What’s not widely known, however, is that this is not the first time the physical exam has gone into decline. We know from surviving medical treatises that the exam was an integral part of a physician’s practice in ancient Greece and Rome. This continued to be true until the late Middle Ages (1300-1500). The hands-on exam then disappeared for hundreds of years, reemerging gradually in the late 18th century. Read more
Tag Archives: medical profession
Wakefield study of vaccine/autism link is a fraud
Is it possible that he was wrong, but not dishonest: that he was so incompetent that he was unable to fairly describe the project, or to report even one of the 12 children’s cases accurately? No. A great deal of thought and effort must have gone into drafting the paper to achieve the results he wanted: the discrepancies all led in one direction; misreporting was gross. Read more
DSM-5: A “wholesale imperial medicalization of normality”
Frances accuses his psychiatry colleagues “not just of bad science but of bad faith, hubris, and blindness, of making diseases out of everyday suffering and, as a result, padding the bottom lines of drug companies.” Particularly objectionable to Frances was an emphasis on early intervention in childhood disorders by labeling – and medicating — children considered “at risk” for a disorder. As he wrote in an article for Psychiatric Times, the creation of “at risk” patients would cause a “wholesale imperial medicalization of normality” and “a bonanza for the pharmaceutical industry.” Read more
Doctor arrested for getting whistle-blowing nurses fired
No one should be allowed to intimidate nurses who report serious wrongdoings they observe. When a nurse goes public about improper medical treatment — a doctor who sewed “part of the rubber tip from suture kit scissors to a patient’s torn, broken thumb” and used olive oil on the abscess of a patient with MRSA — she shouldn’t be fired. Read more
Professionalism of UK doctors questioned over health inequalities
Where was the medical profession? Doctors are supposed to feel an acute responsibility to deliver the best health service to the whole population. It is on this basis that they ask the public and government to support generous pay increases and terms and conditions of service. These attitudes and behaviours are what we commonly mean by professionalism. It seems that doctors failed completely to live up to the rhetoric of their commitment to professional values. Read more
Candid comments from the medical profession
In most branches of medicine, we deal more commonly with old people. So we become much more enthusiastic when a young person comes along. We have more in common with and are more attracted to him or her. Doctors have a limited amount of time, so the younger and more attractive you are, the more likely you are to get more of our time. Read more
Updates: Commercialization of infidelity, medical rivalry, conservatives on climate change, football concussions
As a practicing pediatrician, I, too, feel the nobility and privilege of my profession, and count myself lucky every day that I am able to do what I do. But to denigrate lawyers and journalists as somehow less valuable to society is beneath us as a profession. Read more
The tyranny of health then and now
When we hear the words “tyranny of health” these days, it’s usually a reference to the tyranny of health care. It brings to mind images of protesters carrying signs that denounce the “socialism” of Obamacare. As recently as 1994, however, the tyranny of health had a different meaning … the idea that patients should be coerced into being healthy. Read more
“Tyranny of health” on KevinMD
That we’re not routinely made seriously ill by this shortfall … is due largely to the fact that most medical interventions and advice don’t address life-and-death situations, but rather aim to leave us marginally healthier or less unhealthy, so we usually neither gain nor risk all that much. Read more
Marcus Welby vs. the specialists
Tell me, doctors, are you a specialist or a GP? Or sometimes they say “or just a GP?” But of course we are specialists. And our specialty, like any other, has certain advantages and certain disadvantages. The money is good, but you have to work three times as hard for it. But you people know all about that. Read more
Should doctors work weekends?
Orszag is an economist who wants the medical “industry” to be run as efficiently as any other business. “[I]f you can’t measure it, you can’t manage it,” he says. But medicine is not like other business ventures. For one thing, its services are responsible for the life, death, and suffering of human beings. This is unique. Also, it doesn’t operate with the usual economic model of supply, demand, and shopping for competitive prices. When health hangs in the balance, time is limited and choices are few. You don’t decide to forego surgery the way you postpone the purchase of a new car. Read more
Should psychiatrists go to med school?
One of the problems Carlat readily acknowledges is that psychiatry is excessively focused on psychopharmaceuticals at the expense of other effective treatments. Not only is there too much focus when it comes to treatment. There’s so much money flowing from the pharmaceutical industry to psychiatrists that one has to seriously question the profession’s ability to be objective. Read more
Should grief be labeled and treated as depression?
The American Psychiatric Association (APA) is in the process of revising the Diagnostic and Statistical Manual of Mental Disorders (DSM) – the psychiatrist’s bible. Its last incarnation — known as DSM IV — was published in 2000. The new version will be DSM V. … One item in dispute is whether bereavement – the grieving process that follows the loss of a loved one – might qualify a patient for the DSM label Major Depressive Episode. Read more
The art and science of medicine
A more nuanced translation of Hippocrates’ original Greek text might read: Life is too short; the task is huge; the right time is like a razor blade; the road to experience is fraught with hazards; to continuously accept reality and critical thought over hope and prejudice is taxing. Read more
Physician as lone practitioner
Bureaucratized shift-work is not good for doctors and it’s not good for patients. I don’t know what the solution will be. Primary care doctors are asking to be paid by the hour, not for piece work. That might help. The wealthy can afford concierge doctors. Maybe something will come out of the medical home concept. If doctors and patients get unhappy enough, perhaps a creative solution will evolve. Read more
The tyranny of health
A recent commentary in the Journal of the American Medical Association asks: If individuals don’t use preventive services, “what kind of penalty … would be ethically and morally acceptable?” The question wasn’t “How do we account for unhealthy behavior,” but what punishment would be sufficient either to change that behavior or at least to save money by denying these people health care. Read more
The physician as humanist
In 1980 the historian G.S. Rousseau expressed concern that modern physicians no longer embodied the humanist tradition of their predecessors. Now that medicine had become overwhelmingly a science rather than an art, he claimed, the interests and accomplishments of physicians had narrowed.
It was not uncommon, for Victorian and Edwardian doctors … to write prolifically throughout their careers. … In twentieth-century America … only the most imaginative physicians can hope for this artistic lifestyle as a consequence of the economic constraints and housekeeping demands placed upon the doctor. Read more
The physician as reader of poetry
Why My Wife Should Let Me Have a Dog
If I had a dog his soft fur would not foliate
the sofa or trigger asthma attacks
in my dear wife, ending with a hospital trip,
an adrenaline shot and those inhaler tubes
littering the house. Read more
The physician as poet
There is harm
because there is this innocent animal,
the body;
because a baby’s unguarded gaze,
and the open regard
of animals both hold patience
with the world,
with mineral fact. Impenetrable
consciousness
arising from, locked into flesh. Read more
Are some diseases more prestigious than others?
Among medical specialties, some are more prestigious than others. You can generally tell which ones are more prestigious by how well they pay. Surgery and cardiology, for example, rank at the top of the prestige scale. Psychiatry and dermatology are near the bottom. One can also ask if some diseases are considered more prestigious than… Read more
The esteem of the medical profession: Then and now
Each issue of The Journal of the American Medical Association includes an excerpt from an issue of exactly 100 years ago. (JAMA has been published continuously since 1883.) The May 7, 1910 issue of JAMA included remarks on how much physicians were paid and, by implication, how they were regarded in 2250 B.C. Ability to… Read more
Justice triumphs for whistle-blowing Texas nurse
The wheels of justice may turn slowly, but for Anne Mitchell, the Texas nurse who was prosecuted for complaining about the unethical conduct of a doctor, justice is proceeding. The doctor in question, Rolando Arafiles, is about to be formally disciplined. (For background on this story, see Whistle blowing: Nurse Anne Mitchell vs. Dr. Arafiles.)… Read more
A raffle for free (human) eggs
Source: Babble At a London seminar promoting American donor eggs for infertile British women, a Virginia infertility clinic offered attendees the chance to win an American woman’s eggs. Also included was a free in vitro fertilization (IVF) cycle (a $23,000 value). The reaction, on both sides of the Atlantic, was mixed. According to The Washington… Read more
Health Culture Daily Dose #18
Source: Wunderground When did we start calling the whole day before Christmas “Christmas Eve?” I thought Christmas Eve was the evening before Christmas. But no. Senators voted on health care reform at 1:00 AM on Thursday December 24th. To me, that’s still Wednesday night, but it was widely reported as happening on Christmas Eve. Perhaps… Read more
Are women doctors safer?
Nearly half of students in US medical schools are female. Studies show that, compared to their male counterparts, women doctors are friendlier, spend more time with their patients, and are less likely to be sued. According to Jorge Girotti of the University of Illinois at Chicago Medical School, women doctors are more empathetic, compassionate, and… Read more
Doctors and the health crisis of global warming
Let’s look at the facts. Global warming inevitably leads to a global health crisis. Health and disease are the province of the medical profession. Shouldn’t doctors be speaking out on the health crisis of global warming? Last month the two leading British medical journals – The Lancet and the British Medical Journal — published an… Read more
The doctor/patient relationship: What have we lost?
I collect stories of how the doctor/patient relationship has changed over the last half century. There’s a new generation of doctors and patients who’ve only known the 12-minute office visit. For them, an extended, personal conversation between a patient and her physician is as antiquated as Marcus Welby, MD. In the 12 to 15 minutes… Read more
Doctors in the trenches speak out – Part three
Here’s the third and last installment from the documentary Money-Driven Medicine. The topics this time focus on the financial issues of health care: Insurance premiums, competitive hospitals, the control of medicine by profit-driven corporations, the disconnect between money and health. The first and second installments are in previous posts. Is it possible for opponents and… Read more
Doctors in the trenches speak out – Part two
Here’s a second installment from the documentary Money-Driven Medicine. The producer, Alex Gibney, is an Oscar-winning filmmaker (Enron: The Smartest Guys in the Room). See the previous post for the first installment. Bill Moyers: “Money-Driven Medicine is one of the strongest documentaries I have seen in years and could not be more timely. The more… Read more
Doctors in the trenches speak out – Part One
I grow weary of the politics of health care reform. Powerful interest groups buy the politicians. The need to get re-elected takes precedence over the national interest. Paul Krugman writes: “Actually turning this country around is going to take years of siege warfare against deeply entrenched interests, defending a deeply dysfunctional political system.” My sympathies… Read more