A Medical Perspective on the Negligent Homicide of Eric Garner

I am not going to get into the larger sociopolitical issues surrounding the death of Eric Garner.  I don't want anything to distract from sharing one observation that has not been widely reported, and which may lead to at least one change that every police department in the country should implement.

Is Obesity more like Crime, Cigarettes, or Sex?

Obesity is a massive problem.  35℅ of America is obese.  Democrats are worried that their prized social welfare programs will collapse under the weight of the problem.  Republicans are worried that they will only be able to invade 1 country every 8 years, as the military finds itself forced to accept increasingly sluggish recruits.  Regardless of how you look at it (and how many puns I can make), this is a serious issue.  But how to frame it makes a massive difference in what tactics and tools it makes sense to pursue.

The Lost Glory Days of General Practice, and a Vision of it's Resurrection

I'm on my family medicine rotation right now.  One of my preceptors is ~80 years old, and went through medical school in the 1960s.  He is still sharp as a tack, and quite possibly the most BAMF-ing family practitioner of all time.  He used to do c-sections, hernia repairs, appendectomies, fracture repairs, and get this- emergency burr holes for subdural hematomas (aka neurosurgery).  He stopped ~1997, mostly because he got tired of his morning cases getting bumped constantly for overnight emergencies and throwing off his schedule for the rest of the day when he had clinic in the afternoon.  He has since moved out to Palm Springs, where he still sees more patients than any of his fellow physicians in the group, still does all his own trigger finger release surgeries and SCC/BCC excisions, and still administers the group.  In addition to all this, he is one of the nicest people I've ever met, beloved by his patients.  He truly epitomizes the fading glory days of family medicine, the ideal of the General Practitioner who could truly do it all.

Ebola, Texas Health Presbyterian Hospital, and Medical Errors

Ebola is in the United States!  Everybody (please don't...) panic!  Quarantine all Texans!  Though that might be a good idea anyway (just kidding).  More on Ebola in general in another post if I have time.

First off though, we've found out more information about the sequence of events leading to the hospitalization of the patient, Thomas Duncan.  Apparently, he came to the hospital, told people he'd come back from Liberia, and was still discharged home.  He was only admitted 2 days later when his nephew called the CDC.  The tale reveals a fascinating story of medical quality and system error.

Informed Consent is a Chimera

This post by Paul Levy got me thinking about informed consent, and a case I saw recently got me to take a little time and write about an issue frequently ignored in medical school.

A bit of background for non-medical readers: Informed Consent is a term in medicine for when doctors get the agreement of the patient to do something to said patient.  For example, before a patient is cut open for surgery, the patient has to say "yes I want to be cut open and have _____ happen".  Less extreme examples abound- the patient has to consent to anything from a blood draw for a lab test to a CT scan.  Part of informed consent is that the patient has to be "informed".  It is acceptable for a patient to say "tell me nothing, just do it", but the patient has to be offered information regarding their disease as well as the risks and benefits of the procedure they are consenting to.  For example, "This x-ray will tell us whether or not you have pneumonia or something else, but may slightly increase your risk of cancer in the long run.  I recommend you get it.  Do you agree?"

The Coming Downfall of Medicine: Scientific Corruption

Some recent news about a(nother) scandal in the pharmaceutical industry has led me to post on something that is critical to the future of medicine and science.

Let me start off by saying that I believe strongly in most medicines. I think the data behind their safety is incontrovertible. But for medicines that were invented recently, that same data would still leave me quite suspicious.

Here's why.

America Doesn't Have a Gun Violence Epidemic- We Have a Poverty Epidemic and an Outbreak of School Shootings

Many people are talking about a gun violence epidemic.  This is understandable, in light of what seems like a never-ending stream of horrific school shootings.  Sandy Hook Elementary School, Santa Monica Community College, Arapahoe High School, UC Santa Barbara- the list goes on and on.

Those with more liberal views are responding to all this chaos and violence by going so far as to call for a repeal of the 2nd Amendment.  As you can imagine, this has predictably gone over quite well with the NRA and it's allies.  These are the folks who, in the immortal and inconceivably badly phrased words of President Obama, "cling to their guns and religion."  Matching the President's lack of tact with an insensitivity that borders on psychopathy, Joe the Plumber addressed the parents of the kids killed at UCSB by declaring, "your dead kids don't trump my constitutional rights."

Amidst all this back and forth between right and left is a shared delusion:  There IS NO gun violence epidemic.  There IS a school shooting epidemic.  These two problems are not the same.  And the solutions that can actually save hundreds if not thousands of lives become clear once the problems have been elicited and defined