Mark Glenn Stokes, MD

 We have a lot of data on how and when to screen for certain diseases, particularly cancers, but relatively little on when to stop.  Many guidelines, such as those for mammography and colonoscopies, suggest 70 or 75 years of age, but this is somewhat arbitrary.  A particularly useful thing to think about, in my opinion, is the functional status of an individual in relation to ones perceived life expectancy.  By perceived life expectancy, I mean how long do you expect an individual to remain alive, especially with a reasonable quality of life, not a life expectancy derived from actuarial data.  The data would suggest that an 87 year old man will live for 5 years, but this is based upon a statistical estimate of the population at large.  I've met 87 year old men who I would not expect to live a week, and others that I would not be surprised to live to be a hundred.  I think this is important to consider when offering a screening test.  A woman in ex...

 For many years we had no good screening test for lung cancer.  Traditionally we relied upon chest x-rays (CXR) as the screening modality, but this turned out to be a poor choice.  To qualify as a good screening test, the procedure must meet several criteria. First,  the condition must be prevalent enough in the population to allow  screening to be cost effective.  Lung cancer certainly meets this criteria.  A condition like adrenal cancer wouldn't qualify, as the disease isn't common enough to make a screening test worthwhile.  This of course is from a population point of view; for one afflicted with adrenal cancer, screening might have helped.  But the decisions are based on a value to the population, not an individual. The second criteria is that the test must be easily assessable and acceptable to the patient. A CXR certainly meets this criteria.  A brain biopsy looking for Alzheimers disease would not.  Third, the disease being...

 "I gotta sore throat, doc.  I need an antibiotic." Most instances of sore throat, need, most instances of upper respiratory tract infections, are viral, and self resolve in a short time.  These are are treated with "symptomatic" therapies - throat lozenges, decongestants, etc.  Antibiotics will not help.  The fact that the infection resolves after a few days of an antibiotic is usually coincidence. It would have gotten better regardless.  When assessing the sore throat, we look for four things - tender tonsillar lymph nodes (those that are just under the angle of the jaw); high fever; exudates on the tonsils; absence of a cough. If present, they can be suggestive of a bacterial - streptococcal - infection.  Absent these, the sore throat is likely viral in origin.  Now, sometimes a person will comes in with a cold that has lasted three weeks - runny nose, sore throat, cough.  They give a history that is described as a "double sickening:" ...

Sometimes one needs to reach a physician outside of business hours for medical advice.  I, as a physician, have often been on the receiving ends of such calls. When calling the doctor on call, here are some tips to make the encounter go smoothly.  Reduce the background noise. Turn off the TV.  Put the dog away.  And the kids.  And the six relatives in the background screaming advice or questions.  If I can’t hear you, I can’t help you.    If possible, let me talk to the patient.  Talking to the spouse, or the child or the friend, just confuses things.  I am going to ask you for your temperature, especially if you are calling with symptoms that might be an infection.  No, I can’t hold on while you take it.  Take it before you call. I am going to ask you for your blood sugar if you are a diabetic.  No, I can’t hold while you check it.  Do it before you call. I am going to ask you what mediations you ...

 "Doc, my back hurts.  I need an MRI." The MRI seems to be the Holy Grail of diagnostic tests to many patients, especially for those with back pain. Its utility?  Virtually zero. As with most diagnostic testing, the question to ask is "What am I going to do with the information I get from the test?"  The answer, at least with MRIs order for back pain, is "Nothing." First, a bit about back pain.  In generally, if one does absolutely nothing - no medication, no physical therapy, no MRI, X-ray, CT scan, no massage, no acupuncture - 90% of those presenting with back pain get better in 30 days.  There are exceptions, those that require more aggressive therapy, and more urgent diagnostic testing - the so-called "red flags of back pain" - but those are ascertained by a good history and physical examination.  The majority of cases, though, are not serious, medically speaking.  For sure, back pain can be life interfering, but for the most part acute onset...

 There has always been great interest in the “annual check up” or the “yearly physical.”  But do you know where this came from? In the early 20th Century, as the health insurance industry developed, the insurance companies felt it would be in their best interest if their customers were seen periodically by a physician. Their premise was that problems would be uncovered early, and that would reduce the number and dollar amount of claims they would have to settle, saving them money. (Remember, the mission of insurance companies is not to keep you healthy; it is to increase profit margins).  So they advocated the annual physical and so it has become entrenched in our society.  A myriad of studies, however, have never proven that this activity confers any benefit to the patient. The likelihood of uncovering a serious problem before the onset of symptoms is vanishing small. In nearly 40 years of practice, I’ve diagnosed exactly one problem, before there were symptoms, tha...