By Shawn Vuong
A wise pharmacology professor once told me, "All substances are poisons; there is none which is not a poison. The right dose differentiates a poison and a remedy."
This week Dr. Holm talks about drugs, particularly in the context of heart burn. In our pharmacology class, we are learning about how all types of drugs interact with the body. Prescription drugs, over-the-counter drugs, herbals, and even supplements all effect the body in different ways. The key to prescribing drugs correctly is weighing the risk of toxicity of a drug versus the benefit gained.
Each substance has it's own toxic effect when given at too high of doses. But we must make the dose high enough to see a benefit. In effect, we get a titer-totter like scenario where we are trying to balance the correct dose to see benefit while trying to limit toxic effects (also known as side effects). Some drugs are easy to give, since they have a high benefit but low toxic effects such as statins. Other drugs have medical health professions constantly walking that fine line between lethal effects and benefit to the patient such as chemotherapy agents or anesthetics.
So remember, every substance has toxic effects when given at incorrect doses. Even water can cause lethal effects if you drink too much. So, please work with your doctor to correctly dose your medications, because they can sometimes give you nasty side-effects.
_________________________________________________________________________
By Richard P. Holm MD
It has always amazed me that the stomach can produce large amounts of a very corrosive hydrochloric acid. Of course, we do that in order to breakdown food so our bodies can absorb nutrients.
In response to food stretching the stomach and esophagus, tiny proton-pumps in special cells that line the stomach make acidic stomach juice. The resultant strength of gastric acid during digestions can be not as corrosive as battery acid, but almost.
Fortunately, a special layer of mucus protects the stomach from the acid, and as food moves on into the small intestine, the corrosive juice is neutralized by sodium bicarbonate produced by the pancreas.
When something goes wrong: the stomach-mucus layer fails; the acid rolls up into the unprotected esophagus; or there is not enough sodium bicarbonate to neutralize the acid… then symptoms occur. People can be pretty miserable as digestive juices are eating away at their own tissue, rather than the food they just ate.
Fortunately we have very effective medications to reduce acid production when something goes awry. One group of antacids, which reduce acid quickly are the H2 blockers with ranitidine (Zantac) as an example. Another group, which reduce acid slower but more effectively, are the proton-pump inhibitors, with omeprazole (Prilosec) as an example.
These two types of powerful antacids have been a blessing for many people who truly suffer from excess acid stomach. A major drawback with both types of medicines, however, comes when trying to stop them, which can result in rebound acidity.
A recent study provided two months of omeprazole to people who at start had never been troubled with heartburn. When the medicine was stopped, however, the volunteers had rebound acid symptoms.
People need to be warned when using these stomach acid medicines that short-term use is safe and can be very helpful. However, getting off of them after prolonged use can be a challenge and may require a gradual reduction over two to three months. Certainly some people should never be off of them, but that should be discussed with your doctor.
Take home message: we have good medicines to counter the corrosive battery-like acid made in our stomachs, but they need to be used with caution.
Tuesday, November 24, 2009
Sunday, November 1, 2009
Asthma
By Shawn Vuong
This post from Dr. Holm really hits home with me. In my late elementary school/early middle school years I was plagued with exercise-induced asthma. When I would play in PE class or recess, my chest would just feel like it was tightening up. The wheezing, the tightness, and the shortness of breath is very scary.
My parents took me to a pediatric pulmonologist and I was tested for asthma. Right then, the doctor prescribed me an albuterol inhaler, which became my life line. After that, any physical activity that I did was preceded by a couple puffs from my inhaler. I was too scared to have another asthma episode.
Asthma is not just something that is brought on by exercise, but can be induced by allergies, pollutants, smoking, chronic disease, infections, or even stress. Asthma can be deadly. If you think you have some of the signs or symptoms of asthma I encourage you to see your doctor.
____________________________________________________________________
By Richard P. Holm MD
A few years ago, a 40-something woman was walking across the farm yard when something in the air brought on wheezing, like gangbusters. She turned back to the house for her inhaler, but just couldn't make it, and collapsed in the yard.
While her husband was hurriedly driving her to town, she stopped breathing entirely. Her husband gave her mouth-to-mouth until the ambulance met them.
In the ER, we were able to place the breathing tube down, but her brain had been too long without oxygen. And a few days later, I will never forget how she gently escaped from this earth surrounded by her loving family.
This tragic death taught me how asthma kills. So what can we do to prevent a similar calamity?
First, recognize when you are at risk. Have you experienced an asthma attack that comes on fast and out of the blue?
Next: are you using your rescue-immediate-acting inhaler more often lately? I should add here that albuterol or any of the fast acting adrenaline-like asthma inhalers might cover-up or even cause worsening inflammation in the lungs. They only work for the short run-and increased use of these fast acting rescue meds is a big time danger signal.
Finally: know that when your asthma is accelerating you need to turn off the inflammation and our best tool to do that is a steroid. Not a body building type, but and anti-inflammatory which slowly turns off asthma for the long run.
That's the take home message: although fast acting rescue inhalers are good to have-they forecast danger. The real hero in this disease is the anti-inflammatory steroid inhalers.
So if you or your family member with asthma is using the rescue inhalers more than usual do not dally. You need to be talking to your doctor about anti-inflammatory steroids.
This post from Dr. Holm really hits home with me. In my late elementary school/early middle school years I was plagued with exercise-induced asthma. When I would play in PE class or recess, my chest would just feel like it was tightening up. The wheezing, the tightness, and the shortness of breath is very scary.
My parents took me to a pediatric pulmonologist and I was tested for asthma. Right then, the doctor prescribed me an albuterol inhaler, which became my life line. After that, any physical activity that I did was preceded by a couple puffs from my inhaler. I was too scared to have another asthma episode.
Asthma is not just something that is brought on by exercise, but can be induced by allergies, pollutants, smoking, chronic disease, infections, or even stress. Asthma can be deadly. If you think you have some of the signs or symptoms of asthma I encourage you to see your doctor.
____________________________________________________________________
By Richard P. Holm MD
A few years ago, a 40-something woman was walking across the farm yard when something in the air brought on wheezing, like gangbusters. She turned back to the house for her inhaler, but just couldn't make it, and collapsed in the yard.
While her husband was hurriedly driving her to town, she stopped breathing entirely. Her husband gave her mouth-to-mouth until the ambulance met them.
In the ER, we were able to place the breathing tube down, but her brain had been too long without oxygen. And a few days later, I will never forget how she gently escaped from this earth surrounded by her loving family.
This tragic death taught me how asthma kills. So what can we do to prevent a similar calamity?
First, recognize when you are at risk. Have you experienced an asthma attack that comes on fast and out of the blue?
Next: are you using your rescue-immediate-acting inhaler more often lately? I should add here that albuterol or any of the fast acting adrenaline-like asthma inhalers might cover-up or even cause worsening inflammation in the lungs. They only work for the short run-and increased use of these fast acting rescue meds is a big time danger signal.
Finally: know that when your asthma is accelerating you need to turn off the inflammation and our best tool to do that is a steroid. Not a body building type, but and anti-inflammatory which slowly turns off asthma for the long run.
That's the take home message: although fast acting rescue inhalers are good to have-they forecast danger. The real hero in this disease is the anti-inflammatory steroid inhalers.
So if you or your family member with asthma is using the rescue inhalers more than usual do not dally. You need to be talking to your doctor about anti-inflammatory steroids.
Earwax and Elbows
By Shawn Vuong
In this post, Dr. Holm talks about one topic that doctors have been losing ground on for a long time, the Q Tip. Every physician from the ENT to the family practitioner has seen the damage Q Tips have caused eardrums and ear canals. They warn their patients to not stick anything into their ears, and to let ear wax come out naturally. I remember when I was in grade school, some health professional came in and told us only to use a wash cloth to clean out our ears and to never use a Q Tip. Almost 20 years later, I still use them like a bad habit.
Using Q Tips and Bobby Pins to clean out your ears is a bad habit, although it may seem like you are doing it to keep your ears clean. In this case, the gross wax that a person is trying to clean out of the ear canal is actually the stuff you want in there for protection. Dr. Holm explains more about the Q Tip problem, and gives some better solutions to cleaning out one's ears.
_____________________________________________________________________
By Richard P. Holm MD
It was 1973, and the Professor advised our Sophomore Med School class that the smallest thing that should ever go into the ear canal is your elbow. Through 31 years of practice I have seen many injuries to ears resulting mostly from Q Tips and Bobby Pins. People use these weapons sometimes to scratch an ear itch, but mostly to remove earwax.
Earwax is an oft-maligned material that has an interesting story.
Recently scientists have discovered genetic differences by the character of earwax. East Asians and American Indians are more likely to have a dry grey and flaky type of wax, while Africans and Caucasians are more likely to have the moist honey-brown type. Anthropologists have even used earwax type to track human migratory patterns, and claim the dry type indicates a genetic change, which came as a beneficial reduction in sweating for those living in cold climates.
Also called cerumen, the stuff that comes out of ears is a mixture of oil, sweat, and old sloughed off ear canal skin. As we chew, the jaw movement moves the gooey stuff outward down the canal, dragging with it dirt, dust, and debris. We know it also provides for lubrication and protection against bacteria and fungus.
With aging, dehydration, or metabolic problems, the earwax can sometimes thicken, stop moving, fill the ear canals, and cause trouble. In this case one should apply a couple drops of warm olive oil or baby oil to each ear two or three times a week.
Q-Tips or Bobby Pins should be avoided since they will only pack the wax and potentially perforate the eardrum. If oil fails to drain the wax plug, a few weeks of drops will at least prepare the wax for removal. Then a solution of warm (not hot or cold) vinegar-water irrigated by an inexpensive ear syringe purchased at any drugstore should clear the plug. Failing that, see your doctor.
There’s lots to do besides putting your elbow up there.
In this post, Dr. Holm talks about one topic that doctors have been losing ground on for a long time, the Q Tip. Every physician from the ENT to the family practitioner has seen the damage Q Tips have caused eardrums and ear canals. They warn their patients to not stick anything into their ears, and to let ear wax come out naturally. I remember when I was in grade school, some health professional came in and told us only to use a wash cloth to clean out our ears and to never use a Q Tip. Almost 20 years later, I still use them like a bad habit.
Using Q Tips and Bobby Pins to clean out your ears is a bad habit, although it may seem like you are doing it to keep your ears clean. In this case, the gross wax that a person is trying to clean out of the ear canal is actually the stuff you want in there for protection. Dr. Holm explains more about the Q Tip problem, and gives some better solutions to cleaning out one's ears.
_____________________________________________________________________
By Richard P. Holm MD
It was 1973, and the Professor advised our Sophomore Med School class that the smallest thing that should ever go into the ear canal is your elbow. Through 31 years of practice I have seen many injuries to ears resulting mostly from Q Tips and Bobby Pins. People use these weapons sometimes to scratch an ear itch, but mostly to remove earwax.
Earwax is an oft-maligned material that has an interesting story.
Recently scientists have discovered genetic differences by the character of earwax. East Asians and American Indians are more likely to have a dry grey and flaky type of wax, while Africans and Caucasians are more likely to have the moist honey-brown type. Anthropologists have even used earwax type to track human migratory patterns, and claim the dry type indicates a genetic change, which came as a beneficial reduction in sweating for those living in cold climates.
Also called cerumen, the stuff that comes out of ears is a mixture of oil, sweat, and old sloughed off ear canal skin. As we chew, the jaw movement moves the gooey stuff outward down the canal, dragging with it dirt, dust, and debris. We know it also provides for lubrication and protection against bacteria and fungus.
With aging, dehydration, or metabolic problems, the earwax can sometimes thicken, stop moving, fill the ear canals, and cause trouble. In this case one should apply a couple drops of warm olive oil or baby oil to each ear two or three times a week.
Q-Tips or Bobby Pins should be avoided since they will only pack the wax and potentially perforate the eardrum. If oil fails to drain the wax plug, a few weeks of drops will at least prepare the wax for removal. Then a solution of warm (not hot or cold) vinegar-water irrigated by an inexpensive ear syringe purchased at any drugstore should clear the plug. Failing that, see your doctor.
There’s lots to do besides putting your elbow up there.
Thursday, October 15, 2009
Q. and A. about Health Care Reform
By Shawn Vuong
This week Dr. Holm writes a short Q & A about the current health care reform and debate. It's a nice concise summary of the basic problems of the reform, and I have nothing to add. Hopefully, we find a workable and solid solution to our healthcare system problems. So without further ado, the Health Care Reform Q & A.
_________________________________________
By Richard P. Holm MD
Q. Do we really need health care reform?
A. The answer is a clear yes, because of ACCESS and COST issues:
1. Without reform, insurance companies will remain free to increase profits by cherry-picking only the well people, leaving too many Americans without access to health insurance. What’s more, many people will continue to be unable to change jobs for fear of losing insurance. These are problems of ACCESS;
2. Without reform, health costs will continue to rise, and health insurance will become more unaffordable for many businesses, let alone many individuals. Unchecked, by 2017 Medicare will bankrupt social security. This is a problem of COST.
Q. Why is US health care twice as expensive as any country in the world?
A. There are many reasons, which is why this is so hard to fix. Here are the most significant.
1. Payment for health care rewards hospitals for making available and encouraging the most expensive technology which does not necessarily improve care;
2. Physicians, especially in the emergency rooms have every reason to order the most complete and often most expensive tests or treatment because the patient wants it; the hospital wants it; and there is a risk of law suit if every test or treatment is not done and something bad happens. This again, does not necessarily improve care;
3. Patients expect the most expensive care for their family and for themselves, someone else is paying for it. Studies show the most expensive does not necessarily mean the best care;
4. Too often we do not have our personal doctor directing care, but have turned to that which is specialist driven. This kind of care can become very disjointed and very expensive.
Q. Will the solutions working their way through Congress right now solve the access and cost problems?
A. Both problems are being addressed. Ethically, I believe the access problem must be solved first. Although the more complex challenge of reducing health care costs will require a great deal of political will, it is a problem that also must be solved.
Both parties, of course, are playing their political hands with this issue, but I believe that without health care reform the consequences will be too dire for the any of us to tolerate. Our Washington leaders will have to find a way to make it happen.
This week Dr. Holm writes a short Q & A about the current health care reform and debate. It's a nice concise summary of the basic problems of the reform, and I have nothing to add. Hopefully, we find a workable and solid solution to our healthcare system problems. So without further ado, the Health Care Reform Q & A.
_________________________________________
By Richard P. Holm MD
Q. Do we really need health care reform?
A. The answer is a clear yes, because of ACCESS and COST issues:
1. Without reform, insurance companies will remain free to increase profits by cherry-picking only the well people, leaving too many Americans without access to health insurance. What’s more, many people will continue to be unable to change jobs for fear of losing insurance. These are problems of ACCESS;
2. Without reform, health costs will continue to rise, and health insurance will become more unaffordable for many businesses, let alone many individuals. Unchecked, by 2017 Medicare will bankrupt social security. This is a problem of COST.
Q. Why is US health care twice as expensive as any country in the world?
A. There are many reasons, which is why this is so hard to fix. Here are the most significant.
1. Payment for health care rewards hospitals for making available and encouraging the most expensive technology which does not necessarily improve care;
2. Physicians, especially in the emergency rooms have every reason to order the most complete and often most expensive tests or treatment because the patient wants it; the hospital wants it; and there is a risk of law suit if every test or treatment is not done and something bad happens. This again, does not necessarily improve care;
3. Patients expect the most expensive care for their family and for themselves, someone else is paying for it. Studies show the most expensive does not necessarily mean the best care;
4. Too often we do not have our personal doctor directing care, but have turned to that which is specialist driven. This kind of care can become very disjointed and very expensive.
Q. Will the solutions working their way through Congress right now solve the access and cost problems?
A. Both problems are being addressed. Ethically, I believe the access problem must be solved first. Although the more complex challenge of reducing health care costs will require a great deal of political will, it is a problem that also must be solved.
Both parties, of course, are playing their political hands with this issue, but I believe that without health care reform the consequences will be too dire for the any of us to tolerate. Our Washington leaders will have to find a way to make it happen.
Friday, September 25, 2009
Boys to Men
By Shawn Vuong
In the current society, men and boys are having a hard time defining themselves and fitting into their gender role. What does it mean to be a man?
It is said that nearly one fourth of all American children live in mother-only families. At school they are more than likely taught by a female teacher. Boys are growing up without a solid male role model. This is a problem, as research shows that fathers tend to be more tend to be more challenging, prodding, loud, playful, encourage risk taking, and physical when compared to mothers. This is important for children, and especially boys who are looking to their father for what it means to be a man.
In a world where being a woman is celebrated, it may be difficult for boys to figure out their gender role. Women these days do a great job banding together, groups such as Women At Work, Women In Medicine, Women's Health Group, YWCA, and the many many organizations are devoted to celebrating what it means to be a woman. Yet, you do not see similar things for men. This could be that men only groups seem sexist and are discouraged, or that men just do a poorer job defining their gender role. Either way, this lack of men groups in conjunction with a lack of male-role models may be making it hard for boys to understand what it means to be a man.
__________________________________________________________________
By Richard P. Holm MD
For men, there is always something about our Fathers. I heard it today in my office coming from a very hurt, yet extremely successful businessman how his father had always told him that he was too soft and would never amount to anything. His Dad always expected way too much. He could never do enough… never do it right. His Father was never satisfied with anything he did… Never!
On the other end of it, some would suggest that much of what is wrong in our society comes as a result of inner-city boys growing up without Fathers, or Grandfathers, or male role-models. Without mentoring, these angry boys make the world a very dangerous place.
Robert Bly, a Minnesota poet, is one of the leaders of what has been called "the expressive men's movement," and he tells us that a “man’s work” is to not deny his inner suppressed “wild man”, and at the same time learn from older men principles such as the work ethic, honesty, justice, and especially respect.
They say that a boy growing up needs to experience, from older men, a ritualistic initiation, a robust challenging physical experience with nature. This could be at basic training, at a work setting, or during a football or sports experience. There should be a separating time from Mama when a boy becomes a mature man and learns about his responsibility to protect, not harm. He needs to learn that virtue and justice is the goal, never violence, betrayal, or abandonment.
My own Dad had been a Sergeant in the Army during WWII, and if I dropped the ball on something, I learned to say, “No excuse, Sir.” He challenged me to work hard, and demanded the truth from me always, calling me on it big time when I deceived him.
Certainly he had his failings, and every son sees these things in his Father, but my Dad taught me the “golden rule” and proved it by the way he treated others. And somehow I always sensed that I was safer from whatever bad there was, when he was around.
He has been gone for seventeen years this month, but I still feel him protecting me.
In the current society, men and boys are having a hard time defining themselves and fitting into their gender role. What does it mean to be a man?
It is said that nearly one fourth of all American children live in mother-only families. At school they are more than likely taught by a female teacher. Boys are growing up without a solid male role model. This is a problem, as research shows that fathers tend to be more tend to be more challenging, prodding, loud, playful, encourage risk taking, and physical when compared to mothers. This is important for children, and especially boys who are looking to their father for what it means to be a man.
In a world where being a woman is celebrated, it may be difficult for boys to figure out their gender role. Women these days do a great job banding together, groups such as Women At Work, Women In Medicine, Women's Health Group, YWCA, and the many many organizations are devoted to celebrating what it means to be a woman. Yet, you do not see similar things for men. This could be that men only groups seem sexist and are discouraged, or that men just do a poorer job defining their gender role. Either way, this lack of men groups in conjunction with a lack of male-role models may be making it hard for boys to understand what it means to be a man.
__________________________________________________________________
By Richard P. Holm MD
On the other end of it, some would suggest that much of what is wrong in our society comes as a result of inner-city boys growing up without Fathers, or Grandfathers, or male role-models. Without mentoring, these angry boys make the world a very dangerous place.
They say that a boy growing up needs to experience, from older men, a ritualistic initiation, a robust challenging physical experience with nature. This could be at basic training, at a work setting, or during a football or sports experience. There should be a separating time from Mama when a boy becomes a mature man and learns about his responsibility to protect, not harm. He needs to learn that virtue and justice is the goal, never violence, betrayal, or abandonment.
My own Dad had been a Sergeant in the Army during WWII, and if I dropped the ball on something, I learned to say, “No excuse, Sir.” He challenged me to work hard, and demanded the truth from me always, calling me on it big time when I deceived him.
Certainly he had his failings, and every son sees these things in his Father, but my Dad taught me the “golden rule” and proved it by the way he treated others. And somehow I always sensed that I was safer from whatever bad there was, when he was around.
He has been gone for seventeen years this month, but I still feel him protecting me.
An Old Dog’s Computer Quest
By Shawn Vuong
Technology. I love it.
I am a proud member of the millennial generation (aka Generation Y). While we aren't known for our humility or strong work ethic, we are known for our extreme integration with technology. As time goes on and more of the Generation Y hits the workforce, we will be expecting businesses to be updating to fully integrated all digital business schemes. In medicine this means the adoption of the electronic medical record.
While this seems like a huge step for older physicians still in practice (the baby boomer generation), this is hardly what we (as the Generation Y) envision as our ideal digital medical record. As time goes on, and our generation starts becoming the majority of the medical work force I for see the trend digital medical record becoming much more than some doctors could ever imagine. Fully integrated, international, digitally accessible and protected medical records. If I go to vacation in California and get hurt, I expect the ER doctor to be able to read my full history since my birth on his EMR at his/her hospital. If my child gets a test done at Mayo, I want to see the results online as soon as my physician gets them. We may have a long way to go before we get to this kind of integration. But I believe this is the future of medicine.
________________________________________________________________
Technology. I love it.
I am a proud member of the millennial generation (aka Generation Y). While we aren't known for our humility or strong work ethic, we are known for our extreme integration with technology. As time goes on and more of the Generation Y hits the workforce, we will be expecting businesses to be updating to fully integrated all digital business schemes. In medicine this means the adoption of the electronic medical record.
While this seems like a huge step for older physicians still in practice (the baby boomer generation), this is hardly what we (as the Generation Y) envision as our ideal digital medical record. As time goes on, and our generation starts becoming the majority of the medical work force I for see the trend digital medical record becoming much more than some doctors could ever imagine. Fully integrated, international, digitally accessible and protected medical records. If I go to vacation in California and get hurt, I expect the ER doctor to be able to read my full history since my birth on his EMR at his/her hospital. If my child gets a test done at Mayo, I want to see the results online as soon as my physician gets them. We may have a long way to go before we get to this kind of integration. But I believe this is the future of medicine.
________________________________________________________________
By Richard P. Holm MD
They say you can’t teach an old dog new tricks. Yet today I found myself in front of a Brookings Health System computer with a personal nurse tutor trudging through our new test version of an electronic medical record.
Indeed, for about a year we have been gradually getting used to seeing parts of the hospital record on computer screen. Finally this month we are about to take the leap of dropping our paper orders and progress notes, and going entirely paperless in the hospital.
We have to be prepared so that no patient is harmed by this transformation. That is why the physicians and PA/NPs have spent many meetings this spring developing orders sets, which are pre-defined orders for specific illnesses. That is why we have been having two hours a week of educational meetings all summer long on the topic.
It will be difficult for many of us to make this change, especially since we have been doing things on paper for so many years. At first it will take us all a lot more time. But the whole process is not only taking time, it means our hospital has to make a significant commitment both in personnel and money.
So why would we spend this kind of time and effort? Along with many who are so capably helping us through this, are two RN experts. Today I asked them both just what will result from all this effort, and their answers were straightforward. “It’s all about patient safety and accessing information.” Safety, for example means avoiding dangerous medication allergies and interactions. Access, for example means seeing the patient’s Problem List, prior test results, and medication list whenever needed.
Still, the electronic medical record cannot look into the eyes of a frightened person in pain, listen for a clue to solve a problem, provide for relief of suffering, and then find a way to healing and better health. That’s something this old dog better not forget.
They say you can’t teach an old dog new tricks. Yet today I found myself in front of a Brookings Health System computer with a personal nurse tutor trudging through our new test version of an electronic medical record.
Indeed, for about a year we have been gradually getting used to seeing parts of the hospital record on computer screen. Finally this month we are about to take the leap of dropping our paper orders and progress notes, and going entirely paperless in the hospital.
We have to be prepared so that no patient is harmed by this transformation. That is why the physicians and PA/NPs have spent many meetings this spring developing orders sets, which are pre-defined orders for specific illnesses. That is why we have been having two hours a week of educational meetings all summer long on the topic.
It will be difficult for many of us to make this change, especially since we have been doing things on paper for so many years. At first it will take us all a lot more time. But the whole process is not only taking time, it means our hospital has to make a significant commitment both in personnel and money.
So why would we spend this kind of time and effort? Along with many who are so capably helping us through this, are two RN experts. Today I asked them both just what will result from all this effort, and their answers were straightforward. “It’s all about patient safety and accessing information.” Safety, for example means avoiding dangerous medication allergies and interactions. Access, for example means seeing the patient’s Problem List, prior test results, and medication list whenever needed.
Still, the electronic medical record cannot look into the eyes of a frightened person in pain, listen for a clue to solve a problem, provide for relief of suffering, and then find a way to healing and better health. That’s something this old dog better not forget.
Impossible To Fix
By Shawn Vuong
Medicine demands perfection. Nobody wants their loved one to die of something that could have been caught earlier on a blood test or CT scan.
So, a lady with a headache comes into the ER. The ER doctor knows that this headache is probably a tension headache or a migraine headache. The ER doctor also knows that the odds of this lady having a brain tumor are low, very low. Although every other ER doctor in the state would order a CT scan for every headache case that comes to the ER (due to the fact that they are scared of litigation brought against them, not because they think every headache warrants a CT), this ER doctor decides it is close to the end of his shift and he doesn't want to waste time ordering the CT scan this lady probably doesn't even need. So, he sends her home with some migraine medication.
Well, thanks to Murphy's Law this lady ends up permanently injured due to a malignant brain tumor. So because of this devastating turn of events, the family files a malpractice claim against the ER doctor.
Thanks to the teachings of a very wise law professor with significant expertise in tort law, I know what's coming next.
The doctor will be asked if it is the 'Standard of Care' to order a CT scan for a headache patient. Although medical literature may say that it is not the best practice to order a CT for every headache patient, and although every other ER doctor in the nation is ordering CT scans for fear of medical malpractice litigation, it IS considered the 'Standard of Care' just because every other ER physician is doing it. Right or wrong. Thus, this ER doctor will likely lose this malpractice case.
How do we as a profession change this? Obviously, a group of ER doctors cannot just follow the medical literature and stop ordering CT scans for every headache. This will just increase the chance that they will be successfully sued in a malpractice case. So, in reality, no ER doctor will stop ordering unnecessary scans. The more the 'Standard of Care' deviates from what the medical literature considers the best medical practices, the more of a disservice physicians are providing to patients. Yet, the legal climate prevents the doctors from changing the way they practice from the 'Standard of Care' due to fear of litigation.
This sounds impossible to fix.
-- Please note that this article is not trying to say ER doctors should not order CT scans for headaches. I have no idea if you should or not, I am not a licensed physician. This hypothetical scenario was merely thought up to help illustrate the problem with defensive medicine.
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