Medical Facts and Fiction.

As a Nurse Practitioner I often spend my time teaching. It is an integral part of what I do. As a skeptic I spend that time trying to reinforce critical thinking skills and science based medicine. There are many common medical assumptions that are endemic in the “lay” population. Some have a element of truth and some are dead wrong. This is the first in a series of medical information posts I am hoping to do periodically. They will focus on common myths, falsehoods, and popular misconceptions. I will try to categorize them so that they make some sense. I will have to limit myself to the US healthcare system because it is what I know best. Hopefully the next time you go the doctor’s office you will have improved knowledge and critical thinking skills about your health. Today I will focus on some unrelated but common misperceptions.

1. Doctor’s Can Treat Any Medical Problem-Fiction. Patients instinctively know that having your dentist treat you heart problem is a bad idea, or having your psychiatrist treat your appendicitis is a mistake. Yet having MD after your name does give people the  impression that you are able to handle all medical problems. That is not really true. Medicine has become too complicated and specialized to know enough to be a competent practitioner in all fields. The incorrect assumption that a “really good doctor” can do anything is common in pop culture and the media. For example Dr. Oz, a cardio-thorasic surgeon, offers his medical advice in a variety of medical fields. In fact his training makes him a expert in only one field C-T surgery. Because he is a physician his advice carries weight and authority but is this really the case? Commenting on Women’s health, GI Dysfunction, Urology is not within Oz’s specialty. General medical knowledge is better than none but it is not the same as expert. I have seen him use the “what medical school did you go to?” card to belittle opposing guests. My answer would be “What medical board did you sit for?”. Medical boards are specific and unless he has done residency in those specialties and become board certified he is no expert either. He may be a medical doctor but a doctor can’t just show up in the operating room and do any type of surgery he wants.  Someone like Dr. Dean Edell (Retired) is a good example of a science based physician that appropriately dosed his advice with admission of his limits. Physician do receive extensive generalized medical knowledge in medical school. The longer they are out of school the more dated that information may be. Most physicians have a narrow specialty that they follow after medical school. Even primary care physicians who are forced to wear many hats, are trained to know when they are out of their league. The title Physician does indicate a certain foundation of medical knowledge. It is broad based and it is the best way we know how to educate for the practice of medicine. It is not perfect and does not mean that your neurologist should be performing neurosurgery, or your urologist should be performing cesarean sections.

2. A Nurse Is A Nurse By Any Other Name-Fiction. Like physicians, Nursing is a wide and varied profession with very different training and education levels. It is confusing (Sometimes even to doctors and nurses) and I will try to simplify the alphabet soup surrounding nursing.

CNA or Certified Nurse Assistant- depending on the state laws they are educated through a 90 day program and are usually licensed/regulated. There is no degree usually a certificate program.

LPN or VPN-Licensed practical nurse. LPN are utilized to fill manpower gaps in nursing. Usually a associates degree they have relatively limited roles compared to RN’s. Expanded roles compared to CNA’s.

RN-Registered Nurse, this is what people traditionally think of as a the Nursing profession. There are a variety of degree’s, Associate, Diploma, Bachelor of science. There is a standardized licensure exam, state laws guide practice.

APRN- Advance Practice Registered Nurse(The Terminology has has changed several times). This category is Nurse Midwife, Nurse Practitioner, Certified Nurse Anesthetist, Clinical Nurse Specialist. Always a graduate degree, usually masters level. There has been increasing requirement to Doctoral. Simply put RN, with graduate education and training specific to the specialty. It usually requires a board certifying exam specific to the specialty and licensure.  State nursing practice laws vary slightly.

Nursing is often a stereotyped profession. From Nurse Ratched to Nurse Jackie nurses are usually portrayed as caricatures of reality. People make assumptions based on those stereotypes. Similar to physicians it is important that people know who they are dealing with and what their qualifications are. I am continually perplexed by the persistent sexism in medicine. I walk into a patient room, male in a lab coat, I’m a doctor. My colleague, female, MD same coat, she’s a nurse. Pay attention, never assume because of the clothing or that person’s sex that you know who you are dealing with. Healthcare workers should identify themselves to you. So know what the alphabet soup really means. If you are not sure ask. A good nurse will always want you to learn.

3. Antibiotics Cure Viral Infections-Fiction. People wanting antibiotic treatment for upper respiratory infections and sore throats is classic confirmation bias, and scientific misunderstanding. In the western world the vast majority of contagious illness is viral not bacterial. Antibiotics do nothing to shorten or affect the course of viral illness. Most viral illness has a 7-10 day course. Often by the time someone is seeking medical care they are usually at the peak of the disease. People see their doctor, get a antibiotic, and feel better in 2-3 days. So the the antibiotic cured you, right? No, most likely it was a self limiting viral illness that ended on is own. Your confirmation bias about the antibiotic is putting together the correlation falsely  About half of the 100 million prescriptions written for antibiotics each year are for respiratory ailments that aren’t going to be helped by a drug. Prescribing an antibiotic for a viral infection is not only wasteful, it can hurt the patient. More than 140,000 people, many of them young children, land in the emergency room each year with a serious reaction to an antibiotic. Nearly 9,000 of those patients have to be hospitalized. So why do doctors write the prescription? Most do it out of habit or to make their patients happy. A mother brings her sick child to the pediatrician and expects to walk out with a prescription. It takes time for the doctor to explain why antibiotics won’t do any good and might in fact do her child harm. There is also the ever present CYA or cover your ass medicine. Meaning there is a perception of litigation protection in antibiotic prescription. Bottom line is don’t go looking for antibiotics you probably don’t need them. Don’t get mad if you walk out of the doctor’s office with an explanation and advice not a prescription. It means that him/her is probably a thoughtful practitioner. It is much easier to write the Rx than teach the patient. Make sure the prescriber tells you why they think you need a antibiotic. FYI: Color of mucous is not a predictor of bacterial verses viral illness.

4. You Can Only Have Three Orthopedic Cortisone Injections Per Lifetime-Fiction. This one mystifies me because I have no idea of the origin. In my specialty I hear it all the time. Cortisone is a type of steroid that is produced naturally by a gland in your body called the adrenal gland. Cortisone is released from the adrenal gland when your body is under stress. Natural cortisone is released into the blood stream and is relatively short-acting. Injectable cortisone is synthetically produced and has many different trade names (e.g. Celestone, Kenalog, etc.), but is a close derivative of your body’s own product. The most significant differences are that synthetic cortisone is not injected into the blood stream, but into a particular area of inflammation. Also, the synthetic cortisone is designed to act more potently and for a longer period of time (days instead of minutes). There are side effects to cortisone, non of them are based on lifetime dosage. Probably the most common side-effect is a ‘cortisone flare,’ a condition where the injected cortisone crystallizes and can cause a brief period of pain worse than before the shot. This usually lasts a day or two and is best treated by icing the injected area. Another common side-effect is whitening of the skin where the injection is given. This is only a concern in people with darker skin, and is not harmful, but patients should be aware of this. Other side-effects of cortisone injections, although rare, can be quite serious. The most concerning is infection, especially if the injection is given into a joint. The best prevention is careful injection technique, with sterilization of the skin using iodine and/or alcohol. Also, patients with diabetes may have a transient increase in their blood sugar which they should watch for closely. Because cortisone is a naturally occurring substance, true allergic responses to the injected substance do not occur. However, it is possible to be allergic to other aspects of the injection, most commonly the betadine many physicians use to sterilize the skin. There is no rule as to how many cortisone injections can be given. Often physicians do not want to give more than three, but there is not really a specific limit to the number of shots. However, there are some practical limitations. If a cortisone injection wears off quickly or does not help the problem, then repeating it may not be worthwhile. Also, animal studies have shown effects of weakening of tendons and softening of cartilage with cortisone injections. Realistically you want to avoid frequent short interval steroid injections but there is no lifetime limit.

5. The Flu Vaccine Can Give You The “Flu”-Fact. Flumist is live attenuated vaccine. There is a remote 0.6% chance of getting the flu. 5-20% of the population gets the flu every year, so it is better to get the Flumist than not. There are no inject-able vaccines given in the US that use attenuated live vaccine.   The difference is the virus is completely killed for the inject-able. So if it worries you get the shot.

So that’s a start. I am sure Brian does not want me to turn skeptoid into WebMD so I will limit these posts.

PS: Please, for the love of Pete, your shoulder has a Rotator Cuff not a Rotor cuff, and it is the Pros-tate not pros-trate. ;)

 

References:

http://ideas.time.com/2012/04/16/why-doctors-uselessly-prescribe-antibiotics-for-a-common-cold/#ixzz2KkFT3MUZ

http://orthopedics.about.com/cs/paindrugs/a/cortisone.htm

http://www.cdc.gov/flu/protect/keyfacts.htm

About Stephen Propatier

Stephen Propatier is a board certified acute care nurse practitioner who specializes in spine and sports medicine. He is a member of the Society for Science Based Medicine. He is adjunct faculty for both Brown University Warren Alpert Medical School and Rhode Island College Graduate School of Nursing.
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5 Responses to Medical Facts and Fiction.

  1. gwen says:

    As a practicing RN, I love it! I am disheartened with having to explain #5 over and over to my colleagues. I also get tired of explaining acai berry and pomegranate are not magical cure alls, and acupuncture doesn’t work.. :(

  2. Anonymous says:

    Steven, Very interesting, I love the PS. I hope you received the results of the MRI I had on Sunday. TOH it is according to the report. I did some research and was wondering if I could get a very new and aggressive treatment? It is a one time intravenous treatment of 5mg of Zoledronate for a period of 15 minutes and has been known to relieve symptoms in a week as well as heal the bone density problem. I know my appointment isn’t until the 28th but want to attack this as soon as possible Please let me know if this a possibiulity. Have a great day. John Stenning

  3. John S says:

    Steven, I Hope you received the results of my MRI performed on Saturday. I was wondering if I could have an IV of 5mg of Zoledronate. I have done some research and this is the quickest remedy by far. Thanks and have a great day. I gotta ride. Looks like TOH.

  4. Wordwizard says:

    FCNYC_Cafe@yahoogroups.com is having a discussion about does the flu shot help the elderly, or give shingles…People who get the flu have weak immune systems, so boost your immune system with Vitamin D…I wrote in that taking vitamin supplements doesn’t make people live longer or healthier lives, and was hit by Vitamin C for scurvy (but sailors didn’t prevent scurvy by taking Vit C tablets, they sucked limes!) Perhaps you might do some good jumping in.

    • Reg. says:

      Stephen, to have received only four responses to this means you have either targeted your audience very accurately or have failed to engage with your intended audience. :-)

      I’m not sure whether to congratulate you or sympathize. Perhaps four was your limit?

      I’m only here as part of looking for a response to the Lipitor and Crestor medication argument.

      On evidence it is futile for a cardiologist to say there is no argument when he has so recently agreed with his colleague that one’s body is the best lab for testing medications, and that if there is a bad reaction, it is up to the patient to remove himself from the medication.

      I was mortified that a Cardiologist should spend two thirds of my consultation time in a right-wing tirade against unions, the media and any criticism of broad-based Crestor treatment. After having used Lipitor with bad side effects, I was SHAMED into three more attempts at Crestor treatment with the same outcome. It is only now I realize that my instability with walking may be in direct response to using Lipitor/Crestor.

      Same with a hospital administering BP reducing medication when it has been shown at the same treatment time that the patient’s BP was desperately low.

      I feel that addressing these topics may bring you an overwhelming response.

      More on your topic though, my RN partner of extensive experience is thinking of parting-ways with the aged patient support company she has been working for, after ward injury forced her to lighter involvement. The reason is one of being diametrically opposed to company philosophy, yet to disengage with the company means abandoning the “customer” base she has established. This is what happens when the profit motive takes over from real patient care.

      As you know, listening to lonely old people can be part of medical treatment, especially when the patient is unsure which way to turn next. Now she’s thinking of moving to receptionist duties which is a shameful waste of her talents and experience.

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