Two months later our hound dog, Bo also had prostate surgery. When I brought him in I asked the veterinarian what time I should pick him up. The vet told me Bo would remain over night. "Overnight"? I said "My father came home the same day". The vet looked at me and said, "Bo's not on Medicare!"

This sums it up very well.

The following is the 2007 winning entry from an annual contest at Texas A&M University calling for the most appropriate definition of a contemporary term. This year a definition required for the contemporary term, 'Political Correctness'.

The winner wrote; "Political Correctness is a doctrine, fostered by delusional, illogical minority, and rabidly promoted by an unscrupulous mainstream media, which hold forth the proposition that it is entirely possible to pick up a turd by the clean end."

The American Heart Association has recently recommended compression only CPR for bystanders who witness adult cardiac arrest. This change is based on recent evidence which suggest that the best outcomes for non-asphyxia related cardiac arrest is to start CPR quickly and to minimize interruptions. The recommendation does not apply to cardiac arrest in children or unwitnessed cardiac arrest or suspected asphyxia related arrest due to drowning or drug overdose. It is hoped that this change will increase bystanders willingness to initiate CPR. Prompt defibrillation of course is also needed when available. (Circulation 2008 Mar 31)

Upper respiratory infections are one of the most common primary care diagnoses. About one-third of those patients are diagnosed with acute rhinosinusitis and over three-fourths of these patients receive antibiotics even though there are no clinical criteria that which clearly delineate viral versus bacterial infections. A recent meta-analysis of 2547 adults with rhinosinusitis showed that the odds ratio for cure in the antibiotic group was 1.37 and the estimated number needed to treat with antibiotics to achieve 1 cure was 15. Symptoms, severity, duration, and age did not predict increased benefit from antibiotic treatment. The authors conclude that generally adults with acute rhinosinusitis should not receive antibiotics regardless of their signs and symptoms. The current guidelines suggest using antibiotics if symptoms have persisted longer than seven days but the authors say this is not supported by the evidence. As usual clinicians must weigh the benefits versus the risks of adverse side effects. Much of the time patient expectations influence physicians prescribing these drugs. (Lancet 2008 Mar 15; 371:908)

Michael Kahn writes an interesting perspective in the May 8th issue of the New England Journal and makes a case that medical education should place more emphasis on what he calls etiquette based medicine. Such training would put patient's satisfaction at the center of the clinical encounter and emphasizes good behavior towards patients. He relates a possible check list for the first encounter with the hospitalized patients:

1. Ask permission to enter the room and wait for an answer.
2. Introduce yourself.
3. Shake hands.
4. Sit down and smile if appropriate.
5. Explain your role as part of the care team.
6. Ask the patient how he or she is feeling about being hospitalized.

I do think there is a lesson to be learned in this perspective and recommend it to you. (N Engl J Med May 8 2008; 358; 19)

John J. Mohr, MD