Poll: Who is your favorite fictional doctor?

credit: IMDB.comWe had a little fun with our latest poll.  We asked our physicians, what is your favorite fictional doctor of all time?  The favorites were “Hawkeye” Pierce from “M*A*S*H,” Gregory House, MD from “House M.D.” and “Bones” McCoy from “Star Trek.”

The results are below:

  • Dr. Benjamin Franklin “Hawkeye” Pierce 29%
  • Dr. Gregory House 19%
  • Dr. Leonard H. “Bones” McCoy 15%
  • Dr. John H. Watson (Sherlock) 13%
  • Dr. Percival “Perry” Ulysses Cox (Scrubs) 9%
  • Dr. Quinn Medicine Woman 4%
  • Dr. Beverly Crusher (Star Trek, Next Gen) 4%
  • Dr. Henry Jekyll 3%
  • Dr. Kerry Weaver (ER) 1%

Both Pierce and House are flawed characters who showed their struggles with real issues as they cared for patients.  Pierce, famously dealt with PTSD (post-traumatic stress disorder) as the series final story line and House wrestled with drug addiction through part of the show.  Both men always showed a deep commitment to their patients and a commitment to giving the best care to patients.  And yes, even McCoy in his way, did the same.

For more information about PTSD and veterans, our post about what medical symptoms doctors look for in patients with PTSD is insightful.

As a physician, what do you consider compelling attributes for fictional doctors?  Do you think showing flaws is a good thing?  While we do have some lighter topics inside Sermo, about 60 percent of the discussion is about clinical and practice management topics.  If you’re an M.D. or D.O. please join us.

Photo credits:  IMDB.com

 

Local Chikungunya Cases Reported In US

chikungunya virus, virus in st martens243 travel-related cases of Chikungunya have been reported in the US this year. Our neighbors in the Caribbean and Central America have witnessed an explosion of over 355,000 cases and 21 deaths since the virus was introduced to the region in December of last year.

As of yesterday, the first two cases of home-grown Chikungunya were announced by the CDC. The two patients live 70 miles apart in Southern Florida, neither had traveled recently. The virus causes headache, joint pain, rash and fever. It is similar to dengue fever but with a much smaller mortality rate. Recovery is painful and can take weeks. There is no cure only rest and pain relief for symptoms.

What physicians should look for

A Navy physician inside Sermo talked about the disease last night.

“Because many infections have similar presentations, they are very challenging to diagnose. It is always important to ask about travel in anyone with a fever, what activities they engaged in while on travel (swimming in fresh water, eating local foods, etc.), what vaccinations and prophylactic medications, i.e. doxy or Malarone for malaria they did or did not take. Knowing what diseases are endemic to that area of travel is paramount. There are many great resources you can refer to, such as the CDC and Travex websites.”

According to the CDC, as of July 15th, 73 people in Florida were diagnosed with Chikungunya. The disease spreads by a mosquito biting an infected person and then biting a second uninfected person. The best line of defense is insect repellent.

“CDC officials believe there will be sporadic local transmission but not a widespread outbreak.

“None of the more than 200 imported chikungunya cases between 2006 and 2013 have triggered a local outbreak. However, more chikungunya-infected travelers coming into the U.S. increases the likelihood that local chikungunya transmission will occur,” said officials.

Two different mosquito species carry the virus, the Aedes aegytpi and A albopictus. They reside in the southeastern part of the US, up the East Coast through the Mid-Atlantic, the lower part of the Midwest, and parts of the Southwest.

Puerto Rico declares epidemic

While the US mainland is just beginning to see local cases, the virus is firmly established in Puerto Rico which has just declared an epidemic to free up resources to help combat the problem.

So far over 200 cases have been reported as of June 25th. Officials are urging people to drain standing water, cover skin with clothing and repellent and make sure doors and windows have proper screens.

As a physician, have you seen a case of Chikungunya yet? What do you think about the disease’s spread since its arrival in the Caribbean in December? Will you change your screening process for suspicious cases?

We will be discusses this and more inside Sermo, our physician community. If you’re an M.D. or D.O., please join us.

 

 

Doctor Curmudgeon: It’s High Noon at the Front Desk

doctor curmudgeon, dr curmudgeon

Ah yes.  The Front Desk.

A smile in the voice, a welcoming, “Doctor Curmudgeon’s Office.  This is Scheherazade.  How may I help you?”

Stop! Listen!

It can be a War Zone.

It can be a Funny Zone.

It can be an Idiocy Zone.

But, whatever it is, at that moment, it is a Zone where calmness, patience and professionalism must prevail.

I have culled and combined some choice things that my assistant has heard and may well hear in the future. There are no names presented here and they are not exact quotes, but are mused upon from the sometimes imperfect memory of a practicing curmudgeon.

AND NOW FOR SOME OF WHAT IS HEARD AT THE FRONT DESK, EITHER ON THE TELEPHONE OR IN PERSON (UNFORTUNATELY, IN MONTY PYTHON TERMS, IT IS NOT “TIME FOR SOMETHING COMPLETELY DIFFERENT,” BECAUSE THESE ARE NOT UNIQUE)

My dog ate my prescription.

My Vicodin fell in the toilet

My pills fell on the floor and the cat peed all over them.

I met a nice guy in a bar, so I took him home and he had no right to look in my medicine cabinet, but he did, and then I realized he stole all my pills.

My jeans were tight and I reached into my pocket to pull out my pill bottle and all the pills rolled out and I was in line at Kmart and everybody stepped all over them.

When I got out of the car, my purse was open and the car started to roll and crushed all my pills.

I have to talk to the doctor immediately, this second.  I finished my last blood pressure pill yesterday and she has to call it in right now because I am waiting at the pharmacy and I have no time to sit around because I’m supposed to go to lunch with my best friend, and we want to make a movie…so you have to get her right away…I am waiting.  And I need my medicine.  So tell her to hurry up.

And, of course, there is the patient who calls every half hour to review his/her lab work.  And each time this person calls, she/he is told that the doctor is returning calls after five and the message is on the doctor’s desk. Yet this patient keeps calling all day…all day….all day….

Welcome to the World of the Front Desk where it is always High Noon.

~~

Read Doctor Curmudgeon as she talks about “Yes Virginia, there is still joy in medicine.”

Bio:

Diane Batshaw EismanDoctor Curmudgeon is Diane Batshaw Eisman MD, FAAFP, a Family Physician, writer, voiceover artist, and medical educator. It was in the Neolithic Era that the doctor became renowned for expertise in Trephination. After so much time in practice, Doctor Curmudgeon is now cranky and has rightfully earned the honorific of “Curmudgeon.”

Doctor Curmudgeon has no idea of what will appear in this space. It depends on the Good Doctor’s mood and whatever shamans and doctors are channeled at the moment.

As a curmudgeon, I may stray from what I observe happening in medicine and slink into other areas. But that is the prerogative of a Curmudgeon.  Please check out my first book, “No Such Agency.”

 

How Doctors Die: Only 7% Choose Extraordinary Measures

how doctors die poll

A doctor moves with precision in the ER, attempting to keep death at bay with heroic measures for a struggling patient.  On another hospital floor a patient in the palliative ward quietly sighs his last breath, his family at his side.

Death.  What our doctors decide for themselves often differs from the care patients receive.  In fact, far more would choose the palliative ward over heroic measures. Should we follow their lead?

Our Sermo Physician Poll conducted this month asked, “if faced with terminal illness, what treatment options would you choose?” A small number, only seven percent, said they would choose extraordinary measures. An even stronger vote for less invasive care, 39 percent of doctors said they would sign DNR orders (do not resuscitate).

A separate study, published in PLOS ONE recently, concurs. About 88 percent of the doctors said they would want a DNR for themselves.

A CDC study, published in JAMA, tracking the death of Medicare patients, shows a different set of numbers. As of 2009:

  • 53.8 percent of patients died in either acute care hospital or an intensive care unit
  • 42.2 percent died in hospice care

However, 28.4 percent of patients were in hospice care for three days or less.   This might reflect both cost-saving measures by hospitals and requests from patients and their families.

Palliative Care vs. Hospice Care

Palliative care happens at any stage of illness and focuses on relieving symptoms that are related to chronic illness such as cancer, cardiac disease or AIDS. Hospice care is similar to palliative care except that it focuses on end of life comfort and control of symptoms. Hospice care can only be given in most circumstances after a doctor verifies the patient is terminal with a life expectancy of less than six months.

What We Can Learn From Physicians

We discussed how doctors die last fall and showed that palliative care at the end of life not only eases suffering, but seems to prolong life more than aggressive medical care.

Not only can palliative care extend life beyond expectations, researchers also found the family suffered less, with shorter time periods for grieving and less depression after a loved one died with palliative or hospice care.

“Once we’ve done this for a while and seen outcomes, we become comfortable with what is possible … and what is not,” wrote one physician inside the Sermo community.

A rural family practitioner wrote, “At first I thought it was mostly from patients simply not hearing what they didn’t want to hear, but then I started seeing too many sensible ones I had known for years who did not realize they or their family members were terminally ill until I told them … patients and their families need and deserve an honest appraisal of their situation. Some can deal with it better than others, but all should be afforded the chance to know what we would do were we or our family the one in their situation.”

Jessica McCannon, MD, a pulmonologist as Massachusetts General Hospital, who often works with end of life patients, suggests working the conversation in gradually with patients if time allows. She recommends using the Conversation Project Kit a group of documents for patients to consider and discuss with family members before making final choices.

If only seven percent of physicians would pursue heroic measures should we try to improve communication between a patient and their caregivers? As a physician, how do you approach end of life conversations with your patients? We will be discussing this and more inside the Sermo community if you’re an M.D. or D.O. please join us.

 

SermoSolves: A challenging pregnancy in Panama

floating doctors, bocas del toro

Our physician community frequently collaborates on “digital curbsides.”  Our case today comes from the jungles of Panama and involves a young woman struggling with her first pregnancy.   Dr. Ben LaBrot, a Sermo advisor, posted ultrasounds from the province of Bocas Del Toro and received suggestions for treatment within minutes.

Case

This case comes to us from The Floating Doctors, a non-profit medical relief team that provides free preventive health care services to isolated areas. Their team is currently working in a small impoverished village, in the northeast region of Panama. The patient is a 13 year old girl with an estimated pregnancy of four months. An ultrasound revealed a mass, about 3.5 cm, bordering the occipital region of the fetus’ head.

Patient Background

Floating Doctors note “Indigenous Ngabe girl (Western Panama) living in a small slum community of 250 families perched precariously over a mangrove swamp.  All sanitation and trash goes directly into the mud under the houses.  High worm loads, no treated water.  Very low-income area disenfranchised by the wider community. Diet is poor; high in starches and sugar and fat, low in fresh vegetables and protein.” With very little to no health knowledge, she also had not been taking pre-natal vitamins and has not seen a doctor. The patient has experienced no pain and no other complications during her pregnancy. Test ranging from urological, neurological, cardiovascular, respiratory, and gastrointestinal tract all showed no abnormal results.

The Ultrasound Images

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First Response

Medics started the girl on pre-natal vitamins. The preliminary diagnosis is either Encephalocele or Myelomeningocele.

The Struggle

  • Is this diagnosis correct?
  • Is there a chance for treatment to save the child?
  • Will the child survive to full term and what are the risks for the mother?
  • It is illegal to terminate a pregnancy in Panama
  • Exact gestational age is unknown. An estimation of 4-5 months is all that can be deciphered.
  • Lack of funds and hospitals nearby

Consensus

Floating Doctors presented this case to the Sermo Community in July, 2014 asking for confirmation of their suspected diagnosis and any other feedback. There were a total of 32 comments left on this case and 32 participated in a poll asking whether the fetus would survive to full term. 41% voted “Yes, but it is not likely to survive the first week.” Many comments echoed the importance of maintaining the mother’s health.

One MD who specializes in genetics commented “…Triage decision is to preserve the teen mom’s health. NTDs are probably rampant in the population and related to diet low in folate. Sanitation, education, diet, and microloans for local small business. Teach everyone to read and give them books….”

While an obstetrician stated, “I agree the focus should be on the care of this young mother and preserving her ability to bear children safely later in life. A cesarean for a non viable fetus would put her at increased risk for subsequent pregnancies. She needs to terminate this pregnancy sooner than later. My heart goes out to this mother, who is no more than a child herself, and those caring for her with such limited resources.”

Patient Care Plan

Focus will remain on keeping the mother safe and healthy, knowing the child will not survive. Strong concerns surrounded damaging the young mother with a natural delivery. A goal was set to terminate the pregnancy, if possible, within two weeks. If termination cannot happen, the child will be carried to term and delivered via c-section. Counseling is being made available within the community with the Panamanian Red Cross to help explain to the mother the implications of what is happening to her baby.

Physicians consult regularly within the Sermo community.  If you’re an M.D. or D.O. you can log in for free at any time to use this dynamic and lifesaving service.  You can join anytime, just select iConsult to notify your peers, the first response is within minutes.