Svetlana and Tim came in to talk about infertility. They have both had children from prior relationships; sexually active without contraception; she has regular menses suggesting ovulation; no history of pelvic infection that would block fallopian tubes. So far so good. Anything else, I ask?
Oh, yeah, Tim just had a vasectomy reversal.
What?
The average couple, with no health problems, takes about 7 months to conceive. If seven is the average, then even a year or so of trying without conception does not imply an infertility problem. Umm, come back in a year, I suggest.
But not a wasted visit. We talked about timing of intercourse. Generally, a woman is fertile three days a month (since both sperm and egg are viable for about a day; do the math), so a worthwhile discussion.
Although there are various ways to determine ovulation, it's not exact. So assuming a 28-30 day cycle, I recommend that starting on day 10 of cycle (first day of bleeding is day #1), have sex every 2-3 days for 10 days. Every day would be depleting; four days of abstinence might miss the three day window. Actually to keep it simple, I usually just say, every other day. At which point Svetlana winced.
Wednesday, April 24, 2013
Thursday, April 11, 2013
144. Not in My Lifetime
At a conference the other day, an expert (he's written a book!!) on medical economics, was asked what he thought about the potential for a single-payer medical system for the United States.
His reply, "Not in my lifetime," appears on the surface a dramatic but safe prediction, though on further reflection might ought to be avoided especially given its association with predictions about integration, marriage equality, and the election of a black president. In general, one ought to be careful with predictions about health care.
The largest medical plan in the country (Medicare/Medicaid) is already single-payer.
The country most like us (Canada) is single-payer.
And one state (Vermont) has made major steps towards a single-payer plan.
Is this dude planning an early departure from the world?
His reply, "Not in my lifetime," appears on the surface a dramatic but safe prediction, though on further reflection might ought to be avoided especially given its association with predictions about integration, marriage equality, and the election of a black president. In general, one ought to be careful with predictions about health care.
The largest medical plan in the country (Medicare/Medicaid) is already single-payer.
The country most like us (Canada) is single-payer.
And one state (Vermont) has made major steps towards a single-payer plan.
Is this dude planning an early departure from the world?
Sunday, April 7, 2013
143. Burnout
So... you're in a doctor's waiting room reading a handout introducing you to the practice, where the doctor went to medical school, his or her special interests, and finally the observation that the doctor has lost his/her enthusiasm for medicine, feeling cynical and unaccomplished. How would you feel? Like leaving and finding another doctor?
If your visit is in an ER, an ICU, or a family practice or ob/gyn office, chances are about 50/50 that your doctor would report at least one of these signs of burnout. These four specialties top the list; least likely to have burnout are pathologists and psychiatrists (though still over 30%).
We know the effects of burnout on the doctor: increased rates of suicide and divorce, for example, but what about the effects on the care that they provide? Worse because they just don't care enough to go the extra mile; or better because they are better able to empathize with patient who are experiencing similar feelings?
Many experts fear the former, as the American health care system is strained by increasing patient loads with Obamacare and the difficulty that medical schools face in replacing retiring physicians
If your visit is in an ER, an ICU, or a family practice or ob/gyn office, chances are about 50/50 that your doctor would report at least one of these signs of burnout. These four specialties top the list; least likely to have burnout are pathologists and psychiatrists (though still over 30%).
We know the effects of burnout on the doctor: increased rates of suicide and divorce, for example, but what about the effects on the care that they provide? Worse because they just don't care enough to go the extra mile; or better because they are better able to empathize with patient who are experiencing similar feelings?
Many experts fear the former, as the American health care system is strained by increasing patient loads with Obamacare and the difficulty that medical schools face in replacing retiring physicians
Friday, April 5, 2013
142. Cybermedicine
"I didn't go to school until 30 to be a typist."
"I spend an extra hour every night because of EPIC."
"The only people who like electronic medical records are those who sell them."
Luddites notwithstanding, electronic records such as EPIC promote better care for a number of reasons. Hand written records are easy to lose or are unintelligible. Computer systems allow for data collection and alerts (if a provider attempts to prescribe a medicine to an elderly patient whose age places her at higher risk for side effects, the screen flashes, "Are you sure....?")
Yesterday: a patient has an X-ray, the radiologists dictates the report, which takes a few days to transcribe, and a few more days to make it to the patient chart.
Today, the radiologist uses voice recognition software, so that by the time the patient has walked from the xray room into my exam room, I have already read the report.
the legend is fuzzy, but the states in dark blue (Hawaii, Washington, Oregon, Utah, etc), have a "significantly higher" use of electronic medical records; as for Florida, Louisiana, Kentucky--well, what can I say?
"I spend an extra hour every night because of EPIC."
"The only people who like electronic medical records are those who sell them."
Luddites notwithstanding, electronic records such as EPIC promote better care for a number of reasons. Hand written records are easy to lose or are unintelligible. Computer systems allow for data collection and alerts (if a provider attempts to prescribe a medicine to an elderly patient whose age places her at higher risk for side effects, the screen flashes, "Are you sure....?")
Yesterday: a patient has an X-ray, the radiologists dictates the report, which takes a few days to transcribe, and a few more days to make it to the patient chart.
Today, the radiologist uses voice recognition software, so that by the time the patient has walked from the xray room into my exam room, I have already read the report.
the legend is fuzzy, but the states in dark blue (Hawaii, Washington, Oregon, Utah, etc), have a "significantly higher" use of electronic medical records; as for Florida, Louisiana, Kentucky--well, what can I say?
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