Missed Opportunities for Deprescription. Story From the Front Lines An 88-year-old man presented to the emergency department with episodic light-headedness and dizziness of 4 days’ duration without vertigo.
He had experienced these symptoms 3 years earlier during an episode of hypoglycemia. His medical history included diabetes, hypertension, chronic renal insufficiency without proteinuria (estimated glomerular filtration rate [eGFR] by Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] equation, 20 mL/min/1.73 m2), dyslipidemia, atrial fibrillation, and gout. Prior to arrival, multiple home capillary glucose measurements confirmed hypoglycemia of less than 3.9 mmol/L (reference range, 3.9-11.1 mmol/L). Man evicted from hospital for blocking bed for two years. A hospital applied for a court order to remove a patient who had occupied a bed "unnecessarily" for more than two years.
The man, who has not been named by the hospital, had refused to leave the James Paget University Hospital in Norfolk. Underactive thyroid may be overdiagnosed, overtreated in the elderly. Older people may too often be diagnosed with an underactive thyroid and prescribed thyroid hormones, which can cause new troubles and expenses without improving their lives, researchers say.
A recent case study provides a snapshot of the larger problem, the authors write in JAMA Internal Medicine. Just 1 percent to 2 percent of people have hypothyroidism, in which their thyroid gland is underactive and requires treatment, coauthor Dr. Juan P. Brito of the Mayo Clinic in Rochester, Minnesota, told Reuters Health. But about 15 percent of people have "subclinical hypothyroidism" - hormone levels that are between the healthy range and the diagnostic cutoff for hypothyroidism and that cause few or no symptoms. Clinical hypothyroidism can cause constipation, depression, fatigue, dry skin, unexplained weight gain and greater sensitivity to cold. A month after starting the medication, the patient came to the emergency room with heart palpitations, labored breathing and chest pain. Massive Rectal Hemorrhage After Prostate Biopsy: A Teachable Moment.
Status Iatrogenicus: Medical Decision Making as a "Patient": Pregnancy Leads to A Trip Down The Rabbit Hole - A Personal Story. My wife is pregnant.
Status Iatrogenicus: The Enemy of Good is Better: Maximizing versus Satisficing in Clinical Medicine. Helping to reduce the burden of taking 83 pills a week – A nurse’s perspective – Minimally Disruptive Medicine. I had a patient recently (a male in his late 60’s), whose treatment plan includes taking 83 pills a week!
Pills he cannot easily afford and often neglects to take. I met with him to do a medication reconciliation recently and started by asking him what “matters to you”. I’m healthy, please leave me alone. You’re at an all-you-can-eat restaurant, finishing the last of a country-fried steak.
You’re full to the point of loosening your belt. But knowing it won’t cost a penny more, you push back your chair and head for the chicken and dumplings. Advertisement That image was going through my mind recently when I went in for an annual physical. Intensive Glycemic Control in Type 2 Diabetes Mellitus—A Balancing Act of Latent Benefit and Avoidable Harm: A Teachable Moment. This Teachable Moment provides an example of how patient-centered care and shared decision-making require a comprehensive and transparent discussion between patient and physician of known risks, benefits, costs, and burden of available and reasonable treatment options.
Article InformationCorresponding Author: Rozalina G. McCoy, MD, MSc, Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First St SW. Rochester, MN 55905 (firstname.lastname@example.org). Published Online: February 15, 2016. doi:10.1001/jamainternmed.2015.8320. Competing Mortality in Cancer Screening: A Teachable Moment. Learning to Say No to Dialysis. Diabetes in an older woman living in a long-term care residence. “Why Test For a Condition You Don’t Intend to Treat?” – A Choosing Wisely Patient Story. This is one in a series of patient stories collected by Consumer Reports to share how people are Choosing Wisely about their health care.
“My dad is 79 years old and has survived three cancers. For years, he’s been saying that if he were to get another cancer, he didn’t want to be treated again. Why minimally disruptive medicine matters by Kerri Sparling. “So what happened here,” and my doctor would point to a single blood sugar from three Thursdays ago, a 243 mg/dL at 3 am.
And I wracked my brain trying to remember what happened that night. Listen To Your Patient And They Will Tell You The Problem - A True Story - Mind The Gap. Readers of Mind the Gap, I apologize for my absence in recent months.
As you will see from my latest post, I have been away with my wife as she is dealing with a serious recurrence of her lung cancer. Our recent experiences continue to underscore the need for improved physician-patient communications in the doctor’s office and hospital. Thanks for understanding. Richard Lehman on prescribing Spironolactone. The liveliest e-mail streams I have ever encountered are the ones which are currently coming out of the Overdiagnosis Group, set up by Margaret McCartney last year. The group is now a standing body within the Royal College of General Practitioners and most of its members are working GPs. But there are participants from all over the world too, and from other medical or non-medical disciplines.
A lot of recent discussion has centred on how we actually share decisions with patients. Older Patients With Cardiac Devices. The Need for Better Patient–Doctor Conversations + Author Affiliations Correspondence to Elizabeth E. Drye, MD, SM, Yale University School of Medicine, 1 Church St, Suite 200, New Haven, CT 06510. E-mail Elizabeth.Drye@Yale.edu Key Words:
I-was-diagnosed-with-breast-cancer-did-nothing. In August of 2007 I went to the doctor for a checkup. My doctor recommended a mammogram because my mother had recently been diagnosed with breast cancer for a second time. I was 43 and at that point they were only giving women in their early 40s mammograms if there was a family history of breast cancer and both my mother and her sister had had breast cancer. When my mother was first diagnosed, in 2001, she had a lumpectomy and radiation, which was the standard treatment for what they called breast cancer, but what I’ve now come to understand was DCIS, or ductal carcinoma in situ, which they also call stage zero, but may or may not be correlated with invasive breast cancer. A Pacemaker Wrecks a Family's Life. Photo One October afternoon three years ago while I was visiting my parents, my mother made a request I dreaded and longed to fulfill.
She had just poured me a cup of Earl Grey from her Japanese iron teapot, shaped like a little pumpkin; outside, two cardinals splashed in the birdbath in the weak Connecticut sunlight. Her white hair was gathered at the nape of her neck, and her voice was low. “Please help me get Jeff’s pacemaker turned off,” she said, using my father’s first name. I nodded, and my heart knocked. Overdiagnosis of Gestational Diabetes Mellitus in Pregnant Woman: A Case Report. [Unfavorable outcome of aggressive lowering of high blood pressure. Case report]. Glucose Control in Older Adults With Diabetes Mellitus—More Harm Than Good? Ultrasound and Fury: One Mother's Ordeal. Why I’m Opting out of Mammography. Unintended Influence: When Our Words Mean More Than We Think. Which medical tests are worth doing? There are lots of medical screening tests available and screening is big business, but which of these tests are really useful and what are the drawbacks?
Michael Mosley decided to find out by looking at the evidence and trying a whole battery of them. I began with heart disease, as it is the largest cause of premature death in the UK. Polypharmacy: National Prescribing Service Newsletter. B.C. parents battle for baby’s life. Mind the Outcomes. Overtreatment Is Taking a Harmful Toll. How the CA-125 became a $50,000 blood test. What could be so simple as a blood test? Fran's story. Rational test ordering in family medicine. Simon Morgan, MBBS MPH FRACGP⇑ Correspondence: Dr Simon Morgan; e-mail email@example.com. How heartburn caused a patient to lose her left leg. Cardiac testing in an asymptomatic 42-year-old man - CMA.
No medicine is sometimes the best medicine.