Read the article
Yes, Healthcare is complicated.
Are family doctors doing circumcisions? Osteopathic family physicians rounding in the nursery or delivering babies have done so for many years. The article this month is not a procedural publication but is more about the ethical discussion around the idea of circumcision. Should parents have the right to make the decision about the genital surgery of their child? The article also discusses many other issues related to circumcision.
The longest article of this edition is a review of the diagnosis and treatment of sleep disorders. The topic could be a book so it’s the abbreviated version. The article starts with insomnia, the most common of sleep disorders. Not everyone who has insomnia presents to the doctor and if they do, most are managed in the primary care physician office. Insomnia is treated with hypnotics. The training of physicians causes circadian rhythm disturbances. Shift work or working all night and jet lag are examples of circadian rhythm disturbances. Sleep is the best treatment but may need hypnotics to achieve. Sleep disturbed breathing disorders are a category that includes obstructive sleep apnea and is treated mostly with CPAP but the consideration of an oral device is appropriate in some cases. Sleep behavior disorders include all the bizarre behaviors patients may do while asleep like sleep walking, sleep talking and night terrors. Daytime sleepiness disorders include narcolepsy and idiopathic hypersomnias. Stimulants are the most common treatment of this group of disorders. Sleep movement disorders include restless leg syndrome that is commonly treated with low dose short acting dopamine agonists. Bruxism is the last sleep disorder discussed which is treated with a mouth guard.
Our clinical image entry has radiographs and a case report demonstrating slipped capital femoral epiphysis. The case demonstrates the 1) classic age (between 10-15) 2) pain in the knee radiating to the ipsilateral hip 3) male and 4) obese. The suspicion is confirmed by radiographic imaging, ( plain x-rays ) The author discusses the differential diagnosis in this setting and it is a memorable discussion.
More ethics in Ethical Considerations in Prescribing or Withholding Opioids for Chronic Pain. The author discusses the four basic bioethical principles – beneficence, non-maleficence, justice and autonomy and the application to the dilemma of prescribing narcotics or not prescribing them. The author discusses the considerations for and against prescribing narcotics in both acute and chronic pain.
Who would guess, healthcare is complicated?