Thursday, May 8, 2008
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Image of the Week - Fluorescence Diagnosis of Subclinical Actinic Keratoses
Photodynamic therapy is a noninvasive therapy for nonhyperkeratotic actinic keratoses and basal-cell carcinoma. Photodynamic therapy involves the activation of a photosensitizing drug by visible light to produce activated oxygen species within target cells, resulting in their destruction. Commonly used topical photosensitizers are aminolevulinic acid (ALA) and the methyl ester of ALA (MAL), which act as precursors of the endogenous photosensitizer protoporphyrin IX (PpIX). In addition to its therapeutic uses, fluorescence emitted by MAL-induced PpIX may be useful in providing a fluorescence diagnosis of cutaneous lesions. This permits the detection of otherwise occult areas of abnormal skin (Panel A). Tumor margins can also be delineated with the use of a Woods ultraviolet lamp before surgery, radiotherapy, or therapeutic illumination with a photodynamic-therapy lamp (Panel B). Areas of involved skin exhibit pink fluorescence in the presence of activated PpIX. In this 74-year-old man, an actinic keratosis was diagnosed on the basis of MAL, applied typically under occlusion on the scalp and forehead for 3 hours, and biopsy. Pathological examination of the involved skin revealed actinic keratosis. Photodynamic therapy was administered after the application of MAL with the use of 630-nm red-light irradiation for 8 minutes. Complete remission was achieved, with no recurrence at a 10-month follow-up visit.
Courtesy of: http://content.nejm.org/cgi/content/full/358/19/e21
Wednesday, May 7, 2008
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Tuesday, May 6, 2008
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Monday, May 5, 2008
Doctors Shouldn't Marry Other Doctors
I found an article here in CNNMoney about a husband and wife who are both residents and looking at a huge amount of debt. I know it's early but it is something to consider later on down the road. I think their case is extraordinary because they are both training to be physicians and are shouldering a huge amount of debt from medical school. I love how all these articles always paint doctors as these hard luck cases..."such are the lives of medical residents: med school graduates getting years of on-the-job training, putting in brutal hours for salaries that, on an hourly basis, work out to a little more than they could earn stocking the shelves at Costco." I actually read that the average resident makes 12/hr given the amount of hours they work relative to the pay. And no I am not making this number up out of thin air, I just can't remember where I read this. Another great quote in the CNNmoney article is "for this generation of doctors, and for Meg and Chris in particular, financial security won't come guaranteed with their medical licenses. As health-care economics squeeze physician salaries, rising college and med school tuitions are putting young doctors ever deeper in the hole." Does this mean that doctors will have to be waiting tables on the side? Anyways it's a good read and the take home message here is if you have to get married, don't marry someone that has just as much or more debt than you because not even a doctors salary can get you out of that hole.
Graphics Credit: http://money.cnn.com/2007/11/16/pf/young_doctors.moneymag/index.htm
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Friday, May 2, 2008
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Thursday, May 1, 2008
What Does it Take to be Good a Doctor?
According to the Texas Medical Association there are three personality traits and disorders common to physicians: narcissitic, obsessive-compulsive and antisocial. I think the main question here is whether these traits are endemic amongst medical pratitioners (i.e. the trait makes the physician who he or she is), or does it manifest itself in the individual as they are preparing to enter the medical profession. I believe the later is true. As a disclaimer I am in no way saying that all physicians exhibit these personality traits. I actually googled "what personality traits make a good physician" and this site came up.
"Three personality traits and disorders will be discussed in this module: narcissistic, obsessive-compulsive,and antisocial. These three are the most commonly found among physicians.
Personality disorders are pervasive chronic psychological disorders which can greatly affect a person's life. Having a personality disorder can negatively affect one's work, one's family, and one's social life.
Personality disorders exist on a continuum from mild (traits) to more severe (disorders) in terms of how pervasive and to what extent a person exhibits the features of a particular personality disorder. While most people live normal lives with mild personality traits, during times of increased stress or external pressures (work, family, a new relationship, etc.) the symptoms of the personality disorder may intensify and seriously interfere with emotional and physical functioning.
Those with a personality disorder possess several distinct psychological features including disturbances in self-image; inability to have successful interpersonal relationships; inappropriate range of emotion; misperceptions of themselves and the world; and difficulty possessing proper impulse control. These disturbances combine to create a pervasive pattern of behavior and inner experience that is quite different from the norms of the individual's culture and that often tend to be expressed in behaviors that appear more dramatic than what society considers usual. Consequently, those with a personality disorder often experience conflicts with other people and vice-versa.
Narcissistic Personality DisorderNarcissistic people try to sustain an image of perfection and personal invincibility for themselves, and attempt to project that impression to others as well. Those with Narcissistic Personality Disorder project an inflated sense of self because typically beneath that image of grandiosity is often an insecure person with very low self-esteem.
- Has grandiose sense of self-importance
- Is preoccupied with fantasies of success, power, brilliance
- Believes self to be “special”
- Requires excessive admiration
- Has a sense of entitlement
- Is interpersonally exploitative
- Lacks empathy
- Shows arrogant, haughty behaviors
Narcissistic Personality Disorder tends to be more common in men than women. Because of their inflated sense of self-importance, narcissists tend to be driven to achieve high levels of accomplishments.
Obsessive-Compulsive Personality DisorderObsessive-Compulsive Personality Disorder is not the same thing as Obsessive-Compulsive Disorder.
- Preoccupation with orderliness, perfectionism, and mental and interpersonal control at the expense of flexibility, openness, and efficiency, as indicated by four or more of the following characteristics:
- Preoccupation with details and order
- Perfectionism that interferes with task completion
- Excessive devotion to work
- Rigidity and stubbornness
- Pack-rat (keeps evrything)
- Expectation of complete compliance
- Miserly (financial)
Individuals with Obsessive Compulsive Personality Disorder (OCPD) often are characterized by their lack of openness and flexibility in their daily routines as well as by problems with interpersonal relationships and expectations. An overwhelming preoccupation with orderliness, perfectionism and control of their lives and relationships makes treatment difficult.
Individuals with OCPD have difficulty incorporating new and changing information into their lives. Their ability to work with others is equally affected, since they see the world as black and white--their way of doing things and the wrong way of doing things.
Examples of OCPD would be checking and rechecking dosages; excessive work-ups, etc.
People with OCPD do not feel embarrassed or shameful because of their behavior, whereas people with OCD have a sense of shame. Behavior of the individual with OCPD affects everyone else, making them feel uncomfortable, while behavior of the individual with OCD affects primarily the individual and not everyone around him/her.
Antisocial Personality Disorder
A pattern of disregard for and violation of the rights of others, with three (or more) of the following traits:The main features of Antisocial Personality Disorder (ASPD) revolve around a pervasive lack of remorse or lack of exhibiting any feelings at all. While it tends to be most common among those who run into trouble with the law, there are those individuals with a milder form. We may know him as the politician who feels comfortable lying continuously to the public or the neighbor who constantly cheats on his wife, gambles away the family money, or runs a shady business operation cheating others out of their money.
- Repeated unlawful behavior
- Deceitfulness
- Impulsivity
- Irritability and aggressiveness
- Recklessness
- Consistent irresponsibility
Examples of physicians with Antisocial Personality Disorder:
Insurance fraud
- Medicare/Medicaid fraud
- Over-prescribing
- Over-utilizing for personal gain (ordering too many tests)
- Sexual predators"
Image of the Week - Nevus Sebaceus of Jadassohn
"A 14-year-old girl came to the hospital with her mother, stating that a small birthmark on the scalp had recently started growing rather rapidly. It was increasingly pruritic and caused the patient considerable emotional distress. She was otherwise healthy. On examination a large multilobulated, verrucous lesion was seen on the scalp. The findings were consistent with nevus sebaceus. These lesions have a predilection for the scalp and typically appear early in life as a solitary, hairless patch or small plaque. Often they do not cause problems until the patient reaches adolescence, as hormonal factors induce a verrucous or nodular change and the lesion grows in size, occasionally rather dramatically. Given the size and location of the lesion and the risk of malignant transformation, especially to basal-cell carcinoma, later in life, the patient was referred to plastic surgery for excision. The lesion was successfully excised, and histologic examination confirmed the diagnosis of nevus sebaceus of Jadassohn."
Courtesy of: http://content.nejm.org/cgi/content/full/358/18/e20
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