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Is the new professionalism and ACP's new ethics really just about following guidelines?

The Charter ( Medical Professionalism in the New Millennium.A Physician's Charter) did not deal with just the important relationship of ...

Tuesday, February 20, 2024

Reading Medical Reversal showed me I was not cynical enough regarding medical matters

If you count the first year of medical school until now I have been thinking about medical matters for over 60 years.With the background of private practice of internal medicine in the 1970s my "journey" as a patient through the corporatized medical labyrhynth of a large medical hospital system with and EHR replete with bogus physical exam reports left me as cynical and resentful as possible, or so I thought But after reading Medical Reversal I found my cynicism soaring to new heights. My cynicism is at least on two levels -1.the indidual generalist's lack of medical knowledge and 2 the level of accepted medical practices that are either harmful of ineffective.It is this second level that Cefu and Prasad address in their book "Medical Reversal" Some of the material they discuss is old hat such as the CAST trial,and the injection of material into collapsed vertebra and the hormone treatment of women BUt there is more discussed in the book,including the controversey regarding Tamiflu,the lack of utility of a widely used anti sepsis treatment,the sham trial disproving the value of internal mammary ligation,the sham trial showing the lack of value of meninsectomy for degerative meniscus tear,and the reversal of the popular treatment for sepsis. "No matter how cynical you become its never enough to keep up" Lilly Tomlin.

Why so many more eye drops post cataract surgery in US than Europe

In many european countries a singe intra eye injection of cefuroxime is used instead of multiple topical antibiotic drops.There seems to be no doubt in the eye surgery literature that this "intracameral" injection is very effective reducing the risk of infection by some 4 or 5 fold and seeminly make the use of post op antibiotic eye drops unnecessary So why in Europe and not in US? It may have to do with the lack of availablity of an intra ocular injection form of cefuroxime in US and the drug company profit from dispensing lots of eye drops.

Alexander Hamilton on those who generate chaos

“Those then, who resist a confirmation of public order, are the true Artificers of monarchy—not that this is the intention of the generality of them. Yet it would not be difficult to lay the finger upon some of their party who may justly be suspected. When a man unprincipled in private life desperate in his fortune, bold in his temper, possessed of considerable talents, having the advantage of military habits—despotic in his ordinary demeanour—known to have scoffed in private at the principles of liberty—when such a man is seen to mount the hobby horse of popularity—to join in the cry of danger to liberty—to take every opportunity of embarrassing the General Government & bringing it under suspicion—to flatter and fall in with all the non sense of the zealots of the day—It may justly be suspected that his object is to throw things into confusion that he may “ride the storm and direct the whirlwind.” Dr. Bandy X Lee former Yale psychiatrist was fired from Yale because she believed her duty to warn trumped ( pun intended) the Goldwater rule.Her book title is The Dangerous Case of Donald Trump.She knew DJT was riding his own storm .

Are physicians losing their sense of ownership of their patient's care

Are physicians losing thier sense of owndership of their patients care? I believe so. Physicans' language demonstated their care or commtment to their patient as least when I trained and when I was in private practice. We would say to a consultant Could you see MY patient. or I saw YOUR PATIENT today.The language spoke of their commitment. In the corporatized medical setting in which I was treated last year physicians did not personally refer me to another physician.Rather they entered a order into the EHR and then required me to call and make an appointment. When I was in private practice in a large sub speciliaty internal medicine group, I would call an collegue about a referal or my nurse would contact the physcian's nurse and either way the urgency or lack thereof was transmitted and what took me six weeks to see the next physician in this new world of effecient corporatized medicine would have takeen 2 or 3 days at the most. Further I would be anxious to learn of the consutant's views which would typically be expressd in a phone call or a coffee room conversation.The Gi docs would wanted a ENT consult for me had no sense of when if ever a consultation reort would be available. Out of sight out of mind. No sense of personal ownership was there.Since perhaps with that ownership there may have also been a pride of owndership that is lost in the new medical world where suits dictate efficiency.

Should nonselective His Bundle pacing be called " so called' ?

Should non selective His bundle pacing be called “so called Non selective His Bundle Pacing” ?. The publications (1) of Dr Rehan Malmud makes a case for just that. Mahmud suggests the possibility that the conduction is actually conduction though concealed pathways and suggests that the pathway Is the superior septal connection that were initially described by Mahaim. The theory of His pacing is LBBB is often due to discrete lesions in the His bundle and that the lead is then placed distal to the block thereby correcting The Bundle branch block.This concept is hard to reconcile with several studies That describe the pathology of LBBB consisting of multiple lesions in the His bundle and In the branches.How could scattered lesions in the bundle branches be correction by stimulating the His Bundle? (1 ) Rahan Mahmud et al Stimulating the His Bundle.block by so called non selective His Bundle Pacing.The Potential Role of accessory connections in the ventricular septal crest.Heart Rhythm 2024