Professionalism?

[DermViser]

yes and they will like every single thing your med school ever puts on facebook. it's so easy to tell these people apart it's like shooting fish in a barrel. they have an addiction to sucking up

It isn't an addiction. They very much have underlying self-serving motives for doing so.

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[circulus vitios]

It isn't an addiction. They very much have underlying self-serving motives for doing so.

yes and they will like every single thing your med school ever puts on facebook. it's so easy to tell these people apart it's like shooting fish in a barrel. they have an addiction to sucking up

I think it's more like a mental illness.

 

[DermViser]

I think it's more like a mental illness.

More for residency apps.

 

[Jabbed]

I saw my first case of Guillain–Barré today. He was a healthcare worker status post an influenza vaccine that doesn't even cover this year's strain.

Flu shots ruin lives.

 

[The new guy]

I saw my first case of Guillain–Barré today. He was a healthcare worker status post an influenza vaccine that doesn't even cover this year's strain.

Flu shots ruin lives.

First of all, most people make a full recovery. Second, the flu virus is more likely to cause Guillain barre than the flu shot is. Third, the flu virus itself has ruined more lives than the flu shot has.

 

[Th2]

First of all, most people make a full recovery. Second, the flu virus is more likely to cause Guillain barre than the flu shot is. Third, the flu virus itself has ruined more lives than the flu shot has.

I've heard the flu is more a problem for elderly / young / immunocompromised. That said, is the flu virus more likely to cause Guillain Barre in a healthy, young/middle-aged group? Has the flu virus itself ruined more lives than the flu shot has in a healthy, young/middle-aged group? Genuinely curious.

 

[Jabbed]

I've heard the flu is more a problem for elderly / young / immunocompromised. That said, is the flu virus more likely to cause Guillain Barre in a healthy, young/middle-aged group? Has the flu virus itself ruined more lives than the flu shot has in a healthy, young/middle-aged group? Genuinely curious.

Healthy adults: risk of contracting GBS from influenza virus is on the order of 1-9 per million cases. The risk of GBS from the vaccine is about 1/3 of that.

 

[TeddyMeddy]

.

 

[Aloft085]

First of all, most people make a full recovery. Second, the flu virus is more likely to cause Guillain barre than the flu shot is. Third, the flu virus itself has ruined more lives than the flu shot has.

As a personal anecdote, I tried skipping the flu shot last year due to previous cold-like symptoms that it gave me (mist version). Well, lo and behold, I caught the actual flu later that year. Let me tell you, it was absolutely miserable. People forget how bad the flu can be, because healthy people generally don't catch it all that often. I was sick as a dog for almost two weeks, with lingering effects for an additional two weeks. Basically lost a month of my life due to stubbornness.

Now, I just suck it up and get the d*mn shot. If it makes me feel a little sick for a few days, so be it.

 

[jw3600]

As a personal anecdote, I tried skipping the flu shot last year due to previous cold-like symptoms that it gave me (mist version). Well, lo and behold, I caught the actual flu later that year. Let me tell you, it was absolutely miserable. People forget how bad the flu can be, because healthy people generally don't catch it all that often. I was sick as a dog for almost two weeks, with lingering effects for an additional two weeks. Basically lost a month of my life due to stubbornness.

Now, I just suck it up and get the d*mn shot. If it makes me feel a little sick for a few days, so be it.

It's nice that you now understand how much the flu sucks. But god damn, I feel like so many people don't get this.

You do not get the flu shot for you. You get it for those who can't. End O story.

 

[Psai]

As a personal anecdote, I tried skipping the flu shot last year due to previous cold-like symptoms that it gave me (mist version). Well, lo and behold, I caught the actual flu later that year. Let me tell you, it was absolutely miserable. People forget how bad the flu can be, because healthy people generally don't catch it all that often. I was sick as a dog for almost two weeks, with lingering effects for an additional two weeks. Basically lost a month of my life due to stubbornness.

Now, I just suck it up and get the d*mn shot. If it makes me feel a little sick for a few days, so be it.

Hey look at the bright side, at least your deltoid wasn't sore for a week

 

[alpinism]

I have one as well and post a variety of links to interesting research or last month posted a notice that a local radiology facility was doing free mammograms for the month of October.

Some are just nuts with it though. I went to a conference and my newsfeed was blowing up because people felt the need to tweet every little damn thing that they saw or heard at the conference.

How nice of them.

/sarcasm.

I'm sure the patients were fully informed of all the risks vs. benefits as well as given the latest high quality research on mammograms such as: http://www.cochrane.dk/screening/mammography-leaflet.pdf

Even better:

http://www.thennt.com/nnt/screening-mammography-for-reducing-deaths/
http://www.ncbi.nlm.nih.gov/pubmed/23737396

The trials with adequate randomisation did not find an effect of screening on total cancer mortality, including breast cancer, after 10 years (RR 1.02, 95% CI 0.95 to 1.10) or on all-cause mortality after 13 years (RR 0.99, 95% CI 0.95 to 1.03).Total numbers of lumpectomies and mastectomies were significantly larger in the screened groups (RR 1.31, 95% CI 1.22 to 1.42), as were number of mastectomies (RR 1.20, 95% CI 1.08 to 1.32).

 

[alpinism]

Back on topic:

Get a flu shot. Its one of the few things in medicine that has actually been proven to save lives.

 

[Aloft085]

It's nice that you now understand how much the flu sucks. But god damn, I feel like so many people don't get this.

You do not get the flu shot for you. You get it for those who can't. End O story.

Speak for yourself. I get the flu shot for me. I'm not around patients yet, however.

 

[jw3600]

Speak for yourself. I get the flu shot for me. I'm not around patients yet, however.

I really wish you would go back to your fancy finance job making 80k rather than train to become a physician. Also it would behoove you to reduce the frequency of your posting in allo or at least improve the quality of your posting.

 

[Aloft085]

I really wish you would go back to your fancy finance job making 80k rather than train to become a physician. Also it would behoove you to reduce the frequency of your posting in allo or at least improve the quality of your posting.

No thanks.

 

[Th2]

I really wish you would go back to your fancy finance job making 80k rather than train to become a physician. Also it would behoove you to reduce the frequency of your posting in allo or at least improve the quality of your posting.

I don't understand the contention. He experienced the flu himself and now opts to vaccinate every year to prevent that illness. He's not in healthcare yet so it doesn't behoove him to be vaccinated for the sake of others... unless... Are you arguing his comment unethical/selfish on the basis of "herd immunity"? If that's the point of contention... aren't the "herds" encountered day-to-day exceptionally different if you're, say, an white-collar office worker versus a geriatrician who travels on planes, whose wife is pregnant, whose other kid is in 5th grade, etc. etc.?

 

[jw3600]

I don't understand the contention. He experienced the flu himself and now opts to vaccinate every year to prevent that illness. He's not in healthcare yet so it doesn't behoove him to be vaccinated for the sake of others... unless... Are you arguing his comment unethical/selfish on the basis of "herd immunity"? If that's the point of contention... aren't the "herds" encountered day-to-day exceptionally different if you're, say, an white-collar office worker versus a geriatrician who travels on planes, whose wife is pregnant, whose other kid is in 5th grade, etc. etc.?

Most of your questions could be answered by just reading the last half dozen posts or so.

He said he got the flu one year and now gets the shot because having the flu sucks. I agree. I would also get the flu shot for this exact reason. However, this is not why I get the flu shot. I get the flu shot because there is solid literature showing a reduction in incidence with increasing percentage of the population receiving the seasonal shot. Yes, these studies are mainly hospital based because there is a higher chance of infection there. That does not mean there is not great benefit to society for widespread vaccination because obviously there are many infections are outside the hospital.

Is it possible that as a pre-med or someone without significant clinical experience that he did not know this. I told him that him not wanting to get the flu was not the reason he should be vaccinated. This is a common misconception (again, this was all spelled out fairly explicitly before). He responded: "Speak for yourself" implying that he still does not understand the (very basic) reason for receiving the flu shot or chooses to disregard the societal benefits. This kind of behavior does not bode well for functioning as a physician when more and more the field focuses on societal and individual prevention of disease.

The reason I told him to kindly disengage from (****ty) posting in the allo forums is because this is by no means the first time he has offered his opinions on topics that he seems to not be totally well versed on.

These forums usually function better if A) you read the god damn posts about questions you are posting (directed towards you) and B) contributors to discussions understand their roles.

PS. I just freakin' used behoove. Broaden your diction and don't rely on mimicry.

PPS (2nd edit) Don't you dare quote herd immunity as if it's some buzz word or talking point.

 

[Jabbed]

If anyone was wondering who peed in @jw3600 's coffee this morning...

It was me.

 

[Th2]

However, this is not why I get the flu shot. I get the flu shot because...

Is it possible that as a pre-med or someone without significant clinical experience that he did not know this. I told him that him not wanting to get the flu was not the reason he should be vaccinated.

I don't feel that your general condescension is warranted and wish you would reconsider your enhanced question-answering techniques.

I also observe that, an economics-based idea, many people do what will benefit themself. Pose to anyone that, "You're a finance worker so you wouldn't understand the full implication of getting the flu shot," as opposed to, "It is likely to decrease the chance of getting, or the severity and duration of, the flu." ... Win them over, you silver-tongued devil.

I'm of the school of thought that a good end result regardless of intention is leagues better than a bad end result despite good intentions. His vaccination is fine by me, no matter his motivation on this one topic.

 

[jw3600]

I don't feel that your general condescension is warranted and wish you would reconsider your enhanced question-answering techniques.

I also observe that, an economics-based idea, many people do what will benefit themself. Pose to anyone that, "You're a finance worker so you wouldn't understand the full implication of getting the flu shot," as opposed to, "It is likely to decrease the chance of getting, or the severity and duration of, the flu." ... Win them over, you silver-tongued devil.

I'm of the school of thought that a good end result regardless of intention is leagues better than a bad end result despite good intentions. His vaccination is fine by me, no matter his motivation on this one topic.

Medicine is not economics. Often what is good for oneself and society from a health standpoint is NOT fiscally sound. This fact does not take away from the importance of things like the flu shot. I was merely making a general PSA that one should get the flu shot regardless of whether they wish to have the individual prevention. He chose to volunteer those were not his intentions. He could have merely not responded. I have some studying to do and fear this could develop into a circular argument, so I may have to bow out.

 

[Th2]

Medicine is not economics. Often what is good for oneself and society from a health standpoint is NOT fiscally sound. This fact does not take away from the importance of things like the flu shot. I was merely making a general PSA that one should get the flu shot regardless of whether they wish to have the individual prevention. He chose to volunteer those were not his intentions. He could have merely not responded. I have some studying to do and fear this could develop into a circular argument, so I may have to bow out.

Oh I agree, public health is a far shot from microecon, but disagree that medicine is about only the big picture and not individual patients. I also agree that there are better justifications, but however you can obtain the good outcome is a quality justification (IMO).

And yep, no desire forth circle of arguments here.

 

[touchpause13]

Whether you are doing it for yourself or for others there really is no good reason not to get it.

Also we don't have a great enough percentage of people getting it to have herd immunity.

 

[Jabbed]

Whether you are doing it for yourself or for others there really is no good reason not to get it.

Also we don't have a great enough percentage of people getting it to have herd immunity.

You don't say things like that here without expecting an epidemiology/medical ethics smackdown.

 

[NienQ]

I'm sure the patients were fully informed of all the risks vs. benefits as well as given the latest high quality research on mammograms such as: http://www.cochrane.dk/screening/mammography-leaflet.pdf

Even better:

http://www.thennt.com/nnt/screening-mammography-for-reducing-deaths/
http://www.ncbi.nlm.nih.gov/pubmed/23737396

The trials with adequate randomisation did not find an effect of screening on total cancer mortality, including breast cancer, after 10 years (RR 1.02, 95% CI 0.95 to 1.10) or on all-cause mortality after 13 years (RR 0.99, 95% CI 0.95 to 1.03).Total numbers of lumpectomies and mastectomies were significantly larger in the screened groups (RR 1.31, 95% CI 1.22 to 1.42), as were number of mastectomies (RR 1.20, 95% CI 1.08 to 1.32).

Apart from the evidence against mass screening with mammography from adequate randomized trials, numerous population-based studies also corroborate the fallacy of the mammogram-reduced mortality of breast cancer connection, and if you take the substantial body of relevant data on the many serious risks of the test into consideration, it is evident that mammography does more harm than good - see: "Mammography Screening: Truth, Lies and Controversy" by Peter Gøtzsche and "The Mammogram Myth" by Rolf Hefti (for more on that one: http://www.supplements-and-health.com/mammograms.html ).

Dr. Gøtzsche from the Cochrane collaboration has stated this for quite some time but that perspective impedes on the enormous profits of the mammogram industry.

 

[Th2]

Dr. Gøtzsche from the Cochrane collaboration has stated this for quite some time but that perspective impedes on the enormous profits of the mammogram industry.

Why don't insurance companies stop paying for them?

 

[Winged Scapula]

Why don't insurance companies stop paying for them?

Because while our screening programs for breast health are far from perfect, the links above grossly overstate the stance that screening mammograms are useless, over inflate the risks, assume that anyone actually believes that "mammograms save lives" and neglect study design flaws and multiple confounding factors.

Insurance companies will pay for tests that are considered standard of care recommendations. The recommendations have not changed for screening mammography programs in the US and will not do so based on the linked studies.

No test is undiluted good or evil. For more information read the extensive blog work at Respectful Insolence or Science Based Medicine on the topic.

(lest it be assumed I think otherwise, I definitely believe we over biopsy and over treat women in the US).

 

[touchpause13]

Because while our screening programs for breast health are far from perfect, the links above grossly overstate the stance that screening mammograms are useless, over inflate the risks, assume that anyone actually believes that "mammograms save lives" and neglect study design flaws and multiple confounding factors.

Insurance companies will pay for tests that are considered standard of care recommendations. The recommendations have not changed for screening mammography programs in the US and will not do so based on the linked studies.

No test is undiluted good or evil. For more information read the extensive blog work at Respectful Insolence or Science Based Medicine on the topic.

(lest it be assumed I think otherwise, I definitely believe we over biopsy and over treat women in the US).

What are your thoughts on the self breast exam WS?

In clin med they talked about those basically going out of favor.

 

[Winged Scapula]

What are your thoughts on the self breast exam WS?

In clin med they talked about those basically going out of favor.

Yep - there's little documented utility. Now, some women feel empowered by it and I don't discourage them but most women (and frankly, many health care providers) have no idea what they're feeling, resulting in a lot of examinations, increased anxiety etc.

 

[DermViser]

Because while our screening programs for breast health are far from perfect, the links above grossly overstate the stance that screening mammograms are useless, over inflate the risks, assume that anyone actually believes that "mammograms save lives" and neglect study design flaws and multiple confounding factors.

Insurance companies will pay for tests that are considered standard of care recommendations. The recommendations have not changed for screening mammography programs in the US and will not do so based on the linked studies.

No test is undiluted good or evil. For more information read the extensive blog work at Respectful Insolence or Science Based Medicine on the topic.

(lest it be assumed I think otherwise, I definitely believe we over biopsy and over treat women in the US).

Yup, good luck convincing anyone to stop reimbursing for unnecessary mammograms after the first time when **** hit the fan with USPTF recommendations. If women could fight to get 2 mammograms a year and have it go thru they would.

 

[Winged Scapula]

A semi-joking HPB surgeon said at a meeting recently - "ah yes breast cancer...where the standard of care for surveillance, treatment, and follow-up can all be summed up as - whatever the patient feels like"

Seriously. If there ever was a patient population who felt that, because they graduated from the Google School of Medicine, they knew better than their providers, its women with breast cancer.

Or women with breasts for that matter. I spend a fair bit of time telling low risk women that, no they can't have BRCA testing/MRI/PET/CT/their breasts removed prophylactically just because they think they're high risk and/or are terrified. Its usually the ones with DM, HTN and morbid obesity who seem to underestimate their risk of CV disease and grossly inflate their risk of breast cancer.

 

[DermViser]

Seriously. If there ever was a patient population who felt that, because they graduated from the Google School of Medicine, they knew better than their providers, its women with breast cancer.

Or women with breasts for that matter. I spend a fair bit of time telling low risk women that, no they can't have BRCA testing/MRI/PET/CT/their breasts removed prophylactically just because they think they're high risk and/or are terrified. Its usually the ones with DM, HTN and morbid obesity who seem to underestimate their risk of CV disease and grossly inflate their risk of breast cancer.

I wonder if they'll just go to another provider who WILL give them what they want. The very cynical side of me makes me think the low risk ones who want their breasts removed prophylactically do it bc they want breast implants.

 

[DermViser]

A semi-joking HPB surgeon said at a meeting recently - "ah yes breast cancer...where the standard of care for surveillance, treatment, and follow-up can all be summed up as - whatever the patient feels like"

You can blame Susan G. Komen for the Cure for that.

 

[Winged Scapula]

I wonder if they'll just go to another provider who WILL give them what they want.

That does happen and so be it; I'm not going to be responsible for the gnashing and wailing of teeth when the insurance doesn't approve their unwarranted examination or treatment.

The very cynical side of me makes me think the low risk ones who want their breasts removed prophylactically do it bc they want breast implants.

The very cynical side of me thinks most of the low risk ones who want prophylactic surgery do it because they want a breast reduction.

 

[DermViser]

The very cynical side of me thinks most of the low risk ones who want prophylactic surgery do it because they want a breast reduction.

So do women with smaller breasts think they are lower risk just bc their breasts are smaller?

 

[Winged Scapula]

So do women with smaller breasts think they are lower risk just bc their breasts are smaller?

Perhaps but I believe its more complex psychological issues at play.

Many larger breasted women have significant body image issues which can be intertwined with depression, GAD, chronic pain/fibro, etc. They "hate" their breasts and believe that by removing them, they are solving some of these issues as well as reducing their perceived breast cancer risk (which is generally low/average).

Smaller breasted women may over inflate their risk of breast cancer but they don't ask for prophylactic surgery as often as larger breasted/obese women which leads me to believe that its the psychological issue at work here.

 

[DermViser]

Perhaps but I believe its more complex psychological issues at play.

Many larger breasted women have significant body image issues which can be intertwined with depression, GAD, chronic pain/fibro, etc. They "hate" their breasts and believe that by removing them, they are solving some of these issues as well as reducing their perceived breast cancer risk (which is generally low/average).

Smaller breasted women may over inflate their risk of breast cancer but they don't ask for prophylactic surgery as often as larger breasted/obese women which leads me to believe that its the psychological issue at work here.

I would have thought women with smaller breasts would have MORE psychological and body image issues, and want to "catch up" with everyone else, by getting surgery. I thought the larger breasted women, would get a reduction more for back problem type of issues since only removing breasts doesn't fix the real problem - their obesity.

 

[touchpause13]

I would have thought women with smaller breasts would have MORE psychological and body image issues, and want to "catch up" with everyone else, by getting surgery. I thought the larger breasted women, would get a reduction more for back problem type of issues since only removing breasts doesn't fix the real problem - their obesity.

Naw... Having small boobs isn't really that big of a deal.

 

[Winged Scapula]

I would have thought women with smaller breasts would have MORE psychological and body image issues, and want to "catch up" with everyone else, by getting surgery.

Many of them already have; I live in an area with a considerable amount of cosmetic procedures being done. Smaller breasted women may have issues related to the size of their breasts but they generally are not as disordered as the obese woman with proportionally larger breasts.

I thought the larger breasted women, would get a reduction more for back problem type of issues since only removing breasts doesn't fix the real problem - their obesity.

What obesity? LOL…I'm joking (sort of). You'd be surprised at the number of women who, after having a breast reduction or mastectomy are upset about the size of their abdomen. Because of the (previous) size of their breasts, they have often not realized their abdominal girthiness.

Anyway, they feel reducing the breasts is a fixable "problem" but feel defeated when the plastic surgeons and I tell them that losing weight before surgery will enhance the final product as well as reduce post operative complications.

 

[DermViser]

What obesity? LOL…I'm joking (sort of). You'd be surprised at the number of women who, after having a breast reduction or mastectomy are upset about the size of their abdomen. Because of the (previous) size of their breasts, they have often not realized their abdominal girthiness.

 

[Winged Scapula]

Plus, surgical reconstruction after a mastectomy is not nearly the same as a breast enhancement. It's a very different outcome cosmetically, even when done well.

Yes. Many, many women and health care providers fail to see that. In the words of one of my plastic surgeon friends, "they all become cosmetic patients" reflecting on the unrealistic and often demanding expectations that women have after breast cancer reconstruction.

 

[DermViser]

Yes. Many, many women and health care providers fail to see that. In the words of one of my plastic surgeon friends, "they all become cosmetic patients" reflecting on the unrealistic and often demanding expectations that women have after breast cancer reconstruction.

You mean they want it to look exactly like a normal breast after reconstruction? That's impossible if you're removing cancer tissue.

 

[DermViser]

Usually the problems come in when they are expecting it to look better than before.

But it's a really common misconception - people accused Angelina Jolie of 'just wanting an excuse for her boob job" when she had bilateral prophys.

But Angelina Jolie's double mastectomy was preventive, not treatment from already having cancer.

 

[DermViser]

But the general opinion of the public is that post-mastectomy reconstruction is the same as a "boob job"

Didn't know that. I'm just saying it wouldn't surprise me to have that accusation thrown at someone who had both their breasts removed prophylactically.