Crisis

What you don't know about your doctor. (my sister's site)

Where Knowledge Leaves Off

Children light up a room. When we see them exploring, playing or regrouping even the most jaded among us are hard pressed not to be softened. Is it because we see ourselves or remember our more innocent selves in their joy? Is it because we anticipate and hope for all the potential that their lives promise? Will he inspire others with song, deed or ideas? Will she find cures or mediate grave conflicts? Will they show us in original and imaginative ways the seemingly endless capacity for human creativity and care? Or is it because their heads are disproportionately large compared to the rest of their bodies? Whatever the case, kids make me smile.

My cousin’s almost four year old son was diagnosed with leukemia yesterday. As I am writing this through tears, doctors are inserting an aspirating needle through his lower back. They hope the cerebrospinal fluid they acquire will reveal if this type of white blood cell cancer has infiltrated this brave little man's central nervous system. I know the biology, but I swear I can’t make any sense of this. I am comforted by the fact that treatment of pediatric leukemia is one of the astounding success stories of medicine in the past four decades. Survival rates have improved from a dismal five percent in the 1960’s to the high eighty to ninety percent today. However, WTF?!? He’s facing chemotherapy, blood transfusions and possibly bone marrow transplants for the next two to three years.

A quote on a friend’s wedding website reads:

“Love takes up where knowledge leaves off.”

The context is different, but the sentiment is somehow fitting. His parents, barely older sister, grandparents and a host of cousins, titos and titas, lolos and lolas are all sending our love and praying for him. For now, it’s about all we can do.

Too Many Oh Bee Ghee Why Ends

“We got an issue in America. Too many good docs are gettin’ outta business. Too many OBGYN’s aren’t able to practice their, their love with women all across this country.”

I can’t think of any business other than the medical field whose product price is determined by someone other than the producer or the user. I ran across this quote and it boggles the mind:

Douglas Mathisen, a professor of thoracic surgery at Harvard Medical School, said, "The government has reduced reimbursement rates for coronary artery bypass surgery by nearly 50% since 1987," adding, "Faced with major sacrifices and now modest rewards, young doctors are simply choosing other fields that offer shorter training and greater rewards" (Reichard, CQ HealthBeat, 6/18).

How much does medical school cost? What are the malpractice insurance rates again? I know it is hard to feel sympathy for doctors when the common perception of one is that of the golfing country club type. However, how could anyone be expected to run a business when the price of their product is determined not by the business owner’s costs or the consumer’s need but by a third party whose primary interest is to pay as little as possible for each procedure. How many farmers would be in business if they were getting 50% less than they were 20 years ago. How many auto mechanics, teachers, plumbers or politicians …

I’m looking forward to Michael Moore’s, Sicko. It opens this Friday.

The Health of Nations

Ezra Klein is a Junior at UCLA. In his spare time he likes to read and write about healthcare policy. Crazy kids these days. This week he intends to write a series of introductions, primers if you will, into the healthcare systems of five countries. I’ll update the links as they become available.

• France
• England
• Germany
• Japan
• Canada

Also see Ezra’s comments on the healthcare policy initiatives coming out of the Center for American Progress.

Ezra seems to have substituted Japan for Australia and has grouped his posts into a convenient category list.

{last updated: 4/22/05, 11:38 pm}

Grand Rounds, 30th Edition

Hedwig, at Living the Scientific Life, overcame a nasty malady to post the 30th edition of Grand Rounds. Dr. Maria’s submission, Electroconvulsive Therapy and Bestiality, and BioEthics Dude’s, Trouble with Diagnosis: Car Talk vs. Doctors, immediately caught my eye.

By the way, I'm sure you've noticed the conditional link to fullposts labeled "unfold" at the end of all my frontpage posts. Does anyone know the code to have it only appear when there is actually something below the fold?

{update: 4/23/05, 1:44pm} Never mind. I found a hack.

Grand Rounds 28, Comics Edition

Polite Dissent blogs medicine, comics and sometimes the medicine in comics. The 28th edition of Grand Rounds can be found there as well.

Celebrity Grand Rounds

Graham, at Over My Med Body, hosts the 27th installment of Grand Rounds. Presented through the filter of celebrity, Graham has collected 18 of this week's best medical blogosphere articles. Gwen Stefani and Jennifer Aniston make surprise appearances.

Carnival Barker

Grand Rounds, 26th edition is available at The Well-Timed Period.

Tangled Bank, 24th edition is available at Syaffolee.

Medical Draft?

On October 19, 2004, the NY Times ran an article titled, “U.S. Has Contingency Plans for a Draft of Medical Workers”. This was in the heat of the presidential campaign and was mostly dismissed as the “liberal media’s” attempt to undermine Pres. Bush. The Pentagon denied needing such a draft, but did not deny planning for one. The initial article was based on Selective Service System documents obtained by Freedom of Information Act requests. These documents can be viewed at The Blatant Truth.

The Blatant Truth writes:

In short, if a Skills Draft and Medical Draft are authorized by Bush and the Republican Congress in 2005, nearly 40 million young people and a somewhat overlapping 13.5 million doctors, nurses and specialists ages 20–44 will have to go to their local Post Office and register with the IRS. The form will have on it a list of several hundred skills for the skills draft, and at least 61 medical specialties for the Medical Draft form, probably along with a host of other medical occupations, from dental lab technician to health forms processor. Under penalty of a $250,000 fine, these tens of millions of Americans will “self-declare” their name, address, and all of their skills—and they could be drafted for any one of them—by writing down the coded number for that occupation. (emphasis added)

Less than two weeks from now, SSS will report to the Pentagon that they’re all set to go. Sherlock Google at DailyKos writes:

On March 31st, the Director of the Selective Service System (the SSS) is due to report to the Pentagon that the agency is ready to open 1,980 draft board offices around the country and be ready to operate lotteries by June 15th.

Let’s just hope that Sherlock is mistaken. The guys in power would never think about bringing back the Draft. This is just normal contingency planning, right Mr. President?

Grand Rounds, 25th edition

The latest edition of Grand Rounds is available at Respectful Insolence. Be sure to check out hedwig_the_owl’s entry concerning the biology of influenza and the logistics of vaccine production.

Grand Rounds: Edition 24

The 24th installment of Grand Rounds has been posted at Hospice Blog. You can also find a link on my sidebar.

Medicine Index

TITLE	DATE POSTED
A Misconception is Born	- Monday, April 25, 2005
The Health of Nations	- Wednesday, April 20, 2005
Grand Rounds, 30th Edition	- Tuesday, April 19, 2005
Grand Rounds 28, Comics Edition	- Tuesday, April 05, 2005
Avian Influenza Virus	- Wednesday, March 30, 2005
Celebrity Grand Rounds	- Wednesday, March 30, 2005
Carnival Barker	- Wednesday, March 23, 2005
Medical Draft?	- Sunday, March 20, 2005
Grand Rounds, Edition 25	- Tuesday, March 15, 2005
Grand Rounds, Edition 24	- Tuesday, March 08, 2005
Colorectal Cancer Awareness Month	- Tuesday, March 01, 2005
Grand Rounds, 23rd Edition	- Tuesday, March 01, 2005
New Primer Set Feature	- Thursday, March 03, 2005
A Physician’s Oath	- Thursday, February 17, 2005
Broken Hearts	- Saturday, February 12, 2005

- last updated 04/26/05, 9:16 pm -

- return to frontpage -

Medicine: Colorectal Cancer Awareness Month

Via Kevin, M.D., a Medical Weblog:

As a reminder to all, this link from the American Cancer Society reviews the guidelines on screening and surveillance for the early detection of polyps and colorectal cancer.

There are three risk catagories: average, increased, and high.

Check out the table at the bottom of the link to see what risk category you fall in.50,000 people die from colon cancer each year - one every 9.3 minutes. Prevention is vital to reducing this grim statistic.

Medicine: Grand Rounds, 23rd Edition

Grand Rounds, 23rd Edition is available at intueri: to contemplate in a restaurant menu format.

Medicine: A Physician’s Oath

An oath is more than a promise to another. It is also an essential statement on the stuff of which we're made. The Cheerful Oncologist shares his oath in a terrific post, “High in the Sunlit Silence.” He concludes:

… I understand more clearly now why the doctors on M*A*S*H kept working on that fateful day. After catching their breath they looked down at their hands and saw them move; they opened their mouth and heard their voice. The surgeons searched within themselves and concluded that their only usefulness, their only worth in the world was if they kept the promise they made to another human in need. That promise is what fuels the doctor's engine for the magnificent journey called his career. It is the only thing that can lift him high enough to slip the surly bonds of earth and touch the face of God.

Medicine: Broken Hearts

For those of us bound for the less fortunate side of Valentine’s Day this year, here is an article from the New England Journal of Medicine. Thanks to Medpundit for the link.

Neurohumoral Features of Myocardial Stunning Due to Sudden Emotional Stress

Abstract

Background: Reversible left ventricular dysfunction precipitated by emotional stress has been reported, but the mechanism remains unknown.

Methods: We evaluated 19 patients who presented with left ventricular dysfunction after sudden emotional stress. All patients underwent coronary angiography and serial echocardiography; five underwent endomyocardial biopsy. Plasma catecholamine levels in 13 patients with stress-related myocardial dysfunction were compared with those in 7 patients with Killip class III myocardial infarction ...

The good doctors show the coincidence of high levels of stress hormones with cardio myopathy, including chest pain, pulmonary edema, cardiogenic shock and severe left ventricular dysfunction post emotional distress. 18 of the 19 patients showed no evidence of coronary disease. Elevated stress hormone levels returned to normal and left ventricular dysfunction “rapidly resolved” within a few weeks. The doctors propose that exaggerated sympathetic stimulation played a central role in this syndrome.

Your friends and family have always known it. Now the doctors at Johns Hopkins and Brigham and Women's Hospital concur. Love can surely break your heart, but time can just as surely heal it.