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MKSAP: 79-year-old man with vertigo

mksap

Conditions and Diseases

July 21, 2012

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

A 79-year-old man is evaluated in the emergency department for vertigo that began suddenly about 1 hour ago, associated with severe nausea and vomiting. He noticed that he could not seem to sit up straight and could not walk without assistance. The patient denies confusion, motor weakness, hearing loss, dysarthria, diplopia, fever, or paresthesias. …

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MKSAP: 79-year-old man with vertigo

Will recommendations from Choosing Wisely ever be followed?

William Sullivan, DO, JD

Physician

July 20, 2012

Choosing Wisely is the new campaign advocated by the ABIM Foundation to help physicians “be better stewards of finite health care resources.” The recommendations in the campaign have been published in Consumer Reports and has been distributed to AARP members.

At first glance, the campaign seems to make sense. Limit unnecessary testing and decrease costs. However, I predict that the Choosing Wisely campaign will also have many less desirable effects. I picked out …

Are doctors obligated to seek knowledge that has no medical benefit?

Michael Slade

Physician

July 20, 2012

The New York Times recently published an article titled “A Life-Death Predictor Adds to a Cancer’s Strain” or, alternatively, “Genetic Test Changes Game in Cancer Prognosis.” The piece is interesting on several levels, but, to me, serves to highlight an increasingly common ethical conundrum: are physicians obligated to seek knowledge that is available but has no possible medical benefit?

Most of us are familiar with the Schrödinger’s cat thought experiment …

DSM-5 will capture the dynamic nature of mental illness

David Kupfer, MD

Conditions and Diseases

July 20, 2012

Much of the debate over the future edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has centered on what disorders will be added, modified or dropped. But lost in the discussion is a change that will align disorders along a developmental continuum—one that looks at them across the lifespan. This shift will provide clinicians with a critical perspective that until now has been missing.

Historically, disorders were classified …

Embrace the storm in medical school

Michael Moore

Medical Education

July 19, 2012

There are some things you learn best in calm, and some in storm.
– Willa Cather, The Song of the Lark

Over the past year I have been blogging for The Lancet Student. As luck would have it, I ended up writing during my 3rd year of medical school, American Style. This is my “clinical clerkship” year. In a way, my posts have been a record of my journey during that year.

As …

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Embrace the storm in medical school

What surfing can teach doctors about patient recovery

Kevin R. Campbell, MD

Physician

July 19, 2012

Recently, I decided to take up surfing again. As a 20-year old kid, I was pretty good at most things that required athleticism (even surfing).

However, as a 42-year old, things come a little harder. My daughter began taking surfing lessons about 9 months ago from a young professional surfer. She quickly was able to get up on the board and was soon riding waves (upright) to shore. I decided that …

Localized prostate cancer treatment: Is surgery no longer an option?

Kevin Pho, MD

KevinMD

July 19, 2012

Prostate cancer is in the news again, thanks to a recent study in the New England Journal of Medicine.

The study looked at surgery versus observation for localized prostate cancer. According to MedPage Today, “Neither overall mortality nor cancer-specific mortality differed significantly between men who had surgery and those who were prospectively followed. The absolute difference was less than 3% …

Do people need to suffer the consequences of their bad behavior?

Greg Smith, MD

Physician

July 19, 2012

You know the headlines. You read them and hear them and see them every day.

Someone gets angry at the system and shoots someone or several someones in cold blood, often having planned the act, gathered the necessary firepower and ammunition ahead of time, stalked the victims, checked the schedules and shown up at the right time to do maximum damage.

A family including mother and young children in a van are …

What is the goal of palliative care?

Jeffrey I. Kreisberg, PhD

Physician

July 19, 2012

Most of us do not want to die in the ICU tethered to tubes — not the quality of life we expect. Yet only 30 percent of us have made arrangements to prevent this from happening. Death and dying is a tough subject for us to broach. Be aware that very few of us will die in our sleep — most have a slow sometimes excruciating decline to death.

As we …

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What is the goal of palliative care?

When patients need to find a new equilibrium

John Schumann, MD

Physician

July 18, 2012

Chico (all identifying information removed) was a patient we cared for in the hospital.

Admitting diagnosis: “acute kidney injury,” medical-speak for kidney failure. He would need dialysis.

From my point of view–an instructor teaching residents and medical students–there were two key questions about Chico:

1. What caused his kidneys to fail?

2. Given his kidney failure was “acute,” was there any chance that it’d be reversible? Could Chico’s kidneys heal to the point where …

Why does fear of litigation turn into preference for action?

Peter Ubel, MD

Physician

July 18, 2012

LeBron James exploded past his defender and raced towards the lane. Serge Ibaka, the Thunder’s mountainous center, planted his feet and raised his hands straight up into the air. LeBron ducked his left shoulder and plowed right into Ibaka, who went crashing backwards into a nearby cameraman.

Offensive foul?

Maybe if it had been the first quarter. But given that this was the last minutes of a tightly fought game, the referees …

Patients want to tell us their story

Emily Gibson, MD

Patient

July 18, 2012

If you want to identify me,
ask me not where I live,
or what I like to eat,
or how I comb my hair,
but ask me what I am living for,
in detail,
ask me what I think is keeping me
from living fully
for the thing I want to live for.
– Thomas Merton

As a patient waiting to see my health care provider, I would adapt Merton’s template …

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Patients want to tell us their story

4 things every medical student should know about health policy

Elisabeth Askin

Health Policy

July 18, 2012

When I first got interested in medicine, I also got interested in health policy. I was already out of college and so I decided to educate myself – not a bad discussion topic for med school interviews, after all – and found it much, much harder than expected. There were so many topics, so many opinions, and so little that seemed to connect up to give me the big picture. …

What can ACO providers do to increase patient engagement?

Steve Wilkins, MPH

Physician

July 17, 2012

Accountable Care Organizations (ACOs) and “bundled payments” are set to play a central role in the Affordable Care Act. Under accountable care, physicians and hospitals would be paid out of a “single payment” from CMS or health insurers for all the care needed to treat a clinically defined “episode of care” like a heart attack. The premise is that bundle payments will incentivize physicians and hospitals to deliver more efficient, …

The problem with transformative technologies in medicine

Rob Lamberts, MD

Physician

July 17, 2012

Eric Topol wrote a post on The Health Care Blog where he looks to a future enabled by emerging technology: “Just as the little mobile wireless devices radically transformed our day-to-day lives, so will such devices have a seismic impact on the future of health care. It’s already taking off at a pace that parallels the explosion of another unanticipated digital force — social networks.

Take your electrocardiogram on your smartphone and send …

AMA: Working to move medicine forward in the coming year

Jeremy Lazarus, MD

Health Policy

July 17, 2012

A guest column by the American Medical Association, exclusive to KevinMD.com.

As the new president of the AMA, I’m excited to help lead the nation’s largest physician organization during this important time for our health care system. The year is off to a positive start – only two weeks after I was inaugurated at the AMA’s Annual Meeting, the Supreme Court declared …

How much does surgery cost? About $147 a minute

Nate Johnson

Physician

July 17, 2012

The patient had a large abscess surrounding his spleen. On a large screen in the middle of the operating room, I watched a surgeon drain the fluid collection and remove the organ with small metal tools.

I remember the surgeon navigating the complex anatomy with alacrity, handling the laparoscopic equipment with expert finesse, and quickly and confidently answering the battery of questions from the assisting medical student. To a young and …

9 essential tips for new medical students

WhiteCoat, MD

Medical Education

July 17, 2012

Whether you’re starting medical school or beginning your second year, this post is for you. Will probably work just as well for PAs, NPs and any other health professional student who hasn’t started clinical rotations.

Our former babysitter just graduated from medical school and the WhiteCoats are just as proud as her parents are. Then I started thinking, what advice would I give to students starting medical school?

Our first day of …

Stop searching for the health reform silver bullet

Anees Chagpar, MD

Health Policy

July 16, 2012

I recently had the privilege of joining the Yale Cancer Center’s contingent on a visit to University College London in the U.K., where we share a number of scientific collaborations.

Between discussions of pathways, particles, and personalized medicine, some of the “tea time” conversation turned to policy and how uninsured patients with cancer in the U.S. get care. We talked about …

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