I have been doing yearly wellness exams for the local fire fighters for many years now. I quite enjoy it. Many of them are in such good physical shape that I pronounce them to be “Mary Poppins” fire fighters, meaning “Practically Perfect in Every Way!” Many, however, succumb as they get older to the “weight creep” that is common in the US today. I saw one such firefighter this very week who had gained 8 pounds since I saw him last year. In such cases, I have to educate the patient about the Medical Consequences of Excess Weight. There is even a medical term for this phenomenon: ”Metabolic Syndrome.” I think that just about everyone, whether a firefighter, an inmate in a prison or jail, or the medical staff that takes care of them, should understand Metabolic Syndrome. Continue reading
I ran across a couple of interesting articles about antibiotics recently.
In the first article, entitled We Will Soon Be in a Post-Antibiotic Era, CDC researchers predict that the end of the antibiotic era is coming quickly. Antibiotic resistance is developing so rapidly now, that it is only a matter of time until antibiotics just don’t work anymore. This actually is not surprising when you think about it. If we kill all of the microbes that can be killed by our antibiotics, then of course the only ones left will be those that cannot be killed by antibiotics, in other words, that are resistant. The fact that this will happen eventually is a no-brainer. Continue reading
My good friend Al Cichon in Maine writes:
As health care providers we are trained to be tolerant when patients are less than pleasant – excusing their behavior as a result of their illness / injury. Certainly there are occasions when this is appropriate. However, that tolerance can be abused in the correctional setting. Continue reading
I ran across a quite good article the other day entitled A Powerful Tool in the Doctor’s Toolkit written by Dr. Danielle Ofri. It was about how the placebo effect is underappreciated in medicine. Far from being an esoteric “Gee-Whiz!” phenomenon, the placebo effect and its counterpart, the nocebo effect, are things we can use to our advantage in almost every clinical encounter. Continue reading
Hey Jeff, like you I am an ER doc and am the Medical Director of a 550 bed jail. I would like you thoughts on body cavity searches. We had a case last week where an inmate was seen putting a baggy in his rectum. A search warrant was issued and the inmate was sent to the ER for a body cavity search. The inmate refused to let the ER personal touch him. He told the ER doc that it was a baggy of tobacco. The ER observed him for several hours and sent him back to the jail. No cavity search was done. The ER doc felt she would have to sedate the inmate to do the search and felt uncomfortable doing this against his will. The NCCHC frowns on the jail medical providers doing evidence related procedures or searches. My policy is to do the searches if the inmate will sign an informed consent and allow it to be done. If the inmate were to have a complication of sedation or the removal procedure that was done against his will, I would think a malpractice claim could be supported. How do you handle these types of situations in your jail? Thanks, BJF Continue reading
I am curious to see how other jails/prison handle fasting during Ramadan. We only KOP inhalers and creams at my facility and have no medical commissary. We do a very early medication pass for those who are fasting, but it does cause occasional problems with the management of diabetics and some other chronically ill patients. How do other facilities handle this?
Thanks, Jill McNamara Continue reading
If you have read the title of today’s blog post, you already know the answer to today’s case. The answer is “Lithium Toxicity.” I could have instead presented a “Can you figure this case out?” type of format. But I did not want to do that because, really, what was causing this particular patient’s symptoms is not obvious, especially early on. This is an introspective learning case. I want you to read the case knowing the answer. The answer is “Lithium Toxicity.” As you read this case presentation, I want you to ask yourself when the possibility of lithium toxicity would have first entered your head and when you would have stopped this patient’s lithium? Continue reading
Your patient is a 29-year old male who presents to the medical clinic stating that he has been having a feeling of a racing heart off-and-on for the last couple of months. It comes and goes, maybe two or three episodes a week. They only last a few minutes. He feels odd when this happens but he does not have to stop his activities. He has noticed no pattern to these; they have happened at work (he is an inmate worker), in the middle of the night and every time in between.
His physical exam is normal including blood pressure of 124/78, regular heart rate of 68 and normal heart sounds.
What do you think is going on? Would you order any tests? Continue reading
My friend Al Cichon recently asked the following questions:
I have been asked when I would not approve an existing prescription – non-compliance (over / under); diagnostic mismatch (extreme example anti-viral for bacterial infection); – can you think of others? Continue reading
Imagine that you are a healthcare provider in a jail medical clinic. One of the jail nurses comes to you and says “Will you call me in a prescription for my hypertension meds? I have no more refills and my doctor charges $100.00 for a visit just to get more!” Or perhaps it is a detention deputy who asks, “Can I get a few Ambien from you? This shift work kills me and I need them occasionally.” Or “Can I get some Augmentin? I have Bronchitis.”