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Showing posts from November, 2012

Mammogram screening--reconsidering the wisdom of saying "No."

Three days ago, on November 22, 2012, an article was published in the New England Journal of Medicine questioning the utility of mammogram screening for prevention of death from breast cancer. The authors were research professor Archie Bleyer MD at Oregon Health and Sciences University in Portland, an oncologist who was chief of pediatrics at MD Anderson Cancer Center and H. Gilbert Welch MD, MPH, a professor at Dartmouth Medical School.  The article examines the ability of mammograms to prevent late stage breast cancer by diagnosing and treating breast cancer early as a result of detection by mammograms. They found that mammograms do detect lots of breast cancer, but when we compare women during the years 2006-2008 when mammogram screening was widely practiced to women during the years 1976-1978, there was no difference in the incidence of the really nasty breast cancers, ones that had spread beyond the regional lymph nodes, and only a small decrease in the less nasty but still sign…

Creating dependency--is that what we do for a living?

Lately, it seems, I have been treating quite a lot of people who end up in the hospital as a result of prescription drug abuse. Most of them have chronic pain and have been generously prescribed long acting opiate medications such as methadone and morphine by doctors of various types, have taken excessive numbers of these medications or mixed them with other medications and have ended up being unable to breathe for themselves.

In the beginning of the last decade there was a well intentioned movement to recognize that pain was a real issue and should be treated. Pain is not visible, usually, and can often be ignored. Having lots of pain for a long while or intense pain for shorter periods is bad for us. It causes depression, anxiety, leads to post-traumatic stress disorder, and just generally hurts a lot. Humans view torture, deliberately causing another being to have pain, as vile and unacceptable. Conversely we regard the relief of pain as a great gift. In 1999 the Veterans Administ…

Hospitalists and the field of Hospital Medicine: why we are sometimes terrible and how we can be excellent

Internal Medicine is the branch of medicine that deals with diseases of the internal organs in adults. It also involves dermatology, minor surgical procedures, general psychiatry and preventive care of well people. It is an excellent field, full of opportunities to think and feel and connect with people, mysteries to be solved and an endless variety of stuff to be learned. Internal Medicine contains the subspecialties of nephrology (kidneys), cardiology, oncology and hematology (cancer and blood), infectious diseases, pulmonary and critical care medicine, endocrinology (glands), rheumatology (joints), gastroenterology (guts and livers), neurology and hospital medicine. The most recently invented of those subspecialties is hospital medicine. Unlike the rest of the subspecialties, hospital medicine is defined by the place it is performed, not the body system it aims to treat.

Hospitalists (the internists who practice hospital medicine) take care of patients who are admitted to hospital…