Diagnosis

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I’ve written before about Dr. Milhaud — one of the professors in my French medical school. I really liked him.

He was practical and he was enough of a friend to come visit me when I returned to the USA for my general and orthopedic surgical residency staff at the Jewish Hospital of Cincinnati, Ohio.

Nobody else on my faculty at Amiens even thought of doing that. Read more on Why Use Medical Testing?…

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I was trying to remember when prescription drugs were allowed to advertise on television (called “Direct To Consumer Advertising, or DTCA”).  Fortunately, I didn’t have to bust my memory cells – I just had to “Google it.”

1995. The year all HHHHell broke loose.  At least if you were a doctor.

Suddenly, patients could make their own diagnoses and prescriptions and just phone the order in to their doctor.  At least, that’s how most patients thought it should work.  And – hoo boy! – were they upset when it wasn’t quite that easy.

Comedian Dennis Miller has a hilarious line: “I divide medical practitioners into two camps. Those who will give me a scrip for Vicodin over the phone, and those who won’t.”

Hilarious if you aren’t a doctor, that is. Read more on RX Package Insert — Just Read It!…

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Most people don’t seem to understand how disability benefits work – and that includes doctors as well as patients.  There’s a very good reason for that. The system is screwy.

Thinking that your own regular doctor might be prejudiced and just dish out disability benefits ad infinitum so you never have to go to work (Gee – where did the government get that idea?) the patient is sent to an outside doctor to do an evaluation.

I’ve done plenty of those in my day. I’ve done them for veterans and for Social Security and for worker’s comp and even such exotic things as employee plans for large corporations (such as GM and Ford) and unions (like the Railroad Workers). Read more on Diagnosing For Dollars…

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Recently, a patient’s widow called to cancel a routine assessment because the patient suddenly died. There had been no freak heart attack and it had not been one of those undiagnosed cancers.  He just “died, suddenly, in his sleep, I guess,” she said. That got me thinking.

The first class of drugs I think about, when I think of sudden death, are the stimulants.  I remember when someone decided that everyone who was going to get stimulants needed to have a “cardiocentric” examination first.  Doctors asked a lot of questions about chest pain, and administered an electrocardiogram.  These precautions were especially interesting because they were – of course – used before prescribing Ritalin. Many child psychiatrists had laughed at me when I cautioned usage of this job, claiming it was the safest medication ever invented. Once – at the peak of my massive weight — an endocrinologist offered me a prescription of Meridia, to get rid of my excess weight.  He did not think the fact that there had been a “few” reports of sudden death should get in the way of my using it. Read more on Sudden Death in Psych Patients — From Medicine…

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The next person to see me made a dramatic entrance. First, she had gotten a head start on her crying in the waiting room. But more than the sound of her crying and sobbing, she could barely make it through the waiting room door. I am no good at guessing someone’s weight.  She later admitted to being 380 pounds.  I took her word, as our clinic’s scale only went to 300. Her general appearance was that she was swollen with water – a human sponge.  The edema bloated every part of her body, and her crying eyes were nearly swollen shut. I started by asking her when her problems began.  She was now 42, and said she had thought everything was okay until age 15, when she had been raped by a “friend of the family.” This man was not really a friend, he was a person who went to the same church.  Moreover, he was a Sunday school teacher.  You would think that by now everyone would know that being a Sunday school teacher does not make someone a saint.  But this family had not yet figured it out. In many such cases, this type of person is shielded by the religious community, and even the victim’s parents are often in denial.  This woman was lucky. Her parents told her that they were going to prosecute this sinner to the extent of the law.

There was a trial, and she had testified.  She thought everything had turned out great, and so did her parents. The rapist was convicted and sent to jail. Again, those who are experienced in these things know that this type of trauma is never over quite so easily. The woman went on with her life and ended up in a really abusive relationship — the kind where someone locks you up and won’t let you leave the house and beats you if you look out the window.  By the time she got the courage to escape this living hell and seek a shelter, had a peck of kids. They lived in this shelter for over a year before she found that she had what it takes to start over.  She went to school, gained some clerical skills, and started over. She was actually doing pretty well until something happened that triggered a demon she didn’t know had possessed her. She was called for jury duty and went, with pride, wanting to do her civic duty.  She couldn’t.  She had a panic attack as soon as she entered the courtroom.  She ran to the ladies’ room, threw up, and tried to enter the courtroom again – and it was even worse. People thought she was having a heart attack, and they sent an ambulance for her.  I do not recommend this means of getting out of jury duty, although it sure worked for her. Read more on Murphy’s Law Of Medicine At Work…

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I had a patient once, long ago and far away, who was the worst “Caffeine Fiend” – properly known as “caffeinism” in medical lingo — I had ever heard of. 

He was only 27 but depression and obesity added ten or fifteen years to his appearance. He was single and did not have much of a social life, but he did not much care.  He was one of the earlier generation of people to build himself a career doing something with computers, with some sort of techie abilities which I could not understand at all. That enabled him to work from home at least part of the time, and only occasionally would he have to make a mad run to and from his employers’ office. This was in rural northern California, somewhat removed from the Silicon Valley mainstream of this type of activity.

The “from” part was important, as he did not much like to hang around with other humans, much preferring the company of his computer. Read more on Tale Of A Caffeine Fiend…

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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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I Am A Doctor, But I Don’t Play One On TV

Personality-wise, the cranky and inconsiderate title character of the hit TV series House, MD are mirror opposites.  I actually LIKE people – especially people who need help (patients).

Obviously many people enjoy this series, since it is one of the highest rated. But for me, the challenge is to out-diagnose him.

In case you’ve never watched, the formula for each episode is a seemingly straight-forward illness, which (of course) is the wrong diagnosis.  The rest of the show is slapping another diagnosis on the patient, and testing the patient, which makes the patient worse.  Read more on Being Locked-In May Not Be So Bad For Everybody…

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If this is the first time you’re reading my blog – Welcome!

If not, you know that I’m … ummm … mature and that I’ve been restless enough to study many branches of medicine.

My current credential is in psychiatry, and like Rodney Dangerfield, we shrinks “Don’t get no respect.” Read more on Researchers Are Short-Sighted When Looking At Data…

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After studying in several institutions of higher learning in several nations, I always feel strange when I learn something from television.  Especially network daytime television.

When my husband attended elementary school in rural Kansas, he tells me that the school nurse checked the kids for head lice. In mine, in suburban Boston Massachusetts, it would have taken the school nurse a whole year.  So in third grade, when I happened to be in public school for a little bit, my humongously obese but friendly schoolteacher checked the whole class and found two kids out of about thirty and sent them to the nurse.  Me, she told me to brush my hair a lot because my curly frizz got tangled. Read more on Killing Head Lice With An (Expensive) Sledge Hammer…

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