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It is not easy for anyone to become ill and be at the mercy of doctors, but what about doctors themselves? How do they react to being on the other side of stethoscope? In When Doctors Become Patients Robert Klitzman, Associate Professor of Clinical Psychiatry at Columbia University, looks at what the experience is like for doctors who become sick, and what it can teach us about our current health care system and more broadly, the experience of being ill. In the excerpt below Klitzman explores how doctors go about researching their own diseases and how this research seems more disheartening once they have become part of the statistics.

‘‘We know very little,’’ Roxanne, the gastroenterologist, said, referring to the medical literature on the causes of cancer. As suggested above, once ill, many of these physicians came to reassess the role of research in individual medical decisions, and became more critical in their evaluations of research as a whole. Roxanne, for example, became more sensitive to the elusiveness of ‘‘the truth,’’ no longer thinking there was just one answer. ‘‘People base things on the literature and on one paper that’s not been duplicated. I’m skeptical. There’s a lot of literature, but also fashions—things used in the past. Now we’re into other treatment approaches. We can’t cure anything.’’ Indeed, these ill physicians appeared previously to have paid little heed to the implications of this pattern. (more…)

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Earlier today we introduced you to The Bedside Dysmorphologist: Classic Clinical Signs in Human Malformation Syndromes and their Diagnostic Significance, by William Reardon. Dysmorphology is the study of congenital malformations. This afternoon we have another helpful excerpt, about persistent drooling.

Recognizing the Sign This hardly requires any clinical expertise, but a good history can inform the examination and investigation. The neonatal feeding history will often be of a poor feeding pattern, perhaps requiring nasogastric supplementation. Establish whether there was macroglossia at birth, cleft palate, or micrognathia. Was there any suggestion of velopharygeal incompetence on feeding, often represented by nasal regurgitation of milk during feeding? Gauge the progress of the child with respect to perceptive and expressive speech. (more…)

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Earlier today we posted an article about Deep Brain Stimulation inspired by a 38-year old patient that regained consciousness. Below is an excerpt from Plum and Posner’s Diagnosis of Stupor and Coma 4th edition,  to help you further understand how miraculous Deep Brain Stimulation is.

Consciousness is the state of full awareness of the self and one’s relationship to the environment. Clinically, the level of consciousness of a patient is defined operationally at the bedside by the responses of the patient to the examiner. It is clear from this definition that it is possible for a patient to be conscious yet not responsive to the examiner, for example, if the patient lacks sensory inputs, is paralyzed, or for psychologic reason decides not to respond. Thus, the determination of the state of consciousness can be a technically challenging exercise. In the definitions that follow, we assume that the patient is not unresponsive due to sensory or motor impairment or psychiatric disease. (more…)

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Rebecca OUP-US

Scleroderma is a rare chronic disease that manifests in many parts of the body making treatment particuarly difficult. Below, Maureen D. Mayes, M.D., author of The Scleroderma Book: A Guide For Patients and Families advises patients on how to navigate towards health while coordinating so many doctors. June is National Scleroderma Awareness Month, to get involved visit the foundation’s website.

(more…)

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