Monthly Archives: June 2011

Foodie Friday: mushroom farm

Attending the Boston Flower and Garden show this year, I was taken with the idea of a grow-your-own mushroom kit that was on display. Well, the texture of the final product was chalky and dry and not something I wanted to eat. However, the process was interesting and might be fun for a kids’ project. Here are some photos over a few weeks’ time.

Do you need a cortisone shot?

I presented this article at our recent Rheumatology journal club: “Exercise therapy after corticosteroid injection for moderate to severe shoulder pain: large pragmatic randomised trial” from BMJ (2010).

It is available full text via the link above. In a nutshell, this was a study of 232 people over 40 with unilateral shoulder pain. People with prior  surgery or underlying conditions such as prior surgery or known arthritic conditions like RA were excluded (along with several other exclusion criteria). Patients were randomized into steroid injection (20mg triamcinolone) AND physical therapy or physical therapy only. Response was assessed at weeks 1, 6, 12 and 24. From the article text:

What is already known on this topic

  • Shoulder pain is common, persistent, and often caused by subacromial impingement syndrome

  • Exercise, manual therapy, and corticosteroid injections are common interventions in primary care for this condition

What this study adds

  • Steroid injection combined with exercise is of similar effectiveness to exercise only at 12 weeks

  • A third of patients treated with exercise and manual therapy alone do not improve sufficiently by 12 weeks and will opt for a steroid injection

  • Earlier improvement in pain and function is seen with corticosteroid injection combined with exercise and manual therapy

Will this change how patients with shoulder pain are treated? Probably not, but it is reinforcement of what we do typically see in practice – shoulder pain usually improves by 3 months whether you get a steroid shot or do PT, but it will improve faster with an injection. However, there are complications to injections so if patients are nervous about that, needle phobic or just willing to do a course of PT then there certainly is not a need to absolutely do an injection. There was no arm of people who JUST did an injection and didn’t do PT (which is probably the more likely scenario for people who get injections) and I’d like to know how they compared with the other groups. Thoughts?

Sick of the part-time debate yet?

There’s been a lot of fallout over this weekend’s New York Times Op-Ed piece about doctors, particularly female doctors, working part time. I enjoyed reading the multiple reactions and reader comments and have been thinking about it quite a bit over the past few days. On my recent half day off I joined one of my partners at a conference reviewing Rheumatology board questions with the residents. Afterwards, since I was close to the office, I stopped by to sign some papers, review labs and make a few follow up calls.

Walking in, my partner says, “Hey, what are you doing here? Isn’t this your day off?”

Me: “Yeah, well, haven’t you heard? I’m ruining medicine with this part time nonsense!”

What exactly is part-time? In this world of “widget” medicine where we’re only paid for patients seen face-to-face in the office, we need to assign a value to the hours of uncompensated time outside normal office hours. Indeed, my “time off” is often spent attending meetings, participating in teaching sessions, reviewing research projects, filling out patient forms, catching up on labs, phone calls and emails and coordinating care for patients with difficult or complex cases. Things I maybe didn’t have a chance to do or couldn’t do before the office opens at 8am or after the doors close for the day. Fortunately or unfortunately, the fact that I can access my EMR from my laptop means I’m (and probably a lot of other “part-timers” are) never really away from work.

Is it easier to work a full-time schedule in more of a shift-based specialty like anesthesia, hospital medicine or EM where there seem to be less demands outside of one’s actual on-site work? I certainly don’t want to speak for my colleagues in primary care, as I know my office paperwork burden is a fraction of theirs. However, until there is less bureaucracy in medicine, compensation for time spent in non-contact care coordination and, yes, malpractice reform, physicians (male and female) will continue to seek part-time work or explore other practice environments. I applaud those who have made this lifestyle choice, whether to spend more time with kids, write a book (or blog) or pursue other interests related or not related to medicine. Thanks to those who have echoed Dr. Centor’s assertion that he would rather see a committed part-time doc than a full-time doc who is burned out.

Here are some links to related articles:

Dr. Centor – medrants.com

Dr.Jen

WSJ Blog

KevinMD

Dr. Au’s response

NYT parenting blog