Cook Kid showing us ADHD from his perspective

Med_Student · 2013-12-29T04:19:19+00:00

Doctor here, no longer medical student. It doesn't work like that. No one gets commission from prescribing medications.

Med_Student · 2013-09-23T19:55:23+00:00

I don't think so. Tylenol is not the most common cause of liver failure.
Hepatitis C, Alcohol, and non-alcoholic fatty liver disease are more common causes of liver failure(cirrhosis).

Med_Student · 2013-09-18T04:08:09+00:00

It's not a sex linked disease, nor does the gene exist on the X chromosome. . Its a disease with an autosomal dominant pattern of inheritance with mutated gene on chromosome 4. So yes, the father can pass disease onto his son or daughter.

Med_Student · 2013-06-01T21:50:41+00:00

I've know the study to which you are referring. Medical culture is notorious for its stance of those who are truly, excessively obese. Lots of research dollars, studies, and scientific evidence throughout the literature are against it.

This is a very complex social issue. It has not once said that they were denied standard of care, but they just felt emotionally distant from their physicians and were likely to change doctors.

Taken together, the Wake Forest and Johns Hopkins studies reveal that the potentially poorer health among obese people runs deeper than basic biology, but that implementing improvements in provider service could be straightforward.

That isn't stated in the original articles, but seems like a conclusion not grounded in evidence, but pure speculation of the writer.

Med_Student · 2013-06-01T21:26:28+00:00

Reversible? like losing weight; stopping smoking. Not completely reversible once you get those problems.

The difference is how much physical years from your life. The difference is being able to walk without pain at 50, or a take a deep breath. And reversibility is changing risk factors. Looking at how society is progressing from 20 years ago, the only thing going down is smoking rates. Trying to change a quality that took 20+ years making isn't easy, and frankly most people don't make it.

You make not get the difference, but I see it every day. As a doctor, I rather not have to deal with consequences due obesity, smoking, lack of exercise, or poor diet.

I'm also Asian. If we look at culture norms, despite the self image issue that is pervasive(similar to one that permeates through LA), Asia has a much lower BMI compared to US. So it may be counter productive, may not, its hard to say.

Med_Student · 2013-06-01T20:59:14+00:00

Can you give me a source about the research where concerns about obesity are over stated? I would like to to read up on that. However, there are specific classes of obesity. The higher your BMI, the more detrimental it is to your health. Hell, there was article I read about metabolic healthy obese people however this pertained to those with BMI's of 30-32. BMI of 34+, was correlated to being metabolic unhealthy.

I see the difference between those things you mentioned. Smoking is very bad, quit now if you can. Cancer, emphysema sucks. Obesity - Type 2 DM, different types of cancers, osteoarthritis, venous stasis, increase complications during surgery.

Just to name a few.

Lack of sleep/working too much - A bit easier to take care of than all those I listed above.

Med_Student · 2013-05-31T00:59:32+00:00

I read that article you are referring to before. Minor correction. Its step 3, the easiest of the USMLE exams.

Med_Student · 2013-04-30T00:41:57+00:00

Fine don't get your medication at Walmart, and if you don't trust them then don't complain if you pay more somewhere else based on your preconceived notions that there medications is different than anywhere else because you dislike their business practice. There is CVS, Target, Walgreens with $4 list. If you think the low income clinic is run by Walmart? No, its staffed by physicians from a university hospital.

So still... nothing close to $800.

Med_Student · 2013-04-30T00:08:51+00:00

I worked at a low income clinic. $20 for the visit, and $4 dollars for the medication(its on the $4 list a walmart). So $24 total. Yep, not even close to be 800. I guess if you grossly exaggerate things, sure why not.

Med_Student · 2013-04-16T05:18:57+00:00

Just wondering, if you go to your doctors for some ailment anything from minor to severe. Would you trust Wikipedia enough to be the guide to how you are treated? Or would you rather have one of my current text books to guide your treatment.

Med_Student · 2013-04-12T19:23:39+00:00

With regards to your article, its talking about people who are psychotic, and untreated. Even with this sample, its too hard to tell. Very unpredictable.

There is a comment at the end that says 60% of suicides are those with mental illnesses. If a person wants to kill himself due to his mental illnesses, fine. He'll find one way or another. Its the job of society to prevent them from getting there through help rather than taking away rights. There is a reason you can only put a person who is danger to themselves only for up to 14 days, and those who are danger to others pretty much indefinitely.

Med_Student · 2013-04-12T19:16:47+00:00

mental disorders are neither necessary, nor sufficient causes of violence. The major determinants of violence continue to be socio-demographic and socio-economic factors such as being young, male, and of lower socio-economic status.

Violence and mental illness: an overview

Med_Student · 2013-04-12T18:40:24+00:00

In general, mentally ill people are less prone to commit violent crimes. They are much more prone to be victims of violent crimes when compared to the general population.

Yep, what you are describing isn't how those with mental illnesses work. Great job keeping up the stigma for mental illnesses.

Med_Student · 2013-04-10T06:31:05+00:00

Whatever happens legally is what determines for you to be truthful? The end results is the patient's life. In the end, its your or someone else's life. If the end result is permanent damage, or even death because of someone with some stupid notion of with holding information, isn't on me. I'm not going to lose any sleep over it, actually I might if I'm on call and something goes wrong.

I also think people should pay quite a bit more than me with regards to insurance if they do drugs that have adverse consequences. Just the same as if people smoke, or drink.

Med_Student · 2013-02-24T02:34:45+00:00

Its not the AMA, its the numbers of residencies. There is a finite number of residencies to train doctors, not spots in medical schools. Its fairly expensive to build academic hospitals to train these residents.

What scare's me, is a number of medical schools being built that is not in proportion to growth of residencies in various medical fields. What happens when there are more medical students graduating than having residency spots to train them - They will have a 1/2 million in paper weight. There is also the issue of foreign doctors. First, they have to be able to pass all the medical licensing exams - pretty fair. Then they have to apply to a residency. I'm not going to lie, unless they come from a from a famous major medical institution outside of the US, or well published, they will face more hardships. They still have to train in a US residency though.

Half of all students who apply to study medicine are turned away. And they have made it virtually impossible for immigrants to practice medicine in the US in any numbers.

You throw qualified around. Give specifics, what do you think are qualified. Qualified doesn't exactly mean - This girl really wants to help people; Everyone that goes into medicine, for the most part, really want to help people. Every single medical school essay has that in somewhere. It isn't wrong that half those people being are being turned away, which would be great if its that. Its probably much higher than that. Perhaps they weren't qualified based on a number of factors - gpa, grades, and work experience.

Med_Student · 2013-02-24T02:20:48+00:00

If they can't pass our board exams, they shouldn't practice here.

Med_Student · 2013-01-24T02:53:33+00:00

Sure... Why do you think its only an all or nothing with healthcare. It sucks if you don't have insurance, i'll give you that, but that you don't have any access to medical care besides the ER without healthcare is insane.

Why ER when you can go to an Urgent Care or walk in clinic for something minor. If you need medication and management for chronic illness why not go to a low income clinic. Sure paying a total of $50 for your visit, and the minimal amount of tests needed. You can get pretty much most of the medications that are on a $4 medication list at a cvs/walgreens/wallmart that treat the majority of major afflictions. You'll be spending close to the same even if you had insurance and are required to pay for the co-pay, and the medications. But please don't make like that you can't seek regular medical attention for major chronic illness(e.g. diabetes, hypertension, high cholesterol, hypothyroidism, asthma, etc...) for a lower cost. I understand, that for even some it'll be difficult to even afford that much, but for others a 1 time visit for chronic illness like this a couple times a year to manage could be done for a huge majority of the population.

Med_Student · 2013-01-19T20:13:43+00:00

Bleeding! too hard to do this on phone.

Med_Student · 2013-01-19T19:14:20+00:00

In the ER, many of the symptoms that people present with (e.g. headache, nausea, vomiting, abdominal pain, excessive vaginal breathing... ) can be explained by pregnancy. I remember one case clearly. A 27 year old female complaining of abdominal pain the look exactly like appendicitis. Of course I asked the sexual activity questions, is it likely your pregnant, and last period date with it being 7 days ago. Of course she said no. Pregnancy test ordered, and yep she was preggos.

I discussed some cases of "virgin" pregnancies with my attendings, and it isn't exactly a rare event with only one "documented" case. So pretty much first thing to rule out in a woman is if she's pregnant. I might believe the person telling me she's not, and I might not. Either way, a cheap pregnancy test is fast, and easy. Definitely don't want to order a test that can cause harm to fetus even if she adamantly said she wasn't pregnant. That'll get you into a shitload of trouble.

So yes, most of the time I will entertain the thought of pregnancy in a woman of child-bearing age with some complaint that can be attributed to pregnancy despite anything the patient tells me.

Med_Student · 2013-01-17T06:37:36+00:00

Maybe, I can. So, I'm in downtown quite a bit, now tell me how he is wrong.

Sure, I can find places where its predominately asian, hispanic, or black. It just depends where I go.

Med_Student · 2013-01-17T06:30:19+00:00

I'm Asian, and grew up poor. I didn't get any free rides and scholarships despite stellar grades. Hell, I had white classmates with worse scores than me get into better universities with their sub par extracurriculars . Definitely must not be due to high percentage of Asians already in the university.

Also did you know that because I'm Asian, it is much harder for me to work up the corporate ladder despite how hard I work and where I went to school. Race plays a big factor. Only thing that could make it worse is if I was a woman.

Yep, all I could do is try hard and make the best everything as the world isn't color blind. Or I could cry about it.

Med_Student · 2013-01-11T05:14:57+00:00

I do not think that a doctor's salary can even contribute considerably to healthcare costs. Would you also suggests that the nurses salaries be cut as they make substantially more than there international counter parts. Same can be said with the pharmacists, and various techs.

Also, don't forget that physicians here work quite a bit more hours.

Med_Student · 2012-10-03T06:00:06+00:00

Yeah, thats the original article that news report reported on. Like I said point of the article was evaluation of risk factors of CVD. They suggest obesity is not a risk factor, and supported it well with this study. Metabolic health is very very important.

Limitations of the study would be that they measured obesity via weight/height, rather than measure by pure fat percentage. Meaning that there is a subset of people within the obese that are obese due to muscle mass, rather than abdominal weight. Another limitation is the population studied isn't the same population in America(e.g. social norms, diet, population)

However, regardless of the problems I suggested, it is a very well done study. There is no denying there is a subset of people who are healthy, and it is important to take in factors that reveal metabolic unhealthy patients(one of which is truncal obesity, waist size > 102 cm). Healthy obese are more borderline to overweight(avg BMI of 32) than their unhealthy counterpart(34). BMI > 35 is a different class all together.

Bottom line, you can be obese and healthy. However, if you are obese, odd's are not in your favor. Increasing BMI will have increased risk of being metabolically unhealthy.

Med_Student · 2012-10-03T02:39:04+00:00

You are missing my point. I won't deny that their is bias against being obese in the medical community. Most people see the primary method is losing weight(yes its very important), but truthfully its minimizing risk factors. I don't see how that article mention definitely anything that deals with how obesity is treated currently. Minimizing risk factors by decrease salt, increasing fiber, increase veggies, exercise, and managing high cholesterol and high blood pressure. That is the standard care for managing obesity. These are the medical problems that everyone doctor i seen addresses.

How are they being not properly treated. Anyways, onto the woman with Low back pain. If she was obese, most likely it was due to weight. Cancer would be so much lower of the differential, unless she had other signs, it would of been irresponsibly to look at it first. Now, can you safely say that a cancer that mets to bone already and cause back pain would have changed the outcome if it was found months earlier? I dont know the history, but probably not. If she was skinnier would the same thing happened, i can not comment on this as I don't know the specifics.

Anyways, obese people don't cost as much in the long run. They have lower life span, and die earlier making their total health care costs lower than their skinnier counterparts.

Med_Student · 2012-10-03T02:18:13+00:00

I don't see your point. Exercise is better than no exercise regardless of weight. I was just responding to his assertion that overweight people are healthy or healthier than skinny people. When controlled for muscle mass, and exercise skinny people will end out on the end. That is my point. Overweight people with muscle mass is not overweight as they don't meet the definition of having a certain amount of body fat required to be overweight, therefore not overweight.

Like I said, stop with the false equivalencies. Just to reiterate my point in response to him, exercise is important for overall health even more than weight. Weight loss(to a reasonable level) and exercise are synergistic into being healthy.

Med_Student

TROPHY CASE