All About U DOCTOR

Doctor marks 50 years for heart valve

2010-09-29T08:22:00.000-07:00

Fifty years ago, a young Oregon doctor performed the first successful artificial heart valve surgery. And some of the early patients of Dr. Albert Starr are still living proof of the durability of the tiny mechanical device he developed with engineer Lowell Edwards. The Oregonian reports that one of his patients, 70-year-old Philip Bryson of Portland, was just 25 when he underwent surgery for a defective heart valve and got the relatively new device. That was 45 years ago, and the valve is still ticking away, just fine. The 84-year-old Starr finally retired from surgical practice in 2006.

Surgeon ‘stabbed junior doctor in head with needle

2010-09-29T08:12:00.000-07:00

A surgeon made a string of sarcastic remarks to a junior doctor before he accidentally stabbed her in the forehead with a needle, a disciplinary panel has heard.

James Johnson, a former head of The British Medical Association, grew frustrated with colleagues during a heart operation at Warrington hospital.

The panel heard how the consultant accidentally stabbed first-year doctor Natalie Mason, who was assisting him, as he ‘furiously’ stitched up the patient.

Giving evidence, Dr Mason said the senior doctor vented his frustration, repeatedly referred to her as ‘sweetheart’ and at one point asked: “Didn’t you learn to sew at school?”

But she added that the stabbing was accidental, saying: “It was probably my own fault. My head was probably too close. I was about one or two foot away.”

The panel in Manchester heard how the surgeon had been frustrated that no senior doctors were available to assist him, and that there were delays in beginning the July 3, 2007, operation.

Nurse Janette Pennington claimed the doctor also reacted ‘aggressively’ after being denied water during the seven-hour op because of a policy barring food and drink from the theatre.

She said: “It is quite common to go without food or drink while scrubbed up for cases.”

Mr Johnson, 64, is also accused of ignoring warnings that a bulldog clip was still inside the female patient’s leg. An X-ray later revealed the instrument, and it was removed.

He faces a range of other charges regarding 14 patients between 2006 and 2008.

He is also accused of conducting amputations where less drastic procedures may have worked. Many of the alleged failings took place while he was travelling to London to attend BMA meetings, while also working at Warrington and Runcorn hospitals.

The six-week hearing at the General Medical Council offices is scheduled to last into November.

Doctors say you can treat dengue at home now

2010-09-29T08:08:00.000-07:00

Amrita Tripathi , CNN-IBN
ibnlive.in.com

Delhi is officially the dengue capital of India with more than 2,500 cases registered already.

It’s the worst outbreak in a decade, but some basic steps can make life easier for you.

The outbreak isn't dying down any time soon. Many hospitals have converted rooms into dengue wards and yet there's a shortage of beds in the city.

The last thing you want to have deal with when you've been diagnosed with dengue is to rush from hospital to hospital in the city, looking for space in often overcrowded dengue wards.

The good news is doctors say in most cases, you can provide adequate care -- even at home.

That's because we aren't seeing the more deadly strain of the dengue virus this time. Remember every case isn't dengue haemorrhagic fever and may not require hospitalisation.

So here's what the doctor ordered, for you to take care of yourself at home.

Dr Bagai said: “At home take lot of oral liquids, maintain hydration, pass lot of urine. Medicine should be paracetamol if fever is high.”

“The worst thing is to self-medicate or treat pharmacist as doctor.

Don’t tale a combination fever medicines -- ibuprofen, nismesulide – as this can hamper the platelet production and preciptitae bleeding.”

Dr Bagai said: “The most important thing is if you have a high-grade fever, rash, vomiting and eye pain, visit your local doctor the same day. If you have fever -- low or moderate and lasting 48 hours – you should see a doctor.”

In kids, if there is profuse vomitting or diarrhoea, the fever is very high, there are rashes or impending bleeding and the platelet count is low, see a doctor immediately.

Also be ready to arrange for someone who's got a compatible blood group to volunteer in the event that you need a platelet transfusion.

Doctors' habits affect patient counseling

2010-09-29T08:06:00.000-07:00

upi.com

A doctor who eats fast-food and hardly ever exercises is less apt to counsel patients to eat healthy and exercise, U.S. researchers found.

However, when comparing whether attending physicians who had completed their physician training to doctors still in training, both types of doctors reported low levels of confidence in their ability to counsel patients regarding healthy habits.

Lead author Dr. Michael Howe, chief medical resident at University of Michigan Health System, says a majority of attending physicians talked to patients about a healthy diet, compared to 36 percent of doctors still in internship or residency programs.

The study, scheduled to be published in the Oct. 1 issue of Preventive Cardiology, found for doctors who completed training, factors that increased their confidence in counseling depended on the doctors' own exercise time, being overweight and whether the doctors had adequate training in counseling patients.

Attending physicians reported eating better and exercising more than doctor trainees, whose diets were heavier in fast-food, the study says.

Doctors find worm swimming in man's eye

2010-09-29T08:04:00.000-07:00

abclocal.go.com

A man in Cedar Rapids, Iowa, is thankful to have his sight after doctors found a worm in his left eye.

John Matthews is an avid hunter and travels all over the globe. After returning from a recent trip, Matthews noticed his vision was blurry so he went to a doctor.

The doctor ran a bunch of tests before discovering a microscopic worm swimming around in the retina.

"I saw something wiggling and I asked if the worm was wiggling. The doc said, 'Yes.' I said, 'I can see it,'" Matthews said.

"The thing was just thrashing around violently," said Dr. James Folk of the University of Iowa Hospital.

Folk used a laser to remove it. There are only about 15 known cases like this in the world.

Folk suspects that Matthews ingested the worm while overseas, and the worm ate its way through his tissue all the way to his eye.

No doctor at hand, Rajdhani lady dies

2010-09-29T08:02:00.000-07:00

The Teleraph

Burdwan, Sept. 22: An ailing woman died on board the Sealdah-bound Rajdhani Express after she complained of uneasiness but no doctor could be found for over an hour.

Rahima Bibi, 45, who lived with her elder son Liakat Hossain, 28, in Barasat, was returning to Calcutta from Delhi, where she had gone to visit her younger son, Altaf, 26, an embroiderer.

Altaf’s wife Parveena Bibi, 22, who was accompanying Rahima, said her mother-in-law had fever when she boarded the train yesterday.

“After the train left Asansol station at 9.30am today, my mother-in-law complained of uneasiness. I informed the ticket examiner immediately,” Parveena said.

The ticket examiner and one of the guards asked passengers over the public-address system of the train if there were any doctors among them.

However, they did not get any response.

When the train reached Burdwan after an hour, it made an unscheduled stop. A railway doctor examined Rahima and declared her dead.

A senior railway official said no train in the country had provision for doctors on board. The official said Rahima was “already ill when she had boarded the train”.

A Government Railway Police officer said the body had been sent for post-mortem.

Molest slur on officer

An Australian tourist on her way to north Bengal today accused a railway official from Bengal of molesting her in a near-empty AC-two-tier compartment of the Danapur-Kamakhya Express in Bihar.

Malda resident Anup Kumar Roy, 50, a deputy chief executive engineer, had entered the compartment after the train left Katihar, 320km from Patna.

Roy sat near her and asked the woman why she was travelling alone. After some time, he allegedly started misbehaving with the 41-year-old woman, who was travelling to New Jalpaiguri.

The officer stopped only when she shouted for help, the Australian told police later.

When the train reached Barsoi station after 45 minutes, the woman filed a written complaint with the Government Railway Police. Roy has been arrested. She then continued with her onward journey.

Satyadev Pandey, the deputy superintendent of police (headquarters), railways, said: “Most of the passengers had got down at Katihar. Roy took advantage of the situation and misbehaved with the woman.”

Doctor preparing for upcoming allergy season

2010-09-29T08:01:00.000-07:00

Published September 23, 2010

SEGUIN — Boxes of tissues will be flying off the shelves as cedar pollen counts begin to rise.

Dr. Brooks Mullen, of the Seguin Ear Nose and Throat Clinic, said the symptoms of allergies can often be mistaken for those of the common cold.

“Allergies and the common cold are similar. People confuse an upper respiratory virus with allergies,” he said. “Most people I see think they have allergies when they actually have a cold.”

Common symptoms of an allergic attack can include itchy watery eyes, congestion and nose and face pressure.

The first step to fighting an allergic reaction is knowing what your body is fighting against, Mullen said.

“It is important to identify people with seasonal or perennial allergies because there are so many ways to treat them,” he said. “First we distinguish with a brief medical exam. If we could identify ahead of time we can decrease the amount of productivity that is lost.”

Once the antigen has been recognized, the doctor can create a plan of attack.

“There is preemptive therapy with steroid treatments also there are dozens of antihistamines that can be used to combat symptoms,” he said. “Our main approach is to educate about allergies and create a regiment of medication that works to reduce allergies.”

Mullen’s staff also offers an alternative treatment.

“We have allergy therapy. The goal of allergy therapy is to keep the patient comfortable,” he said. “They are low-dose shots of extracts of the allergens that you are allergic to and it helps to build the antibodies that fight the allergens.”

While it may help to fight the allergies, it is not a cure-all, Mullen said.

“Over a period of 1-3 years it is possible to build enough antibodies that are permanent but that is not everybody,” he said.

Allergens have no age limit, Mullen said.

“Youth and adults alike have allergies and we see them and everybody in between,” he said. “Symptoms typically will start during childhood.”

Location can play a part in whether a person develops a sensitivity to an antigen.

“Sometimes they will start in adulthood when a person moves to a different geographic location and they will start to manifest symptoms,” he said. “It is also possible to develop allergies in adulthood without changing geographic locations, but that is not very common.”

Mullen has been named for the last three years one of Consumer Research Council of America’s top physicians.

The Seguin Ear Nose and Throat Clinic has been serving the community for more than 20 years and is located at 908 E Court St No. 2.

Anthrax Update on 30 September 2010

2010-09-21T09:09:00.000-07:00

Number of Cutaneous Anthrax cases from 18 August to 30 September 2010:

Districts Upazila Number In last 24 hours (30/09/2010)

Pabna 68 0

Bera 11

Santhia 35

Faridpur 22

Sirajganj 218 0

Shahjadpur 56

Belkuchi 54

Kamarkhanda 98

Ullapara 10

Kushtia 49 0

Daulotpur 46

Bheramara 03

Tangail 26 0

Ghatail 14

Gopalpur 12

Meherpur 82 0

Gangni 81

Mujibnagar 01

Manikganj 08 0

Shaturia 08

Shatkhira 01 0

Sadar 01

Lalmonirhat 107 0

Sadar 78

Aditmari 29

Rajshahi 08 0

Charghat 07

Tanore 01*

Narayangonj 12 0

Araihajar 12

Laxmipur 25 0

Kamalnagar 25

Chittagong 01 0

City 01

Total

605 Last 24 hours 0

* Imported from Sirajganj

Last day it was 605

Read More on Anthrax:

Epidemiology

Anthrax is commonly known as ‘Tarka disease’ among the villagers and caused by Bacillus anthracis, a bacterium that can form spores. Spores allow it to survive in the soil for long periods of time.

Anthrax is primarily a disease of herbivorous mammals such as cattle, sheep, goats and buffaloes, which can ingest anthrax spores while grazing. Humans generally acquire the disease directly or indirectly from infected animals, or occupational exposure to infected or contaminated animal products. Control in livestock is therefore the key to reduced incidence. There are no documented cases of person to person transmission. The disease's impact on animal and human health can be devastating.

The disease exists in animals and humans in most countries of Africa and Asia, in several southern European countries, in the Americas, and certain areas of Australia. But It was just 9 years back. After 9/11, Anthrax was a serious issue in the western world. Still today, Anthrax is of serious interest due to the world terrorism issues. As an infective agent, it is a concern because it forms very resistant spores that can be transported easily. At present, it has come back in Bangladesh and infecting human and cattle.

Disease outbreaks in animals also occur sporadically in other countries. Prevalence of anthrax in Bangladesh was not well documented, however, since August 2009 IEDCR has investigated 14 outbreaks of cutaneous anthrax in three districts of Bangladesh (Pabna, Sirajganj and Tangail). Recently, more and more outbreaks are being reported.

Anthrax in human

There are 3 types of anthrax in humans:

cutaneous anthrax,

gastrointestinal tract anthrax, and

pulmonary (inhalation) anthrax.

The incubation period for the disease is approximately 2 to 7 days.

In people, cutaneous anthrax accounts for about 95% of all infections and develops when B. anthracis comes in contact with the skin. Antibiotic treatment cures cutaneous anthrax; if appropriately treated, death is rare.

Intestinal anthrax results from consumption of contaminated and undercooked meat. Affected individuals may experience nausea, vomiting, and fever, followed by abdominal pain, blood in the vomitus, and severe diarrhea. Mortality is estimated at 25 to 75%. No case of intestinal anthrax has been reported in Bangladesh so far.

Inhalational anthrax may initially present as a flu-like illness. A short period of improvement may follow, after which the patient rapidly deteriorates with high fever, respiratory distress, and shock. Fatalities approach 95% if not treated within the first 48 hours. It is very rare.

Anthrax in animals

Anthrax infection in animals can be respiratory or intestinal. Clinical signs may include fever, respiratory difficulty, excitement followed by depression, incoordination, vomiting, diarrhea, bloody discharges, convulsions, and death.

Prevention

Prevention of anthrax in both humans and animals is based on control measures in livestock in endemic areas, such as the safe disposal of anthrax carcasses and mass vaccination of cattle. The most efficient method of disposal is incineration in a manner that ensures heat sterilization of the underlying soil. However, vaccination of livestock is the most efficient way of preventing this disease.

Isolation of human cases is not required and there are no quarantine requirements as human to human transmission has not been documented. Dressings and other contaminated materials should be disposed of, preferably by incineration.

Some remarkable points about widely talked Anthrax:

•Anthrax infection is a condition caused by a bacteria Bacillus anthracis that usually causes infections with mainly domestic animals like cattle, goats, sheep, dogs, horses etc. The infection in humans is also called ‘Woolsorters disease’.

•The bacterium infects the skin — most occupational cases are skin infections. But fortunately, skin infections are less severe and a more easily treated. It also infects the lungs — causing a form of pneumonia. It infects many small air sacs in the lung. This tends to be the most dangerous form. It sometimes infects the intestines. But this is rather rare.

Treatment

Infection in human can be treated with antibiotics. Because the course of the disease is rapid, prompt administration is essential. Effective antibiotics include ciprofloxacin, doxycycline, and phenoxymethyl penicillin.

* this article does not provide anthrax treatment advice. You should consult a qualified medical doctor for Anthrax infection advice and treatment specific to you.

Is the physical exam facing extinction?

2010-09-20T12:04:00.001-07:00

Many doctors are truncating the physical exam or just skipping it altogether, NPR reports. It seems the days of doctors poking, prodding, peering, sniffing and listening to a patient's body may be fast disappearing.

Senior Cardiologist Roman DeSanctis at Massachusetts General Hospital told NPR he is always amazed to learn when his patients' doctors have not examined them. In one recent case, he heard the sounds of an abnormal fluid buildup in the chest of a patient who turned out to have lung cancer. Strangely enough, another doctor he had seen before DeSanctis had not "really examined" him.

Physicals can help a physician identify problems that the patient didn't know about before they become much harder to treat. From that standpoint, a physical exam could help cut costs. But a tendency to rely more on tests and other diagnostic procedures is more pronounced these days.

"I sometimes joke that if you come to our hospital missing a finger, no one will believe you until we get a CAT scan, an MRI and an orthopedic consult," Dr. Abraham Verghese, a professor at Stanford Medical School, told NPR. "We just don’t trust our senses."

Stanford is trying to reverse the trend away from physical exams by requiring the med school's graduates to master 25 different bedside exam skills, which include detecting fluid in the abdomen and abdominal blood flow and testing ankle reflexes for nerve abnormalities.

Critics say that it's more important to talk to the patient and note that some tests are much more accurate than the physical exam. A recent New York Times article that seems to endorse physical exams even notes that for a healthy person, an "abnormal finding" on a physical exam is more likely to be a false positive than a real sign of illness.

In the often heated comments that follow the NPR story, one doctor notes that in his experience, med schools are cutting courses that emphasize traditional and cheaper forms of analysis in favor of "blackbox" techniques. Another commenter says he sees a trend toward irrelevant, but rote mechanized procedures.

Another physician who commented calls the article one-sided. If it is a truism of medicine that 90 percent of diagnosis is accomplished by talking to the patient, he writes, "...if anything, doctors should spend more time talking and less doing routine physicals."

New doctor welcoming babies at Skiff

2010-09-20T11:39:00.001-07:00

A new pair of highly trained hands is now bringing little ones into the world at Skiff Medical Center, thanks to the arrival of Malini Dandu, M.D.

The family practice physician is the newest health-care provider at Newton Clinic, where 13 doctors and two nurse practitioners offer services in the areas of family medicine, obstetrics, gynecology, internal medicine and podiatry. Dr. Dandu is one of five Newton Clinic doctors who deliver babies at Skiff. In addition to her medical degree and completion of a family practice residency, Dr. Dandu also did a fellowship in obstetrics.

Due to this specialized training, Dr. Dandu is capable of more advanced obstetrical and gynecological procedures, including cesarean sections and colposcopies. She can also see women through pregnancies that are classified as high-risk due to gestational diabetes or preeclampsia (pregnancy-related high blood pressure).

Ever since her childhood in India, Dr. Dandu knew that she had a calling for medicine. “I have a lot of doctors in my family,” she said. “They were my inspiration. I drew my energy from them.”

During medical school, she came to realize that family practice would be the best fit for her.

“It covers the whole spectrum of health care,” she said. “And as I learned that I enjoyed doing procedures, I decided that it would be beneficial and rewarding to add extra training in obstetrics and gynecology.”

By having a medical practice featuring both family practice and obstetrics, Dr. Dandu said she can enjoy complete continuity.

“Not only can I see the mother during pregnancy, but I can also be the baby’s doctor after birth,” she said. “I can care for the whole family, which gives me a lot of happiness.”

“Newton Clinic and Skiff Medical Center are both delighted that Dr. Dandu has chosen to practice medicine here in Newton,” said Mark Thayer, clinic administrator. “We couldn’t be happier to have her here.”

Fellow FP/OB provider Dr. Leighton Frost agreed. “Dr. Dandu is well-trained, a hard worker and an excellent listener. She’s a great fit for the clinic and for the community.”

Dr. Dandu moved to Newton in early August, accompanied by her husband, a general surgeon. The town and its residents have been kind and welcoming, she said.

“Newton is peaceful and relaxing. And everyone, from my colleagues to my patients, has been so friendly and nice,” Dandu said. “This is a wonderful place to be and I’m thrilled to grow my practice here.”

Doctor describes behind-the-scenes life in emergency room in new book

2010-09-20T11:38:00.000-07:00

The countless Canadians who have visited a hospital emergency room after the sun goes down and waited and waited, fretting about why it's taking so long to receive treatment, will find some illumination in a new book by a veteran ER doctor.

Dr. Brian Goldman's story not only sheds light on challenges faced by health professionals during those darkest hours of the night, but also on the deep satisfaction they feel when they can send someone on their way, problem solved and on the mend.

Doctors tend to be put on a pedestal in our society. But in "The Night Shift" (HarperCollins Canada), Goldman offers a refreshing approach that reveals them to be "as human as the rest of us."

"The public isn't well served thinking of physicians and nurses and pharmacists and social workers and other health professionals as perfect," Goldman, who is also host of CBC Radio's "White Coat, Black Art," said in an interview.

"I think that when we expect people to be perfect, never tired, never making a mistake, then I think that induces a lot of shame amongst health professionals when they discover yes, that I do get tired and I do make mistakes.

"It's the avoidance of that feeling of shame that I think makes it difficult for people like me — practising health-care professionals — to come clean about mistakes, to be open about them, not just with patients and with the public, but with ourselves. And when we aren't open with each other, then we miss an opportunity to observe each other more, correct mistakes, take near misses, for instance, and do a better job of talking about them and making the system safer."

Goldman has worked for more than 20 years at Mount Sinai Hospital in downtown Toronto, and gives accounts of numerous cases — with patient identity appropriately concealed — that might arrive at an ER on a typical night. The reader is offered a glimpse of what it's like to treat a cancer patient who's having a seizure, a dislocated shoulder, someone who thought he'd been slipped a date rape drug, a woman having a miscarriage, a guy who was in a street fight, a binge drinker, a man with a swollen testicle — the list goes on.

In fact, when his wife Tamara finished reading the book, she told Goldman that for the first time she felt as if she'd gone with him to the hospital for a night shift.

In emergency, doctors are constantly learning new things, Goldman noted. It's a bit like a box of chocolates, as the character Forrest Gump would say. "You never know what you're gonna get," especially nowadays with patients being more complicated and living to an older age with more illnesses, Goldman said.

While he writes that he loves working nights and the patients who inhabit the ER at that time, he also admits to anxiety prior to his shift because "there are things I don't know and procedures I can't do as well as some of my colleagues." For instance, he writes about his difficulty intubating patients, and subsequent training he got to properly master the procedure to open an airway for a patient with breathing difficulty.

In order to stay awake, Goldman writes that he uses modafinil, a mild stimulant that "increases my alertness by about 10 to 20 per cent."

Another challenge is the need to call on specialists for complicated cases. On the night shift, this can mean waking someone up, which isn't done lightly. But Goldman relates the case of a man who was complaining that he thought he had food poisoning, when in fact he had an abdominal aneurysm and urgently needed an operation. In this case, it was an easy decision to call a vascular surgeon at 5 in the morning.

"My guardian angel directed me to put my hand on his belly to feel it and I felt it, and I called the surgeons and it got fixed," he said. "And instead of this guy dying, he went home 10 days later. Saved. There's no greater feeling than that."

But it's more difficult to decide how to handle a swollen testicle. It could be an infection called epididymitis — not a good reason to get a specialist out of bed — or possibly testicular torsion — a good reason to rouse a urologist, because the testicle has twisted around until its circulation is cut off, and needs to be untwisted by a surgeon within roughly six hours, or the testicle dies.

"You have to learn when you call right away, and when you don't," Goldman said.

It can get incredibly busy.

The triage nurse has to assess patients and determine who needs to be seen first. Delays can occur when an X-ray or lab report doesn't get sent back to ER in a timely fashion, or a doctor isn't aware that results are in. Or, a surgical resident might be tied up with a sicker patient on the wards, and can't make it to ER quickly for a consultation.

"That stuff happens all the time because we don't have robots running the system," Goldman said.

Patients and their loved ones have every right to speak up if the wait seems too long, but there's a way to do it to get better results, he advised.

"When you meet the nurse in the area, learn their name and speak to them, address them by their name ... if you approach somebody and start talking, almost like a 'hey you,' you don't get as good service as if you walk up to people, smile, be polite," he recommended.

"The second thing I'd recommend is get a feel for what is in the control ... of the person you're asking. There's no point in asking someone to do something that they can't do. For instance, I can't snap my fingers and make the surgical resident come down now, unless I call STAT (immediately). But like the boy who cried wolf, I better mean it ...

"The surgeons, the gynecologists will very quickly learn that when Goldman calls STAT, he doesn't mean STAT. So you've got to be very careful about that."

The Hippocratic Oath and its Ability to Evolve

2010-09-20T10:17:00.000-07:00

The Classical and Modern versions of the Hippocratic Oath are one in the same. Although the two oaths have varying clauses, the overall composure of the modern vow seems to stay true to its predecessor. The theme that is most prevalent throughout both pieces is that medical science is a sort of “art” that demands respect. The classical version of the oath differs greatly in its desire to keep the “art” of medicine among a sort of priesthood. The two oaths also differ in the fact that sympathy towards the patient in the modern version is highly valued; whereas the classical version only mentions the caretaker will stay away from abortion, euthanasia, and sexual relations with patients. In order to reflect the historical and cultural values that we posses in modern society, the recent versions of the oath have been written in a manner accepting of the technological advances we have come to witness in our society. Medicine when looked at as a form of Art requires a sympathetic touch that we see through a priesthood of doctors sticking together, holding true to their oath. Many forms of Art are only successfully composed with a sympathetic touch, such as medicine. In this sense, a priesthood takes on the responsibility of an artist, painting a sympathetic canvas of guidelines that must be followed. I “will guard my life and my art,” the classical oath proclaims. “There is art to medicine and science,” claims the modern version of the oath. Hippocrates was the first to proclaim this science as a sort of “art.” Although Hippocrates‟ true translation may constitute “techne” as a “skill,” this definition could easily relate a skilled practitioner, to a skilled “Artist.” In the humanities, we try to “reflect upon our lives and ask fundamental questions of value, purpose, and meaning in a rigorous and systematic way” (mfh.org). When realizing that individuals from the past considered medicine a sort of “art,” I decided to reflect upon my own life experiences with doctors in the past, in hopes of linking our definition of “What is Art?” into this question. Although my definition of art, in my piece about “What is Art?,” led me to conclude that art is what one conceives it to be, with the ability to use life-experiences and personal interactions in order to create or classify art. Doctors are introduced to various patient problems and
experiences throughout their life, providing the ability to make educated opinions, “painting” their medical prognosis of their patient. In Ancient Greek society, an oath is defined as “A promise or a statement of fact calling upon something or someone that the oath maker considers sacred... as a witness to the binding nature of the promise or the truth…” (Wikipedia.com) The Hippocratic Oath, both modern and classical, follows the rules of a typical oath. The original “doctors” of the time seemed to create somewhat of a priesthood, in which the oath-taker promises to “[instruct] my sons and [the] sons of him who [have] instructed me and to the pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.” (Hippo. Oath – Classical Version) A priesthood is defined as the “clergy [who perform] ritual[„s] within the sphere of the sacred or numinous, communicating with the gods on behalf of the community.” (Wikipedia.com) Clergy members were known for their ability to conduct ritual aspects of the religious life such as the teaching or spreading of the religion‟s doctrine. They were also known for dealing with life events such as childbirth etc. The classical oath is definitely reminiscent of these values and duties. The individual who would profess this oath swore to the Greek Gods, proclaiming that they would allow themselves to stick with the rituals of the past by allowing the gods to be witness, by “communicating with the gods on behalf of the community,” just as the clergy. (Wikipedia.com) However, the modern version of the oath seems to open its gates to everyone, promising to uphold the oath through personal ability and judgment. The modern oath calls for the sharing of “such knowledge as is mine with those who are to follow.” The restriction of teaching this “art” to new members of the science cannot be seen in the modern version of the oath. As time advanced, all members of society were granted the possibility of learning the “art”. It seems as if as time and technology advanced, individuals became more in-tune, changing the oath to reflect social and cultural standards. Art was a skill developed in the West and originally dealt with the High Renaissance. Like medicine, Art was originally a defining standard only practiced by a certain group of individuals who related to a higher society. Art was heavily criticized and like medicine, it had rough beginnings.
The fact now recognized in modern medical practice that sympathy towards a patient plays a large role in the well-being of an individual, can be seen in the modern version of the oath. As we discussed in class, only recently has the sympathetic approach to a patient proven that sympathy and understanding provides the patient with a sense of acceptance and understanding. Personally, in my own past visits to doctor‟s offices, I have noticed the difference that sympathy plays in the ability for the patient to feel secure. I have undergone only two surgeries in my life, neither being an extreme operation. When removing my tonsils, I felt that because the doctor was unsympathetic towards my pre-operatal needs, I was more unprepared for the surgery than I could have been if my doctor WAS sympathetic. Previous surgeries have proved to me that a doctor, sympathetic in his art is most successful. Lasagna‟s modern version of the oath makes sure to make evident to the oath-taker that they are “not treat[ing] a fever chart,” but “a sick human being.” The realization that sympathy plays such a large role in the treatment of patients is definitely a modern advancement that was discovered throughout the ages of health-care. Today‟s society is a witness to our amazing technological and medical advances throughout time. The Hippocratic Oath, whether modern or classical, is one in the same when it comes to the basic clauses. Advances in medical technology as well as changes in societal values HAVE changed certain aspects and clauses originally included in the classical, original version. However, these changes conformed to the more sympathetically driven values that are common in today‟s society. The modern and classical versions of the oath are easily comparable, showing that medicine is the culmination of one‟s desire to create an Art, sympathetically necessary to the life of a human being. I believe that the meanings behind the oath‟s are closely comparable due to the fact that they resemble a form of covenant, overall, both promise to uphold truth and justice while providing care for those in need.

Nigeria: Are Doctors Still Bound By the Hippocratic Oath? (1)

2010-09-20T10:03:00.000-07:00

Isah

19 September 2010

Despite the oath doctors swear to, to uphold in the discharge of their duties, tales still abound of the shoddy manner and attitude in which they treat their patients, irrespective of the patient's plight. Winifred Ogbebo reports on the issues.

I swear by Apollo the physician, Esculapius, and and All-heal, and all the gods and goddesses, that, according to my ability and judgement, I will keep this Oath and this stipulation.

To rechon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look up his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according the law of medicine, but to none others.

I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give a woman a pessary to produce abortion.

With purity and with holiness I will pass my life and practice my Art. I will not cut persons labouring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males, of freemen and slaves.

Whatever in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret.
While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot!"

The original text of the Hippocratic Oath is usually interpreted as one of the first statements of a moral of conduct to be used by doctors, assuming the respect for all human life, even unborn. It requires a new doctor to swear upon a number of healing gods that he will uphold a number of professional ethical standards.
In the words of the immediate past president, Nigerian Medical Association, FCT chapter, Sir, Dr Jerry Oguzie, it is very necessary to bring all these issues up with respect to medical training and the Hippocratic Oath because majority of the challenges which the medical doctors face in these contemporary times, is as a result of abuse of medical training and violation of the oath.

Referring to some nasty experiences he has had in the hands of some doctors , Sam Asowata, a journalist and public analyst said, " most doctors' attitude to their patients is appalling. They fail to take into consideration, the plight of the people who brought the patient to the hospital and also the well-being of the patient.
A national daily, This Day last weekend published an article on how twins were carelessly left to die in some public hospitals in the Federal Capital Territory.

Corroborating the view of most Nigerians who have had raw deals in the hands of the medical practitioners in the country, Prof Christian Onyebuchi Chukwu disclosed at the Medical and Dental Council's third plenary session, in Abuja that Nigerians now believe that the doctors are the ones disrupting the health sector.
In his first annual distinguished member's lecture of the Nigerian Medical Association, FCT chapter, on the topic, "The Medical Doctor In Contemporary Nigeria", Dr Oguzie took a cursory look at some of the issues that have been contravened by doctors under the oath.

1. I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan. Though euthanasia is not yet legal in Nigeria, how many of us by misdiagnosis have actually given "lethal drugs" to a patient? How many of us have painstakingly examined the laboratory results of a patient brought to us to know if he has a malignancy or not? How many of us even bother to carry out some laboratory investigations ab initio before commencing treatment of supposedly minor ailment, which may turn out to be a major one?
2. Similarly, I will not give a woman a pessary to cause an abortion. "Again, abortion is not legalised in Nigeria, yet every day, we treat complications arising from abortion.

How many of us have actually built our practices on the proceeds of abortion? It is commonly stated that soon after his O & G posting, the first "surgery" a medical student performs is "Menstrual Regulation" which is an aphorism for abortion. How many of us have turned the other eye when those we have engaged in our practices have resorted to "menstrual regulation" Life is sacrosanct, it is said and one of the things that God hates with a passion is "the shedding of innocent blood." Though sometimes, circumstances beyond the control of the medical doctor may make him resort to committing abortion, but at the end of the day, the question that usually begs for an answer is "was it really worth it?"

Specifically, on the 7th issue of the oath which focused on keeping the good of the patient as the highest priority. He said there may be other conflicting good purposes such as community welfare, conserving economic resources, supporting the criminal justice system, or simply making money for the physician or his employer that provide recurring challenges to physicians.

His words: " When we bleed the patient unnecessarily, are we keeping the good of that patient? When we do not do what we ought to do and rather do what we ought not to do, are we keeping the good of the patient? When we mislead the patient just because we want to collect more money from him, are we keeping to the good of the patient? When we reject patients because of their financial status and pander rather to those that can pay our bills, are we keeping to the good of the patient? These are questions that really need a soul searching response"
The immediate past president of the NMA, FCT chapter, who came down hard on his colleagues in the profession, disclosed that the medical practice in Nigeria has become an all comers affair as absence of legislation and inappropriate legislation has given room for charlatans, usurpers, pretenders and imitators to take over the medical air space.

"A lot of quackery is going on right under the noses of the genuine practitioners and there seems to be nothing anybody can do about it. Pharmacists, nurses, medical laboratory scientists, community health officers, community health extension workers, even patent medicine dealers are all masquerading as various joints as medical doctors since the average Nigerian patient regards every man in a white ward coat as medical doctor. Either due to lack of political will or lack of necessary resources or a combination of two, medical practitioners through the Medical and Dental Council of Nigeria Monitoring Committees is unable to stem the tide of quackery going on in the nation"

But the President of the Nigerian Medical Association, Dr Omede Idris, said that one's attitude is a reflection of upbringing and training received in the field of medicine as in his words is enshrined in training under ethics and code of practice and codified in Hippocratic Oath.
According to him, " all these emphasize empathy, care, compassion, concern and firmness in taking decisions that would be beneficial to the patient. This orientation is built upon in the cause of rendering services and through workshops, courses training and conferences. I believe most doctors exhibit this quality and attributes. If there are deviations and variations from this, it may not be unconnected to individual differences. However, the bottom line of doctors' attitude to patient is optimal care and attention for the patient."
To ensure accountability and efficient quality health care, the former minister of Health, Prof Babatunde Osotimehin, last year directed health workers in all tertiary hospitals to wear name tags to enable patients report quality of service rendered them.

At the formal launch of the patient's feedback platform supported by MTN and Globacom last year, Osotimehin said the system was designed to enable patients who visit any of the 52 Federal Government Hospitals and Medical Centres across the country to provide feedback on the quality of services provided by the healthcare centres through text massages.
He said that healthcare workers has the responsibilities to render quality service and most be held responsible in an event of failure.

His words, "The way the Doctors, Nurses and pharmacist go about as if they are doing patients a favour. It is not because we have a responsibility which we swore to and if we are not discharging it, then it is a problem that must be addressed."

He said the platform is commencing in the 52 federal hospitals but will soon be extended to the states and local government levels to make the health workers accountable to their actions.
He said the messages will be delivered directly to the ministry, adding that it will be disaggregated according to hospitals through a dedicated code number.
"On a weekly, monthly and quarterly meetings all these will be collated and analysed so that we can sit down and talk to Chief Medical Directors in our hospitals to arrest issues that may come up," he said.

On what the Medical and Dental Council of Nigeria (MDCN), a regulatory body for all medical and dental workers in the country, is doing to enhance doctors' attitude towards their patients, the registrar, Br Abdulmunin Ibrahim said the council has been receiving a lot of complain against doctors as regards their behavior towards their patients.

He said, "If you look at it critically, it falls back to when they were trained. If you look at the training now and the training of those days in the 80s, the doctors that graduated in those years conform with the ethics of the profession. Am sure these complaints are against the younger doctors. And what is happening now, if you look back to their training institutions, you find that most of the training institutions are producing large number of doctors that I will say are without control. Without control in the sense that council being the regulator allows each institution to take a particular number so that they will get both teaching in the profession and also learning in character. But a lot of these are absent. The doctors will go through the curriculum of their training but the character and the ethics of the profession is not adequately brought to them so when they come out, how then do you expect them to behave? These are people that have not imbibed the culture and the ethics of the profession properly so they will behave in such manner."

Speaking further, he said, "Most of them that really do not confine themselves to the ethics are the ones found wanting so the council for now cannot do much unless we go back to their training institutions and sanitize those training institutions. You will see of recent that the council is getting commendation that it has woken up. We have closed down two medical health training institutions because the condition in those institutions, both infrastructure facility and also the manpower has fallen below the standard expected by the council so the council decided to close down particularly the medical school in the University of Benin and Igbinedion University. We gave them a period of one year to amend those deficiencies. The council will continue to also hammer other medical schools that have fallen below the standard. I believe that if the training institutions should do what is expected of them both in character and learning, the crop of doctors that will be graduating in the near future will be as comparable as the doctors that were produced in the early years."

Here's to your good health: Know how to ask questions

2010-09-20T02:52:00.000-07:00

Daniel Nelson went to the University of Minnesota Medical Center, Fairview, this summer for a gut check — the medical term for his abdominal procedure was 11 syllables long. A week later, while waiting to be told how the exam turned out, the Woodbury man was summoned for a second, 17-syllable procedure.

Medicine tends to become more worrisome by the syllable, so Nelson wanted a clear explanation of what was wrong and what to do next. But despite talking to two doctors and reading a report about his first procedure, he had questions about his diagnosis and was confused about a drug he was supposed to take.

So he went to the top, sending letters to the hospital's patient relations department and copying Fairview Health Services President and CEO Mark Eustis for good measure. When he didn't hear back from anybody for a month, he contacted the Watchdog.

Shortly after the Watchdog called Fairview Health Services' media relations manager, Ryan Davenport, Nelson got the information he needed — and in writing, the form he preferred after talking to the doctors. After weeks of waiting, the Watchdog's involvement made it possible for Nelson to find out exactly what the doctors meant and to know exactly what to do.

Nelson thanked the Watchdog for stepping in: "Once in a while, you get someone else to shake the tree," he said.

Communication between health care providers and patients is fraught with peril: Complicated conditions can be difficultto explain in layperson's terms — a patient more familiar with, say, sports or high-finance lingo can find himself perplexed by medical terminology.

So what's an ailing patient's best chance for a communication cure?

Here's what Fairview Health Services has to say:

Patients should play an active role in their own medical care, and that means talking to the doctor and other care providers as much as necessary to understand what's going on. Patients shouldn't hesitate to call, Davenport said.

Your best bet, especially if you foresee your condition may be complicated or require long-term care, is to ask the doctor up front: "If I have a question, what's the best way to connect with you?"

Depending on the doctor and the situation, you may decide to leave a message with the doctor's office, call the direct number for a particular nurse or to e-mail the doctor directly. Ask how long you can expect to wait to get a return call or e-mail.

"We would expect it to be expedient," Davenport said.

To get some types of information quicker, Fairview has an online program, MyChart, where patients can access their lab and test results, make appointments, check prescriptions and e-mail care providers.

If polysyllabic medical words tend to confuse you, or if you're under a lot of stress, bring along a trusted loved one to provide an extra set of ears. That person may later be able to help you make sense of what your doctor had to say. Prepare yourself before the appointment, bring a list of questions and take notes.

If you still find you have a question once you get home, make that call or send that e-mail. If it's urgent, don't wait until the end of the day.

If it works better for you to get information about your case in a particular way — like Nelson, who wanted to see it in writing — then ask for it that way.

As for the letters Nelson sent to the higher-ups:

The Fairview patient relations department responds to medical questions directed their way by sending them back to care providers. If it's a written inquiry about an issue that's not immediate — a complaint about hospital service, for example — a patient relations staffer tries to write back within 30 days, Davenport said.

And letters sent to top dog Eustis do get his attention, Davenport said. Eustis reads them, and most he passes on: A complaint about someone's emergency room experience could go to the ER's medical director, with a request to respond to the patient and copy Eustis. The chief personally answers questions about certain big-picture topics — Fairview's plans to expand and health care reform proposals, for example.

Nelson wanted to keep private details of his medical condition. But now, as he continues to be treated, he'll know just what to do.

Physician, Humanize Thyself

2010-09-19T21:18:00.000-07:00

By SALLY SATEL

'Be the kind of physician that you would want to have if you were sick." With these words, Dr. Arnold P. Gold welcomed the incoming class of medical students at Columbia University College of Physicians and Surgeons last month. As thrilled parents looked on, 168 young men and women sat expectantly in the school's auditorium, their white coats folded over their arms, each waiting to be called to the front of the room and "cloaked" by a senior physician.

This marked the 18th annual White Coat Ceremony at Columbia. Dr. Gold, a white-haired and avuncular pediatric neurologist, popularized the practice years ago because, he said, "medical students were becoming enamored of technology and were losing the important aspects of human relationships with patients." Columbia's chaplain referred to the coats as "cloaks of compassion."

I asked to observe the "cloaking" ceremony at Columbia because my generation did not have such a tradition in the early 1980s. As I recall, a secretary in the dean's office instructed us, most unceremoniously, to go to the hospital laundry and pick out a coat in our size.

This year, most of the 133 medical schools in the U.S. held white-coat rituals. The ceremonies are the centerpiece of a movement known as "humanism in medicine." It gathered momentum in the early 1980s when cost-cutting efforts imposed by insurance companies began to infringe upon the doctor-patient encounter. Physicians bristled as they were told how long their patients could stay in a hospital and how often they could schedule outpatient visits. Managed care, which blossomed in the 1990s, exacerbated this trend.

Proponents of humanism contend that these changes in the medical culture have filtered down to students, distorting their outlook as they progress through school. Indeed, numerous studies from the last decade or so document an increase in cynicism and loss of idealism in medical students during education.

Yet, this is hardly new. A 1955 paper in the Journal of Medical Ethics found that students' attitudes about patients became increasingly cynical with seniority. Surely, shielding oneself from the suffering of others with gallows humor, ritualized slang, or a detached bunker mentality, is as old as hospital-based medicine itself. Even so, advances in medical technology occur almost daily, and heavy reliance on diagnostic tests has partially displaced the more intimate activities of in-depth history taking and physical examination.

Fostering "humanism" is a big enterprise. A number of schools, such as the University of Pennsylvania, Ohio State University and the University of Medicine and Dentistry of New Jersey have assistant deanships and centers dedicated to "professionalism and humanism."

Mt. Sinai School of Medicine and a handful of others reserve a block of admission slots for students who majored in English, history, philosophy or other humanities but never took physics or organic chemistry. They also forego the MCAT exam, which is required of traditional pre-med students.

"A liberal arts background may provide these students with enhanced communications skills and improved bedside manner," says Dr. David Muller, co-author of a recently published five-year study on the Mt. Sinai program.

To expand clinical empathy, some medical-school instructors have students imagine the life of their cadaver and write about their feelings towards him or her. Penning confessionals to one's cadaver strikes me as gimmicky, but the basic idea is laudable. After all, respect for the patient as a unique individual is at the core of what it means to be a doctor. As the venerated physician Sir William Osler told students in an address at Albany Medical College in 1899, "Care more particularly for the individual patient than for the special features of the disease."

But the question of whether empathy can be taught—and, in particular, whether a white-coat ceremony is a good means for promoting that virtue—is a matter of some debate.

Judah Goldberg, a young doctor at Chilton Memorial Hospital in New Jersey raises an intriguing paradox. He asks how the white coat can bring doctors closer to the subjective experience of patients when, as an icon of the profession, it is meant to isolate and distinguish them from the lay community.

"To the extent that empathy can be taught through a ritual," Dr. Goldberg told me, "a hospital gown, the common garb of human frailty, would be more fitting than a distancing white coat."

As for the students, it is not at all clear that deep empathy as an intuition can ever be inculcated. I, for one, am skeptical. After all, the most humane physicians—like a Dr. Gold—tend to be humane people to begin with.

Nonetheless, basic fluency in the human dimensions of patient care, e.g. respectful attentiveness and a genuine commitment to a patient's welfare, can and must be instilled throughout training. It happens not in the classroom, of course, but, ideally, on the wards and in clinics under the watchful mentorship of seasoned physicians.

The fledgling medical students I observed will soon lose their innocence, naturally. Yet the policy climate that greets them will put the prospect of rich doctor-patient relationships under further strain.

The new Affordable Care Act, for example, will require hours of detailed coding and notes to justify billing, siphoning even more time away from patients. Guideline-driven care, depending upon how rigidly it is enforced, may well put physicians in the position of pressuring patients to accept certain treatments, irrespective of their choice.

Juggling the timeless injunction to all doctors—be a mensch—with concepts like "Medicare metrics" and "standardization," (the new watchwords in health reform) will make it even harder for the newly coated students to become the kind of doctors that they themselves would like to have. An induction ritual acknowledging as much wouldn't hurt.

Dr. Satel, a psychiatrist, is a resident scholar at the American Enterprise Institute and a lecturer at Yale University School of Medicine.

Should doctors talk about religion with patients?

2010-09-19T21:11:00.000-07:00

Doctors should follow the patient's lead when it comes to discussing religion. A large percentage of the population have faith and religious beliefs. They look to God for their strength and ability to overcome the seemingly impossible. Believers are comforted by God and His word. While a doctor should not question their patient's particular beliefs or attempt to impose his own on them, general discussion and shared prayers can help the patient.

Not all religious people will want to discuss their faith with a doctor. Some may feel that it is inappropriate since the doctor is there to care for their physical health, not their spiritual well being. Some may disagree with the doctor's beliefs and not care to hear what he has to say. Still others regard their faith as something very private and they do not want to discuss it with anyone.

Non believers, of course, will not appreciate a doctor talking to them about religious matters that they do not believe in. Doing so is very off putting for the patient with no faith in a higher Being. They may see the conversation as a means for the doctor to "force" religion on them and react in a hostile manner. Non believers sometimes view believers with distrust or lacking credibility. That is not the type of relationship a doctor wants to create with his or her patient.

There are no hard and fast rules pertaining to whether or not a doctor should discuss religion with his or her patients. There are hospitals and other medical facilities that do discourage the staff from talking about religion with the patients. If an establishment that he or she works at has rules stating that religious subjects are off limits the doctor would of course need to abide by this, or risk termination.

Given the right conditions and circumstances speaking about religious issues can be very beneficial. Not just for the patient, but the doctor as well! The patient will likely be calmer and more optimistic about his or her prognosis when God is brought into the situation. This, in turn, gives the doctor a patient who is cooperative and willing to be proactive about their health which makes it easier to provide them with care.

Religion is a controversial subject these days. Many non believers are trying to push God out of schools, government buildings and everywhere else that they can. It is little wonder that a doctor would be cautious about discussing Him with a patient. By using common sense and following the patient's lead a doctor can determine if the subject is appropriate.

Indian doctor makes calculating time of deliveries easy

2010-09-19T21:08:00.001-07:00

VARANASI: How about referring to a paperless partogram for monitoring the progress of labour and arriving at an accurate decision for intervention to ensure safe delivery?

While the WHO recommended partogram, used extensively by obstetricians and gynaecologists in the world, has proved to be complex and cumbersome requiring a lot of paperwork, the one devised by an Indian doctor has made the task easy and simple so that even an auxiliary nursing midwife (ANM) can ensure safe delivery.

"We call it Indian partogram that gives instant results and is now successfully used in the country," said former president of Indian Society of Perinatology and Reproductive Biology (ISOPARB) AK Debdas while talking to TOI on Sunday. "We have coined the new formula that makes easy and simple application of Friedman formula that has been used since 1972 in the world. It not only reduces the hassles of paperwork but also ensures safe delivery with precise and timely intervention," claimed the man from Jamshedpur, who was in the city to participate in a CME and general body meeting of ISOPARB.

Saying that earlier partogram (recommended by WHO) had been made complex and cumbersome over a period of time, the mastermind behind the Indian partogram emphasised that the technique still used the 'Golden Friedman Formula' but with easy and simple application and interpretation. "We look for openings and dilation of cervix at 4cm and then expected time of delivery (ETD) is calculated using the Friedman formula that records rate of dilation at one cm per hour. After 10 cm dilation, or six hours of ETD, the period of alert ETD starts and it the time where 75 per cent of delivery takes place. We add four hours to make it action ETD and the time limit ensures accurate intervention for safe delivery," he informed.

It may be mentioned that Dr Debdas has also presented the paper on paperless partogram in a recent international conference at Pune and is all set to present it at the forthcoming National Association of Reproductive and Health in India, a national conference to be held in Nagpur on September 25 this year.

"The paperless partogram has received encouraging response particularly in Indian context and doctors have also found it simple and easy to use, not bothering about complex curves and graphs to record developments during labour," he said, highlighting the advantages of the technique. "Even, doctors working in shifts can easily look at ETD and plan the deliveries accordingly," he added.

Family Doctor: Calcium, vitamin D keys to treating osteoporosis

2010-09-19T10:52:00.001-07:00

Q: I have been diagnosed with osteoporosis and am presently taking two calcium tablets and one multivitamin for mature adults. Would this help my condition?

A: Osteoporosis occurs when the normal buildup and breakdown of minerals in healthy bones falls out of balance. The condition is difficult to detect in its early stages, but the first clue is often a bone fracture, loss of height, back pain, stooped shoulders or through a routine bone density (X-ray) study.

There are a number of prescription medications; however, as you may be aware, several can lead to osteonecrosis of the jaw and other serious complications.

The recommendation for people 51 and older is 1,200 milligrams of calcium per day. Vitamin D is of equal importance in order to utilize the calcium and should not exceed 2,000 IU daily for healthy people. Therefore, in answer to your question, it all depends on how much calcium and D is present in the vitamin regimen you are taking. Read the ingredient label. If necessary, switch to combinations of calcium and D available at your local pharmacy in single-tablet form.

Beyond that, don’t smoke, avoid alcohol, maintain good posture, eat well and exercise.

Woman in a bind after losing her bra

2010-09-19T06:35:00.000-07:00

Woman typically changes clothes while waiting at her chiropractor's office.

DEAR ABBY: A most embarrassing thing happened to me at my chiropractor's office. I see him before going to the gym, and I change into my gym clothes in the waiting area restroom. It's easier for my doctor to treat me when I'm not in my office attire.

After completing my workout, I realized my bra hadn't made it into my gym bag and must still be on the doctor's restroom floor. I'm embarrassed for two reasons: He is single and handsome and I don't want him to think I'm trying to send him a "signal” of some kind, and it was my favorite bra!
What can I do?
"Debbie” in Dallas

DEAR "DEBBIE”: Your bra may be gone, but I'm here to support you. Please stop feeling embarrassed. It's entirely possible that your chiropractor never saw the bra. Call the person who schedules your doctor's appointments, explain what happened and ask if the item was turned in. If it was, collect it when you go in for your next appointment or ask that it be sent to you.

DEAR ABBY: I reconnected with "Andy,” a former high school classmate, and we started a relationship. Because of his actions last year, the relationship ended. It started again several months ago. It's on the right track now.
Andy is a great guy who fulfills almost everything I am looking for. He accepts me for who I am and doesn't judge me. He's polite and cares about me.
My problem: I'm not physically attracted to him. If he's "almost” everything I'm looking for, why am I not attracted to him? Am I blowing it with the one guy I'm supposed to be with, or is there someone else for me?
Confused
in Connecticut

DEAR CONFUSED: I wish you had mentioned what caused your breakup last year. If the reason you're not physically attracted to Andy is something he can change, you should talk to him about it. If it's nothing you can put your finger on, then talk with a counselor to see if the problem could be a fear of commitment on your part. But if it is neither, then face it: You need to let him find someone who is attracted to him. To marry someone feeling as you do would be dishonest and cheat you both out of a full and happy union.

DEAR ABBY: I have been seeing a guy, "Bill,” who I believe is my soul mate. We have discussed our future and decided that after college, we will have four kids. We love each other, and we're trying to wait until we're married to have sex. I talked to my parents about it, and Mom offered to put me on the pill.

I don't see any reason not to make love, other than I always thought I'd wait until my honeymoon. Bill isn't pressuring me, either. I'm afraid that if we do, it will complicate our relationship. I guess now I'm looking for reasons not to, because I don't have any. Is it wrong for me to want this?
In Love in Washington

DEAR IN LOVE: I don't think so. You're an idealistic young woman who would like to give her husband a gift on her wedding night that can be given only once. It takes self-control, discipline and determination to accomplish that, particularly with the emphasis on sex in popular culture. If you wait to have sex until you are married, you never will regret it. If you don't, you might. Hang in there until you're sure you're ready or you've said "I do.”

DOCTOR'S ADVICE - My Fiancé's Not Interested In Sex

2010-09-19T06:32:00.000-07:00

Q. Doctor, could you give me advice as to what I should do about my fiancé? We have been engaged for three months, and we have a wedding date for early next year. However, our sex life is currently at zero! We used to have sex a lot and I enjoyed it very much. But over the last 10 or 12 weeks, he seems to have totally lost interest in my body. I asked him if there was anything wrong with his sex drive, and he told me no. In fact, he has admitted to me that he masturbates around four times for the week, and sometimes more than that. What is going on? Is there some way I can rekindle his sexual appetite for me?

A. I have encountered this situation with couples before, where the man suddenly withdraws. In this case, it seems to have started at about the time that you got engaged.

I am afraid you may not like what I am going to say. This pattern of behaviour usually suggests that, deep down, this man no longer wants to continue with the relationship. So his mind tells him to stop having sex with his female partner. And he turns to self-stimulation instead.

There is one other possibility. Occasionally, a man behaves like that because he has suddenly 'lost his nature'. In order to hide this from his partner, he stops making sexual advances towards her. But in order to reassure himself about his virility, he resorts to regular masturbation.

I fear that what is really going on is that your man no longer wants to continue the engagement, and does not wish to go ahead with the marriage. Please prepare yourself for that.

All you can do now is to tell him that the two of you must sit down and talk things over, as soon as possible. In the meantime, do not get yourself involved in any unnecessary expenditure for the wedding - because there is a high possibility that it will not happen. Sorry.

Q. I am a 26-year-old man and I think I have a lump in my testicle. I wondered if it could be cancer, but my friends say that I am too young for that.

A. Your friends are wrong. Cancer of the testicle is unlike most other malignancies, because the peak age for it is quite young. The majority of men who get it are in their mid-20s. You must see a doctor immediately. He will probably arrange an ultrasound for you, so that the exact nature of this lump can be established.

Q. My husband and I are both 45, and we seem to have a pretty good sex life. But in your medical opinion, Doctor, how often should a couple our age be making love?

A. Well, there are no medical rules about this. Couples should make love as often as they want to. However, extensive research in the United States has shown that on average, couples who are in their mid-40s usually have sex just under twice per week.

Q. I am a 37-year-old woman with two children, aged 16 and eight. Since 2005, I have been trying to get pregnant again, but to no avail. So I went to doctor and had some tests done. The results came back as bilateral tubal obstruction. When I look back at my life, I recall that some years ago I had an infection that took three years to clear up. Then finally I went to a gynaecologist and he cured it. It never came back, thank God. So I have some questions: Am I infertile? Based on what I have told you, do you think I can ever get pregnant again? If so, what can I do to get pregnant now?

A. Well, your tests have shown that you have bilateral tubal obstruction. This means that both of your Fallopian tubes are blocked. If the blockage is complete, your eggs cannot get through from your ovaries to your womb. That is a common situation.

However, there is just a chance that the blockage is not complete, and that an egg could somehow find its way through. Sadly, that is not very likely. In most cases, the blockage occurs because the woman had an infection earlier in her life, and the germs attacked her tubes.

In your case, it is certainly possible that the infection, which went on for three years, was the one that blocked your tubes. But there is no way of proving that. Certainly, the blockage must have occurred after your younger child was born, because your tubes could not have been blocked at that time.

You probably are infertile, as it seems that your Fallopian tubes are blocked. Second, you can become pregnant again. Something can be done about your tubal blockage. And finally, you should go back to your gynaecologist and ask him if he can do something to unblock your tubes. Sometimes it is possible to unblock the Fallopian tubes by surgery, though that is difficult.

If surgery cannot solve your problem, the only other solution would be to have the 'test-tube baby' technique, also known as 'in vitro fertilisation', or IVF. Good luck.

Q. My husband wants me to watch porn with him on his computer. Should I agree?

A. Only if you really want to. Unlike men, many women do not find it very romantic to look at sex on a computer screen.

Q. I am convinced that my wife has been unfaithful with a younger man. You see, Doctor, I found sperm stains on her night-dress. Could a doctor check these to find out if they were mine?

A. No. However, if you search on the Internet, you can find firms who would test these stains for you, to see if they contain your DNA or someone else's. But this would cost a lot and probably cause trouble in your marriage. Frankly, I feel you would do better to persuade your wife to visit a marriage counsellor. It will cost a great deal less.

Q. I have just developed a candida infection. Does this mean my husband has been unfaithful?

A. No. Candida is not a venereal disease.

Patients 'at grave risk' from poorly trained doctors

2010-09-19T06:23:00.000-07:00

Confidential documents reveal 'inadequately skilled temporary staff left to treat patients'

By Nina Lakhani

One of Britain's largest NHS trusts is at the centre of "grave" safety concerns after confidential documents revealed inadequately skilled temporary doctors were being left to treat critically ill patients.

The London Deanery, which oversees the training of qualified doctors, is threatening to withdraw all trainee anaesthetists from Queen Elizabeth Hospital (QEH) because of "major patient-safety concerns".

The threat follows a confidential report which revealed that junior and locum (temporary) doctors are routinely left to deal with patients unsupervised, at times working 36-hour stretches because of a shortage of consultants. The damning report, seen by The Independent on Sunday, says junior doctors felt pressured into undertaking activities "beyond their competence" and were not being properly trained. Complaints of bullying were also common.

Threatening to withdraw trainee doctors is a rare and drastic measure as it would leave the QEH unable to function properly. Anaesthetists are essential for a wide variety of operations and procedures and withdrawal could lead to hundreds of operations being cancelled and delayed.

The London Deanery report, following complaints from trainees, found overseas locum doctors unfamiliar with NHS anaesthetic equipment and procedures being employed without any induction or vetting.

"There appeared to be no individual vetting for locums; some were clearly out of their depth clinically and were completely unsuited to the demands of the post they were covering," the report said. The Deanery is demanding South London NHS Healthcare Trust make extensive improvements by the end of October.

Doctors insist the trust management was "fully aware" of problems for more than a year but took no action.

The latest revelation comes after the trust was referred to the regulator by the local MP, Home Office minister James Brokenshire. Mr Brokenshire said a number of consultants came to him in confidence to report widespread equipment shortages and failing safety standards. As a result investigators from the Care Quality Commission (CQC) watchdog are now believed to be investigating. The CQC refused to comment.

Katherine Murphy, of the Patients Association, warned yesterday the situation had "Dr Ubani written all over it" – a reference to Dr Daniel Ubani, a German out-of-hours locum doctor who killed a British patient in 2008 by prescribing a fatal dose of painkillers during his first NHS shift. She urged the CQC to take a more hands-on approach to patient safety and hold managers to account. Morale among staff is reported to be "very low" as the trust tries to reduce a £35m deficit by downgrading nursing posts, closing wards and cutting back on equipment.

An internal review of another of the trust's hospitals, Queen Mary's in Sidcup, is under way amid fears that it is not fit to cope with the imminent winter pressures. Plans to close its A&E and maternity department have been put on hold after the Secretary of State for Health, Andrew Lansley, ordered the review.

Dr Roger Smith, the trust's medical director, said: "The trust is fully aware of the issues around training junior doctors. We have already taken significant steps to improve the situation, started a round of consultant recruitment and have moved experienced consultants to help."

Doctor Faustus

2010-09-19T06:21:00.001-07:00

Clare Brennan

Like the text itself, this production is a hotchpotch of silliness, crude humour and sublimity. There are two versions of the original Doctor Faustus, handily known as A and B, and nobody is quite sure how much of either is actually by Christopher Marlowe (contemporary of Shakespeare and early victim of knife crime in Deptford). Director Toby Frow has opted for the longer, more knockabout B and fills it with stage trickeries of giant puppets, zombie-like devils (à la Michael Jackson's "Thriller"), a pantomime-boy-style Lucifer (Gwendoline Christie dropping in from the flies) and a Monty Pythonesque papal court (cackling cardinals and self-pleasuring pontiff). Damnation isn't what it used to be, though, and, for much of the time, this tale of the scholar who sold his soul to the devil for 24 years of wishes granted has the spiritual depth of a Doctor Who Christmas special. However, what all these shenanigans build up to is a truly magnificent and profoundly affecting ending when Patrick O'Kane's desperate Faust, confronting death alone, finally appreciates how thoroughly the banalities of evil have eroded his soul.

Doctor, beauty queen support Tibet cause with blood

2010-09-19T06:19:00.000-07:00

An ayurvedic doctor who claims to have saved the lives of 38 persons with timely blood donation on Friday supported the campaign of Tibetans for their homeland by smearing the precious drops on a poster of the Chinese president.

Accompanying Dr Mahesh Yadav was Miss Himachal, Purva Rana, lending her support to the issue.
'' Tibet has been under Chinese rule for a long time and I am fighting to free it. I am doing this for India's security and for the sake of humanity. The way Tibetans have been treated is unfair and it is about time they got justice,'' said Yadav.

The beauty queen said, ''I am from Dharamshala and can see how Tibetan people feel shattered by what the Chinese have done. I wanted to help them and that's why I am here.''

At a protest held in Sector 15 on Saturday, Yadav smeared his blood on the poster of Chinese president Hu Jintao as a sign of protest. This is not the first time he has used his blood to agitate.

''I have been campaigning for Tibet for nearly 14 years and have made several portraits of freedom fighters from India and abroad with my blood. I have been to almost all the cities in the country and recently finished my protest in Dharamshala. I am follower of Mahatma Gandhi and Nelson Mandela and want to do for Tibet what they did for their countries,'' he said. On being asked why he used blood as a sign of protest when Gandhi and Nelson believed in non-violence, he replied, ''I have been part of human rights campaigns for a very long time. I have saved 38 lives by donating blood and am trying to save thousands of lives in Tibet by using my blood to make portraits.''

Tibetan students were also present to extend their support. ''I want to do something for my people in Tibet. They have suffered a lot and I believe this campaign can help them,'' said Tenzin Dolma, a first-year student of computer science from Panjab University.

Phunsook Dorjee, a first-year BA student from the varsity, expressed similar views. ''I am very touched by what Yadav and Rana are doing even though they are not Tibetan. My people require all the help they can get,'' Dorjee said.

A signature campaign for a petition requesting the UN to declare China as a terrorist state was also part of the protest. Yadav and Rana plan on going to Delhi soon.

Serbian Doctor “Cures” Homosexuality!?

2010-09-19T06:12:00.000-07:00

BY Ljubica Vujadinovic

While the authorities struggle to assure the safety for the participants of the Belgrade Gay Pride scheduled for October 10, the Serbian doctor Miroljub Petrovic announced his clinic for the treatment of the homosexuality is just about to be opened.

“There are a few levels in the treatment of homosexuality. The first one is informative. We are trying to explain our patients that the sexual drive is fostered in our minds, and that the sexual intercourse is not a physiological need…” Petrovic said to Serbian dailyAlo.

A year ago, he opened a centre for the treatment of homosexuality, which he perceives as a “serious psychiatric illness that comes as a consequence of unhealthy life style, bad education and use of narcotics.” Accordingly, he had treated 20 patients so far.

Years ago, the American Psychiatric Association's board stated the treatment aimed solely at turning gays into heterosexuals can cause depression, anxiety and self-destructive behavior.

In the meantime, Petrovic also leads the Center for Natural Studies. Since his education seems to have majored in the field of geology, many question his medical competencies. But his biography states Petrovic is actually a graduate of the American International Institute of Original Medicine.

His latest public statements have caused mass outrage amongst the Serbian gay and lesbian organizations.

In a letter of protest, they have invited Health Minister Tomica Milosavljevic to start an investigation in the work of Petrovic’s centre and clinic, asking if the Health Ministry actually provided his practice with the permission for work.

“We invite you to make a public statement that homosexuality is not an illness”, the letter read, reminding the results of the latest research have shown that 67% of Serbian citizens perceive homosexuality as sickness.

Doctor 'report cards' not last word on performance

2010-09-19T06:10:00.001-07:00

By Robert Preidt, HealthDay

Public information about U.S. doctors' education, certification and malpractice claims may not be enough to help patients determine whether a physician provides high-quality care, a new study suggests.

"To improve the quality of care received by their beneficiaries, some health plans use physician report cards and tiered physician networks to steer their members towards physicians who provide high-quality care. However, most patients do not have access to physician quality measures," wrote Rachel O. Reid, of the University of Pittsburgh and colleagues.

"Patients are therefore encouraged to use publicly available proxies for clinical performance when choosing a physician. The Agency for Healthcare Research and Quality advises patients to consult state medical boards and to seek information on board certification and training as a way to assess the quality of care physicians provide."

In this study, the researchers analyzed claims 2004-05 data from 1.13 million adult patients to calculate performance scores of 10,408 Massachusetts physicians. They then gathered information about the same doctors from the Massachusetts Board of Registration in Medicine.

They found that higher performance scores were associated with three characteristics: being female, board certification, and graduation from a domestic medical school. However, the researchers said there's little evidence to suggest that a patient would consistently receive better quality care by having a doctor with these three characteristics, noting that the average difference in performance scores for a male, non-certified and internationally trained physician was only 5.9%.

They also said they found no significant association between malpractice claims and performance score. This suggests that malpractice claims may have more to do with a physician's communication style and other attributes rather than negligent care.

"In conclusion, we found that individual physician characteristics are poor proxies for performance on clinical quality measures and are not well suited for use as such by patients," the researchers wrote. "Public reporting of individual physician quality data may provide the consumer with more valuable guidance when seeking providers of high-quality health care."