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Showing posts from December, 2019

Can a Doctor Do a Medical Procedure Without Consent?

Some time ago, I performed a colonoscopy on a patient who was having serious internal bleeding.   He had already received multiple transfusions since he was admitted to the hospital.   After obtaining informed consent for the procedure, I performed the colon exam.    I encountered blood throughout the entire colon, but saw no definite bleeding site, raising the possibility that the source of blood might be higher up than the colon, such as from the stomach.   I had not considered this possibility when I met the patient, but this was now plausible.   Can I proceed with the upper scope test, which the patient did not consent to, while the patient is still sedated from the colon exam? Could the Stomach be the Culprit? Seasoned gastroenterologists can usually predict the site of internal bleeding based on numerous medical facts, but there are times that we are surprised or misled.    Patients don’t always behave according to the textbook presentations we learned.   At t

Whistleblower Holiday Cheer 2019!

‘Twas the night before Christmas, And all through the House, All the creatures were plotting, Claiming Trump was a….RAT! We have Schiff and Nadler And, of course, Madame Speaker, Who are as transparent, As the Anonymous leaker! Our Democracy might fail, Our Dem statesmen teach, So what choice do they have But to hold hands and impeach. When Mueller fell flat, They all felt the pain, But, the Lord heard their prayers And POOF – came Ukraine! With so many versions How could we know If Trump really offered A quid pro quo. The witnesses swore Trump’s plan was – Extort! Jim Jordan responded With a loud bleating snort. And with all of this static Some can’t be heard, When the candidates speak, We hear nary a word. So Warren and Bernie, (And Blitzen and Dasher) Have been squelched and muzzled. By the Candidate Crashers. When it all ends And the Senate says, No! No minds will change. I told you so!

'Doctor, What Would You Do?'

There’s a phrase that every physician hears repeatedly from patients, that requires a nuanced response. Doctor, what would you do if you were me? There are variations on this inquiry, such as ‘what would you do if I were your father’, but they all are aiming at the same target.  The patient, or often the patient’s family, asks the doctor what advice the physician would choose if he were in the patient’s place.  For example, if the physician were the patient would he opt for: Surgery Chemotherapy Experimental treatment Watchful waiting A second opinion A third opinion Alternative medicine Acupuncture Hospice 'Doctor, what would you do? Patients erroneously believe that this form of inquiry is the magic bullet of finding out what the physician’s truly best advice is for a particular medical circumstance.  After all, if the doctor would recommend a treatment for his own mom, then surely this must be the best option. Except, it isn’t.  Here’s why. P

Are Female Gynecologists more Sensitive than Males?

Would you rather be right, wrong or interesting?   When I was a medical student rotating on the OB-GYN rotation, the issue arose if female OB-GYNs were more sympathetic to patients than their male colleagues were.  Before reading on, what's your opinion here? There was a view that females in this medical specialty would have more empathy for patients as they may have experienced menstrual cramps, pelvic pain and childbirth.  No man can relate to these symptoms and they might be expected to be more dismissive or distant over these ‘minor hormonal disturbances’.  In other words, men just don't get it. A discrete GYN exam 200 years ago It is true that one who has ‘walked the walk’ may connect more closely with one who hasn't.  For example, since I have never suffered from an addiction, I can never counsel a drug addict or alcoholic with the same street cred as one who has triumphed over these afflictions. The chief of the OB-GYN department at my medical

Is Everything Offensive?

I will digress from this blog’s medical quality theme to let off the gaseous form of H20, also known as steam.   I wouldn’t consider this to be a rant, a genre that I have offered previously.   But, it’s more than just venting to my readers.   So, it’s somewhere between a rant a and a vent.    In my world, I try hard to challenge myself and others.   It’s the way I’ve always been.   I love the debate, the argument and the rhetorical fencing.   I feel satisfied if I can change someone’s mind and I particularly relish when someone can change mine.   Let the better argument prevail.    Of course, contestants in this arena must be willing change their views and give an opposing argument a fair hearing.   There have been instances during these colloquies, and at other times, that I have inadvertently offended someone.  At times, this occurred because my words were clumsily selected.  On other occasions, the recipient may have been overly sensitive and had a low offense threshold