Medpie Interviews

"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.

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.

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.