Not all patients with Irregular cycles have PCOD

Posted on 20. Aug, 2014 by in Anti-Müllerian hormone, Follicle-stimulating hormone, In vitro fertilisation, Irregular menstruation, Luteinizing hormone, Ovarian reserve, patient, Polycystic ovary syndrome

Many doctors and gynecologists misdiagnose and mismanage patients with irregular cycles.  Most of them seem to automatically jump to the conclusion that any young patient with irregular cycle has PCOD .  While it is true that the commonest ca…

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Alcohol induced hypertension

Posted on 20. Aug, 2014 by in cardiovascular

Free full text review.  

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Posted on 20. Aug, 2014 by in Uncategorized

Dr. Grumpy: “So, how are you doing with the new medication?”Mr. Noventa: “It’s awful! It isn’t helping my symptoms, and hurts my stomach. It also makes me sleepy all the time, I can’t concentrate, and I think it’s thinning my hair.”Dr. Grumpy: “Okay, t…

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Use patient power to tackle medical corruption

Posted on 19. Aug, 2014 by in BMJ, Health care, Healthcare in India, India, Mumbai, patient, Physician, United States

Educated and empowered patients make it much harder for corrupt practices to occur in the health system, writes Aniruddha Malpani in the BMJ.Corruption (the abuse of power for private gain) seems to be a problem that afflicts healthcare systems the wor…

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MY EXPERIENCES WITH I V F from a patient at Malpani Infertility Clinic

Posted on 19. Aug, 2014 by in Assisted reproductive technology, Dr.Malpani, Health, In vitro fertilisation, India, ivf, Malpani, Mumbai

I am writing this at the request of Dr.Aniruddha Malpani with whom my wife underwent IVF procedure in November 2013 at it clicked at the first cycle by God’s grace.While I have tried to give the best analysis from my first hand experience,I have to men…

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Talking to Men About PSA Testing

Posted on 19. Aug, 2014 by in Doctors, Featured, Prostate Cancer, Tests (Medical)

Despite recommendations against widespread screening for prostate cancer, many doctors continue to routinely offer PSA testing because it’s easier than explaining the pros and cons.

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Markers of fitness and all cause mortality

Posted on 19. Aug, 2014 by in cardiovascular

This study looked at outcomes of a population of patients with no
known cardiovascular disease who underwent exercise testing. We
wouldn’t do such testing on health subjects nowadays but these data
were gathered from 1993 to 2003:

and Res…

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Posted on 19. Aug, 2014 by in Uncategorized

Mary: “Dr. Grumpy’s office, this is Mary.”Mr. Cheech: “Hi, I need to make an appointment with Dr. Grumpy.”Mary: “Okay, we can see you on…”Mr. Cheech: “I don’t have insurance. Does he accept other forms of payment?”Mary: “Well, we take MasterCard, Vis…

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Please do not waste your money

Posted on 18. Aug, 2014 by in Endometrial polyp, Health, In vitro fertilisation, India, Infertility, Medical ultrasonography, patient, Uterus

I often see patients who do not require any medical intervention at all.  For example, I just saw a couple where the wife is 26 years old, the husband is 30, and even though they have been married for 3 years, they have been trying to have a baby …

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Don’t worry, your information’s safe. Community Health Systems says data stolen in cyber attack: just a mere 4.5 million people affected this time.

Posted on 18. Aug, 2014 by in computer security, medical record confidentiality, medical record privacy

I have often written about my observations of the generally unimpressive qualifications and capabilities of IT personnel, up to and including the CIO’s, in healthcare settings (e.g., baccalaureate-level education in a doctoral and post-doctoral setting…

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A Zero Tolerance Policy for Patient Dialog

Posted on 18. Aug, 2014 by in Uncategorized

A UK medical practice has posted a sign attempting to prohibit public conversation by patients.  Citing a Zero Tolerance Policy apparently invoked to protect NHS staff, this type of veiled threat illustrates how disconnected the medical community can be from the realities of medicine in a connected age. You can read about this over at […]

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Mexico congress recap — Is it selfish for doctors not to be on Social Media?

Posted on 18. Aug, 2014 by in Atrial fibrillation, Dabigatran/Rivaroxaban/Apixaban, Social Media/Writing/Blogging

When Dr Eduardo Hernandez Castillo (@CardioLeaks) asked me to come to Mexico to speak with a group of physicians about the power of social media, I paused. Should I go to Mexico? I have been traveling a lot; it was a long trip; I was just starting to get fit again, and the atrial fibrillation/anticoagulation […]

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Update on valvular heart disease

Posted on 18. Aug, 2014 by in cardiovascular

A concise free full
text review in the American Journal of Medicine.

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Posted on 18. Aug, 2014 by in Uncategorized

Dear Mrs. Patient,I’m glad you’re feeling better. It was nice of you to send me a thank you card. I actually treasure notes like yours, and keep them in (as my friend Amanda Brown calls it) the “I don’t suck box.” On really bad days I read stuff from i…

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ACEP Now still silent on EM President interviews.

Posted on 18. Aug, 2014 by in Policy, Rants

Which is terrible, yet predictable. ACEP Now | The Official Voice of Emergency Medicine. Yeah, it’s completely devoid of interviews or conversations with the purported future leaders of Emergency Medicine. What a surprise. Again, if you’re running for President of ACEP but abide by the Gag Order, you aren’t worthy, and we (as a specialty) […]

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The do nothing consultation

Posted on 17. Aug, 2014 by in Endometrial polyp, Health, In vitro fertilisation, India, Infertility, Medical ultrasonography, patient, Uterus

The last few consultations I have done have been what I call “ do-nothing consultations “. This is when I tell the patient that they do not need my help in order to get pregnant  ; and that their best course of action would be continue trying …

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Doctors taking kickbacks

Posted on 17. Aug, 2014 by in India, Medical Council of India, Medical prescription, medication side effects, NDTV, Pharmaceutical drug, Physician, Practice Fusion

Why do doctors prescribe a branded drug when its generic variant is easily available at a fraction of the price ? NDTV’s hidden camera expose proves that doctors blatantly violate this guideline in exchange for kickbacks from pharmaceutical firms.http:…

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Should Twitter be Regulated at Medical Meetings?

Posted on 17. Aug, 2014 by in backchannel, medical meeting, Twitter

The organizer of a medical meeting in Milan recently made an appeal (tongue-in-cheek, it would appear) to attendees to avoid status updates and mindless backchannel banter. The social side of any conference is important, and Twitter, being part of the social media, will naturally show that side. There is, however, a danger that the orchestra’s symphony […]

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From a happy patient

Posted on 17. Aug, 2014 by in Dr.Malpani, IVF success, IVF success stories, IVF success story, Malpani, Malpani Clinic

Dear Aniruddha,I assume our birth announcement arrived in good order :) Yes, everything went well, I made it to full term,  38 weeks minus one day and had an elective Cesarean. The boys were still very comfortable in my belly and didn’t make any r…

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RCT of dexmedetomidine for severe alcohol withdrawal, as adjunctive to benzodiazepines

Posted on 17. Aug, 2014 by in Critical Care, Neurology, Pharmacology, toxicology

This is the
first RCT I know of looking at dexmedetomidine for alcohol

Design:  Prospective,
randomized, double-blind, placebo-controlled trial.

Setting:  Single
center; medical ICU.

Patients:  Twenty-four
adult patients with a …

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Physicians Lose Right of Free Speech

Posted on 17. Aug, 2014 by in Legal Quality

I’m all for free speech and I’m very hostile to censorship.  The response to ugly speech is not censorship, but is rebuttal speech.   Of course, there’s a lot of speech out there that should never be uttered.  Indecent and rud…

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Drug testing doctors: Will Californians see through the smoke?

Posted on 16. Aug, 2014 by in Malpractice, Physician

California is contemplating requiring physicians to submit to alcohol and drug testing.   Citizens there will be voting on this proposal this November. I do think that the public is entitled to be treated by physicians who are unimpaired.  Physicians, as members of the human species, have the same vices and frailties as the rest of […]

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Bring your daughter to work: A reminder of what’s important in medicine

Posted on 16. Aug, 2014 by in heart, Physician

“Dad, you have the nicest patients!” She was right, of course. Daughters that you bring to work with you to shadow for a day can bring you back to what’s important in medicine.  In fact, seeing medicine through fresh eyes is helpful, especially when we forget to look up from our work-a-day lives. It had been […]

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Medicine has lost sight of the big picture

Posted on 16. Aug, 2014 by in Physician, Primary care

We must bear in mind the difference between thoroughness and efficiency. Thoroughness gathers all the facts, but efficiency distinguishes the two-cent pieces of non-essential data from the twenty-dollar gold pieces of fundamental fact. – Dr. William Mayo The practice of medicine involves a lot of details, but details without the big picture are meaningless at […]

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Quality measures benefit from quality improvement

Posted on 16. Aug, 2014 by in Health reform, Hospital, Policy

I am a long-time proponent of measuring provider performance and aligning it with payment as an effective means for improving the quality of care and with it, patient outcomes. Because of this, I welcomed the value-based purchasing concepts and quality improvement initiatives that are fundamental to the Affordable Care Act (ACA). Continue reading … Your […]

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Incorporating urgent care into the medical home

Posted on 16. Aug, 2014 by in Physician, Primary care

During her annual physical exam, one of my patients recently asked me, “Are urgent care centers any good, Dr. P?” She recounted an incident a few months earlier where she awoke with an acute illness and was sick enough that she felt she needed to receive care — at least some medical attention — more […]

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MKSAP: 57-year-old woman with decreased exercise tolerance

Posted on 16. Aug, 2014 by in conditions, Primary care

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 57-year-old woman is evaluated for a 2-week history of decreased exercise tolerance and substernal chest pain on exertion. She also has an 8-month history of macrocytic anemia. On physical examination, temperature is 36.7 °C (98.0 °F), blood pressure is 137/78 […]

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Macrolides and mortality in critically ill patients with community acquired pneumonia

Posted on 16. Aug, 2014 by in Infectious disease, pulmonary

From a recent
systematic review and meta-analysis:

observational studies of almost 10,000 critically ill patients with
community-acquired pneumonia, macrolide use was associated with a
significant 18% relative (3% absolute) reducti…

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ZDoggMD Riffs on Dr Oz

Posted on 16. Aug, 2014 by in Mehmet Oz, ZDoggMD

If you’re the type of person who slows down to peek at accidents, you might want to take a moment to watch ZDoggMD rhythmically eviscerate Mehmet Oz.  The entertainment value of ZDogg’s calculated language is surpassed only by the fact that Oz looks about as uncomfortable as a prostitute in church. Hell hath no fury […]

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How do I track my " fertile time " ?

Posted on 15. Aug, 2014 by in cervix, Fertilisation, Fertility, Menstrual cycle, ovulation, Pregnancy, Saliva, Trying to Conceive

Do you know what this image means ? If you cannot, you need help ! Most couples know that women can get pregnant only at a particular time during their  menstrual cycle – when they are ovulating. However, because ovulation is not visible, most wom…

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