National Healthcare

National Healthcare

Michael Moore's Sicko is a treatise for a National Health Service Program. It sounds good on the surface, to use tax dollars as a means to improve the health of the country. However, if you are an otherwise healthy individual, why should you participate? Granted, as a physician, you applaud the implementation of a plan that would allow everyone the access to health care. However, maybe you feel, as a new graduate at the age of 27, that you shouldn't be paying for a new defibrillator for Dick Cheney or for Bob Dole's erectile dysfunction. Also, with an eye towards history, maybe you think by paying for a health benefit now, you will be paying for a program that will be phased out by the time you really may benefit. But, in a civilized society, what is the option? Do we move towards a nationalized health care system or not? So often these topics are infused with special interest groups and millions of dollars, but as a purely ethical question, is health care a right?

Case 3

This patient comes to your ER complaining of joint pain. On further questioning, you also find the patient complains of pain on urination and matting in her eyes in the morning. What is the diagnosis?


A geographic tongue is a loss of pappillae in the tongue that often changes with time. In general, the patient is asymptomatic, and the patient has spontaneous resolution. The georgrapic tongue may be due to psoriasis, Reiter syndrome, lichen planus, herpes simplex virus. systemic lupus erythematosus, drug reaction and leukoplakia. In this case, the other symptoms of arthritis, urethritis and conjunctivitis comprise the triad known as Reiter syndrome. In a related note, the medical establishment is moving away from the term Reiter syndrome as it is named after Nazi physician who described it after experimenting on unwilling patients during World War II.

Issue 2

Anticoagluation Medication



Often, treatment with anticoaugluation drugs are recommended in individuals to guard against clots resulting in heart attacks and strokes. Aspirin has been advocated as a useful initial guard against these devestating diseases. Recently, however, many NSAIDS such as VIOXX and Celebrex have been shown to actually have an increase in CVA's and MI's. One theory is that ASA inhibits platelet coagulation. Any other NSAID the person may be taking interferes with the action of ASA. Thus, any NSAID will intefere with the action of ASA and result in more cardiovascular events than ASA alone. However, many of these patients suffer from pain, such as the significant pain asssociated with arthritis. If a patient is taking ASA, would you recommend any pain reliever to further decrease the pain experienced more than the action ASA itself would result in. If so, which pain reiever would you recommend in this hypothetical patient?

Case 2

What are the likely responsible organisms?






Staghorn calculi are often the result of urea producing organisms such as Klebsiella and Proteus.

Case of the Week 1

Which group of people do not get these fractures?
The fracture of the 5th metatarsal is known as a Boxer's fracture. Ironically, boxers do not often get this fracture, as they know how to land a punch.

Current Issues 1

I wanted to change this around a bit and make it a bit more accessible.

Current Issues

The USA Today rerports the sutdy of a 14 month examination of behavioral therapy versus pharmaceutical treatment here. The Journal of the American Academy of Child and Adolescent Physchiatry reports that children with ADHD often recover in a few years of treatment. Behavioral therapy or medication seem to be equally effective. A further interview with Dr. Peter Jensen reveals that the medication offered childred afflicted with ADHD may not necessarily be effective.

In primary care, we are often asked to prescribe medication for children thought to be afficted with ADHD. How do you feel about prescribing medication to treat these children?

Bariatric Surgery

Last year, over 175,000 patients had bariatric surgery. This surgery is generally seen as a last resort, for people with a BMI over 40 or over 35 and a co-morbid illness. As the surgery becomes more common, I worry about the repercussions. During medical school, I assisted on three gastric bypasses. One had a standard recovery, one had a painful and long recovery necessitating additional surgeries, and the third died on post-op day three. While I know that obesity is a major factor in many diseases and losing weight is incredibly difficult, it must be remembered that this is an elective procedure!

Time summarizes a report by NEJM. Between 1984 and 2002, over 15,000 obese patients were studied, half of whom had gastric bypass. In a mean follow up of 7 years, the group that had surgery was:
92% less likely to die from diabetes
59% less likely to die from coronary artery disease
60% less likely to die from cancer

Another study in Sweden of 4000 patients, half who received surgery had a 10 year mean follow-up. In the 10 years, the study group had:
24% decrease in all cause mortality
58% increase in mortality from accidents and suicide

I don't know what the answer is. I don't want anyone to die from an MI, or to suffer from diabetes complications. However, I'm not sure this is the answer. Even with the nutrition and psychological counseling most bariatric centers provide, surgery only perpetuates the idea of a quick fix. In addition, like most of the treatment in medicine today, the cures have side effects that may be worse than what they are treating, and that can't be taken lightly.