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How is fungal meningitis diagnosed and treated?

Conditions and Diseases

November 21, 2012

As the number of deaths from fungal meningitis mounts, many people want to know how fungal meningitis is diagnosed and treated.

As an infectious disease doctor, it is routine for me to care for patients who come in the hospital with a fever. At first glance it is impossible to tell whether the patient has meningitis, pneumonia or a urine infection.

If a patient has headache, confusion or stiff neck along with …

Cancer makes you realize the gift of time

Don S. Dizon, MD

Physician

November 21, 2012

When I was 16 my dad had a heart attack. I still recall studying in my room when my mom came in to tell me he wasn’t feeling well. At the time, I was a volunteer in the emergency room at our local hospital, located in the tiny Pacific Island of Guam. I recall asking him what he was experiencing: …

Repeated story syndrome: Finding the right balance for patients

Ishani Ganguli, MD

Physician

November 21, 2012

The other night, a patient gave me a piece of his mind. Mr. Q was a middle-aged man debilitated by days of nausea, vomiting and intractable belly pain. That morning, his wife finally convinced him to get medical attention and drove him to our emergency department. On arrival, he sat in a cubicle in the waiting room and explained his story to a triage doctor: how he was doing well …

Enough with government interference in the patient-doctor relationship

Bob Doherty

Health Policy

November 21, 2012

Worried about a government takeover of health care?

You should be, but it isn’t the bureaucrats and politicians in Washington that you should be most concerned about. Instead, it is the growing propensity of state legislators to dictate to physicians what they can and can’t say to their patients, what tests they must provide, and what advice they must give to them—the patient’s wishes, the medical evidence, and the physician’s clinical …

If pilots worked like doctors, the sky would rain planes

PalMD

Physician

November 20, 2012

“This note was produced using [mega-brand] medical dictation software. While every effort has been made to insure accuracy, errors may still exist.”

Really? What kind of doctor would admit in a medical chart to being too lazy or incompetent to produce an accurate record?

A lot of them. Dictations are easy to read if you are willing to confound legibility and accuracy. Dictation software is relatively cheap, and with the continued profusion …

Why there’s still value in the routine physical

John Mandrola, MD

Physician

November 20, 2012

Millions of Americans believe in the practice.

Government reformers believe in it.

Doctors too.

Heck, even I, an accused therapeutic nihilist, tracked down a poor soul who agreed to be my primary care doctor. Call it old-fashioned, but I wanted my own doc, and I wanted yearly “checkups.”

No procedure—not even AF ablation–is as good as prevention. Taking your body in for routine checks and scheduled maintenance makes perfect sense. Call such a notion–obvious.

But …

Why are we still failing patients despite open communication?

Linda Brodsky, MD

Physician

November 20, 2012

Did you know that urine pregnancy tests are routinely performed on all females before every surgery? No exceptions. The Children’s Hospital in Buffalo tests 9 years and above. Don’t know if a parent or a patient has a right to refuse the test, but I do know that the anesthesiologist will refuse to give anesthesia, except for a life-threatening emergency.

I have never paid much attention to these tests. The nurses …

The new standard of an exceptional physician

Wes Fisher, MD

Physician

November 20, 2012

There are so many changes in medicine these days, but it takes a bit of time away from the keyboard to appreciate them.

So glued have I become to looking at computer screens, it’s been hard to pull my head from them any more. Doctors lives are spent staring at these damn screens now. I wonder how many of my youngest colleagues know how to start an IV, a foley, place a central …

Penalizing hospitals for never event infections is ineffective

Skeptical Scalpel, MD

Health Policy

November 20, 2012

I told you so.

Three months ago, I blogged about the Medicare (CMS) “never events” list, diagnoses that Medicare will no longer reimburse hospitals for. In Medicare’s eyes, these diagnoses are totally preventable, should never happen and will not be reimbursed. I pointed out that several were in fact not 100% preventable despite any institution’s best efforts, and the rates of many of these occurrences would not fall to zero.

Now …

The futile attempt to provide cheaper care to poor people

Margalit Gur-Arie

Health Policy

November 20, 2012

Wherever health care reformation and transformation is discussed, sooner or later the imperative of patient engagement is sure to materialize. Patients, it seems, are no longer content to be passive spectators while care is administered to them, and instead are demanding to be active participants in their own health care decisions. Gone are the paternalistic days of doctor knows best, replaced by informed and educated patients on an equal footing …

Cancer survivors are truly remarkable people

J. Leonard Lichtenfeld, MD

Physician

November 19, 2012

David Sampson, who is a colleague of mine here at the American Cancer Society, recently sent me a blog written by a woman well known in the breast cancer community who days previously had been diagnosed with recurrence of her breast cancer. The blog has captivated me, perhaps more so now that I have been facing some of my own …

Why I hate the SOAP note

Suzanne Koven, MD

Physician

November 19, 2012

Medicine, like law, the military, and many other professions, has its own language–a kind of verbal secret handshake by which its members recognize one another and close ranks against outsiders.

Sometimes, the use of technical terms, abbreviations, and other forms of jargon can impair patients’ understanding of their medical care. This article discusses the extent to which clinicians overestimate patients’ “health literacy“–with potentially dangerous results.

But sometimes, medical lingo has …

Read more…

Why I hate the SOAP note

Where are the tonsils and why would we take them out?

Christopher Johnson, MD

Conditions and Diseases

November 19, 2012

There are some important new recommendations both about strep throats in general and about tonsillectomy – taking out the tonsils — as a treatment for recurrent strep throats.

Some of us can recall a time when getting your tonsils out was one of the rites of passage of childhood. Usually a related procedure is added — an adenoidectomy, removing the adenoids as well. It’s called a T&A …

In defense of the terrible twos

Heidi Roman, MD

Physician

November 19, 2012

People often ask how old my son is when we are out and about. When he proudly says, “Two!”, the most common response is a smile to him … and a knowing glance to me. This is often accompanied by, “Oooh, the terrible twos!”

I’m here today to stand in the defense of two-year-olds. Sure, they have their share of tantrums and the transition from infant to preschooler is sometimes a …

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In defense of the terrible twos

Good decision making often depends on good communication

Peter Ubel, MD

Physician

November 19, 2012

We live in an age of patient empowerment. Medical students are now routinely taught that the “right choice” often depends on patient preferences—on how an individual patient weighs the pros and cons of her treatment alternatives. That means medical decisions depend, more than ever, on good communication. Physicians need to help patients understand their choices so that they can partner with their patients in discovering the best alternatives, ones personalized …

What are the biggest issues with EMR today?

Kevin R. Campbell, MD

Health Technology

November 19, 2012

As medicine moves forward in its most technologically advanced era yet, we continue to struggle with basic concepts such as record keeping. The medical record is vital to the care of the patient. It tells the story of each patient’s journey through the medical system. The idea of centralizing all pertinent medical information is, in theory, a step in the right direction. In utopia, there would be one medical record …

5 steps to establish a partnership for shared diagnosis

Leana Wen, MD

Physician

November 18, 2012

In a recent post, you met Catherine, a young woman who came down with a stomach bug but was ushered through numerous blood tests and a CT scan, only to be even more confused than ever. You saw how shared decision-making needs to begin with the process of establishing a partnership for shared diagnosis, because diagnosis is the first and most critical step to your medical care.

Here …

Love: A word that medicine fears

Kirsten Meisinger, MD

Physician

November 18, 2012

Mom, what is the one thing you can’t live without?” My six-year-old son asked me out of nowhere one day.

Air? Water? It was a more interesting riddle than usual.

“Love.” He said proudly, not waiting for me to answer.

Wow. He’s right. Love. But if it is the one thing you can’t live without, why are we so afraid of it in medicine – a field that sustains life?

Doctors seldom use the word …

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Love: A word that medicine fears

Care on the continuum far surpasses the episodic approach

Rob Lamberts, MD

Physician

November 18, 2012

My change from a traditional practice to direct-care has caused me to challenge some of the basic assumptions of the care I’ve given up to this point. Certainly, the nature of my documentation will radically change with my freedom from the tyranny of E/M coding requirements.

Perhaps the biggest change in my care comes courtesy of the way I get paid. The traditional way to be paid is for service rendered (either at …

MKSAP: 24-year-old man with aplastic anemia

mksap

Conditions and Diseases

November 18, 2012

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

A 24-year-old man undergoes follow-up evaluation for treatment of aplastic anemia. Two of his siblings are HLA-identical matches.

Laboratory studies:

Hemoglobin	8.3 g/dL (83 g/L) (following transfusion of 1 unit of irradiated packed erythrocytes last week)
Leukocyte count	500/µL (0.5 × 10⁹/L) with 23% neutrophils, 3% band forms, and 71% lymphocytes
Platelet count	26,000/µL (26 × 10⁹/L)
Reticulocyte count	0.2%

Review of the bone …

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