Mallet Finger – Diagnosis, Treatment, and Rehabilitation

How to take care of and recover from a common but sometimes vexing finger injury.[1]

Mallet finger usually results from forced flexion of the distal (most distant) part of the finger (distal phalanx – DP) during active extension of the DP. The condition is caused by a rupture of the extensor tendon (on the back of the finger) that crosses the distal interphalangeal joint (DIPJ) from the proximal phalanx (PP) to the DP. Part of the bone may also be avulsed (pulled away). Mallet finger is the most common closed tendon injury in athletes.[2] Often, patients explain that a ball hit their partially flexed fingertip. Patients complain of pain, swelling, and an inability to fully extend their DP.

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Study Discussion – Gender Disparities in Internal Medicine Residency Awards

In the March 2021 issue of The American Journal of Medicine, seven physicians, whose first names suggest that they are all female, wrote “Investigating Gender Disparities in Internal Medicine Residency Awards.”[1] The authors began by recounting gender disparities in salary, academic rank, grant funding, and awards. They performed a multi-institutional study based on survey data from academic internal medicine residency programs starting in 2009 and extending through 2019. These physicians’ initial findings are in Table 1:[2]

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How to Do No Harm

How leaders can minimize harm in health care, in other industries, and in all areas of life.

“How can we change this process to prevent this error from happening again?” the senior ward nurse asked the group. It is a common question, one that I have heard thousands of times from experienced and dedicated health care professionals of all stripes.

I have worked in health care for many years, serving in positions from volunteer to emergency medical technician to senior attending physician to chief of staff at a hospital to chief medical officer of a large network. In every position, “do no harm” is a fundamental theme. This famous statement from the writings of Hippocrates encapsulates quality improvement, patient safety, access to care, and many other goals in modern medicine.

“Do no harm” can be thought of as eliminating risks that could lead to a bad outcome, such as injury or death. Occupational and Environmental Medicine physicians learn that there are four ways to decrease risk in the workplace and in the environment:

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Your Permanent Record

Everything that we do, or fail to do, impacts us for good or for ill for the rest of our lives. Our teachers were right…each of us has a permanent record.

A little boy couldn’t resist the urge to pull the hair of the girl sitting in front of him. Across the room, a little girl couldn’t help chatting with her friend while the teacher was talking. These incidents happen every day in thousands of classrooms across the United States. Modern teachers have a variety of new techniques for dealing with such infractions, but in bygone days teachers would often respond with the same threat: “if you do that again, I will write that in your permanent record.” The children would immediately stop, at least for the moment, because everyone feared bad reports in their permanent record.

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Medical Preparation for Humanitarian Missions

Going on a mission trip or a humanitarian event to a developing country? Prepare yourself by doing this.

“Doctor, this will be a very long war if for every division I have facing the enemy, I must count on a second division in hospital with malaria and a third division convalescing from this debilitating disease.” General Douglas MacArthur to Colonel Paul F. Russell, US Army malaria consultant, May 1943.

Just like soldiers going to war, people on humanitarian missions anywhere in the world can fail to accomplish their mission due to illness or injury. Whether missionaries seeking to advance the gospel of Christ, secular humanitarians trying to dig a well and build a school in a rural African village, or a combination of both, medical problems can inactivate the best intentioned and most capable teams. This article is intended to help people medically prepare themselves to go overseas on humanitarian missions. You can also watch the video.

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DOTMLPF-P Analysis and Military Medicine

A comprehensive and highly useful military model for analyzing and addressing problems that does well in non-military settings as well.

My staff and I were meeting at the end of a long day. As representatives of the regional headquarters they had been working with their counterparts at our subordinate medical facilities on an important project with a tight suspense, and they had met resistance. One exasperated lady at a hospital said, “Tell your boss that we have full time jobs already!” Another one said, “This regional initiative just isn’t my top priority right now”, and one of my staff said “Sir, there just aren’t enough hours in the day.” Everyone who has worked long in leadership and management has heard these complaints time and again.

There is always a temptation to ignore such concerns and keep pushing, but that is rarely the right thing to do. One concern from my staff is that they did not feel as though their counterparts in the clinics and hospitals considered them value added. They wanted cooperation on these vital projects but did not perceive that they had much to give in return. This is a perpetual problem and when I worked in a hospital, I felt the same way about the regional staff.

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The Future of the Military Health System

What will the Military Health System look like in the future? The operational forces will be more military, and the CONUS facilities will be more civilian. 

In the book Retribution: The Battle for Japan, 1944-1945, Max Hastings described how ships’ crews took on the characteristics of their commanders. One captain was not well liked but was respected because “he had a mind like a slide rule.” Most good commanders took care of their sailors.

One characteristic of all effective commanders was that they communicated all that they knew about the strategic situation to their crews. In December 1944 the US Navy had 1100 warships and 5000 support ships. Most sailors never saw the big battles and instead spent the war shipping cargo between ports. For example, it is 5100 nautical miles from Honolulu, Hawaii to Darwin, Australia. Cargo ships took 21 days each way to make the trip. Temperatures in these all-metal ships reached 110 degrees, the odor of fuel and sweat was ubiquitous, and the noise was deafening. Men swabbed, repaired, ate, slept and repeated the process endlessly. They saw nothing but the sea, the sky, their ship, and each other. Few knew how their part, no matter how small, fit into the overall plan for victory.

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How to Pick Your Fitness Goals

Few of us are athletes, and even fewer of us are Olympians, but we should all have fitness goals. How to make them, and how do you keep them?

For the past two weeks many Americans have enjoyed the Olympic Games.  Watching the fastest runners and swimmers, the finest gymnasts, and the best teams in the world is both an inspiration and a thrill.  It stirs the heart to see the athletic prowess that these young stars can reach.  So moved, many people commit to improve their own physical fitness and set goals to achieve that end.

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Who is Responsible?

Are we individually responsible for what we do? When are we responsible for what happens to us? If we take credit for our successes, how can we avoid the blame for our failures?

I was at a Preventive Medicine conference in February of 2011 and the speaker was discussing unhealthy lifestyle choices.  Her theme was that people really weren’t responsible for smoking cigarettes, being overweight or sedentary, or any other unhealthy choice.  Instead, they were victims of their genetics and their environment.

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