Recommended Readings

(1). Richard Smith. A neurosurgeon confronts his death. 2022;400(10362):P1505-6.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02089-X/fulltext

When I worked at The BMJ, I came to see that we had a glut of personal views that followed a predictable pattern: “I thought I was a good doctor, then I became a patient and realised how different and awful it was to be a patient, now I’ll be a better doctor.” We eventually decided to stop publishing these articles. I wondered if they did become better doctors or simply reverted to type as the experience of being a patient wore off. Now Henry Marsh, neurosurgeon and deservedly a best-selling author of books about his medical career, has written an extended, literary version of those personal views, describing his experience of prostate cancer.

(2). Batya Swift Yasgur. Physicians Talking: Time and Family Demands Make Friendships Difficult. 2022.

https://www.medscape.com/viewarticle/982772?src=WNL_mdpls_221025_mscpedit_card&uac=346576HG&spon=2&impID=4790536#vp_1

The 13th century theologian Thomas Aquinas wrote, “Among all worldly things there is nothing preferable to friendship. Friendship is needed by all men in whatsoever occupations they engage.”

But how well does medicine, as a highly demanding and time-consuming occupation, blend with developing and maintaining rewarding friendships inside and away from work? In the “Physician Friendships: The Joys and Challenges” report, Medscape surveyed more than 1600 doctors about how they make and keep friends while balancing against work and family demands.

(3). Marlene Busko. New Guidelines for Bariatric Surgery Are ‘an Important Reset’. 2022.

https://www.medscape.com/viewarticle/982827?src=WNL_trdalrt_pos1_ous_221024&uac=83814HV&impID=4785679

In a new statement, two metabolic and bariatric surgery societies recommend expanding eligibility for bariatric surgery to include individuals with a body mass index (BMI) lower than the current threshold, among other updates.

The statement recommends that the threshold for metabolic and bariatric surgery should be a BMI ≥ 35 kg/m2, regardless of comorbidities.

In contrast, providers, hospitals, and insurers currently use BMI thresholds of ≥ 40 kg/m2, or ≥ 35 kg/m2 with an obesity-related comorbidity (such as hypertension or heart disease), to define patients eligible for metabolic and bariatric surgery based on criteria established in a 1991 consensus statement by the US National Institutes of Health (NIH). A joint statement issued today by the American Society for Metabolic & Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) updates the indications for surgery to reflect the progress in the field over the past 30 years.

(4). Leigh Page. You and the Skeptical Patient: Who’s the Doctor Here? 2022.

It can be extremely frustrating for doctors when patients question or disbelieve their physician’s medical advice and explanations. And many physicians resent the amount of time they spend trying to explain or make their case, especially during a busy day. But patients’ skepticism about the validity of some treatments seems to be increasing.

(5). Cecilia Sorensen. Treatment and Prevention of Heat-Related Illness. N Engl J Med 2022; 387:1404-1413.

https://www.nejm.org/doi/full/10.1056/NEJMcp2210623

A 71-year-old man with a history of coronary artery disease, congestive heart failure, and schizoaffective disorder presents to the emergency department with confusion. On the day of presentation, he was seen walking near his apartment complex in a busy urban area and was later found collapsed outside his building. The local heat index (accounting for temperature and relative humidity) is 105^oF (40.6^oC). On arrival in the emergency department, he is conscious but confused. His heart rate is 130 beats per minute, blood pressure 100/70 mm Hg, respiratory rate 28 breaths per minute, rectal temperature 40.5^oC, and oxygen saturation 90% while he is receiving oxygen at a rate of 3 liters per minute through a nasal cannula. He opens his eyes to voice and can state his name. He is able to move his arms and legs and has no focal neurologic deficits. His skin is hot and dry to the touch. His medications include furosemide, risperidone, and carvedilol. The patient lives alone in a top-floor apartment without air conditioning. How should this heat-related illness be treated, and how could it have been prevented?

(6). Writing Committee, et al. 2022 ACC Expert Consensus Decision Pathway on Cardiovascular Sequelae of COVID-19 in Adults: Myocarditis and Other Myocardial Involvement, Post-Acute Sequelae of SARS-CoV-2 Infection, and Return to Play: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2022 May 3;79(17):1717-1756.

https://pubmed.ncbi.nlm.nih.gov/35307156/#:~:text=Set%20Oversight%20Committee-,2022%20ACC%20 Expert%20Consensus%20Decision%20Pathway%20on%20Cardiovascular%20Sequelae%20of, Cardiology%20Solution%20Set%20Oversight%20Committee

(7). Sorensen C, et al. Reducing the health impacts of ambient air pollution. BMJ 2022;379:e069487.

https://www.bmj.com/content/379/bmj-2021-069487

What you need to know

Inhaling polluted ambient air has many health effects, including childhood onset of asthma, and onset and progression of atherosclerosis.

Vulnerable people can consider using well fitted N95 face masks, avoiding outdoor exercise on days when the air quality is poor, and using indoor HEPA air filters.

Consider establishing air quality monitoring and warning systems for use by clinicians and in hospitals.

Recommended Readings