Thursday, August 12, 2004

Good Medical Tip

If you c/o pain, and a physician asks what has worked in the past to relieve pain, do not answer "Vicodin q4" or "Percocet TID". In fact, don't mention any sort of narcotic unless you are being seen in a pain clinic, and even then, you should only be requesting said meds from that physician.

The result of doing the above is an immediate bias towards your presentation with a constant blinking reminder "drug-seeker". Might be untrue, but sorry, that's the world we live in.

Bias In Medicine?

So, overheard in conversation between faculty and r2 yesterday was the following interesting political view (slightly paraphrased as my memory allows):

Patient complaining of not getting medical care, when asked who she would vote for, said she wanted to vote for the most 'Godly' man; the man against homosexual marriages and such. It always amazes me, those who need the most help vote for those who have no plans to help them. They don't understand that if you vote for Republicans, you're voting to immediately cut health care service for the poor.


Wow. I didn't venture a response, as that would have been stupid. But suffice it to say, this isn't the first time I've heard such a response on the floor, nor will it be the last. Are people simply dense, or do they truly believe that Republicans are out to screw everyone but the super-riche? Where does such a misunderstanding come from? I refuse to believe that Michael Moore is responsible for the out-and-out lies that spew from regular individual's mouths when discussing politics, but I am at a loss of the true cause.

My guess is that individuals think that privatizing services == cutting services for the poor. Or that if the government doesn't perform the service, it's not a worthy service. Either of the above are quite stupid, in my opinion, but I strongly believe many individuals represent these views. So sad.

Leave comments if you have any ideas.

Thursday, August 05, 2004

Alcohol The New Wunderdrug

After reports stating the bliss that can be had from drinking Guinness, and now this study stating that drinking half a bottle of wine per day can make you smarter, I thought I'd piss on the party.

First off, the study recently published stating the latter of the two statements above has quite a few holes. Most notably, when researchers controlled for 'education' using a slipshod standard of 'earning power', almost all statistical significance was lost in those areas whereby education has the most benefit (verbal and mathematical problem solving). Hence, those who were smarter, remained smarter even after drinking wine. Lo and behold, those who are 'smarter', have larger job responsibilities, etc. are more prone to 1) stress, which is relieved via alcohol and 2) the uncanny ability to still be smart AFTER drinking. We all know that people act stupid while drunk, but it's not as if individuals lose 100 iq points during a kegger.

With the above in mind, I'd also like to quote the following from Blueprints Psychiatry, 3rd Edition:

Alcohol-dependent patients also develop elevated [HDL] cholesterol and decreased [LDL] cholesterol....
Wow, taken completely out of context, we've got the next statin on our hands in a much cheaper form. However, since we're not morons, we know that telling an overweight person to become an alcoholic to reduce LDL and raise HDL is rather stupid. Incidentally, we should have the same reaction to this wasteful study, whereby the authors weren't even stupid enough to say that drinking alcohol in such amounts would be beneficial, regardless of the apparent 'increase' in intelligence they purported to find.

Wednesday, August 04, 2004

Psychiatry

As my first rotation comes to a close, I figured it was time to start a series. Not intending to go into psych upon graduation, this rotation was seen as a way to ease into 3rd year. In this regard, it didn't disappoint. However, I did come away with some surprises.

First off, the job is harder than most give credit for being. Because psych deals with many unknowns, it's quite easy for students and MDs alike to scoff at the purveyors of anti-psychotics as less than medical. While being wholy unfair, it's rather disengenious. True, the schedule is more lax,but to say the health professionals involved are not working as hard or expending as much effort as a CT surgeon is simply untrue. To paraphrase from a review article on dementia/delirium, the psych consult will have to make the distinction as most MDs will be unable. Try to remember that folks.

Secondly, I learned more in this rotation with regards to diagnosis, pharmacology and treatment than in my entire first two years of school. Maybe it's because I was finally able to put symptoms and diagnoses with treatment and drugs, as opposed to learning about them in separate 'pods', but whatever the reason, it's quite a feeling. We'll see how the shelf exam goes though before I post my 'Mission Accomplished' banner.

Lastly, I learned that while many individuals see physicians for more concrete reasons, taking psych into account is extremely important. The key to a good history is finding out some of those gritty details, such as family history of psych diagnoses, or even sexual abuse. Of course, these are usually the most uncomfortable questions to ask a patient, but that's why we get paid the little bucks. Most patients are more than willing to cooperate as long as you treat them as a human being, not as 1% of your mortgage.

All in all, it was a rather fulfilling experience. I know the upcoming rotations will test me in different ways (mostly stamina), but I fear I will not have the same great feeling that comes with taking an acute schizophrenic, restarting her Zyprexa, and sending her back out to conquer the world a mere 3-4 days later. The satisfaction that comes with seeing a truly sick individual recover in such a drastic fashion is something I will most certainly miss.

P.S. It's been rather hard, but I also learned that not being cynical of adolescent pysch inpatient is tantamount to treating them. Some kids are a pain in the arse, but any kid you see on the unit needs help. Be sure to provide it.

Tuesday, August 03, 2004

Don't Waste Samples

Noticed a nursing tech opening up samples bottles of meds and placing the pills in a large container. When asked what was going on, she stated that the samples had expired and it was time to ship them back to the drug company. There must've been over 5000 doses of that one drug sitting in the container.

What a waste. If you get samples, give them out. If you cannot give them out before they expire, donate them to a needy clinic close by so that they can be used. Seriously, someone should not have to be told something like this.

Monday, August 02, 2004

Do You Trust The Market?

Guess that depends on one's political persuasion. First will start with what the market currently says about Bush's reelection:

Bid: 53.6 Ask: 54.2

The above values represent the percentage of electorate votes Bush is projected to receive on November 2nd. Now, this snapshot is uninteresting considering Bush has yet to fall under 50 since I've been tracking these values(there was a split-second drop, but for sake of my argument I'll handily forget about that).

However, the real fun comes in the trend, notably after the DNC wrapped up. Click the above link, then click the contract to see the lifetime trend. The pop-up is rather small, but you can certainly make up the massive jump from 50.0 to 54.2 in a 1 week time frame. The graph isn't quite as drastic as one would like, thanks to weak scaling, but the 'past week' graph demonstrates the increase rather well.

Suffice it to say, the market does not believe Kerry is the future POTUS, at least not at this point. What does this all mean? A little more than polling does, at least in my opinion. Take from it what you want, but the trend fits with reports that Kerry did not get any sort of bounce following the Edwards VP selection, nor the DNC Hoopla that bored its way to the worst ratings showing in history.