Saturday, March 12, 2016

She thought it was only a 24-hour bug. What she really had almost killed her. - The Washington Post

In my years as a prosecutor, I saw plenty of violence, including many deaths. Some were accidental, but some were the work of killers, even serial killers. I have always been fascinated by serial killers. How do they choose their victims? How is it that they can take a life so easily? I studied them, tried to understand their behavior. None of that prepared me for the day I met a serial killer of a different sort — a medical one with the ominous name "the widowmaker" — that had come for me.

On Tuesday, Jan. 13, 2015, I suddenly became wide awake at 5 a.m. I lay in bed with my eyes open for maybe a minute, thinking, "Hmm, this is weird," and then, "I feel kind of funny." Within about 30 seconds I rushed to the bathroom and threw up. I felt very cold and climbed back into bed with my husband and snuggled back under the covers. A minute later, though, I knew I was going to be sick again. I figured I was coming down with a virus, but it was strange how suddenly it had come on.

My husband, Tim, was concerned. He sat beside me, felt my cold, clammy forehead and said I just looked so pale. Then he whispered, "Let's go to the emergency room." I laughed. "Why?" I asked. He replied, "You could be having a heart attack."

Tim's father had died of a heart attack at age 64 after feeling the classic stabbing chest pain and heaviness in the chest that you always associate with a heart attack. But that wasn't me. I was 46, I just had a bit of a bug, probably a 24-hour thing. I just needed a little rest. Tim wouldn't have it, though.

And so 30 minutes later we walked into the emergency room at the Vanderbilt University Medical Center, where half-jokingly I said, "My husband thinks I may be having a heart attack."

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A physical exam without touching the patient -

Step 1: Greet patient.

Step 2: While chatting, check all boxes in electronic medical record for a complete review of systems and physical exam. Copy and paste parts of previous chart note while looking at patient every once in a while. Smile if possible.

Step 3: Tell patient to do yoga.

Step 4: Bill insurance company for complete physical exam.

Welcome to big box assembly line medicine.

Ever wonder what happens when a doctor goes to the doctor? Same sh*t.

A physician friend recently told me: "My last trip to my PCP was shorter than the time it takes to brush my teeth! If I hear one more suggestion to drink chamomile tea and do yoga … I just don't need the 3-minute bullsh*t session."

The truth is health care can't happen in 3-minute increments. Assembly-line medicine doesn't work for patients or doctors. Here's why: doctors aren't factory workers and patients aren't widgets.

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Thursday, March 10, 2016

Medicine | Topics | Watch | TED

A collection of TED Talks (and more) on the topic of medicine.

Russ Altman: What really happens when you mix medications? | TED Talk |

If you take two different medications for two different reasons, here's a sobering thought: your doctor may not fully understand what happens when they're combined, because drug interactions are incredibly hard to study. In this fascinating and accessible talk, Russ Altman shows how doctors are studying unexpected drug interactions using a surprising resource: search engine queries.

Waste in Cancer Drugs Costs $3 Billion a Year, a Study Says - The New York Times

The federal Medicare program and private health insurers waste nearly $3 billion every year buying cancer medicines that are thrown out because many drug makers distribute the drugs only in vials that hold too much for most patients, a group of cancer researchers has found.

The expensive drugs are usually injected by nurses working in doctors' offices and hospitals who carefully measure the amount needed for a particular patient and then, because of safety concerns, discard the rest.

If drug makers distributed vials containing smaller quantities, nurses could pick the right volume for a patient and minimize waste. Instead, many drug makers exclusively sell one-size-fits-all vials, ensuring that many smaller patients pay thousands of dollars for medicine they are never given, according to researchers at Memorial Sloan Kettering Cancer Center, who published a study on Tuesday in BMJ, formerly known as the British Medical Journal.

Some of these medicines are distributed in smaller vial sizes in Europe, where governments play a more active role than the United States does in drug pricing and distribution.

"Drug companies are quietly making billions forcing little old ladies to buy enough medicine to treat football players, and regulators have completely missed it," said Dr. Peter B. Bach, director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering and a co-author of the study. "If we're ever going to start saving money in health care, this is an obvious place to cut."

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NYTimes: New Procedure Allows Kidney Transplants From Any Donor

In the anguishing wait for a new kidney, tens of thousands of patients on waiting lists may never find a match because their immune systems will reject almost any transplanted organ. Now, in a large national study that experts are calling revolutionary, researchers have found a way to get them the desperately needed procedure.

In the new study, published Wednesday in The New England Journal of Medicine, doctors successfully altered patients' immune systems to allow them to accept kidneys from incompatible donors. Significantly more of those patients were still alive after eight years than patients who had remained on waiting lists or received a kidney transplanted from a deceased donor.

The method, known as desensitization, "has the potential to save many lives," said Dr. Jeffery Berns, a kidney specialist at the University of Pennsylvania's Perelman School of Medicine and the president of the National Kidney Foundation.

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Sunday, March 6, 2016

NYTimes: How to Tell Someone You’re Terminally Ill

'I say, 'The doctors told me there is nothing they can do, it is inoperable and incurable,' '' says Wanda N., who is 50 and in hospice care at home in New York with metastasized colon cancer. ''When I tell people, I use the same words the doctors used to tell me.'' You might not have time or energy to formulate the exact right phrasing — but you are not obliged to be the town crier, spreading the news of a terminal diagnosis. ''Don't feel the need to announce your situation over and over again,'' says Wanda, who has told only a handful of people, including her father, a cousin and a few women from her Army veterans' group. Some she told in person, others by phone or text.

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