Medical

A medical educator recently argued in her blog that medical school admissions requirements should minimize requirements in math and science topics, especially areas like calculus and physics. There is no question that medicine, and even informatics for that matter, require knowledge and competency in many areas beyond math and science.However, the problem with the math we teach to potential healthcare professionals and informaticians, indeed to everyone in society, is that we teach the wrong math. I took three semesters of calculus in college and can say that I have almost never used any of it. On the other hand, I had almost no education in statistics, a type of math I use not only in my work, but also in my function as an informed citizen. Indeed, most healthcare professionals, whether clinicians or researchers, use statistics daily. Likewise, as thoughtful citizens in society, we also encounter statistics daily in the news and other aspects of our lives.For these reasons, I believe that statistics should be a core competency of every citizen in the modern world.It is not even the mathematics in statistics that are most important, but rather the concepts and the thinking they engender. Every citizen in the world should understand the basic concepts of inferential statistics and be able to answer such questions as:What does statistical significance mean? How is it different from a clinical (not necessarily in the medical context) significance?What is the difference between absolute and relative risk? What is the meaning of large relative risk differences in the setting of small absolute risk?In health-related topics, how do we discern and compare different types of health risks?Also in health, what do sensitivity and specificity of diagnostic tests mean, and how does prevalence impact the risk of disease in the face of positive or negative diagnostic tests?One of the most articulate advocates of this view is John Allen Paulos, whose books Innumeracy and A Mathematician Reads the Newspaper inform us why basic numeracy and statistical competency are so important. These kinds of engaging writings, and basic education about statistics, should be a part of every high school education, not to mention in education of clinicians and informaticians.

When Angelina Jolie announced that she’d undergone a bilateral mastectomy to prevent the breast cancer for which a genetic mutation puts her at high risk, I found myself, as a doctor and as a woman, full of admiration and gratitude for her… and also, in retrospect, for Betty Ford. In a single New York Times op-ed piece, Ms. Jolie used her celebrity to accomplish several things: she brought attention to the high prevalence of breast cancer; she brought attention to the availability (but also, for most people, the prohibitively high cost) of genetic testing; and, no less important, as Rebecca Mead pointed out in this post, she shifted the public discussion of a celebrity’s breasts away from “Are they big enough? Are they sexy enough? Are they really hers?—[questions that] are objectifying and demeaning.” (Anyone who saw Seth MacFarlane’s “We Saw Your Boobs” number at this year’s Oscars knows that this is a welcome and needed shift, indeed). Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.

Boys win Lego award for medication reminder robot and app (Ireland) | Telehealth and Telecare Aware

So it’s been an entire decade since type 1 diabetes turned my life on its ear, or something along those lines… Many of you know my story: How I had a new baby who had just turned 5 months old,…The post Ten-Year Diaversary (No Way!) appeared first on DiabetesMine: the all things diabetes blog.

“J.T.” is 92 and clearly a soul who lives to the beat of a different drummer. She has no children and her closest relative is a niece who she despises. Despite this the niece oversees her care, sending in a full time aide and her personnel assistant to run the household. J.T. will not come to the office for a visit. If I call and make an appointment to see her in her home she at times will not permit me into her home. Despite her abrasive nature she is legally competent to make decisions and remains thin and frail but with no major acute medical problems. She is cognitively impaired to a moderate degree but legally competent to make decisions.  She too has executed a living will and has a large “do not resuscitate” form posted on her refrigerator door. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.

Brought to you by MedPage Today. 1. Medical Home Transition Long but Worth It. The path to becoming a patient-centered medical home is long, rough, and varies for each practice, but getting there is essential to providing high-quality, affordable healthcare to all Americans. 2. Any Bed-Sharing Puts Baby at Risk for SIDS. Bed-sharing is associated with a five-fold increased risk of sudden infant death syndrome (SIDS) among younger infants even if their parents don’t smoke, use alcohol, or take drugs. 3. No Major Benefit for IV Feeding in ICU. Early parenteral nutrition in critically ill adults who could not tolerate early enteral nutrition did not lead to better survival outcomes or a shorter stay in the intensive care unit when compared with standard care. Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.

In their book Science Left Behind: Feel-Good Fallacies and the Rise of the Anti-Scientific Left, Alex Berezow and Hank Campbell counter allegations of a Republican war on science by pointing out how political progressives are equally anti-science. According to Berezow and Campbell, progressives hold opinions that are not based on physical reality, and claim that their beliefs are based on science even when they are not. I try to stay out of politics, but anti-science attitudes should be discouraged wherever they are found, and the mythology of progressives as described by Berezow and Campbell is very much like the thinking of alternative medicine: Everything natural is good Everything unnatural is bad Unchecked science and progress will destroy us Science is only relative anyway I wasn’t clear on what “progressives” meant, but apparently progressives are similar to liberals in that they value economic authoritarianism and different in that they are also social authoritarians. Liberal economic authoritarianism favors higher taxes on the wealthy, more regulations on the marketplace, and social programs that redirect money to target social inequality. Conservatives want to limit such government interference with the economy; but they are social authoritarians like progressives, only on different issues. Where conservative social authoritarians want government to ban “immoral” things like sex and drugs, progressive social authoritarians endorse government control over the environment, food production, and education. Conservatives want to ban abortion; progressives want to ban plastic grocery bags. Here’s another definition: …”liberals” in our current parlance are those who focus on using taxpayer money to help better society. A “progressive” are [sic] those who focus on using government power to make large institutions play by a set of rules…A liberal policy towards prescription drugs is one that would throw a lot of taxpayer cash at the pharmaceutical industry to get them to provide medicine to the poor; A progressive prescription drug policy would be one that centered around price regulations… Republicans have been criticized for their anti-science stance on evolution, global warming, and stem cell research. There is an equally disturbing tendency for activists on the other side of the aisle to cherry pick, misinterpret, misrepresent, and abuse science to advance their ideological and political agendas. They have misused science to attack vaccines and genetically modified foods, to promote organic food, and to propose poorly thought out environmental protection legislation. When science is co-opted to serve ideology, science is degraded and the resulting public policies do more harm than good. The authors present many examples of progressive ideology’s misuse of science and support of injudicious policies, for example: One would think animal rights activists, conservationists, and food fetishists would all be enthusiastic about innovations to improve the future of food production, like laboratory-grown meat and technology to improve agricultural efficiency; but they typically reject them, perhaps because they think of them as “unnatural.” “It takes 1 gallon of gas to make 1 pound of beef” is a false claim, as is the claim that walking to the store creates 4 times as much emissions as driving to the store. These claims are based on math and reasoning errors: they took a fact out of context, mixed terms, and guessed. Mandatory low flush toilets have inconvenienced us all, and they have also caused sludge accumulation and odors so bad that San Francisco is spending $14 million to dump bleach into the sewers to combat it (and bleach is not exactly environmentally friendly). Domestic water use only represents 1% of total use and toilets are a small fraction of that; it would make far more sense to target efficiency in power plants (49% of water use) and irrigation (31%). The toilets were a typical “Band-Ai

Women are undertreated and underserved when it comes to cardiovascular disease and stroke.  Now, more than ever, this may even be more important due to several recent studies that have been published recently. Several investigations have demonstrated two troublesome facts. In certain areas of the country, life expectancy for women is decreasing and women who smoke are much more likely to have lung cancer than men who smoke.  These facts argue for more aggressive treatment of women and more targeted gender specific prevention efforts–no longer can women’s risk for disease be discounted. Although awareness efforts are continuing, we continue to fall short in identifying and treating women with cardiovascular disease. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.

Video PlatformVideo Management Video SolutionsVideo Player Even if I didn’t know anything about what went into creating Three Fold, Stanford Medicine’s new sculpture by Alyson Shotz, I’d love it. As I wrote in today’s Inside Stanford Medicine, the 56-foot-long sculpture, which hangs from a ceiling in the Li Ka Shing Center for Learning and Knowledge, shimmers in an ever-changing array of iridescent colors. Pretty colors get me every time. There’s a lot more to the sculpture than pretty, though. Shotz is a widely respected artist. Her works, exhibited in prestigious museums like New York City’s Guggenheim and DC’s Hirshhorn, are engineering feats inspired by scientific concepts - this one, by a CAT scan. As Shotz tells it: I was very interested to learn that CAT scans image by sections, using a penetrating wave. This seems quite relevant, as my work represents an imaging of space, and the wave illuminating the shape, in this case, is color: the varying wavelengths of light that the viewer will see reflecting off the sculpture. Shotz has other interesting things to say in a Stanford video, above, where she describes how her creative process reminds her of protein folding: Proteins achieve functionality when they go from a non-dimensional shape to a folded three-dimensional shape, which is fascinating to me because when I started these drawings the lines are actually non-dimensional and then I expand them out into three-dimensional surfaces which then become functional as sculpture. While reporting the article I learned that the artwork was born on a computer. I found out that despite its gossamer appearance, it weighs more than 3,000 pounds. (It’s made of about 10,000 pieces of custom-cut plastic, 600 pieces of aluminum and more than 20,000 screws.) And I learned the secret behind the pretty colors: dichroic-acrylic-coated plastic, which not only reflects light but refracts it. Three Fold is being dedicated this week to the medical school’s former dean Philip Pizzo, MD. If you’re in the neighborhood, it’s worth a look. Photo in featured entry box, of Shotz overseeing assembly of Three Fold, by Norbert von der Groeben

A few years after I entered my practice as a newly certified internist, about two decades ago now, I started to burn out. I felt I was becoming a documentation drone and a guideline-following automaton. I was embarrassed for some of the care I gave–attempting to fit patients’ round needs into the square peg of the medical model. Patients who came to talk about depression were marched through a complete review of systems because that is what I understood it meant to be a good doctor. In a brief visit, I would try to: accomplish all the screening and advising that was recommended by every agency and organization; do a credible job evaluating multiple complaints; be compassionate and smart in the care of those who were ill; dodge legal bullets by what I said and what I documented; repeat the same detailed, normal physical exam into my recorder patient after patient because the note was how I thought my care was graded; and, comply with the then new and confusing coding rules. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.