menometrorrhagia

Three big reasons I like the NEJM this week:

1. The first “Perspective” article discusses ways to approach the awkward opposite-sex “intimate exam” (genital, breast, rectal). The author quotes practices in other parts of the world where guidelines are a bit more firm than here in the States. One example is from the movie Kandahar set in Taliban controlled Afghanistan. An opaque screen separates the female patient from the male physician, and the patient’s young son serves as a mediator. The physician asks questions, the son repeats them, the woman answers, and the son repeats the answers. This way the burka-clad woman is free from the taint of speaking directly to a man. A two-inch hole is cut in the screen and the doctor instructs the son to have the woman put her mouth, eye, etc. to the hole so that he can examine her. She has a stomachache and the doctor is not allowed to touch her abdomen. While the point of the article was not to mock the ludicrous nature of such a practice, it should have been.
2. Tipping their hands as liberals, the editorial staff of NEJM elects to follow the article about gender relations in the exam room with one about the legalization of medical marijuana. They carefully avoid taking a stance on the issue, but do paint a sympathetic picture of the patient, Angel Raich, whose recent case before the Supreme Court resulted in federal agencies winning the right to investigate, arrest, and prosecute patients who use medical marijuana and their suppliers in states that have laws allowing medicinal uses of the chronic.
   [For grins, guess which 11 states have medical marijuana laws. I'll even give you a hint: Texas doesn't.]
3. Every issue of NEJM seems to carry one or two themes in the research articles published. For instance, last week’s journal had a theme of osteoporosis treatment. This week’s issue has two themes. The first is the use of coronary artery stents which blah blah blah. The second is another clue to the liberal nature of the editorial board. Three articles deal with the differences in quality of health care in regards to sex and race.

I also think this article in Wired is really interesting. I gave a presentation on imprinting for a genetics class at UT in which I got to say “Genome sequences might allow us to figure out how cells say ‘Juliet’s pretty’, but epigenetics will allow us to figure out how they say ‘But soft, what light through yonder window breaks?’” No one was impressed in class either.

An email I received today:

Dr. Unwin was indeed one of my favorite professors at UTSW. He is the rare individual who excels at every facet of life. He was by all accounts a fabulous physician, an internationally recognized researcher, and an outstanding educator. Oh, and an award winning concert organist for good measure. It is truly a shame that future classes of medical students have been deprived of the opportunity to study under him. I had hoped to possibly complete a neurology residency under him and am saddened to have lost the opportunity to learn more both from and of him.

Great and tragic article here in NEJM. It’s this sort of thing that terrifies me most about becoming a doctor — not the high-speed “this man is going to die right now if you don’t do the right thing” but this sort of “this woman is going to die a slow death and you can do nothing about it.”

Just a quick post to let everyone know that government and medical lobbyists are working on the really important issues. I’ll sleep better tonight knowing that strippers can now get the finest double D’s nature never intended.