Disease

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“Concordance.”  That means doctor and patient wanting the same thing.  In psychiatry we call it a “therapeutic alliance.”  We work for it — assuming we have the time.  But if the time is not there, on some level we all know that nothing will happen.

Leave it to the pharmacists to at least touch on a reason for “lack of concordance” that nobody seems to discuss. “With increasing numbers of medications shown to do more good than harm when taken as prescribed, low compliance is a major problem in health care,” reads an unpretentious sentence in the abstract.

And people wonder why there is no “trust” between patient and doctor. Read more on Trusting Your Doctor…

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Microscopic Photo of E. Coli

Cute but deadly E. Coli

Subscribers to my newsletter got to read my inside information and some exclusive insights on the E. Coli disaster that is devastating Germany.

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The Renegade Doctor

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If you have a choice and are not involved in an emergency, you can improve your chances of coming out of the hospital alive if you time it right.

I have read lots of articles suggesting that mortality in American hospitals is higher around July 1, when a new group of trainees finish medical school and start in their hospital based clinical training positions. This is not just an aberration in the USA, but apparently is also true in the U. K, where the new training programs start on August 1. Another cause of in-hospital mortality has been identified — When nursing staff falls below certain target levels, patients die. I do recall that nursing schools, at least when I was close to such things, did not have the same kind of fixed scheduling for trainees that medical schools did. When nursing students were present, they always seemed to be observing and logging in time, although whenever they had procedures, they were more rigorously monitored than physicians. Read more on How To Get Out Of The Hospital Alive…

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It is a sad fact of modern life that it takes tragedy to bring important information to the notice of the general public.  In this case – the death of a young person participating in sports. Read more on Sports Dangers Are Too Often Revealed In Tragedy…

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Okay, let me get this straight.  We are looking for new science to stop an aged population from getting Alzheimer’s and getting dependent on others for that structured “senile” type care that is expensive and — let’s be honest — usually not enough to keep people really productive.

The first of the two studies reported here is basically saying that people with lower amounts of measurable beta amyloid marker have more cognitive decline over the nine years studied.  Another report on the elusive “marker” for Alzheimer’s.  If someone can tell with a blood test that you got it, what are you going to do? There are several drug companies, presumably including the folks at Avid Pharmaceuticals, who sponsored the second study, for a molecule that binds to the protein that ends up in microscopically visible “tangles” that show up in biopsies and autopsies of Alzheimer’s type brain tissue. It is also reported that educated people are less likely to get Alzheimer’s.  Frankly, this sort of finding is usually attributed to a “use it or lose it” analogy to the physical workout.  In some ways this is true. I remember some lovely studies when I was in France that led La Nation to tell seniors to slowly practice memorizing their shopping lists, and they did indeed seem to improve their recent memory.

I also remember a study I suspect the rest of the world has forgotten, called the “Minneapolis Nun Study.” Read more on Misguided Research Is Dithering Around Alzheimer’s Again…

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Recent research by the Centers for Disease Control and Prevention’s National Center for Health Statistics has confirmed a longstanding trend — namely that whites live longer than blacks pretty much consistently, and have for a long time. People have attributed this to the increased difficulty of containing blood pressure in black people — probably a genetic difficulty– which leads to increased rates of both stroke and of heart disease. Both have long been established as being deadly. Plenty of well meaning people have at least tried to deal with this. One of the well-meaning people is me. Many times I have seen people of color for other reasons, checked their blood pressure, been concerned, and referred them to appropriate blood pressure followup by general medical personnel. Of course, I have no way of knowing how many (if any) went where I told them, but I tried.  

I mean, I would tell them, “If there is something extra that can be done to make sure you are around for a  few more years, to see the grandchildren grow a bit or whatever is precious, then it should be done.”   I usually have no problem getting the person to agree, at least in my presence. Menthol cigarettes are a different kind of issue, and therefore a little tougher to be unequivocal about. Read more on Ban Menthols? Our Government To The Rescue!…

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She said she was depressed and anxious.  She was 38, large, and animated, with almost glazed over excited eyes, and talking a mile a minute.

Every person who tells me he or she is depressed gets asked the necessary questions to determine if he or she has manic-depressive illness, otherwise known as bipolar illness. The only way to determine this that I know about is by asking.  Nobody who is depressed and comes in for treatment of same is going to spontaneously volunteer the info I need to make the diagnosis. Read more on Bipolar Could Be Misdiagnosed As Depression…

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Some of the most vivid and memorable lectures I sat through in medical school were about bacteriology.  Our professor was a woman who was a consultant to the World Health Organization and who returned from assignments with dramatic first person stories about how she had collected trachoma samples from children in darkest Africa, and would thus help prevent their blindness.

She told us about Cholera, a horrible disease that killed quickly by diarrhea and subsequent dehydration.  A disease of poor hygiene that was found where people lived in congested settings and hygiene was tough to maintain. Did not even need antibiotics to save most of the lives; just hydration and electrolytes.  An illness apparently easy to prevent; there were pills to sterilize the water, simple public health interventions. But none of us were likely to ever see it.  We would all practice in civilized countries, like France. Vive la France. Read more on How Cholera Showed Up In Haiti…

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I first found out about this list of so-called “Influential Doctors in the USA Today newspaper and did not finish the article before I became aware of two powerful realities: 1. This list does not sound like it will help people who need a doctor, but more likely it will benefit someone else in the health care industry.  2. Nobody compiling a list of influential doctors is going to add me because I’m a professional pain in the rear-end of the other doctors on the list.

It sounds like one of those times when somebody is making money from patients pockets by marketing drugs or services, via insurance companies or drug companies. 

Hello “parasite!”  Hello person-making-money-from-sick-people without adding “value” to healing them. Read more on Turning The Brain Back Ten Years And Slowing The Decline…

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He was 35 and tall and thin, with beige hair and a rare grin he claimed only I could elicit.  He enjoyed seeing me. He always came with a knapsack, because he didn’t really trust the other people in the residence where he lived.  He probably had reason to feel that way, for things had been stolen from him before.  Things like medications.  He reported these things to the pharmacy involved.  Both they and I believed him.  After all, these things happen.  He had not abused anything known to us.  Besides, medications are frequently stolen.

The diagnosis was schizophrenia, that too-often debilitating disease that hits at least about 1% of the population and that is still generally considered manageable but incurable.  He was actually doing pretty well, living in a residence and “stable” after countless hospitalizations.  I asked him about his plans for the future.  He told me he had been attending information sessions about an interesting course at a local college.  Now I knew that local colleges, this one in particular, were famous for providing “practical” education.  I had even heard of a bachelor’s degree in auto body work. He told me he wanted to learn to make guns.  I tried not to appear nervous here, but I was impressed that he could read my emotions well enough to tell I was worried.

“Don’t worry, Dr. G.  I am not going to hurt anybody and I don’t want to kill myself.  You must worry a lot about that because you ask me every time.” Good — he was smart about that.  But what could happen if his medicines were stolen before I could replace them?  In his distant past, he had some real troubles with “false beliefs,” worrying that criminals were out to get him.  What if he believed that, and tried to shoot someone?  I could not ask him that, I knew he would tell me it would never happen – but I knew it could.  “I really like hunting animals.  Little ones, not bears or anything.  Squirrels, but that was a long time ago.  There are lots of squirrels and things like that around here.”  He went on.  He was exhibiting more insight and understanding than I had ever heard from him.

“I like the insides of the gun and how it works and I want to learn how to make them.  I did like the feeling of shooting a little animal, because it meant I was smarter than he was.”

Read more on Schizophrenics and Guns…

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