WhiteCoat

Healthcare Update Satellite — 06-10-2014

See more health-related stories from around the web on my other blog at DrWhitecoat.com.

The doctor will call you now …
Rural health clinics increasingly turning to telemedicine. The story gives an example of a South Dakota clinic physician who used a video feed to get advice on how to insert a chest tube – while a patient was in the room with a hemothorax.

Want to see some of the trick questions that plaintiff attorneys will throw at you during a malpractice trial and see some good responses to those questions? Good examples in this article from Colorado’s Cortez Journal.

Even though your state may have approved medical marijuana, don’t forget that marijuana is still banned by federal law.
DEA cracking down on Massachusetts physicians associated with medical marijuana dispensaries.

Kind of ballsy approach to managing uncomplicated appendicitis in kids. Researchers find that children 7 to 17 years old with pain less than 48 hours, WBC count < 18k, appendix < 1.1 cm on CT or ultrasound, and no evidence of abscess or fecalith can be effectively managed with antibiotics instead of surgery.
I’d be interested in information about relapse rate. If a child has a propensity toward developing “medically managed” appendicitis, it better to just have the appendix removed than to have the patient risk relapses requiring repeat hospital visits for IV antibiotics and CT scans/ultrasounds?

Do you prescribe steroids to patients with acute low back pain? This study found no benefit in doing so. However, note that the study population was limited to patients with a “bending or twisting injury.” Patients were excluded if they had suspected nonmusculoskeletal etiology, direct trauma, motor deficits, or local occupational medicine program visits.
I’m still giving steroids for exacerbations of chronic pain and for radiculopathy.

Potential patients gone wild … Colorado man shot in emergency department parking lot after “confronting” police with a knife.
Lesson #1: Don’t run around in a parking lot wielding a knife
Lesson #2: Don’t use a knife to threaten a man with a gun

Speaking about guns … you know how the incidence of gun-related deaths is increasing over the years? Well it isn’t. A Pew Research study (.pdf link) shows that firearm homicides dropped by 50% and non-fatal firearm crime has dropped 75% between 1993 and 2010. 56% of people think that gun crimes have gone up in the past 20 years.
Wonder why accurate facts like this aren’t being publicized in the evening news?

Woman lays dead in a Paris emergency department for six hours before someone checks on her and realizes that she is cold. Unidentified French official is matter of fact about the death. “People die every day in the emergency room.”

Fortunately, marijuana is a harmless drug … NY Times reporter writes about how she laid in a “hallucinatory state” for eight hours and thought that she had died after eating a pot candy bar in Colorado.

More ideas from people who know little about the effects of the policies they create. Prohibiting people using food stamps from purchasing sugar-sweetened beverages “expected to” improve nutrition and drive down diabetes. And these authors just assume that everyone uses their food stamps legitimately.
I’m not going to pay for the entire study, but I’d wager that they don’t consider how often people misuse food stamps. Therefore the authors are putting invalid data into their calculations. It is not uncommon for people to act as “straw purchasers” of grocery items. I’ve had people offer to do it with me on more than one occasion. You have cash, they’ll purchase all your groceries if you give them half of the total cost in cash. Grocery stores will also purchase food for half of its retail value. I recall reading one article about how bottles of soda were used as a currency of sorts by people in a rural community with people filling up pickup truck beds with cases of soda and bartering the cases for money, cigarettes, and other items – but couldn’t find the article on a web search.
Who cares, though? The authors are now published in a reputable magazine. Their conclusions must be valid.

Chicago files lawsuit against world’s largest narcotics manufacturers accusing the drugmakers of concealing the health risks associated with taking pain medications.
Next up: Suing alcohol companies on behalf of alcoholics and suing fast food restaurants on behalf of overweight people.
Here’s hoping that the drug companies file a counterclaim against the City of Chicago.

4 Responses to “Healthcare Update Satellite — 06-10-2014”

  1. Skeptical Scalpel says:

    Great post as always.

    Last month I addressed that study on antibiotic treatment of appendicitis in children as well as another recent one in adults.

    You are right about needing data on relapses. The follow-up in the paper on kids was for only 30 days.

    If you are interested, here’s the link: http://skepticalscalpel.blogspot.com/2014/05/antibiotics-instead-of-surgery-for.html

  2. BD MD says:

    I’ll have to say that I give decadron 10
    Mg and Toradol 60 mg to many, many back and neck pain patients and 99% walk out of my ER much, much better. I haven’t done a study on long term benefit but I don’t often see bounce backs. Saves me tons of Percocet prescriptions…unless that is what they came for in the first place…And that I’ll usually figure out pretty quick.
    LOVE steroids!

  3. RSDS says:

    The $15.00 per month, for a household of 2, on the SNAP (foodstamp) program does not cover the entire cost of a single full bag of groceries!

    • Mandy says:

      SNAP is the SUPPLEMENTAL Nutrition Assistance Program. It’s calculated based on your other sources of income, because you’re meant to spend at least SOME of your other income on feeding yourself. SNAP is not designed to provide everyone with all the “free” (i.e. taxpayer-funded) groceries they can eat, it meshes in with other income support and welfare programs.

      $15 in SUPPLEMENTAL Nutrition Assistance for a family of two is the absolute minimum you can get, $347 in SUPPLEMENTAL Nutrition Assistance for a family of two is the maximum.

      See the government SNAP site, “How Much Could I Receive”. http://www.fns.usda.gov/snap/how-much-could-i-receive

Leave a Reply


seven + = 10

Popular Authors

  • Greg Henry
  • Rick Bukata
  • Mark Plaster
  • Kevin Klauer
  • Jesse Pines
  • David Newman
  • Rich Levitan
  • Ghazala Sharieff
  • Nicholas Genes
  • Jeannette Wolfe
  • William Sullivan
  • Michael Silverman

Subscribe to EPM