Medpie Interviews

Recently, I had the opportunity to have a dialogue with a very thoughtful retired oral surgeon, Dr. Ira E. Williams, who has published a book describing some of the failings with the current regulatory and medicolegal answers to the problem of inconsistent quality of care provided by physicians. What he proposes is no less than a paradigm shift in medicine, a system of robust peer review that would, over time, replace our failed systems, improve care, and would be more fair to both patients and doctors.

But I looked up risks associated with playing wind instruments and found, to my great surprise, that even healthy adolescents that play wind instruments can develop an obstructive breathing pattern that is normally associated with disease.

Should we reneg on the band committment, or can we balance this risk by swimming and playing basketball?

I guess marriage is like my old Honda lawn mower in my garage. It worked great for the first couple of years and now doesn't quite as well. Should I clean it, bring it in for repair when needed, and take to beautiful park-like lawns for exercise, or I should I dump it and get a brand new one? Or maybe I should accuse my neighbor of sneaking it out of my garage to mow his lawn in the middle of the night, and then set my lawn mower up in the backyard and throw rocks at it until its engine falls out and gasoline leaks all over the ground. Hmm...

Pediatrician Dr. Jesse Lock explores the frontier of parenthood, and is dismayed to learn that years of expert training in the health care of children means nothing at four in the morning when your own child is crying.

His credo? If there is no optimal way to raise a child, and there isn't, then all we can hope to do is our best.

The fact is, immigrants and their first generation offspring are at greater risk of developing schizophrenia than others, even after adjusting for socioeconomic status.
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The hypothesis that low Vitamin D (the sunshine vitamin) is the link between immigrants and schizophrenia is gaining traction, and delay in clarifying this connection could continue to put future generations at risk.

Le fait est que les immigrés et leurs descendants de première génération sont plus à risque de développer une schizophrénie que d'autres, même après ajustement pour le statut socio-économique.
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L'hypothèse que les faibles en vitamine D (la vitamine du soleil) est le lien entre les immigrants et la schizophrénie gagne du terrain, et le retard dans la clarification à cet égard pourrait continuer à mettre les générations futures en danger.

Child actor-turned-addict Corey Haim is reported to have obtained 553 pills of strong prescription drug medications in the 5 days before he died from various doctors.

I know what it is like to be lied to by patients seeking drugs. When patients lie to you so frequently, it changes your view of the world.

Then you wonder: am I really as gullible as I look?

And you think: these patients are destroying my humanity, just as they are destroying themselves.

"You should consider smoking outside," I advised the mother of a grown man who had a skin infection. "Exposure to cigarette smoke can make infections worse." To my surprise, she became extremely angry, questioning my motives for giving such advice.

But isn't the knowledge that cigarette smoking is bad for you widespread?

"My 22 year old son is addicted to cocaine. He has been prescribed a medication called trazodone to help him sleep. He says that he has no trouble sleeping. I am worried because the medication carries a black box warning. Should I be concerned?" Medpie.com answers these questions and more: How does trazodone work? How does cocaine work? Is trazodone dangerous in the setting of cocaine addiction?

As an Emergency Medicine physician practicing in New York State, I am subject to the new regulations requiring that all healthcare workers be immunized against regular seasonal flu, and the swine flu, when the vaccines become available.

To get a better idea of the ethics of this regulation, I contacted George Annas, JD. He is the Edward R. Utley Professor, and Chair, Health Law, Bioethics & Human Rights, of Boston University School of Public Health.

He thinks that mandatory immunization of healthcare workers, while legal, is dubious public policy.

What a relief! Dr. Dart set me straight: cough and cold medications are not really the silent child killers that the media reports and the FDA have made them out to be: in his study, cases of death in children associated with cough and cold medications were exceedingly rare, and were due to accidental, or, sadly, intentional overdose. He writes: "We have not found a pediatric death where it appeared that a true therapeutic dose was administered – they were all overdoses....It’s important to remember that a small overdose is not harmful to a child. For example, most poison centers in the United States do not refer a child into healthcare until the dose ingested is several times the normal therapeutic dose." Phew!

Dr. Peter Wyer, Co-Chair of the Section on Evidence Based Health Care of the New York Academy of Medicine, describes why evidence based medicine matters.

David Newman is an Emergency Physician and the author of Hippocrates’ Shadow, a book that analyzes the nature of medical practice in our highly dysfunctional healthcare system. Dr. Newman’s central argument in Hippocrates’ Shadow is that the essence of wellness and healing lies in the human interaction between the doctor and the patient. In this section, Dr. Newman talks about the communication secrets that exist between doctors and patients.

US government spends approximately 2.5 trillion dollars on health care each year. This translates into over 8,000 dollars per person per year. This is a staggering sum. In 2009, health care will make up 17.6% of our GNP, rising to 20% of GNP by 2018. Dr. Newman, author of Hippocrates' Shadow, argues that delivering quality care, based on good science is essential to controlling these spiraling costs.

We are in the midst of a nursing shortage in the US and it will continue for the foreseeable future. According to the American Association of Colleges of Nursing,: the United States is in the midst of a nursing shortage that is expected to intensify. The shortage of registered nurses (RNs) in the U.S. could reach as high as >500,000 by 2025, according to a report released by Dr. Peter Buerhaus and colleagues in March 2008.

While suffering from breast cancer, Susan Sontag, wrote two ground-breaking essays, Illness as Metaphor and later AIDS and its Metaphors. She argued that society assigned meaning to illness, which had an impact on how patients reacted to their illness, the treatments they sought, and ultimately, the outcomes they suffered. The "meaning response" is an attempt to articulate the true healing effect that a doctor-patient interaction can have.

Evidence Based Medicine is an integrative decision making process that takes into consideration the clinical data, patient values and the best evidence available. Dr. David Newman, author of Hippocrates' Shadow,is particularly interested in incorporating the Number Needed to Treat (NNT) into the doctor-patient interaction when considering risks and benefits of therapeutic interventions.

The only way I could have made my parents proud was to get in to medical school. I told the admissions committee that I was interested in the 'Art' of Medicine, not just the science. This was before the information age. Now, a medical school applicant can just Google the “art of medicine” and find Dr. Newman’s definition of it. In this clip, Dr. Newman puts the concept of the 'art' of medicine in the context of history and relates it to the origin of western medicine. To Dr. Newman, the Art of medicine is simply the art of connecting with another human being.