July 2017 Archives

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I find a lot of things I like in the New York Times. This article resonated with me as few others. First, there is the purpose of the human profiled.  Changing medicine into data science?  God save us all.

Sometimes I feel the best thing I do for a patient is to be human.  Just to have the pretension (a pretension which I do not take lightly) of being one human being in a room with another human being, trying to make them feel better.  This does more, I think, to make most of my patients “better” than all of the pills I have spent years studying about. All those years studying normative use of medications on large populations of humans.  And they work enough to please the powers that be.

Read more on Human Beings Are Not Computers…

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It was not political correctness, but rather a deep and visceral thirst that has driven me to reach out to people who are different — very different from myself. Being brought up Jewish (traditional eastern-European Jewish Ashkenaze) is not all of who I am, not even close to that, but it is the raw clay out of which I have been sculpted in America. Canada is different.  A pharmacist I worked with in Edmonton, Alberta, Canada was well-traveled and told me how it was different from America. “America is a melting-pot — Canada is a salad.”

Americans really seem (or at least seemed) to want to be Americans.  I remember the emigrants to America joking about learning about baseball, the bat being likened to a chicken drumstick, a “pulkeh.” To understand and love baseball was a very important part of being American. Part of the lore of the time was that it was possible to unmask a foreign spy who spoke perfect English if you asked him who had won the last world series and he did not know. Very different from Canadians who kept their own traditions and their own languages in tiny equivalents of their native lands around Edmonton where ethnic traditions were publicly exalted, in places called “little Germany” or “little Italy.”

Read more on Cross-Cultural ‘R’ Us…

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She was an active patient, who I am still trying to see once a week until I direct her in how to survive and flourish in the universe. She was in her forties, depressed and anxious.  She had “a little panic attack,” some chest pain and the feeling her breath was cut off. I wasted no time sending her to an Emergency Room, (or, if she really did not feel it was that bad, to an Urgent Care — what we used to call it a “doc in a box”) because it is cheaper, sounds less foreboding, and any doctor who is sentient and has a pulse and is on duty would send her to an Emergency Room if anything was really wrong.

Chest pain or tightness or shortness of breath or a “tight feeling, like a vice” could always be a heart problem, and could always be life threatening until proven otherwise.  I tend to send  even the most mild discomforts of this nature, that people had for years to primary physicians for a “cardiocentric examination.”  For “auscultation,” the old fashioned Latin-origin word for a good listening to the well as generally an electrocardiogram and sometimes even an echocardiogram.

Read more on Don’t Ignore Chest Pain…

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How low can you go? Stealing drugs from veterans?  I am a proud U.S. veteran, prouder still to consider myself a veterans advocate. I’ve seen too many veterans in pain.  I don’t think people who haven’t been there realize how much war is hell. They were stolen by a doctor.  A credentialed anesthesiologist.

I remember when I was first hitting dating bars and such, it was not uncommon for a  non-doctor to wear a T-shirt that said “trust me; I’m a doctor” that I guess was supposed to induce young women into the early stages of romance. Read more on Stealing Drugs And Eliminating Health Care…

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I just did one of those continuing medical education courses — in psychiatry, my very own field no less. It says that people who get a bout of depression are twice as likely to get a bout of back pain. What I read is a meta-analysis.  That means some clever person who probably needed the publication on his (or her) resume did a statistical (and critical) analysis of research other people did. This a noble attempt to asymptotically approach “the Truth and the Light” on a subject. It is also a delightfully erudite way to do research and get a publication without using a lot of time and money that the author had to scrape up.

Look, the relationship between depression and low back pain is something I have seen from every imaginable angle. As a neurosurgeon, it did not take me terribly long to figure out that surgery was not a very good solution for back pain. Of course, we rigorously restricted ourselves to operating focalized sciatica.  Cases where we could reasonably infer that an intervertebral disc seemed to be compressing a distinct (lumbar) nerve root that formed part of the sciatic nerve (plexus) that descended from the spinal cord to the leg and foot. There was the physical examination.  If someone were lying flat on his (more rarely, her) back and their straight leg was raised toward the ceiling, pain would appear on a trajectory anatomically consistent with one of those nerves. This was the sign of Laseque.  And we took it to be as solid as money in the bank. Read more on Depression and Low Back Pain…