Multiple diagnoses ... and multiple diagnoses

I feel certain scruples about blogging about my new workplace (Johns Hopkins) - I suppose that's a good thing. I like it, is what I'll say to start.

The patients are different. Half of them are very well educated and knowledgeable about their conditions, bringing in lists of diagnoses.

The question I try to address - well, the question I haven't addressed yet, but would like to, is: do these long lists of diagnoses serve a purpose?

I mean, there are lists and there are lists. Let's say

List 1. Diabetes, hypertension, coronary artery disease, depression, tobacco use

List 2. Cervicalgia, autonomic dysfunction, benign prostatic hyperplasia, degenerative disk disease

List 1 is more than the sum of its parts, and list 2 - not so much. Which doesn't mean the problems in list 2 are minor (every one has a right to think that their problems are not minor! why else would they come to the doctor?), just that the multiplicity of the diagnoses is less important.

"This is Dr. Berger. He is visiting Australia to see what a modern medical system looks like."

I spent the day enjoyably. I gave a talk this morning to the folks at VMA General Practice Training, one of a number of provider training centers throughout Australia. (Recently - within the past decade or so - the Australian government has decentralized the training of general practitioners, formerly under the College of General Practitioners, in order to promote competition.) I had a feeling of being at home among people like those at the primary care program I just graduated from. Now, primary care doctors in the US are (with the addition of philosophical self-consciousness and their own advocacy organization) just like internists, while their equivalent in Australia is the GP. Australia is civilized because about half their practitioners are GPs. What struck me was how little difference there seems to be, on a brief first glance, in outlook and sensibility.

Then this afternoon and evening I have been shadowing the clinicians at Parkridge Medical Centre in Melbourne. Besides the obvious differences (namely, that Australia has a "modern medical system" with universal healthcare coverage) I noted, again anecdotally, a relative reluctance to spring first for the pharmaceutical solution, something I know I did as a resident (mere weeks ago!).

Presenting the presenters!

I was at Hopkins last week giving a talk as a recipient of one of the GIM Housestaff Research Awards. The other awardees were impressive. I wish they were as blogorrheic as I am, so I could provide links to their life & work. In any case, among the presentations were

• a discussion by Matt DeCamp of intellectual property rights and distributive justice, and their interdependence
  
• Lee Jennings' study of osteoporosis treatment in the hospital (per guidelines: calcium, vitamin D, and anti-resorptive/bone-forming agents). Two percent of patients got recommended treatment in-house!
• a sobering fact about residents' physical examinations of women (Rosette Chakkalakal): they don't listen to the heart like they should (is it because they respect too much their patients' modesty? or they're uncomfortable with moving their breast out of the way?)
• a study by Nitin Kapur of interpartner violence and sexually transmitted infections among Indian women (with a 1-month prevalence of IPV of around 20%, if I remember correctly; related link)

• Last but not least, my study about factors associated with patients' failure to fill new asthma prescriptions [Google version above not yet re-edited to account for Power Point - Google incompatibility].