references to Wikipedia for college papers and research. This is terrifying.

This recent Canadian report suggest that YouTube videos (related to vaccinations) are filled with faults and these misinformed videos are viewed MORE often than educated videos.

YouTube as a Source of Information on Immunization: A Content Analysis

The Internet is a wonderful thing and I FULLY support online research. However, we must view all information as suspicious and consider it's source. Wikipedia, YouTube, and other openly populated informational sights can be a good starting point of information, but they should not be considered factual without further study.
What makes Wiki and YouTube great, is also it's downfall.

Remember: Knowledge determined by the majority does NOT make it true.

I think Galileo & Copernicus would agree with that.

Better to be Fat and Fit....

2007-12-05T00:00:00-05:00

I for some time now have been telling my patients, "it's better to be Fat and Fit then to be Thin but a couch potato."

I'm constantly trying to educate patients to exercise for the sake of being fit and feeling better, not just to lose weight. Sure, weight lose is a natural byproduct of exercise and healthy eating but that should not be the driving force.

With recent studies suggesting that people with a little extra weight actually having lower all cause death rates

(Cause-Specific Excess Deaths Associated With Underweight, Overweight, and Obesity-JAMA)

and

This study supporting that being fit is more important than actual body weight

(Cardiorespiratory Fitness and Adiposity as Mortality Predictors in Older Adults)

I think we may be seeing a shift in American healthcare away from the "Loss weight at all cost" mentality. Constant fad diets and schemes to "melt" away fat abound in our image conscience society. But do they improve our mental or physical health. I just somehow doubt it.

We are physical creatures and before long, hopefully, we will understand the importance of movement and exercise and not worry so much about the extra weight.

Medical Identification Theft

2007-11-29T00:00:00-05:00

It has been recently brought to my attention that there is a new form of Identification theft.
Medical ID Theft

As I understand it, bad people out there are stealing Health Insurance and personal information and then using it to get "free" health care. It doesn't surprise me as health care has become so expensive that it is now a major commodity that's worth stealing.

What is even scarier about this is it can affect your health. If persons claiming to be you seek health care from a physician or hospital their diagnosis and medical records will be linked to you. It could affect your insurance coverage as well as possibly link medical conditions or allergies to you that you do not have.

This is just a reminder to be careful and protect your personal information. Your Insurance cards and benefits records (which you receive in the mail) could all be used to gain access to your Insurance coverage.

Thanks to the fine people at "The Prescriber's Letter" for creating a nice patient informational sheet on this topic.

Medical Identification Theft Info Sheet from The Prescriber's Letter

Raising Smart Kids?

2007-11-29T00:00:00-05:00

This Article from Scientific America is one of the best summaries I have seen about how to encourage children and not blindly "praise" them.

We have for years been so worried about our children's self-esteem that we have forgotten to teach our children to constantly strive for better. As Ernest Hemmingway put it,
"Contentment is the foe of heresy." i.e.- Those who are content will never question anything.

The Secret to Raising Smart Kids
Hint: Don't tell your kids that they are. More than three decades of research shows that a focus on effort—not on intelligence or ability—is key to success in school and in life

Return of the Bubonic Plague!?!?

2007-11-10T00:00:00-05:00

Every so often an unfortunate story like this shows up.
A young person (usually out west) contracts a strange disease and becomes very ill or worse dies. The diagnosis is made and it is the PLAGUE!!!! (RUN FOR YOUR LIVES!!!)
The media immediately picks up on the story and before you know, it's Plague hysteria everywhere. Well I would like to calm some fears.
This story recently occurred. An unfortunate 37 year old biologist from the Grand Canyon recently contracted and died from pulmonary (or lung) plague a few days after performing an autopsy on a mountain lion from the region. This is tragic and my thoughts go out to the young man's family and friends, but this is a rare and a freak event.
Plague is caused by a bacteria that is found in many animal populations. During the 1400s, crowded inner city populations in Europe and horrible public sanitation the bacteria was rapidly passed from rats to people by flea bites. Because they had no antibiotics the illness killed nearly 25% of the worlds population at the time. The Bubonic (or Black) Plague.
It often killed by blood infections and lead to large black lymph nodes or Bubos (thus the name.) Rarely the bacteria can go airborne and cause a severe and almost always fatal pneumonia (which seems to have happened in our unfortunate biologist in Arizona.)
But the fact is that Yersinia pestis (the dubious bacteria) is sensitive to simple penicillin.
It is treatable (most of the time.)

So please.... it is an interesting and historical illness but NOT something for people to get worked up about. If you want to worry... worry about cervical cancer, diabetes, and malaria. Those diseases cause much more death and illness and we can do something about it.

Plague Suspected In Death Of Man In Arizona

Can Green Tea Save Someone from Severe Sepsis

2007-11-10T00:00:00-05:00

Over the last few years new light has been shed on the condition known as sepsis. Sepsis is the term used when someone dies from an overwhelming blood infection. It is extremely common and seen often in the hospital. We previously thought that it was related to toxins produced by the infecting organisms. But new evidence suggest that it is actually caused by an immune response from the body against the invaders. Like an autoimmune disease. Sepsis is hallmarked by blood pressure and cardiac collapse.
This interesting study suggest that a compound in green tea may actually reduce the risk of Sepsis occurring in infected people. This is exciting because to date we have little to nothing to truly treat sepsis.
This is only a study on mice so much more study is needed but I'm encouraged by this.

Green Tea Proves Powerful Medicine Against Sepsis

Keeping Holidays Simple for Grandma

2007-11-10T00:00:00-05:00

This is some great advice. We often want to do so much for our elderly yet... most of the time. SIMPLE is Better.

Six Creative Holiday Ideas For Your Senior Family Member

Journal of Neglected Diseases

2007-11-08T00:00:00-05:00

Finally a little respect for all the infamous but neglected diseases of the world!

Dracunculus medinensis, Tularemia , Q-fever, and even leishmaniasis will all finally get their due.

it seemed like no one would ever want to play with a Charlie in the box!

Journal of Neglected Tropical Diseases

Pentagons New Death Ray, or at Least Hurt Real Bad Ray.

2007-10-31T00:00:00-05:00

This is kind of scary. The military has created a new weapon that is like a focused microwave ray. it can target groups of people of even a single person from 500 yards away. It cause intense heat and pain but is reported to not be lethal.
They are suggesting it may even be used soon in Iraq.

How can they possibly understand what the long term (or even short term) consequences of this thing? what about pregnant women?

Well, it gets points for the awe factor but I'm afraid of what will happen. will this be another "Agent Orange" or "Gulf War Syndrome?"

Non-Lethal Weapon Emits Invisible Rays of Pain

"But I dont like taking medicine"

2007-10-19T00:00:00-05:00

It has been brought to my attention once again that the American public has a poor misconception of what is medicine.
Whether it is the "natural" supplements that patients forget to mention to the doctor, or the 7 cups of coffee that the anxiety patient has each day. There is one simple truth about medicine.

It is ANYTHING you put on or into your body for a desired effect.

well, you may say... that seems silly Dr B. think about it.

We take medicine into our body to produce some specific effect.
Water? of course it's medicine. without it we die. We use water to treat people all the time in the hospital. it can even make you sick if you take to much (an adverse side effect.)

Food? almost the same as above. we eat so that we feel good and not hungry. To much and we again, can become sick.

Sun-Tan Lotion? applied to the skin to protect from the sun and prevent aging and burns.

what about the Sun? some people chose to allow the suns rays to enter their body so they can change their skin color or to feel "rejuvenated." But of course, to much and you burn and even can get cancer.

I hope readers can understand. Obviously I have taken this to an extreme, but the point is that we are surrounded by medicine. it is everywhere! And it is silly for us to believe that side effects and adverse reactions are somehow limited to the "medicines" that you buy at a pharmacy.
I encourage people to always consider everything in their lives when they have medical problems. The source of the problem may lay with the simplest and most natural thing in your house.

Remember that everything that goes on or into your body can potentially harm you. Even "natural" things. Rattlesnake poison is natural, doesn't make it good for you!

Doc, I think I got bit by a spider!

2007-10-18T00:00:00-05:00

This has been brewing for several years now but it is sadly becoming a frequent problem. Severe skin infections caused by MRSA (Methicillian Resistant Staph Aureus.)
MRSA is a Staph A. bacteria. MRSA is a form of this bacteria that has developed resistants to several classes of antibiotics. What has made this Bacteria scary in the community is it's production of potent toxens that make it an increasing cause of skin infections. These infections have been frequently misdiagnosed (often attributed to spider bites, which are very rare!) The poor Brown Recluse spider is also frequently blamed but is rarely the cause.
All should be aware and vigilant of severe (often blistering) skin infections and should seek medical attention to have them treated. Of note: the community form of MRSA is different from the Hospital aquired form of MRSA. Confusing, but the distinction is important because they are treated differently.

Invasive Methicillin-Resistant Staphylococcus aureus Infections in the United States

Only One Probiotic Shown to Help IBS Symptoms

2007-10-16T00:00:00-05:00

There is more and more interest is in probiotics (or "good" bacteria) for different gastrointestinal complaints. Specifically Irritable Bowel Syndrome. A vague and poorly understood condition of stomach complaints. We have been encouraging patients to consume beneficial bacteria, but this is the first good study I have seen on it's benefits.

This study (although a review) is good evidence that Bifidobacterium infantis 35624 (main ingredient in Align(R)) helps with IBS Symptoms.

Review Of Probiotic Trial Research Finds Only Bifantis(R) Able To Claim Efficacy Versus Placebo For IBS Symptoms

The Religion of Medicine

2007-09-17T00:00:00-05:00

On my first day of medical school, the professor walked in and she said, "Despite my best efforts, I know that by the end of your four years here, 75% of what I will tell you will be wrong."

Sobering and terrifying for me on a daily basis.

Once again, I have found a great article written in the New York Times to help me with my thoughts.

Do We Really Know What Makes Us Healthy?

Science and medicine are all to often looked at as "sterile" and absolute. I would like to challenge this assumption. Is Science really all that different from Religion? Religions seek God and choose to do so through belief and faith, avoiding the need for rationality. But what about science? Is science really doing more than just looking for God (or The Answer, if you will.) Instead of blind faith, scientist do this through rigid rationality, but they still MUST have faith. Faith that the universe follows certain rules. Faith that "The Answer" is worth finding. Faith that knowledge will lead them to "salvation" when in actuality it is only going to lead them to more questions (not to different from religion, but that is another topic:)

But what does that mean for medicine?
well, it's back to medicine being an art. Just like traditional art often reflects and commentates on religion, medicine reflects and commentates on science.
We take an immense amount of information and reflect our best guess as to the right answer. But given the sheer complexity and almost infinite variables in our biology and our lives it's a miracle that we get anything correct. Alas, modern medicine (for all it's faults) has been successful. Average life span and quality of life have all risen over the last 50yrs, despite rapid declination of "healthy" lifestyles in America.
Do we know what makes someone healthy? Well.... no. but, we have a good guess and I'm confident our jobs as physicians are to make people comfortable and to help them enjoy their lives. A job that we can do if people have a good relationship with their doctor and faith.
Faith of good intentions and the will to live and be healthy. This is what makes us healthy. (I hope.... :)

Your Doctors Neck Tie Might Kill you.

2007-09-17T00:00:00-05:00

Ok.... so we have known this for a long time. I'm just happy to see someone do something about it.
By this point, I have antibodies that attack small dogs. But we should be so careful not to spread our cuddies to patients. HAND WASHING is still the most important rule for infection control. But I think this is a good step to. No more Neck Ties for me :)

End for traditional doctor's coat