Found some interesting methodology in
this article exploring alcohol usage interventions in the ED
. (Heavy but non-alcoholic drinkers were found to have decreased their drinking at 3 months.) For everyone that qualified for the study, they asked them on a scale
of 1-10 how ready they were to change some aspect of their drinking (10 being fully ready). But this score wasn’t really that important–it was to
secretly get at the patient’s own underlying concerns about drinking, because here were the follow-up questions:
if 2 or higher, ask: “Why did you choose that number and not a lower one?”
if less than 2, ask pros and cons: a) Help me to understand what you enjoy about drinking? b) Now tell me what you enjoy less about drinking.
I love it. If you answer anything but 1, you’re indirectly acknowledging that there might be something less than optimal with your drinking. If you answer
1, you ask people to volunteer their own ideas about what’s good and bad about drinking. It’s essentially a sneaky way to plant discrepancy and
cognitive dissonance in a patient’s mind.
Now of course, duh, this won’t work for everyone. Just thought it was a very clever way to force the patient to come up with his or her own ideas instead of
casting that whole “You shouldn’t be drinking so much” light onto patients.
The “normal” body temperature, 98.6 degrees F has a fever
, according to the LA Times. Turns out we base good ol’ 98.6 on experiments using mercury thermometers from the 1800s, and that depending on your race, age,
gender, and time of day, your temperature is probably a couple tenths of a point lower than that. (Personally it would have been nice had the writer mentioned in
the article that a person doesn’t have a
fever
until 100.4 degrees or higher, to do a little patient education out there in La La land.)
KevinMD
and now
the usually sensible Shadowfax
continue to be wrong on teaching the business of medicine. (Don’t get my wrong, I completely agree these things should be taught, but it makes absolutely no
sense to have the primary teaching be in med school.) Teaching it to pre-clinical students certainly makes no sense, they’re busy learning everything for Step
1. Teaching it to clinical students isn’t all that practical, as most are preparing for residency applications and wrapping up med school. (And my main point
here: if you don’t use knowledge, you lose it. When will anyone but a senior resident be doing any sort of billing or admin stuff? You think an
intern
is going to retain knowledge of CPT codes? Perhaps if they’re in a continuity clinic or something–but then that’s something they should be
learning on the job, in the clinic. Again, every single EM residency program I’ve seen so far has 2 weeks set aside for “Administration” in the
final year, but honestly, if you all think it’s so important, residency programs could certainly find time for it. You could have it coupled with two weeks of
X to make a 4 week block; you could have a morning lecture series for all the residents, or dedicate one noon conference every month or something to the topic. Med
students are so far removed (remember, we’re not even DOCTORS yet)–what’s the point of filling our head with information that will just be quickly
forgotten when it’s much more important for us to remember the possible side effects of ACE inhibitors we’re about to be pimped on?
Insurance does matter for cancer prevention
, as Matthew runs through a recent study: “For all cancer sites combined, patients who were uninsured were 1.6 times as likely to die in five years as those
with private insurance.” This is sadly one of those “duh” studies that has to be done anyway, because of well-insured, financially-secure
naysayers who somehow believe their situations are no different from people without insurance.
Ignore those calorie burning meters at the gym.
There’s almost nothing more inaccurate in the fitness/weight-loss/exercise world. I’d previously heard the eliptical machines overestimate by 20%, but
this article claims they’re just plain wrong. Break a sweat (after approval from your doctor, Mr. Quintuple Bypass with Chest Pain at Rest), and exert more
than you take in. 1 pound = 3500 Calories. 500 less Calories a day = 1 pound of weight loss a week. Slow and steady wins the race.
And finally…
Google Talk introduces instant translation in IM conversations
. This would be pretty awesome in medicine, if we ever chatted with patients. (Damn you, HIPAA!) The translation is actually pretty good, at least for Spanish. Your
pretty typical conversation in the Emergency Department:
Trying out a new feature here at Over My Med Body. Short little commentaries on links, a la
KevinMD
, as there’s tons of great blog posts and health policy news, and so little time to discuss them! (Also, this will be more productive than watching
The People’s Court
and Montel.)
Dr. Wes pimps med students interviewing for residency on billing codes
, and Kevin (I hope jokingly)
says med students
should have to get an MBA before starting med school. How silly. The point of med school (which most of the commenters point out) is to give you a foundation of
knowledge to learn how to practice medicine, get exposed to all the medical specialties, and prepare you for internship. It’s residency that should be
teaching doctors about how to be an attending. (All the residency programs I’ve seen so far have a specific “Administration” component to them
where you learn about billing and getting paid.) Wes says med students “are woefully unprepared to enter the big wide world of medicine,” but if
there’s some way to enter medicine without doing a residency, I missed that day in class.
Via KevinMD,
this great quote about the two sides of medicine
we’re trying to turn into one: “Today, we are in between two images of the doctor. One image is the heroic personal savior, who uses his own experience
and intimate knowledge of the patient to make the best decisions. The other image is the trained technician, who gathers data, feeds it into a decision tree, and
implements that recommended course of action.” Totally agree. The best is the caring, experienced doctor who knows the data, when to use it–and when not
to.
College is not the time that many young women want to get pregnant, but
Congress isn’t making that any easier
, closing a provision that allowed drug companies to sell cheap birth control to student health centers. A monthly supply used to be $3-$10, now it’s $30-$50.
Some members of Congress are aware of the issue, but can’t get it fixed, since birth control pills are so closely tied to abortion (that’s sarcasm).
It’s amazing to me that tiny little oversights can have such huge impacts on people’s lives.
Speaking of bad daytime television, I saw
this quack
tell a poor woman suffering from pretty classic
hypnopompic sleep paralysis
that she was just doing “astral projection.” The poor lady was scared out of her mind, thinking the devil was visiting her.
This pilot program at UCLA sounds pretty awesome
–bilingual docs who train in Spanish-speaking countries get help preparing for US board exams in exchange for 3 years working in under-served areas in
California. More surprising in the article is the claim that only 8 of the 27 family medicine residents at the highlighted residency speak Spanish. (I’d
imagine all of them can at least speak basic Spanish.) But I agree–there are certainly nuances that you lose only speaking basic Spanish, and cultural nuances
that affect what a person is saying.
(If you’re squeamish, this isn’t the post for you.) There’s a total
RIBBFOMP
story and photo over at
White Coat Rants
, hand versus snowblower. If you’ve always wondered what the tendons look like that allow your fingers to flex and extend, but never wanted to take the anatomy
class, there’s a perfect specimen in the post. Wow.
Beware the rhododendron! (That’s the flower seen here.)
There’s
an interesting case report in the American Journal of Emergency Medicine
from Turkey describing a man with NSTEMI (EKG changes and the release of a chemical in the blood indicating heart injury) after eating mad honey, which is apparently
honey made from the pollen of some species of flowers, especially the rhododendron. These flowers’ pollen contain grayanotoxin, a class of chemicals that block
repolarization of excitable cell membranes (nerve and muscle). Symptoms seem to be pretty cholinergic–diarrhea, nausea, vomiting, sweating–
according to this review article in Food and Chemical Toxicology
.
Earlier this year, one of our colleagues from Spain
There’s