The Skeptical EP

The Blog Page of Robert Clare MD

Credit: Non-Sequitur by Wiley Miller

“Questioning medical dogma to improve the lives of patients.”

Skepticism, from the Greek word skepticos (to inquire), is not simply a noun but a process. Skeptics demand evidence before accepting claims of truth; they enjoy the process of inquiry and analysis. Unlike cynics who take a negative view of both the claims of others and the people making them, skeptics are perfectly happy to change their minds when better evidence comes along. For physicians, a questioning attitude is an essential component to decision-making. When faced with increasing pressure from administrators and pharmaceutical companies to “Show me the money!” the best counter from the physician is “Show me the evidence!” The purpose of this blog is to raise awareness through an inquiry of the best available medical knowledge, to foster discussion, and to challenge prevailing truths in order to improve the lives of patients everywhere.

Disclaimer: The opinions put forth in this blog are just that: opinions. They should not be used as a substitute for your own good sense or that of your doctor. Readers of this column do so at their own risk—this blog is not intended to treat or diagnose disease. Information contained here should be considered a “dietary supplement.” None of it is FDA approved. Mistakes in data interpretation are mine alone (I don’t claim to be a statistician), and you should assume that mistakes will occasionally be made. All personal patient information has been altered.

I’m skeptical about … strep throat.

Strep is a bacterium meaning that it has a cell wall, cytoplasm, DNA, and can replicate independently thereby rendering it susceptible to a host of antibiotics including penicillin. Viruses, on the other hand, lacking these same attributes do not respond to routine antibiotics. There are many varieties of strep including S. pneumoniae, the most common cause of pneumonia, but for the remainder of this post when I use the word strep, I am referring to group A beta-hemolytic strep, the bug that causes strep throat. Continue reading

I’m skeptical about … concussion.

In the US, head injury is the leading cause of traumatic pediatric death, resulting in roughly 7,400 fatalities, 60,000 hospitalizations, and more than 600,000 ER visits annually, so it follows that all this talk about concussion is a big deal, right? As an emergency physician and the parent of athletic kids who have been very active in soccer and gymnastics, I can’t begin to recall the number of times I have listened to a parent tell of rushing his/her child to the ER for a CT scan after some well-meaning health professional deemed the injury a “concussion.” The term conjures up a host of scary images. After all, everybody knows that Muhammad Ali’s Parkinson’s didn’t come from a bad-luck roll of the genetic dice; it came from getting his brain bashed in. Continue reading

I’m skeptical about … malpractice reform, part 2.

In my last post, I noted that malpractice reform enacted in Texas in 2003 making it almost impossible to sue physicians failed to save money or decrease defensive medical testing. We now have ER data from South Carolina and Georgia demonstrating the same thing. Doctors in those states continued ordering tests up the yin-yang despite legislation substantially reducing the likelihood of a lawsuit. Why? Continue reading

I’m skeptical about … malpractice reform.

Responding to a 2009 request from Senator Orrin Hatch (R, Utah), the Congressional Budget Office issued a letter suggesting that medical malpractice tort reform would “reduce federal budget deficits by roughly $54 billion over the next 10 years.” Sounds great—a billion here, a billion there and pretty soon you’re talking real money—but the devil is in the details. The CBO letter reported that 40% of the savings would come in the form of lower malpractice premiums to physicians and 60% from “less utilization of health care services.” Continue reading

I’m skeptical about … cough medicines

The typical adult can expect to develop 2 to 4 URIs (upper respiratory infections) annually. Included in this category are colds with nasal congestion, sore throat, and cough. Bronchitis is a term meaning “airway inflammation.” People who are coughing have bronchitis by definition, and there is nothing about this term that implies a need for antibiotics. More than 90% of cough illnesses are virally mediated, and multiple studies have confirmed that antibiotics fail to shorten the severity of cough or duration of symptoms (even when the infection is bacterial). The CDC specifically states, “Routine antibiotic treatment of uncomplicated bronchitis is not recommended, regardless of the duration of cough.”

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I’m skeptical about … pain scores

 

In 2001, a year after President Clinton signed into law a bill declaring 2001-2010 to be the “Decade of Pain Control and Research,” JCAHO (Joint Commission on Accreditation of Healthcare Organizations) initiated standards mandating that all patients receive pain screening during their visit to accredited institutions. Pain was declared the “5th vital sign,” along with pulse, blood pressure, respiratory rate, and temperature. Every ER in the nation now includes a pain assessment as part of its triage protocol, most commonly a 1-10 score for adults and a smiley/frowny face score for kids. Continue reading