Tuesday, October 6, 2015
Sunday, January 18, 2015
This child is experiencing simple breath holding spells, a relatively common and benign condition that usually begins in children between the ages of 6 months and 6 years. The cause is uncertain but seems to be related to overactivity of the autonomic nervous system in association with emotions such as fear, anger, and frustration. The episodes are self limited and may be associated with pallor, cyanosis, and loss of conciousness if prolonged. There may be an association with iron deficiency anemia, but this child had a recent normal hemoglobin level.
These events are not volitional, so disciplinary methods are neither effective nor warranted. While children may experience a loss of consciousness and even exhibit some twitching behavior, the episodes are not seizures so neither EEG evaluation nor anticonvulsant therapy is indicated. No additional laboratory studies are indicated. Parents should be reassured that the episodes are benign and will resolve without treatment.
Ref: Rudolph CD, Rudolph AM, Lister G, et al (eds): Rudolph's Pediatrics, ed 22. McGraw Hill, 2011, p 2223.
These events are not volitional, so disciplinary methods are neither effective nor warranted. While children may experience a loss of consciousness and even exhibit some twitching behavior, the episodes are not seizures so neither EEG evaluation nor anticonvulsant therapy is indicated. No additional laboratory studies are indicated. Parents should be reassured that the episodes are benign and will resolve without treatment.
Ref: Rudolph CD, Rudolph AM, Lister G, et al (eds): Rudolph's Pediatrics, ed 22. McGraw Hill, 2011, p 2223.
Tuesday, January 13, 2015
Lets start with smoking .....
Tobacco use is a major preventable cause of premature death and disease worldwide. Approximately 6 million deaths related to tobacco use occur each year, including 600,000 from secondhand smoke. In the United States, an estimated 45.3 million people – about one in five adults – currently smoke, and an estimated 443,000 people die prematurely from diseases caused by smoking or secondhand smoke exposure.
CDC has identified reducing tobacco use as a Winnable Battle. With additional effort and support for evidence-based, cost-effective strategies that we can implement now, we will have a significant impact on our nation's health.
There is some evidence, at least anecdotally, that smoking is related to an increased risk in suicide... (those old "coffin nails"... but no one disagrees smoking is bad for you...not really.....
How about alcohol?.... of course, more serious impact with over-drinking, but even..."moderate alcohol intake ...is associated with increased risk of breast cancer, violence, drowning, and injuries from falls and motor vehicle crashes."
and alcohol has been linked, at least anecdotally (? sp), to depression and suicide...
" Alcohol and drug abuse are second
only to depression and other mood disorders as
the most frequent risk factors for suicidal behavior
(2, 3). Alcohol and some drugs can result in a loss
of inhibition, may increase impulsive behavior,
can lead to changes in the brain that result in
depression over time, and can be disruptive to
relationships—resulting in alienation and a loss
of social connection (4). Furthermore, excessive
acute drug and/or alcohol ingestion could result in
death. According to data from a recent National
Violent Death Reporting System (NVDRS) report,
in 2007 alcohol was a factor in approximately onethird
of the reported suicides, and 62% of these
decedents had a Blood Alcohol Content (BAC) of
>0.08 g/dL at the time of death (5).
how about nutrition? (namely Over-nutrition, given the obesity stats...)
bullying, obesity, and suicide
even just believing you are overweight...
bullying also has immediate and long-term health impacts...
cuts across social class
increases with age,
(you get the idea...)
and obese adults aren't spared, even the ones who have surgery....
obesity and suicide
so there are no quick fixes there, either....
So where is all this coming from?
(my background makes me familiar with it.... but recent series of events are as follows:)
---------- recently sent me this article, asking if I had read it:
I hadn't read kevin md's post, but had been aware of the physician suicides, though not the exact numbers...
Following up on this, I gathered a huge pile of materials, research, programs, etc...
(Dr. Wible's work is fascinating--I also found some good information about programs addressing burnout in residents, including one at UNC:
Motivational Interviewing--(which I do, have read some books, been to some workshops, and essentially espouse the philosophy in my dealings with people, including clients--namely, people do what they are doing because it works for them, and until they decide it isn't, there is no changing their mind, let alone their behavior.
I think it also applies to MOC, CME, etc.... anything like this where you get so much push-back.
Until someone recognizes something as a problem, and is willing to address it, nothing changes...
So, suicide is a huge problem in the general population...
and also in physicians.
If physicians don't acknowledge suicide in their own community (http://www.washingtonpost.
physicians certainly won't get help...
If physicians don't ask their patients, http://www.ncbi.nlm.
even if there are models:
Who will intervene?
Primary care is certainly positioned for intervention, whether they like it or not...
Primary Care: A Crucial Setting for Suicide Prevention
Jerry Reed, PhD, MSW, Director, Suicide Prevention Resource Center
Up to 45% of individuals who die by suicide have visited their primary care physician within a month of their death; additional research suggests that up to 67% of those who attempt suicide receive medical attention as a result of their attempt. Given these statistics, primary care has enormous potential to prevent suicides and connect people to needed specialty care — especially when they collaborate or formally partner with behavioral healthcare providers.
but a good share of what you read about physicians and suicide is not about suicide per se, or suicide by physicians, but just what the role of physician's should be in supporting/aiding people who approach their physician about suicide....
This bit is meant to address the issue of physician assisted suicide.....
What are physician's responsibilities when it comes to garden-variety suicide?
Don't these patients (colleagues, students, family members, etc...) deserve every bit as much?
Is it less understandable, or less tragic, somehow?
(emphasis above and below, mine)...
Opinion 2.211 - Physician-Assisted Suicide
Physician-assisted suicide occurs when a physician facilitates a patient’s death by providing the necessary means and/or information to enable the patient to perform the life-ending act (eg, the physician provides sleeping pills and information about the lethal dose, while aware that the patient may commit suicide).
It is understandable, though tragic, that some patients in extreme duress--such as those suffering from a terminal, painful, debilitating illness--may come to decide that death is preferable to life. However, allowing physicians to participate in assisted suicide would cause more harm than good. Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.
Instead of participating in assisted suicide, physicians must aggressively respond to the needs of patients at the end of life. Patients should not be abandoned once it is determined that cure is impossible. Multidisciplinary interventions should be sought including specialty consultation, hospice care, pastoral support, family counseling, and other modalities. Patients near the end of life must continue to receive emotional support, comfort care, adequate pain control, respect for patient autonomy, and good communication. (I, IV)
Issued June 1994 based on the reports "Decisions Near the End of Life
," adopted June 1991, and "Physician-Assisted Suicide," adopted December 1993 (JAMA. 1992; 267: 2229-33); Updated June 1996.
," adopted June 1991, and "Physician-Assisted Suicide," adopted December 1993 (JAMA. 1992; 267: 2229-33); Updated June 1996.
So anyway.....
How are physicians to help themselves and each other, let alone their patients, if no one will own the situation?
I thought, maybe a Quality Improvement effort on the education of and screening for depression/suicidal ideation in our community might really be a good starting place....
Back to KevinMD... this article was published on 1-9-2015...
MOC is medicine’s self-inflicted wound
Again, the imagery is vivid enough, and the message pretty clear:
"Really? Of all the issues we face in health care, this is the one where we collectively draw a line in the sand?
Pardon me, but that’s just stupid.
While it’s encouraging that professional organizations like the ACP are actively responding to the concerns of their members, it’s also taking away from efforts that matter more in the long-term.
We’ve taken our eyes off the ball. Fighting among ourselves on MOC means that more concerning problems that threaten our profession are left unchecked."
“A person in difficulties wants in the first place the help of another person on
whom he can rely as a friend—someone with knowledge of what is feasible but
also with good judgment on what is desirable in the particular circumstances, and
an understanding of what the circumstances are. The more complex medicine
becomes, the stronger are the reasons why everyone should have a personal doctor
who will take continuous responsibility for him, and, knowing how he lives, will
keep things in proportion…”1,p752
--TF Fox, 1960 in The Lancet
anyway...
there are obviously lots of resources....
some incredibly simple and user friendly (there is a mental health "first aid" model called QPR--Question, Persuade, and Refer... essentially you ask if someone is thinking about killing themself, persuade them to get help, and refer them to an appropriate source...
It should really be taught like self-defense, or first aid... because it isn't dangerous, and really gives people a format to intervene when they are concerned about someone.
but why do physicians need to train on this?
physician personality can impact ability to assess depression
so knowing that, instruments are even more important....
analyzing clinic notes...
The military thinks it is a good idea...
and even a virtual patient, denise, to help train physicians!
anyway....lots of random stuff...
Subscribe to:
Posts (Atom)