WILTIMS #319: Do as I say, unless you do as I do

An ongoing theme for my medical education is learning some of the hypocritical tendencies of doctors. Well, actually that's not quite right. Doctors may do things that they don't want their patients to do, but research has shown that they won't impose their hypocritical recommendations on their patients. For example, obese doctors generally don't counsel patients to lose weight. Doctors who smoke fail to counsel their smoking patients to quit. I don't think this is actually better than just being outright hypocritical.

The example brought up today was in regards to caffeine. Caffeine, like any stimulant, can trigger anxiety disorders. But there's no consistent, evidence-based recommendation for the safe amount of caffeine a day. So the "joke" goes like this:

How many cups of coffee is ok to drink?
One more than your doctor.
How many cups is too much?
Two more than your doctor.

I didn't find it all that funny.

TIL: Panic attacks can mimic many different medical conditions. Since several of those potential conditions can be life-threatening, if someone presents with panic attack symptoms but no history of panic attacks, you must give them the benefit of the doubt and work them up for dangerous conditions like a heart attack or pulmonary embolism. If nothing turns up, especially a few times, then perhaps a psych consult is indicated for treatment of an anxiety or panic disorder. However, epidemiological studies have shown that, if the patient is over ~40 years old and has never had a panic attack, then it's vanishingly unlikely that they are having their first one right now. It's probably worth taking a second look at those possible medical causes.