When Good Doctors Go Bad

Hail: Very brief post here, while the recently fed cats and dishwasher purr in the kitchen.

Every so often I scan throught the medical journals. It's a lot less often than it should be but lately my priorities have become warped to include a life with my family and friends, and so I let the journals lie and carry on through the guilt.

Now, I don't know if I've mentioned this before, but medical journals are weird places. Due to this whole "evidence based madicine" thing, where to believe something that hasn't been proved to be true marks you down as a dangerous simpleton, there's a lot of crap research out there, "proving" stuff that everybody already knows.

Sexually Transmissible Diseases More Common in Sexually Promiscuous Populations.

Disabling Stroke Often Associated with Depression in Elderly, New Study Shows.

Physician Expertise Improves Outcome of Carotid Artery Stenting (i.e.: If someone's going to make a hole in your groin and use some long wire to shove a little steel tube thing into the big artery that goes straight to your brain, while you're in a very deep coma, it goes better if they know what they're doing).

and my recent favourite:

At-Risk Drinking Linked to Higher Mortality Rate in Older Men (i.e.: doing something risky, like drinking enough to make you get sick or die, means there's more of a risk that something bad's probably gonna happen - like you'll get sick or die. Risky things are... well, risky.).

But they are the minority. There are a lot of articles about stuff I barely understand now - stuff referring to techniques and equipment in fields I never really understood and have little to do with a pulic health service operating in the poorest part of a small, isolated city.

And a lot of the articles are astounding. There is a simple surgical procedure that can help your child get over bedwetting - and it's a lot less alarming than you'd think. It's called a tonsillectomy. Yes, kids who get their tonsils out stop betwetting earlier - maybe something to do with improved sleep, circadian rhythms, that kind of thing.

And if you've got a patent foramen ovale (and if not, they are probably available on ebay), it could be behind your headaches. Apparently people who have a hole in the heart, (a hole in the wall between the left and right sides of the heart), and you get it closed, it can stop migraines. Having said that, I'd guess most bad headaches aren't migraines and most people with migraines probably won't benefit from heart surgery, but it's still "gee whiz" interesting.

And tucked among these are the truly alarming ones. Black people (in the US) respond less well to hepatitis C treatment - presumably for genetic reasons, although I haven't read the paper, and these studies have to be damn well designed to remove any confounding factors. The alarming part of that is hepatitis C is very common amongst people who inject drugs, and those people are likely to be poor, and in the US being poor means you run a higher than otherwise risk of also being black. So the people who most need the therapy are the people who are likely to respond least well.

Also on the fear front: Cognitive Impairment in Older Physicians May Be Widespread. There is an interesting article about this to which I shall try to link.

If it didn't work, the fascinating part is how the authors compare the response of colleagues to the cognitively impaired (otherwise known as demented or dementing) doctor to the response to the mentally ill or drug dependent doctor. The model with the mentally ill or drug dependent doctor is as follows:

People recognize the problem
People confront the physician
The physician acknowledges that there is a problem.
The physician seeks treatment through various sorts of programs
The physician is successfully treated (in many circumstances)
The physician is certified to return to work with some kind of ongoing monitoring.

Obviously, there's a lot that can go wrong at either step, which accounts for a lot of the terrifyingly drug dependent and/or evidently mentally ill doctors I have worked with, but at least it's a model. There isn't a formal model for telling someone, often a very senior colleague, that s/he's not able to do it anymore. And the last half of the equation, the whole treatment/improvement/return thing... in a lot of causes of dementia, the treatment is minimally effective and the prognosis remains unspeakably poor.

Anyway.

And for the last article, something remarkable published in JAMA. White, middle aged, British people smoke more, are more overweight and spend less on their health than equivalent Americans. So why are they so much healthier?

Obviously, we know it's not the tattered remnants of the welfare state, that'd be both subversive and ridiculous. Must be something to do with watching cricket.

Anyway, interesting stuff.

John