Reversal of knowledge flow: heart attacks, beta blockers, migraines, sleep, jet lag, and premature ejaculation

A piece of wisdom, please heed.

If you want to know more, you can read.

But don’t think to balk

At the casual talk

Between docs.  It’s something we need.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work.  In June of 2011 I joined up with the Community Health Center, which provides care for the underserved.  I’m now working part-time, which, for a doctor, means 54 hours a week.

Quite some time ago I attended a series of patients with porphyria, a blood disease so rare that most doctors will never see a case.  When the dust settled I had successfully proven the diagnosis three dozen times.  The story of the research I never published and why I would even think to look in a particular bunch of selected patients would take pages and would only interest a small handful of people who probably would never think to look at my blog. 

I learned that if a doctor reads for four hours about a disease, he or she will know more than half of the doctors.  Eight hours of study will bring one to a state of knowledge greater than 80%, and sixteen hours will put a physician in the bottom half of the top ten percent.  But to get to the top of the top requires years of study and clinical experience.

No doctor can know everything about everything, though one of my colleagues comes close (he has good social skills, too, and if we could clone him I’d be out of a job).  Average front line docs have, on average, about the same level of knowledge.  I really, really like hospital work because it makes me talk to doctors who know more than I do.

Most of the specialists and subspecialists I deal with approach the knowledge gap gently, and every conversation brings me to a richer state of learning.  Once in a while, I get to push the knowledge flow the other way.

An excellent conversation over mediocre hospital food with a cardiologist started with discussion of the fine points of managing heart attacks, and brought us to a discussion of beta blockers, a class of blood pressure drugs that interfere with some of the actions of adrenaline.  Labetalol rates favorite status among some of the docs, he said.  I pointed out that it cost more than any other generic in the class; carvedilol, the most recently generic of the group, costs the least.  I looked at the priceless expression on his face and explained that I’d just talked with one of the Community Health Center pharmacists.

Then we talked about propranolol, the oldest beta blocker of them all.  The cardiologist mentioned that men won’t take it because of sexual dysfunction, I talked about how I prescribe very low doses to treat premature ejaculation. 

While the cardiologist listened, I held forth about propranolol’s uses having nothing to do with its original indication, hypertension.  His interested escalated when I got to migraines, which led me to sleep and thence to jet lag.

No reason, I asserted, to have jet lag in the 21st century.  A simple sequence of five drugs would multiply the effective days of vacation.

In the course of twenty minutes, I learned more cardiology, he learned a good deal about sleep management, and we both walked away better doctors.



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2 Responses to “Reversal of knowledge flow: heart attacks, beta blockers, migraines, sleep, jet lag, and premature ejaculation”

  1. Iskandar Linardi Says:

    Dear Doctor
    I would like to know further the dosage propanolol for treat premature ejaculation and it is use on demand or daily treatment?
    Many thanks for sharing

    • walkaboutdoc Says:

      I generally prescribe 10 mg an hour before sexual activity. Only if the person is having sex daily would I recommend taking it on a prescription.

      Note that the Masters and Johnson Squeeze works well, too. You can find instructions for that on the net.

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