NEJM Audio Summary - Sep 1, 2011

TIME TABLE

00:51 | Early versus Later Rhythm Analysis in Patients with Out-of-Hospital Cardiac Arrest
02:30 | A Trial of an Impedance Threshold Device in Out-of-Hospital Cardiac Arrest
03:48 | Cardiac Arrest and the Limitations of Clinical Trials
04:54 | A Functional Element Necessary for Fetal Hemoglobin Silencing
05:55 | Progress in Understanding the Hemoglobin Switch
06:22 | Cord Colitis Syndrome in Cord-Blood Stem-Cell Transplantation
08:00 | Electronic Health Records and Quality of Diabetes Care
09:27 | Finding the Meaning in Meaningful Use
10:35 | Care of the Adult Patient after Sexual Assault
12:15 | A Problem in Gestation
14:00 | Opportunities and Challenges for Episode-Based Payment
15:41 | Global Health: Health Technologies and Innovation in the Global Health Arena
17:24 | The Art of Doing Nothing
19:21 | Scleroderma
20:13 | Lung Herniation after Minimally Invasive Cardiothoracic Surgery

"The Art of Doing Nothing"

A perspective article by Lisa Rosenbaum, a cardiology fellow at New York–Presbyterian/Weill Cornell Medical Center, New York.
Near the end of medical school, Dr Rosenbaum injured her knee running a marathon.  What began as classic “runner's knee” during training worsened when she ran the race anyway. A month later, she still couldn't run comfortably.Then one day, she felt an odd, round mass protruding from the most tender area. Was it a tear? An infection? A tumor? The only logical solution seemed to be an MRI and a referral to an orthopedist. Her primary care physician, Dr. B eyed her lump.  “It's just a simple tendon cyst, a ganglion,” he told her. “You don't need an MRI; you just need to rest.” When she faced Dr. B. again, she informed him of the expert opinion of her distant cousin, an orthopedist. “He says I need an MRI,” she said “I might have a torn meniscus or something.”
Three weeks later, she got an MRI. Dr. B. called with the results. “You have something called `lateral compression syndrome'.” She pushed her knee to the point where, on imaging, it looked like someone had repeatedly whacked her with a club. Dr. B. said he suspected the orthopedist would recommend surgery.“But Dr. B.,” Dr Rosenbaum said, “don't you think I just need to rest?” Of course, in the end Dr. B. had been right all along; proper rest was all she ever needed.
Dr Rosenbaum writes: What a culture values may be constantly in flux, but it is still up to us to determine. We may choose to value an MRI more than the wisdom and experience of our physicians, but this does not mean that an MRI is inherently more beneficial to our health.

Podcastでは触れられてませんが、この記事の執筆者Lisa Rosenbaum先生は、日本でも公開されたウィリアム・ハート主演の映画「ドクター」のネタ本の著者のお孫さんだそうです。本誌の記事では、お爺ちゃんの思い出とともに綴られています。