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MKSAP: 50-year-old man with cirrhosis

mksap

Conditions and Diseases

December 13, 2014

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 50-year-old man is evaluated in follow-up for a recent diagnosis of cirrhosis secondary to nonalcoholic steatohepatitis. He has a history of asthma, type 2 diabetes mellitus, hyperlipidemia, and obesity. His current medications are inhaled fluticasone, montelukast, insulin glargine, insulin lispro, simvastatin, and lisinopril.

On physical examination, temperature is 37.5 °C (99.5 °F), …

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MKSAP: 50-year-old man with cirrhosis

Medical errors: We can’t trust doctors to get it right

Allen Frances, MD

Physician

December 12, 2014

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“If doctors do no other good, they at least prepare their patients early for death, undermining little by little and cutting off their enjoyment of life.”

These words from Montaigne are 350 years old, but, sadly, too often they describe the results of modern medicine, particularly when it is mindlessly applied in a needlessly heroic way to the end of life.

I spend …

You’re fine: That’s the hardest diagnosis to make

Roy Benaroch, MD

Conditions and Diseases

December 12, 2014

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A thought provoking article in the November, 2014 edition of Pediatrics highlights a growing problem with modern medicine: Just because we can make a diagnosis doesn’t mean we should.

The article, titled “Overdiagnosis: How our compulsion for diagnosis may be harming our children,” has been made available for free to everyone. It’s fairly dense and technical, but if you’ve been following this blog …

Here’s what genomics is all about

Robert Pearl, MD

Medications

December 12, 2014

Personalized medicine. Predictive medicine. Targeted medicine. These are just some of the descriptors being applied to “genomic medicine,” a field of medical research generating much fanfare and hope for the future.

Genomics, according to the Centers for Disease Control and Prevention (CDC), is the study of all the genes in the human genome – that double-stranded DNA helix that defines who we are and what we’re made of. Building on classical …

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Here’s what genomics is all about

A controversial email. But not for this patient.

Lucy Hornstein, MD

Physician

December 12, 2014

It’s been a fascinating week or so listening to everyone weigh in on which response they thought I sent to my patient. The general consensus, unsurprisingly, was that the first was far too cheeky — not to mention insulting — to effectively convey the necessary information. The second, of course, was the one I send every day, day in and day out. Just this once, circumstances conspired to allow me to send the …

Is there really a doctor shortage, and what can we do about it?

Tanya Feke, MD

Health Policy

December 12, 2014

There is controversy about whether or not there will be a doctor shortage in the near future. I wonder why there is so much speculation. The Association of American Medical Colleges estimates that we will be short 90,000 physicians by 2020 and 130,000 physicians by 2025. If things stay as they are now, of course there will be a shortage. The …

A doctor goes networking, and is horrified by what she finds

Abigail Schildcrout, MD

Physician

December 11, 2014

I was invited to a “networking party.” I went. I was horrified by what transpired there. And disgusted. And felt blindsided. And angry. And blown away by the prevalence of what I couldn’t decide was greed, ignorance, or an unseemly combination of the two. And what magnified the intensity of my repulsion was the fact that a large proportion of the people involved have the …

Science bashing: The latest threat to research in America

Sherry Pagoto, PhD

Health Policy

December 11, 2014

In the midst of multiple public health crises, the NIH budget is in an unprecedented period of stagnation. So why the growing chorus of voices calling to slash more science?

Senator Rand Paul recently slammed the NIH, specifically calling out a study of “origami condoms” which he says are “designed with Japanese folding paper in mind.” In fact, this research is …

Jonathan Gruber: What if he’s right?

Margalit Gur-Arie

Health Policy

December 11, 2014

So there is this guy from MIT or Harvard, or some other place where they teach our leaders how to lead, and his name is Jonathan Gruber. Mr. Gruber, it seems, was hired to consult with the Obama administration during the time the Affordable Care Act (ACA) was created because of his extensive expertise in designing the Massachusetts health care system. In recent weeks, people who don’t particularly like our …

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Jonathan Gruber: What if he’s right?

Obamacare: What did Jonathan Gruber really say?

Peter Ubel, MD

Health Policy

December 11, 2014

Jonathan Gruber went from unknown to infamous in the last few weeks, a result of disparaging comments he made about the Affordable Care Act (Obamacare) and even more disparaging ones he made about the American people. According to Gruber, the Obama administration counted on “the stupidity of the American voter” to pass the bill. In fact, the Obama team’s “lack of transparency” was deliberate, because they believed the law would …

Medical students in the couples match: One student’s story

Moises Gallegos

Medical Education

December 11, 2014

I recently wrote about the pressure that comes with the scrutiny of residency applications and the interview process. Adding to this, many applicants apply alongside their significant other, making use of the “couples match” option. Let’s think about that: No longer do you have to stress for yourself, but now you worry for your partner too. And while your primary …

Married to a physician: Holiday blessings in disguise

Rochelle Bach

Physician

December 11, 2014

Each year as the holidays approach, countless medical families prepare for the dreaded release of the holiday schedule. Will the physician spouse be home this year? Will the non-physician spouse be packing up three kids under the age of five and traveling across the country alone to visit family they may only see once a year? It can be stressful. It …

Health care’s future: An interview with a hospital CEO

Trudy Lieberman

Health Policy

December 10, 2014

Not long ago I interviewed Dr. Todd Sorensen, the CEO of Regional West Medical Center, a 184-bed facility serving a large swath of rural western Nebraska. I’ve known Dr. Sorensen since junior high school, and we’ve kept in touch over the years to discuss the health care system from his perspective as a physician and administrator and mine as a health …

Fixing obesity: It’s a matter of changing our perspective

David L. Katz, MD

Conditions and Diseases

December 10, 2014

McKinsey & Company recently issued a report on effective means of fighting hyper-endemic obesity in the modern world. Among other things, they concluded that “implementing an obesity-abatement program on the required scale will not be easy.” I presume that is intended to be somber, but the magnitude of understatement makes it almost funny. And sad.

No, it will not be easy — not in the world as it is. In the world as …

How to choose a good medical school: A look behind the scenes

Richard Gunderman, MD, PhD

Medical Education

December 10, 2014

The competition to get into medical school is fierce. The Association of American Medical Colleges just announced that this year, nearly 50,000 students applied for just over 20,000 positions at the nation’s 141 MD-granting schools — a record. But medical schools do not have a monopoly on selectivity. The average student applies to approximately 15 schools, and many are accepted by more …

A cardiologist undergoes knee surgery. Read what he learned.

Wes Fisher, MD

Physician

December 10, 2014

The phone rang one evening and a pleasant voice was on the other end. “Hi, my name is nurse so-and-so and I’m the educational coordinator for your upcoming knee surgery. Do you want to go to the patient orientation session?” she asked. “It’s very helpful to go over things before and after your surgery and to answer any questions you might …

Death with dignity: Perspectives from a medical student

Heather Alva

Medical Education

December 10, 2014

Background

Under the 1997 Death with Dignity Act, Oregon was the first of the now-handful of states to allow physicians to write a prescription that, when filled and administered, would cause intentional death.

Let me be clear: Death with dignity is not offered to Oregonians en masse or even on a whim. To legally qualify, a patient must be 18 years or older, a resident of Oregon, capable of making and communicating …

Evidence-based preventive care: Should it be free?

Kenneth Lin, MD

Conditions and Diseases

December 10, 2014

One of my residents presented some research that she had completed under my supervision. Since I left the staff of the U.S. Preventive Services Task Force four years ago, it has been my sense that the Task Force has substantially lowered its evidence “bar” for recommending a preventive service, an impression confirmed in private discussions with colleagues who closely follow the group’s activities. In a JAMA editorial published last year, Drs. Steven Woolf …

Why you should protest the deaths of Eric Garner and Michael Brown

Christy Duan

Health Policy

December 9, 2014

In the pediatrics playroom, the medical team and I, a medical student, hunkered down in child-sized chairs to review patient progress notes. A television screen nearby diverted my attention. On CNN, video of protesters alternated with Eric Garner’s final moments. The television was mute, but I could hear Garner say, “I can’t breathe …I can’t breathe …” One moment, he is …

Antibiotics during gynecological surgery: When are they necessary?

Jennifer Gunter, MD

Conditions and Diseases

December 9, 2014

Preventing infection after surgery is very important as not only are these infections often uncomfortable and make you feel very sick, but they also increase the risk of more serious complications. For example, if you are less mobile because of an infection after surgery you are at higher risk for a blood clot or if you need a prolonged hospitalization because of an infection in your surgical wound you are …

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