windsurfr

Sorry to tell you but Calan does not do most of what you are talking about... I hope you are not telling patients that stuff b/c you will confuse them. For your info, there are two types of CCB's. Calan is the type that does NOT work on blood vessels. It slows conduction through the AV node, therefore reducing the incidence of SVT (the most common type of SVT originates in the AV node, so by slowing it you break the cycle... and thus ablate the arrhythmia) CCB's have NO EFFECT on plaque. The calcium that accumulates in a plaque is extracellular... thus CCB's would in no way stabilize. Finally Calan is only RARELY used in hypertension.... the other CCB's that dilate vessels are used for that. So the simple answer to the "why CCB" question is that it simply slows down the rhythm of the heart so you are not symptomatic. If you are going to give advice/info, the info should be at least somewhat correct.

A chest film can only tell that something more or less dense than the lung is present. They probably saw a 'solitary pulmonary nodule' which is an extremely common finding in people (about 1/4 of all people will have them). Most of the time they are bundles of scar tissue or old calcified areas of infection... however in any smoker the probability of something more serious (tumor) has to be considered. Therefore the next step is to obtain a study which can give more detail to the lesion. CT can look at the actual pattern of the lesion, and depending on the degree of necrosis/calcification/shape/etc radiologists/pulmonologists can get a pretty good idea of what it is. If they are still concerned about tumor, but not completely sure, they will do a biopsy. Best of wishes. Also for your information, the breath tests that are given to patients look for lung destruction (emphysema - COPD) or fibrosis/etc... only rarely would it give evidence for tumor if one was present.

Maxs- Yes, in fact, the fact that he is a sociology professor does discredit him... just as a MD preaching sociology would be discredited. And yes it is a problem when that person is making rediculous comments that he/she knows nothing about. 1/3 of the increase in C-sections comes from a higher rate of detecting dystocia 10% comes from the abdominal delivery of breech presentations 15% can be attributed to a growing propensity to diagnose fetal distress Finaly, approximately 25% of the increase results from repeat cesareans. Again, before you accuse physicains of inappropriate use of C-sections, look at the facts and indications for the procedure. Look at the INTERNATIONAL rate. Look at the legal pressure. And look at the public pressure.

Arrrggggg... I'm perseverating but it is aggrivating when I hear sweeping generalizations such as the "sociology professor's" comment. Ask him/her about the huge increase in cephalopelvic disproportion (android pelvis, etc) seen in younger patients these days. This is one of the most common causes of c-sections today. See if the good professor knows about it's increasing incidence. Also ask about the increase in women older than 30 delivering... and potential complications that can arise. Ask about increased (voluntary) utilization of reproductive specialists and the resultant increase in high-risk deliveries. Ask about the increasing incidence of C-sections WORLDWIDE, not just in the US. These countries have completely different reimbursement patterns... And we've already touched on the legal pressures to decrease VBAC's. Finally, if anyone wants to do a VBAC, there must be facilities to deliver the baby within 15-20 minutes to avoid neonatal neurological problems. There must therefore always be an obstetrician and an anaethetist present in the labour ward at all times. Because of these requirements and the fear of litigation, the incidence of VBAC is steadily declining. Again, I'm sure your professor has thought this all through before making rediculous comments about physicians.

Perfect... medical advice from a sociology professor. Cesarian sections are done for two reasons: 1. fetal complications 2. maternal complications (decels, 9 lb baby in a 7 lb pelvis, etc) If a c-section is performed for fetal complications, and there are no maternal complications... a lady partsl delivery can be performed in subsequent deliveries (V-back). The problem is that the LEGAL (not medical) system is mandating that v-backs be performed less and less. It has nothing to do with patient safety because v-backs are safer. It has everything to do with trial lawyers suing a hospital into the ground if complications arise from a v-back. Again, IT IS SAFER TO PERFORM A V-BACK THAN A REPEAT C-SECTION, however we are often not allowed to do so. But I'm sure your sociology professor knows all of this....

Avery, Being an RN before med school will help greatly, especially your third and fourth years. The first two years are normal anatomy/physiology/etc. Second year is all pathology / pathophysiology / pharm, etc. The third year is where it will be handy to be an RN. Third year is all about learning to form a differential diagnosis, order tests to rule in/out, and forming a preliminary treatment plan. It is tougher than you think. Now compound that with having no idea what a line or foley (let alone how to insert one)is, what a 'drip' is, or even how the units work. This is stuff we are expected to learn on the fly and as an RN you will be much more comfortable during your third, fourth years and probably even your intern year. Despite other posters here, medicine is a wonderful field and the 'thank you's' you recieve outweigh the hassles of HMO's, etc. Furthermore take a good look at a drug rep's day: Sit in a drug closet and wait for a doc, set up lunch and BS to a doc about skewed drug facts, then the afternoon try to get docs signaturs. Diagnosing and treating sounds more fun, doesn't it?

I am a fourth year med student and I hate the show. I wish they would show the residents actually studying, trying to raise families, and take care of themselves... the things that really happen during residency. That wouldn't make much for good watching though...

Zenman, I'm not much for little pissing contets and from your other posts elsewhere it is obvious that you take much joy in them. I will stick to other boards where people can actually make replies with more gusto than "you're only 29 years old and must not know anything". You are a sad person and I hope the future treats you better. P.S. Who is to fault for the health of our country being #38? Might it have to do with obesity, entitlement, complex health systems, etc?

Several things wrong with your narrow quote: 1. There has been an absolute explosion in medical knowledge. Both in disease pathophysiology, diagnostic modalities, and treatment regimens. Medicine is becoming increasingly complex (with an increasing amount of quackery to sort through) and patients actually demand current recommendations, etc. I cant tell you how many times patients have loved when I pull up a med on my PDA and tell them how much of the cost their insurance will cover. 2. The patient coming in with chest pain is not telling you what the problem is.... that was your job, remember. 3. Diagnosing is harder than you think, and even the most seasoned veteran physician went through many years of consulting books to help sort things out. Sure, if you practice 20 years things start to stick. But no one is able to just walk in and 'talk to the patient' and come up with a diagnosis right away. 4. Physicians didn't used to get sued nearly as much. This makes us all weary to get a perfect diagnosis, order the correct tests, and the right treatment. Next homework: Patient comes in with acute exacerbation of CHF, has a history of DM/ mild Alzheimer's/chronic renal failure/ALL. He also has a Factor V Leiden mutation history and has recently been on a long flight. What workup and initial medications/interventions would you use. Do this without a PDA. A perfect example of why you are so wrong: 20 years ago the acute MI protocol was to place the patient in the hospital with a nitro and heparin drip. Compare that to the complexities of today... but I remember those great 'ol days when physians just had to talk to patients to figure out a diagnosis.

USFguy- There is no real difference between the DO and the "medical model". The "medical model" that is thrown around so much is simply to acquire a very detailed knowledge of normal human anatomy/physiology/histology/etc. Then using that you learn the fundimentals of disease processes/pharmacology/etc. Then the third and fourth years you learn to diagnose and the basics of treatment formulation. The ONLY formal difference between MD and DO training is that DO's have a bit more experience with 'manipulation'. But since the evidence base of manipulation is dwindling, they are getting taught less and less. This idea that MD students learn the 'medical model' and DO's learn a more holistic approach is simply not true. That is used by DO admissions to recruit students, but once you actually talk to DO students you will realize there is no difference. There is no real difference between MD and DO. DO school is traditionally easier to get into because not as many people are aware of it. But once you are in it will be just as demanding as an MD program.

ZENMAN.... Humor me and follow this Patient complains of chestpain. Go talk to the patient... no palm, no book. Give me a FULL differential diagnosis (what might it be, what not to miss, etc) including what historical findings and clinical PE findings make each more or less likely. Then (in an evidence-based and cost effective approach) what labs do you you want to order and then why. Finally, what are the primary interventions shown effective, and what needs to be done for followup. Also just for kicks: if you mis-diagnose or mis-treat you will get sued. If you run too many tests insurance companies and hospital administrators get pissed. Thats right... you probably dont need a book or palm pilot for that one. JUST GO TALK TO THE PATIENT and figure it out. Please respond to that, and for extra credit: Patient coming in with hematuria. How about a headache. How about a cough. How about a bump on the knee. But remember... no book, no palm. Just talk to the patient