Monday, March 23, 2009

Cost? depends on who's counting

Much in the business of medicine is made of the "cost effectiveness" of a treatment. A recent example is Gardicil, the new vaccine that provides immunity against four strains of the HPV or human papilloma virus. Two strains are responsible for about 70 % of cervical cancer and the other are responsible for about 90 % of genital warts.

I have heard many arguments against the vaccine. Some of them have been from mothers who tell me that their daughters will never have sex until they are wed. To them I simply ask if they can be that sure about their future son-in-law. A few of the arguments come from physicians who say that the number of cases of cervical cancer that will be prevented is not that great while the cost of the vaccine is tremendous. To those physicians, who I might add, are not gynecologist, I reply they must not be aware of all the time and money spent on the precancerous problems. Preventing even the agony and the fear that patients experience after being told that they have a virus that potentially could cause cancer seems worth the price.

Today I saw a 34 year old with cervical cancer. I also saw a 17 year old with genital warts. I can't help but believe that both of these could be prevented by proper education, safer sexual practices, and in the case of the 17 year old possibly by Gardicil.

One treatment that receives a great deal of advertising dollars are the medications for male erectile dysfunction. I have never heard any cost effectiveness discussions where these medications are concerned. Also much has been made of the safety of these medications as many of the patients who need them also have heart disease.

Conclusion: It is easy to see that the cost depends on who is doing the counting.
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Wednesday, March 18, 2009

Real time

Most of the posts in this blog have to do with things that have happened in the past. At 3:06 am or zero three hundred hours on this shift as an OB hospitalist, I am posting in real time. I can't sleep even though things are quiet at the moment because the housekeeping crew has decided tonight is the night that they will wax the floors in the on call area. I wonder if this happens on the same day every month? Maybe I can negotiate that day out of my contract.

This is a new phase in my career. I am going to be working as a hospitalist nine to twelve days a month. So far so good. There are several potential disasters but all is quiet. It is like being a resident again with no staff to back me up. I am also the staff physician for the resident clinic. I have done deliveries, staffed residents on their deliveries, taken care of many mundane health problem, seen one extremely interesting case unlike anything I have ever seen before, and the only problem is this noise induced insomnia. Well, that and I am still a bit nervous about what might happen.
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Friday, March 13, 2009

It's the truth

This story should come under a title like: How do you make this stuff up? The truth is I couldn't if I tried.

Phone call with the nurse, "I need to come in for some blood tests. I have been dieting and exercising and I just can't lose any weight." The nurse said there were sniffs and she felt the patient was about to cry.

I called the patient back. "What kind of blood work do you think you need? What kind of symptoms are you having," I ask.

"Well, I am having trouble with my hormones. I think they are out of balance because I can't loose weight, " my patient replies.

Trying harder to figure this out I continue, "Are your menstrual periods regular? Are you having any hot flashes or night sweats?"

"No," my patient continues slowly. "The worst thing is that I get dizzy when I eat cake and ice cream."

I am glad we were on the telephone.
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