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Showing posts from July, 2012

Sigmoidoscopy--might it be better than colonoscopy?

Sigmoidoscopy means visualization of the sigmoid colon, usually by a flexible fiberoptic scope. Colonoscopy is visualization of the whole colon by means of a longer fiberoptic scope. Both have been recommended as methods of detecting colon cancer early or preventing it by identifying abnormalities such as polyps that can lead to colon cancer.

Sigmoidoscopy looks at most of the left portion of the colon and can be done without anesthesia, in a doctor's office after an enema prep the morning of the procedure. After the procedure most people can go have breakfast and go back to work. A colonoscopy, when successful, looks at the entire colon after a patient is sedated by various intravenous medications, and follows a bowel prep that usual involves drinking 1/2-1 gallon of a polyethylene glycol solution that tastes a little like lemonade with baking soda in it and having many many bowel movements starting the afternoon before the procedure. The anesthesia, which is usually quite pleasa…

New recommendation about Pap smear screening for cervical cancer--we REALLY don't need this test yearly!

In the 1920s a couple of pathologists, Aurel Babes of Romania and Georgios Papanikolaou from Greece discovered that in women who had uterine cancer, malignant cells could be found in samples of vaginal secretions. The details of their original reports and recommendation are shrouded in internet obscurity (that is to say I can't find any of the original articles, which would probably be really interesting) but it appears that the idea of sampling the contents of the vagina or the cervix therein did not immediately engender enthusiasm.

In 1941 Dr. Papanikolaou and his colleague, a gynecologist Dr. Herbert Traut, published a paper in the American Journal of Obstetrics and Gynecology describing how to make the diagnosis, and at some point screening for uterine cancer by sampling cells shed from the lining of the uterine cervix became a common practice. Dr. P. himself appears to have been a major force in the practical aspects of making screening an expected part of being female, at le…

Passing the American Board of Internal Medicine MOC

I took the American Board of Internal Medicine maintenance of certification test on April 25, 2012. On June 26, 2012 the board notified me by e-mail that I passed the written test, the final step.

I started the whole process June 30, 2010, by paying for the $1570 fee to the ABIM and began to do the self study and practice evaluation modules. I was able to do the self guided modules on the website pretty easily while working full time, but I'm not sure they were that valuable, since completing them just required a multiple choice test that I did while looking for specific answers. I guess that is pretty similar to how I solve academic problems for my practice, but I don't think the information sunk in too well. The best self study module was a totally self guided one in which I asked questions as they arose with my patients and later went back and found resources to answer them and described the process.

The biggest hurdle for me was the Practice Improvement Module which requi…

More on ultrasound use at the bedside: this short week in review

This week I was supposed to work 7 days at a busy hospital as a hospitalist. I am, however, done today, after only 3 days because the company that hired me found someone cheaper to work for 4 of the 7 days I was scheduled. I found out about this too late to refuse, but it is really not a good thing and I am moderately annoyed. It is, of course, nice to not work 7 straight very difficult days and to be headed home on a beautiful Thursday to spend some unexpected free time with my family, but the disruptions involved in working in shifts, as hospitalists do, are bad enough when we change every 7 days. The reason I'm more expensive and therefore at a disadvantage in my present job is that I am represented by a locum tenens company that is particularly nice to me and therefore costs the client hospital more money. I'm just learning this.

Nevertheless, it was a very good 3 days for learning. There were patients with mysterious illnesses that I got to discover and almost figure out,…

Mysteries revealed: why do medical supplies cost so much and how do the poor and uninsured pay for their hospital care?

A couple of weeks ago I wrote a post about the cost of various medical supplies at our hospital and about the cost of similar supplies from a veterinary source. Central venous catheters of various types (also called "central lines" or "PICC lines") when billed out by our hospital cost about 30 times what similar products cost vets. I ordered a central venous catheter from a veterinary supply company to see what 29 bucks could buy. I got it in the mail a few days ago.

The veterinary central line looked fine. It was almost exactly what we used maybe 25 years ago, which is only slightly different from what we use now. There have been some design changes that involve making sure that unintentional needle sticks to the provider placing the line are avoided, due to the risk of blood borne diseases like AIDS and Hepatitis C. There was no drape or sterile gown, but those are pretty inexpensive, especially from the vet source. I also bought a regular peripheral IV, the kind…