Posted in Education, Influence peddling, Pain, Patient Safety, Policy Issues, Quality, Rule of Law, U.S. Constitution, Uncategorized

Female Genital Mutilation: Why Are Doctors Silent?

“…we have seen a trend moving it away from villages and homes, where it has usually been done, and into hospitals, clinics, and private offices. The location change has ushered in a vocational change. Health professionals—doctors and nurses—are now frequently the ones performing this procedure on young girls.[5]

Medicalization is rapidly increasing around the world. For example, in Egypt and Sudan, where FGM/C is nearly universal, almost 80%[5] of procedures are performed by members of the health sector.”

 

 

Why are health professionals, who have sworn to do no harm, participating in a practice that is considered a human rights violation? A recent review[7] of 14 studies conducted in countries where FGM/C is common documented several ways that health professionals rationalize their participation.

https://www.medscape.com/viewarticle/907104

Posted in Access to healthcare, Doctor-Patient Relations, Government Regulations, Medical conditions and illness, outcomes, Pain, Patient Safety, Patient-centered Care, Policy Issues, primary care, Protocols, Uncategorized

The Pendulum Has Swung Too Far

“…an act, a habit, an institution, a law, gives birth not only to an effect, but to a series of effects. Of these effects, the first only is immediate; it manifests itself simultaneously with its cause—it is seen. The others unfold in succession—they are not seen: it is well for us, if they are foreseen…The one takes account of the visible effect; the other takes account both of the effects which are seen, and also of those which it is necessary to foresee. Now this difference is enormous, for it almost always happens that when the immediate consequence is favourable, the ultimate consequences are fatal, and the converse.” ~ Frederic Bastiat


Treating Pain in Primary Care

“If there is ever a case for patient-centered care, it is probably the chronic pain patient, especially the older chronic pain patient,” Vega suggests.

He recalled the case of a 72-year-old retiree with chronic degenerative disease of the spine. “She also had stage IV chronic kidney disease, hypertension, and diabetes, all fairly stable and well-controlled. It would be a huge mistake to put her on chronic anti-inflammatory drugs; acetaminophen doesn’t do enough, and she has trouble accessing physical therapy,” he explained. “What really sets her free is tramadol once a day, which she takes in the morning. And then she uses acetaminophen the rest of the day. When I last wrote her the usual prescription, the pharmacy denied it, saying she didn’t have a chronic condition and was at risk for overdose. They didn’t notify me and she went 10 days without therapy. She finally called me, asking why I had withheld her medicine, and I didn’t know what she was talking about.”

Source: The Pendulum Has Swung Too Far

Posted in Education, emotional intelligence, Pain, Philosophy, Uncategorized

Pascal on Why Living in the Present Is So Difficult (Yet so Important) | Intellectual Takeout

Welcome to another edition of Friday’s Philosophical Foray beyond Healthcare!  In this Friday’s installment, we ponder Blaise Pascal’s explorations regarding the trappings of Time. 

…Pascal says that man has an intimation of perfect happiness deep in his soul but is unable to attain it.  Put another way, man longs for eternity but is stuck in time.  According to Christianity, this time-conditioned earthly existence is only a halfway house on our way to eternal life, when time will dissolve.  We are not naturally at home here on earth, and that is why the present “hurts.”

Although Pascal doesn’t spell out a solution to the dilemma, we can easily draw one.  Our happiness depends on maximizing those experiences which help us escape the “treadmill” of life and find a foretaste of the eternal Now. These include aesthetic experiences, being with family or friends, and the act of simply looking at and contemplating the world in all its richness.

Yet at the same time, the mundane practical aspects of life don’t shrink into nothing—far from it.

They become the arena of service and ethics, part of the drama of life where what we do matters for eternity.  Western civilization was built and sustained in part on these words of Jesus of Nazareth: “Do not be anxious about tomorrow, for tomorrow will be anxious for itself…Seek first his kingdom and his righteousness, and all these things shall be yours as well.”

Pascal, as serious a Christian as they come, would no doubt have agreed that focusing our thoughts away from the self will allow us to banish anxiety and dwell securely in the present.

Source: Pascal on Why Living in the Present Is So Difficult (Yet so Important) | Intellectual Takeout

Posted in Access to healthcare, Doctor-Patient Relations, Doctor-Patient Relationship, Independent Physicians, outcomes, outcomes measurement, Pain, Patient Choice, Patient Safety, Patient-centered Care, primary care, Quality, Sleep, Uncategorized

Sometimes You Just Gotta Treat It | A Country Doctor Writes:

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A Country Doctor Writes

Notes from a doctor with a laptop, a house call bag and a fountain pen

I thought to myself about how often specialists are in a position where they can simply declare “Not my department”, but primary care docs are then more or less obligated to pick up the ball again and do something.

Two weeks later, Red was a new man.

I’m sleeping through the night, and no pain”, he grinned.

I still don’t know exactly what this was, but it’s gone.

Sometimes you just gotta treat it.

https://acountrydoctorwrites.blog/2018/12/03/sometimes-you-just-gotta-treat-it/

Posted in American Presidents, Education, Evidence-based Medicine, Free Society, Government Regulations, Medical conditions and illness, outcomes measurement, Pain, Patient Choice, Patient Safety, Policy Issues, Prevention, Quality, Rule of Law, State Medical Boards, Unsettled Science

Opioid Policy: The Devil and the Deep Blue Sea | Medpage Today

Great insight and perspective by Heath McAnally, MD, MSPH, regarding the sometimes reactive, albeit good intentioned, response of gov’t and private entities to the opioid crisis.  Worth the read for sure.

Pendulum swings in medicine aren’t new, but damping the oscillation rarely bears such urgency. To paraphrase the original document, we call on our leaders to:

  • Recognize that opioid tapering requires evidence-based careful selection, patient-centered methods, realistic goals, and close monitoring for adverse events.

  • Include the expertise of pain management subspecialists at every level of decision-making about future opioid policies and guidelines.

  • Put a halt to policies forcing opioid tapering/cessation outside the contexts of diversion or unequivocal, documented harm: benefit ratio imbalance

Dr. McAnally is a board-certified anesthesiologist, pain physician, and addictionologist practicing in Alaska (the military sent him there and he decided to stay). If he wasn’t trying to guide people in improving their own lives, teaching medical students to do the same, or writing about it, he’d probably be outdoors right now slogging up a mountain with a good friend or two.

Source: Opioid Policy: The Devil and the Deep Blue Sea | Medpage Today

Posted in Education, emotional intelligence, Pain, Stress, Uncategorized

Pascal on Why Living in the Present Is So Difficult (Yet so Important) | Intellectual Takeout


We spend most of our lives not truly living at all but shoring up goods for some time in the future when we can enjoy them—which never comes, since we have incapacitated ourselves from enjoying the present. It’s no wonder that our waking hours are often filled with care and anxiety, rarely with serenity.

https://www.intellectualtakeout.org/article/pascal-why-living-present-so-difficult-yet-so-important

Posted in Medical conditions and illness, Pain, Technology, Uncategorized, Unsettled Science

sTMS: Promising Migraine Therapy | Neurology Times

sTMRecently, single-pulse transcranial magnetic stimulation (sTMS)—a novel nonpharmacologic, well-tolerated, and safe therapy—has shown promise for the treatment of migraine.

via sTMS: Promising Migraine Therapy | Neurology Times.

Posted in Disease Prevention, Evidence-based Medicine, Nutrition, Pain, Patient Choice, Patient Safety, Quality, Uncategorized, Unsettled Science

Glucosamine Drink Flops in Knee Osteoarthritis Trial

 

xrays

This is a well-done study that shows, in the short-term, that oral glucosamine alone does not reduce pain or improve cartilage loss in patients with knee Osteoarthritis. Keep in mind, this was a 6 month study. A longer study may or may not show benefit. But, would you take a prescription or any medication for longer than 6 months with no clear sign of improvement? The study could have been better if the authors would have studied the more common form of Glucosamine-Chondroitin-MSM. If they do that for one year, I think we could have a conclusive verdict on this.

Not sure why Medscape chose a pelvic x-ray for a story about knee arthritis, but you get the idea…

Glucosamine Drink Flops in Knee Osteoarthritis Trial.