June 28th, 2011 by Dr. Val Jones in Opinion
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I’ve often heard physicians say that “the history is 90% of the diagnosis.” In other words, they can usually determine the underlying cause of a patient’s problem just by listening to their account of how it evolved. The physical exam is merely to confirm the diagnosis, and is often cursory, limited, or ignored.
I believe that the physical exam is far more important than it seems – and I learned this during my recent oral medical specialty board examination. Although I have been sworn to secrecy regarding the content of the test questions, I will share an epiphany that I had during the exam.
The examiners’ job is to describe a patient and then ask the examinee what else she’d like to know and what she’d do next. With each description, I found myself struggling to visualize the patient – wishing I could see their face and hear their tone of their voice as they described their condition. I hadn’t realized that so much of my clinical judgement was based on laying eyes on a patient – I needed to see if they were in pain, if they were straining to breathe, if their skin was pasty or pale, if they were disconnected and potentially drug-seeking, if they were fidgety, if they were articulate, forgetful, or well-groomed. All of these subtle cues were gone. I was left staring at the examiner – who himself couldn’t describe the patient more fully because he was to stick to the script, reading verbatim from a prepared list of signs and symptoms. Read more »
June 15th, 2011 by admin in Health Tips
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My left knee hurts. When I put weight on it with my leg bent, like when I get out of the car, I feel a dull pain in my knee. My doctor and physical therapist have given me a diagnosis of patellofemoral pain syndrome, also known as “runner’s knee” or patellar knee-tracking syndrome. Simply put, my kneecap doesn’t run smoothly up and down its track—a groove called the trochlea.
Anyone can get patellofemoral pain syndrome, but for some reason it is more common in women than men—especially in mid-life women who’ve been running for many years. The problem, say researchers who just published a study in the journal Gait and Posture, is that lots of “mature” women develop alignment problems with their knees. The researchers compared younger female runners to older female runners and found misalignment of the knee to be much more common in the older women. Some knees sagged inward, others bowed outward or were rotated.
When the alignment is off, the kneecap can’t smoothly follow its vertical track as the knee bends and extends. This causes wear and tear on the joint. That leads to overuse injuries like runner’s knee and, down the line, osteoarthritis, which can really put a cramp in a runner’s career.
My physical therapist recommended that I Read more »
*This blog post was originally published at Harvard Health Blog*
June 9th, 2011 by RyanDuBosar in News
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Active, healthy medical students are more likely to prescribe physical activity to patients, according to research presented at a meeting of the American College of Sports Medicine.
A research team assessed objective markers of cardiometabolic health, including cardiorespiratory fitness and attitudes on physical activity counseling, in 577 freshman medical students in Colombia from 2005 to 2010. Students’ health and fitness were measured by waist circumference, body mass index, fasting glucose levels and lipid profiles, in addition to the 20-meter shuttle run test.
Attitudes toward physical activity counseling were gauged through students’ answers to “How relevant do you think it will be in your future medical practice to counsel your patients on physical activity?” and “I will have the ability to counsel my patients more credibly and effectively if I am physically active.” Read more »
*This blog post was originally published at ACP Internist*
June 9th, 2011 by Dr. Val Jones in News, Opinion
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The World Health Organization (WHO) and the World Bank just revealed the first-ever global estimate of disability. The report suggests that at least 1 billion people are currently disabled, and about 1/5 of those are experiencing significant difficulties with their activities of daily living. Since people with disabilities experience poorer health, lower educational achievements, fewer economic opportunities and higher rates of poverty than people without disabilities, this vulnerable segment of the population needs much closer attention.
I’m a physical medicine and rehabilitation (PM&R) specialist by training, and there are only about 8000 of us in the United States. Some have called PM&R specialists: “primary care physicians for the disabled” and I think that’s a reasonable description. The task before us is daunting – with hundreds of millions of people who are not living their lives at maximum functional capacity, rehab physicians should be in great demand.
My experience is that while the demand is great, funding is limited. I’ve seen tragic cases of children being denied critical wheelchair parts, and Read more »
June 7th, 2011 by Paul Auerbach, M.D. in Health Tips
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Outdoor recreation is intended for everyone, and can be enormously beneficial for persons with disabilities. I am in awe of disabled skiers, climbers, divers, and others who have learned to coordinate their bodies and take great enjoyment and a sense of accomplishment from their wilderness activities.
It behooves everyone in the healthcare profession to be aware of certain special medical concerns for persons who are disabled physically or emotionally. Additionally, family members and friends are often well aware of what they can do to help in providing a joint effort to support the disabled.
At the 2010 Wilderness Medical Society annual meeting in Snowmass, Colorado, JenFu Cheng, MD (a pediatric rehabilitation specialist from NJ), gave a wonderful presentation on the medical aspects of (scuba) diving with a disability. He pointed out that there may be up to nine million certified recreational scuba divers in the United States alone. His presentation, rather than focusing on persons who are fully capable physically and emotionally, examined the lesser-known benefits of being in the water for individuals in need of additional support. For instance, aqua therapy (largely enacted in swimming pools) takes advantage of the buoyancy of water to allow a range of mobility that is not possible on land. For example, aquatic exercise has been shown to improve lung capacity and mobility skills in children with cerebral palsy. Read more »
This post, SCUBA Diving With A Disability, was originally published on
Healthine.com by Paul Auerbach, M.D..
