Monthly Archives: April 2012

Review Articles of the Month–Emphasis Psychiatry

Like most physicians, I subscribe to several medical education and CME sites.  One of my favorites is Primary Care Medical Abstracts.  PCMA chooses 30 papers a month of interest to primary care physicians and then these papers are reviewed by two physicians (usually Rick Bukata and Jerry Hoffman).  The reviews are insightful and funny and pretty fun to listen to.  These guys have no problem calling B.S. when they review certain papers.  I like that!  (By the way, I have no affiliation with PCMA). Continue reading

The Proper Way to Document Study Results!

Inappropriate! Someone needs to be flogged!

So let’s say you order a lab test on a patient.  Or an X-ray.  Or let’s say you order old records.  When the results are returned to you, how do you document this?  What I have often seen is the practitioner documenting by initialing and dating the hard copy, as has been done on the lab order in the picture.  I see this commonly.

But this is poor medical practice.  Notice on the lab report that there is a critical lab abnormality.  Did the practitioner who initialed the lab report see this?  What does it mean?  What is he going to do about it?  Initials and date tell you nothing, other than the practitioner actually held the lab slip. Continue reading

Embracing the Placebo Effect of Antidepressants.

Social Worker Shanna at work in the Ada County Jail Boise, Idaho

I recently ran across this interesting article (found here) which is the latest in a long series over the years comparing antidepressant efficacy to placebos.  I know that this is a controversial subject with some believing that all (or most) of antidepressant effect is placebo effect and others believing that antidepressants do indeed work better than placebos, especially among the most severely depressed patients.  The researchers in this article did a review of several trials and concluded that antidepressants work better than placebo in those with mild and moderate depression.  The most interesting statistic from this paper in my mind is this:  in this, the most positive analysis that I have read  on the effect of antidepressants, the “Number Needed to Treat” (NNT) to have one patient do better than by placebo alone was five (5).  In other words, 4 out of 5 patients in this study got no benefit from the antidepressant over placebo. Continue reading

The Concept of a “Hypertensive Urgency” is a Myth

One of my nurses called me recently worried about a patient’s blood pressure.  The patient had just recently arrived at the jail and had no complaints, but when his blood pressure was measured, it was 230/120.  The patient otherwise felt fine and had no complaints, but the nurse was concerned that the blood pressure was dangerously high and we needed to give the patient something to get this blood pressure down right away.  My nurse had been taught that such patients had a “Hypertensive Urgency” and needed to be given a medication that would immediately lower their blood pressure. Continue reading

What Makes Correctional Medicine Different?

Correctional Nurse Kim. She can say "No."

I recently read my friend Lorry Schoenley’s excellent article on Correctional Nursing is Different–Research Report which is about the differences between correctional medicine and traditional community medicine. Coincidentally, I also found myself at about the same time hiring a new full-time Physician Assistant with no correctional experience and having to explain how important these differences are.   If you do not recognize and embrace these differences, you can get yourself and your patients into serious trouble.  In this article, I am going to point out some of the important differences between correctional medicine and what I am going to call  “Outside Medicine.” Continue reading

Diabetic Snacks: Part Two!

Full Service Prison Cafeteria

In my previous post on Rethinking Diabetic Snacks for Type 2 Diabetics, I mentioned that there are two theoretical justifications for the practice or prescribing bedtime snacks for type 2 diabetics.  I would like to expound on these two issues here and also comment on another issue that I failed to mention in the first article but that is important:  the non-medical security issues of having diabetic snacks.

Myth:  Four Meals are Better than Three for Type 2 Diabetics

The first justification for diabetic snacks is the idea that if Type 2 diabetics eat several small meals rather than 3 big meals, there will be more even absorption of calories and carbs.  This would cause smaller blood sugar spikes at meals.  In other words, four meals (counting the bedtime snack) is better than three meals. Continue reading

Constipation Case: What Would You Do?

Constipated?

I am looking for some feedback here.  How would you manage this case?

A patient in her early 30s states that she has taken a Dulcolax tablet daily for over ten years.  She states she spent most of that time in correctional facilities but never had any problem receiving an order for daily Dulcolax.  She was out of jail for a time and continued to take OTC Dulcolax.  She reports no abdominal work ups.  Her only surgery was an appendectomy.  Her only other medical problem is episodic asthma.  Her physical exam is normal.

She now has arrived at one of my jails and wants me to continue her daily Dulcolax prescription.  Should I?  Here is my thought process: Continue reading