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MKSAP: 38-year-old man with a mass in his right neck

mksap

Conditions and Diseases

December 6, 2014

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

A 38-year-old man is evaluated for a mass in his right neck that he first noticed 2 weeks ago while shaving. The patient also reports experiencing a pressure sensation when swallowing solid foods for the past year and daily diarrhea for the past 2 months. His personal medical history is unremarkable. His …

3 guaranteed ways to improve patient satisfaction

Brant Avondet

Patient

December 5, 2014

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With roughly 1 billion in Medicare reimbursement dollars being tied to patient satisfaction, it’s no wonder the focus on patient experience is swelling. Of course there are other factors fueling the focus — the proliferation of online physician ratings websites, ACOs, and CG-CAHPS to name a few.

Over the past decade I have visited 100+ different inpatient and outpatient practices. Ironically, …

Medical schools fail to teach students about the health care system

Nathan Moore, MD

Health Policy

December 5, 2014

Any health care provider can tell you that clinical knowledge isn’t the only thing that determines how well you care for your patients. We’ve all seen — many times — the patient that can’t afford the correct antibiotic, doesn’t get preauthorization for the necessary CT scan, and can’t find a specialist who will take his or her insurance. Making the correct diagnosis is only the first step in helping a …

The last house call: Turning off the defibrillator

James Ong, MD

Physician

December 5, 2014

Standing in front of my patient’s home, I reach out to ring the bell. On the other side of the door live a man and his wife, who have been waiting patiently for my arrival. I hesitate for a moment before pressing the button.

As I wait uneasily for the door to open, I think to myself that this is the first time I make a house call on my patient …

After Joan Rivers: How we can make patients safer

Ahmed Zaafran, MD

Physician

December 5, 2014

On September 4th, 2014, iconic comedian and TV personality Joan Rivers passed away due to complications following what seemed to be a routine visit to her gastroenterologist.

Up until now, a wave of speculation and mystery has surrounded her case with a trove of unanswered questions. What happened on that tragic day? What kind of procedure did she have? Was it a dangerous surgery? Who was in the room?

On October 16th …

Ferguson: What should physicians do?

Rhea Boyd, MD

Physician

December 5, 2014

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There is little to say once you’ve said this before. Although the sadness brings fresh tears, they are also old tears. The grief becomes familiar and so too the inevitable resumption of everyday life. The pain bores to the soul but settles in the subconscious, where it rests, privately born and quietly hidden, lest Read more…

Ferguson: What should physicians do?

5 questions to ask before buying health insurance

Christine K. Cassel, MD

Health Policy

December 5, 2014

While millions of Americans are re-enrolling in Obamacare, signing up for health insurance for the first time, or double-checking the plans their employer offers, many will undoubtedly ask what’s affordable for them.

Good luck defining affordability. Like beauty, it’s in the eye of the beholder.

To better understand what affordability in health care means from the vantage point of the ‘kitchen table,’ the National Quality Forum, with support from the Robert Wood …

Stop using food stamps to buy soda. But how?

Peter Ubel, MD

Health Policy

December 4, 2014

The food stamp program helps over 40 million Americans pay for groceries. Unlike other forms of economic assistance, this program, called SNAP (the Supplemental Nutrition Assistance Program), only pays for food, thereby constraining how recipients make use of the aid. But are food stamps constrained enough?

SNAP recipients experience higher rates of obesity and diabetes than the general population. Experts estimate that SNAP recipients consume almost twice as many calories …

Why we must lower the cost of researching new drugs

Kevin R. Campbell, MD

Medications

December 4, 2014

In a controversial study, Tufts University’s Center for the Study of Drug Development estimates that the cost to bring a new drug to market exceeds nearly 2.6 billion dollars. The study, which was 40 percent funded by industry has been criticized for over estimating these costs in favor of industry and misrepresenting some cost estimates. While we will not know fully the extent of the methodology of the study until later …

The Shooting at Sandy Hook report: 4 things we can learn from it

Claudia M. Gold, MD

Physician

December 4, 2014

The recently released report, Shooting at Sandy Hook Elementary School, from Connecticut’s Office of the Child Advocate offers a searing in-depth account of the holes in our mental health care system. The report is careful to point out that no causative link exists between their findings and the events at Sandy Hook. However, this in-depth investigation offers an opportunity, if we are able to hear and take action on its …

Lung cancer screening and shared decision making: Will it happen?

Kenneth Lin, MD

Conditions and Diseases

December 4, 2014

Recently, the Centers for Medicare & Medicaid Services (CMS) officially proposed coverage for annual low-dose computed tomography (LDCT) screening for lung cancer in current or former smokers age 55 to 74 years with at least a 30 pack-year history. In doing so, CMS followed the lead of the U.S. Preventive Services Task Force, which had previously given a “B” grade recommendation for screening in a similar population through age 80 years.

In the …

Get help: Most physicians are not good at business

Michael Kirsch, MD

Physician

December 4, 2014

We’ve all heard or used the phrase, “Leave it to the professionals.” It certainly applies to me as the only tools that I can use with competence are the scopes that I pass through either end of the digestive tunnel. Yeah, I have a toolbox at home, but it is stocked similarly to the first aid kit that your new car …

A walk in Central Park: Contemplating physician burnout

Bernadette Sheridan, MD

Physician

December 4, 2014

There are times when who you are and what you do are inseparable. A photographer views a scene from the camera’s point-of-view even when the camera is not in hand. A police officer assesses situations with an “on duty” reaction, even when off-duty. And a health care professional rarely turn off the knee-jerk reaction to assist when someone requires help.

That immediate …

Why does the government fail to bend the cost curve?

Jordan Grumet, MD

Health Policy

December 3, 2014

A few months ago I assessed a patient with dementia. I dutifully ordered the appropriate blood testing and MRI. As I delved further into the history, I was concerned that there may be a component of depression. Pseudodementia (memory disturbance and dementia like symptoms caused by depression) can often mimic classic Alzheimer’s disease, but resolves with proper treatment. The best way to differentiate these two syndromes is neuropsychological testing. I decided to send my patient to a colleague …

After residency: I’m scared to practice outpatient medicine

Rebecca Crow, DO

Medical Education

December 3, 2014

As a graduating senior resident I’m scared to practice outpatient medicine. In a community of patients and physicians crying out for primary care doctors, what are we doing at a training level to foster and promote confidence and independence at doing this?

Many bright eyed freshly graduated medical school students enter residency understanding the need and embodying the hope of pursing outpatient …

Quality improvement is a marathon, not a sprint

Alexandra S. Brown, MD

Health Policy

December 3, 2014

My husband and I both like to run. I run about 3 miles once or twice a week — if the weather’s not too bad, and if I don’t have something else going on. Keith, on the other hand, runs half marathons. He goes for long runs on the weekend for 3 to 4 hours at a time, and shorter runs during the week. He runs in the heat, rain …

Can serendipity be engineered?

Alberto Hazan, MD

Conditions and Diseases

December 3, 2014

You know the story. It goes something like this:

On an ordinary September morning in 1928, Alexander Fleming, a Scottish bacteriologist working at St. Mary’s Hospital in London, came back from vacation to find that one of his Petri dishes containing Staphylococcus aureus growing in culture had been contaminated by greenish mold.

Instead of throwing a fit, Fleming grew curious over this finding. After …

Read more…

Can serendipity be engineered?

Hospital closures affect the safety net. Here’s how.

Rhea Boyd, MD

Health Policy

December 3, 2014

In the post-Affordable Care Act health care landscape, sweeping hospital closures have created new barriers to access in a system already criticized for its fragmentation and saturation. Looking back over the past 20 years, urban hospitals, and urban trauma centers in particular, bore the brunt of this impact, closing at the highest rates in the country. Now, evidence suggests the impact of urban hospital closures may disproportionately affect those …

Physicians are treating the well, and nurses are treating the sick

Hans Duvefelt, MD

Physician

December 2, 2014

A rash could be leukemia or idiopathic thrombocytopenic purpura. A sore throat could be glossopharyngeal neuralgia or a retropharyngeal abscess. A blocked ear could be Ramsay-Hunt syndrome, a self-limited serous otitis or sudden sensorineural hearing loss with an abysmal prognosis if not treated immediately with high doses of steroids. A headache or sinus pain could be cancer, and a cough could …

Why teaching anatomically correct words matters

Natasha Burgert, MD

Physician

December 2, 2014

As a doc, I need to take care of the whole child. I do this with respect for every kiddo; and with their parent’s consent, presence, and permission. Sometimes the job includes discussing or examining a child’s genitals.

In the past, it was not thought of as appropriate to allow children to speak openly about sensitive anatomical areas (“private parts.”) Growing up as kids, we may have …

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