As a nurse, I spend a lot of time with other nurses. When they ask me to explain why I think the iPad is great, I respond with the following metaphor: imagine that you are a nurse who has been asked to design a new hospital from scratch. You are free to question every prior assumption, to throw out old ideas that no longer fit, to redesign everything according …
Why is the iPad be revolutionary for doctors and nurses?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 64-year-old man is evaluated for a 3-month history of abdominal bloating and mid-epigastric discomfort associated with a 6.8-kg (15-lb) weight loss. The patient has no significant medical history and takes no medications.
On physical examination, vital signs are normal, and the only significant finding is mild …
MKSAP: 64-year-old man with abdominal bloating and epigastric discomfort
I had a patient once—a fellow physician—who came to see me complaining of mid-back pain. When I examined him, I found I could reproduce his pain by pressing firmly on the spot he said was hurting him. He said pressing there also made the pain radiate around to his stomach, a phenomenon known as “referred pain” that meant his pain was almost certainly caused by a trigger point. I …
How early closure can cause doctors to misdiagnose
Patients want to know why they can’t get a return call from their doctor’s office – here are six reasons why the calls have increased and physician offices are having trouble meeting the needs of their patients.
1. Medication questions and requests for a prescription change. The average number of retail prescriptions per capita increased from 10.1 in 1999 to 12.6 in 2009 (Kaiser Family Foundation calculations using data from …
6 reasons why doctors won’t call patients back
I’ve been sick since 2001 when I failed to recover from what appeared to be an acute viral infection. It has left me mostly house-bound, often bed-bound. In effect, I’ve had the flu without the fever for almost ten years: the aches and pains, the dazed sick feeling, the low grade headache, the severe fatigue. It cost me my career as a law professor; it cost me the ability to …
An apology to patients with chronic fatigue syndrome
A reader writes, “Can you do a post on what procedures constitute a thorough physical, in your opinion? I haven’t had one in several years and thinking of making an appointment now. The last doctor I went to didn’t even listen to my heart or go though the motions with feeling my belly and that stuff. And of the last 3 doctors I went to, I realized they didn’t …
There is no such thing as a complete physical examination
A cover story by Gardiner Harris in the New York Times spotlights the changes in modern psychiatry, from extensive, psychotherapy-based interaction to brief, medication-oriented “psychopharm” practice.
The article shares nothing new, particularly to anyone who has paid any attention to the rapid evolution of the psychiatric profession over the last ten years (or who has been a patient over the same period). While the article does a nice …
Do patients accept hurried, fragmented, disconnected care?
Doctors use laboratory values to interpret your medical condition. With respect to kidney disease, the BUN and the creatinine help your nephrologist (as well as your internist and family physician) determine if your kidneys are working correctly. These two tests are commonly ordered for many reasons and are invaluable tools to help your doctor assess your condition. Let’s define what BUN (pronounced by spelling out the letters “B”, “U”, …
How a nephrologist assesses your kidney function
Ok, imagine this.
You take a video of your little girl’s soccer practice with your iPhone. Within moments it’s posted on YouTube for the grandparents to see.
Minutes later search engines called spiders begin to crawl across the data set of images on your upload. Face recognition technology identifies a face on the video and, with some assistance from the geo-tagging of the built in GPS metadata that accompanied the upload, …
Are our privacy rules robust enough to protect our patients?
Doctor D has been blogging about the doctor-patient relationship for a while now. It’s sort of the thing I’m known for. I’ve usually been on the doctor side of this equation. Most of my blogging, however, is to help patients figure out the weird world of medicine.
Doctor D recently found himself on the patient side of a nasty injury.
Even as Doctor D looked down and realized his leg wasn’t …
What this doctor learned when he was a patient
A guest column by the American Medical Association, exclusive to KevinMD.com.
Health IT holds the promise of improving the efficiency of a physician’s practice, but physicians can easily become overwhelmed by the broad range of products and the multiple, varying federal incentive and penalty programs currently underway. The American Medical Association (AMA) continues to be in close contact with the Centers for …
AMA working to improve e-prescribing incentives and help physicians adopt health IT
For most women, a couple of irregular menstrual cycles or an occasional yeast infection are just a part of life — nothing that time or simple treatment won’t cure.
However, there are a few symptoms that warrant a call to the doctor. This article will cover when you should call your doctor for problems “down there”?
1. Pelvic pain. Pain at the time of ovulation is referred to as Mittelschmerz. However, if …
Women with these 5 pelvic symptoms should call their doctor
Are there moments when caregiving makes you want to scream?
Any number of things related to caring for your aging parent can cause you to feel like you’re at the end of the proverbial rope including:
But here’s where things get a bit dicey: While …
Caregiver burnout is just a fancy term for exhaustion
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From helping you wake up rested to getting couch potatoes ready for a 5K, there really is an app for everything.
But when it comes to health apps, many don’t get the job done.
Companies are often in such a hurry to sell their app that they don’t conduct a study to see if users will adopt real, lasting change. And, app stores don’t have medical reviewers who make sure health …
How to choose a better health app
Many of you know that a judge in Pennsylvania has determined that the popular “I Heart Boobies” bracelets worn by middle school students are a form of free speech intended to raise awareness of breast cancer and cannot be restricted by schools.
As much as I love a good double-entrendre, I find the entire situation to be sad, particularly the misinformed comments I’ve seen made by parents of …
The problem with I Heart Boobies bracelets worn by middle school students
When I was in medical school, we had a class on health economics taught by William Kissick. I didn’t pay as close attention as I should have (especially given what I do now). But I remember one thing he stressed. It involved the iron triangle of health care.
There are three aspects of health care systems that are essential: quality, cost, and access (thus the triangle). The problem …
Health reform and the iron triangle of health care
A recent issue of Pediatrics includes a new report detailing the need for doctors to improve patient teaching about fever and fever-reducing drugs.
Many parents fear their child getting a fever or have “fever phobia.” I certainly can understand why. Kids can do crazy things when they get fevers. They don’t sleep well, eat poorly, and behave strangely. Some children …
Fever in children: 5 facts you must know
Darshak Sanghavi recently wrote an excellent piece in the New York Times summarizing the controversy over resident work hours.
The topic has been discussed here frequently, with ramifications ranging from the fact that errors arising from patient handoffs negate any benefit gained from restricting work hours, to surgeons not accumulating enough experience during their work hour-restricted training.
I’ve often …
Why work hour restrictions won’t improve patient safety
Which will improve a person’s health more? Running around the block for 20 minutes or sitting at a computer entering their cholesterol and blood pressure readings?
The answer is one reason why Google’s decision to end its electronic personal health record (PHR) service offers important lessons about health IT and will affect the way patients get their health information and the way physicians communicate with their patients.
A recent survey …
Google gave up on electronic personal health records, but we shouldn’t
As I look back over my 10 year career in obstetrics and gynecology, I am sometimes struck at how many things have been discovered in this time period.
When I started the origin of pre-eclampsia was unknown, and now we know that it likely originates in an overabundance of a molecule called Soluble FMS-Like Tyrosine Kinase, a competitive inhibitor to natural angiogenesis in the placenta. Ten years ago the origins of …
Explaining an abnormal pap smear is no longer simple
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