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Medicine

Submission + - How Doctors Die 6

Hugh Pickens writes writes: "Dr. Ken Murray, a Clinical Assistant Professor of Family Medicine at USC, writes that doctors don’t die like the rest of us. What’s unusual about doctors is not how much treatment they get when faced with death themselves, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves because they know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. "Almost all medical professionals have seen what we call “futile care” being performed on people," writes Murray. "What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, 'Promise me if you find me like this that you’ll kill me.'" Feeding into the problem are unrealistic expectations of what doctors can accomplish. Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming. "If there is a state of the art of end-of-life care, it is this: death with dignity. As for me, my physician has my choices," says Murray. "They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night.""
Medicine

Submission + - Doctors Are Creating Too Many Patients 2

Hugh Pickens writes writes: "H. Gilbert Welch writes in the LA Times that the threshold for diagnosis has fallen too low with physicians making diagnoses in individuals who wouldn't have been considered sick in the past, raising healthcare costs for everyone. Welch, a a practicing physician and professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, says that part of the explanation is technological: diagnostic tests able to detect biochemical and anatomic abnormalities that were undetectable in the past. "But part of the explanation is behavioral: We look harder for things to be wrong. We test more often, we are more likely to test people who have no symptoms, and we have changed the rules about what degree of abnormality constitutes disease (a fasting blood sugar of 130 was not considered to be diabetes before 1997; now it is)." Welch says that the problem is that low thresholds have a way of leading to treatments that are worse than the disease and while clinicians are sued for failure to diagnose or failure to treat, there are few corresponding penalties for overdiagnosis or overtreatment so doctors view low thresholds as the safest strategy to avoid a courtroom appearance. "We are trained to focus on the few we might be able to help, even if it's only 1 out of 100 (the benefit of lowering cholesterol in those with normal cholesterol but elevated C-reactive protein) or 1 out of 1,000 (the benefit of breast and prostate cancer screening)," writes Welch. "But it's time for everyone to start caring about what happens to the other 999.""

Comment Scanning works great with the right scanner (Score 1) 371

i scan all mail to pdf files on my macbook as soon as I receive it, then whenever i have time i review the files and categorize them. works great mainly because i have an awesome scanner: epson workforce pro gt-s50 (http://www.epson.com/cgi-bin/Store/jsp/Product.do?sku=B11B194011). seriously, i absolutely love the thing: led based so no lamp warm-up time, scans both sides at once, 75 page feeder never jams, mac image capture converts and saves each batch as a separate pdf. only minus is price: got mine for $300 from b&h... but it has to be the best money i ever spent. i am now down to a single folder of documents that i can't really throw out (school diplomas, transcripts, etc) and hope to keep it this way.

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