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Mike Merrill, MD

I'm a doctor (internal medicine).

Interests: Crossfit Tae Kwon Do Philosophy Economics

Recent Activity

Is coronary angiography overused in Western New York?

Coronary angiography is the "gold-standard" test for coronary disease. It's considered the final word on whether or not you have it. It involves threading a catheter to the arteries that supply the heart. A liquid that x-rays don't penetrate is injected into the blood, and so with an x-ray (really... Continue reading

Posted yesterday at Dr. Mike Merrill

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Screening tests may not make sense from the individual's perspective

There's a big difference between how doctors traditionally think about screening and how patients should think about it. Let's say I'm a doctor, and I'm considering all my patients as a group. I have 1,000 men that I'm trying to save from prostate cancer. That's about this many guys: Source:... Continue reading

Posted Nov 9, 2018 at Dr. Mike Merrill

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Yeah, I'm diabetic and my sugar gets low sometimes. No big deal, right?

Actually it can be a pretty big deal, especially if you are older and you've had diabetes for a while. Hypoglycemia causes anxiety, tremors and sweating. In more severe cases, you can get confused, lose consciousness, have a seizure, or even die. Think about driving and having all that sneak... Continue reading

Posted Nov 2, 2018 at Dr. Mike Merrill

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Better medical tests: "normal" becomes "disease"

Human beings are smart, and we keep inventing new things. In medicine, that means more and better tests to analyze us in increasingly sophisticated ways. This trend will continue, so we need to get used to it, and be smart about it. Sometimes when tests get better, they are able... Continue reading

Posted Oct 26, 2018 at Dr. Mike Merrill

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Over time, disease definitions are expanded. Is that good?

A great many things are labelled diseases nowadays. "Caffeine withdrawal" is a formal diagnosis, for example. But there are also examples of existing diagnoses getting expanded, such that more people are classified as unwell. Pre-diabetes and "mild cognitive impairment" (basically pre-dementia) would be examples. This all creates higher risk of... Continue reading

Posted Oct 19, 2018 at Dr. Mike Merrill

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Is it OK to say to your doctor, "I don't know what you're talking about"?

Many patients think they will get better care from doctors if they are nice. Some think it's better to be aggressive. Many just want to get away as soon as possible. Of the ones who try to be nice, there's a risk that they will not get what they need.... Continue reading

Posted Oct 12, 2018 at Dr. Mike Merrill

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Overdiagnosis is an error in prognosis

In overdiagnosis, a clinician identifies an abnormality that would never have hurt the patient, and treats it as an actionable pathology. You can never know who is overdiagnosed in real time; it only becomes apparent after the fact, while examining populations. In a way, the term "overdiagnosis" is misleading. It... Continue reading

Posted Oct 5, 2018 at Dr. Mike Merrill

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Lab tests before surgery: not always useful

Partly out of habit, physicians frequently order lab tests before surgery, to make sure everything is OK. But this is not always useful. The purpose of pre-operative testing is to figure out what risks there are, and to minimize those risks. If you are going through a low risk surgery,... Continue reading

Posted Sep 14, 2018 at Dr. Mike Merrill

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How do you explain overdiagnosis?

You can't know if an individual has been overdiagnosed. You only see it at the aggregate level. The decision point is the choice to seek a diagnosis. After that point, overdiagnosis can occur. By definition, overdiagnosis will not improve prognosis - it's not going to make you live longer or... Continue reading

Posted Sep 5, 2018 at Dr. Mike Merrill

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In overdiagnosis, harm looks like benefit

It's hard to explain the concept of overdiagnosis to the public. Think of overdiagnosis as "pseudo-disease," in which something innocuous is labelled as a disease, and leads the patient down a pathway of unnecessary testing and treatment. An example would be finding and treating a prostate cancer in a 75-year-old... Continue reading

Posted Aug 27, 2018 at Dr. Mike Merrill

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Why do doctors order unnecessary imaging of the back?

Imaging for low back pain (LBP) is only recommended in certain situations. The Choosing Wisely campaign suggests avoiding imaging during the first six weeks in the absence of red flags, like weight loss, a history of cancer, recent trauma, osteoporosis or age greater than 50. And imaging for LBP is... Continue reading

Posted Aug 24, 2018 at Dr. Mike Merrill

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Avoid testicular self-exams

I still see some physician offices recommending testicular self-examination for males, adolescent and older. This isn't the right thing to do. According to the U.S. Preventive Services Task Force, if you have no symptoms, there is no evidence doing self-examination prolongs life or reduces suffering (the two main goals of... Continue reading

Posted Aug 24, 2018 at Dr. Mike Merrill

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Mammograms if you're 90?

Most people want to live a long time, and many people want to be good patients. So they do their screening tests, like mammograms and colonoscopies. Unfortunately, sometimes these tests are done for too long. At an advanced age, these tests are unlikely to be beneficial. For example, the American... Continue reading

Posted Aug 17, 2018 at Dr. Mike Merrill

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Fewer fingersticks for type 2 diabetics

Pricking your finger for blood is one of the worst things about having diabetes. It hurts, it's messy, and you have to maintain and carry around a glucometer. it's tremendously important for type 1 diabetes, in which the body does not make enough insulin. The therapy for type 1 is... Continue reading

Posted Aug 10, 2018 at Dr. Mike Merrill

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Choosing Wisely: with back pain, don't rush to an MRI

Someone out there may completely understand back pain, but I haven't met them, and it's not me. But there are things we do know. And one of them is that in most cases, an MRI is not useful. The low back is a weak spot in human anatomy because we... Continue reading

Posted Aug 3, 2018 at Dr. Mike Merrill

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Can't hear well? You're probably isolated and unhappy

When my grandmother got hearing aids at age 75, I suddenly realized she was a very intelligent woman. She started making timely, incisive comments in the middle of fast conversations. She started paying attention to things more. And she became funnier. She apparently had had hearing loss for many years.... Continue reading

Posted Sep 27, 2016 at Dr. Mike Merrill

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At the end of life, how do you tell if it's time?

The last years of life can be filled with a repeating cycle of serious illness, and recoveries that seem to restore us to a reasonable state. We can find ourselves moving from one episode of congestive heart failure, or COPD exacerbation, to another, and returning to our homes, back to... Continue reading

Posted Sep 5, 2016 at Dr. Mike Merrill

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One of my ways to avoid back pain

Probably somebody out there completely understands back pain, but I haven't been able to find them, and it's not me. Nonetheless, certain things are obvious. The low back is a weak spot in human anatomy, because we vertically load weight on it. It's originally designed to hang weight anteriorly (think... Continue reading

Posted Aug 29, 2016 at Dr. Mike Merrill

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old man in hospital

I'm taking care of a very old, frail man. He can only whisper. I ask him what he needs and he says, "Don't leave." He grabs my hand, weakly. I hold it for a few minutes. Is he going to die tonight? A few minutes later his daughter comes in... Continue reading

Posted Aug 21, 2016 at Dr. Mike Merrill

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Why you need a health care proxy

A proxy is someone who your doctors talk to when you can’t. Let’s say you’re in a car accident and you’re in a coma. Or let’s say you have septic shock and you have been sedated and put on a mechanical ventilator. In these situations, the medical team needs someone... Continue reading

Posted Aug 7, 2016 at Dr. Mike Merrill

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Building a good refugee camp

In San Francisco recently, I walked down a few industrial streets that were lined with tents. They were all closed up, but voices emerged from a few of them. I wondered how they disposed of their human waste. There was no smell, and no sign of any dumped waste or... Continue reading

Posted Apr 3, 2016 at Dr. Mike Merrill

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How to be a happy old person

Being happy as an old person is a problem I deal with every day. I spend a lot of time breaking it down into easily understandable bites, for purposes of counseling my unhappy older patients, and easily implementable changes, to help them recover. A caveat is that this is just... Continue reading

Posted Mar 25, 2016 at Dr. Mike Merrill

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Getting used to the idea of climate engineering

We should get used to the idea of climate engineering, also known as geoengineering, the large-scale manipulation of the Earth's climate. This is because it's possible that, eventually, the risks of climate engineering will be smaller than what's already happening. When we try to predict what will happen to us,... Continue reading

Posted Feb 3, 2016 at Dr. Mike Merrill

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The Health Hazards of Shift Work

This is a guest post from Eastern Kentucky's Online Bachelor's in Occupational Safety. Shift work has become a prominent topic of interest lately, predominantly because of the progressive increase in night shift workers. Currently, there are over 15 million U.S. citizens that work full time night shifts, and it is... Continue reading

Posted Sep 6, 2015 at Hacking the Night Shift

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People get treated so much at the end of life when there is little to be gained. It's not really ethical. When you're old and sick, you might become tired of the medical care process. In this situation, dying can be pretty straightforward. The hard part is beforehand, sorting through... Continue reading

Posted Sep 3, 2015 at Dr. Mike Merrill

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