Just the other day I was called to see a patient coming up to the Intensive Care Unit with a diagnosis of pneumonia. Upon my arrival the patient is “hanging in there” with the blood pressure in the 60’ and 70’s systolic.
This is a no-brainer situation – the patient is in sepsis and septic shock.
Early intravenous antibiotics and aggressive resuscitation is what this gentleman needs right now. Per the ER …
I recently finished another 5-week clinical rotation. This one was primary care (outpatient internal medicine +/- family medicine).
First a few words about primary care as a field: I found it to be both awesome and boring.
It was awesome because I was the “doctor.” I had essentially full responsibility for my each patient. From calling him in from the …
Here are ways doctors can help autistic or delayed children behave and learn.
I certainly do not mean to trivialize the behavior issues that erupt as typical children develop, but the problems of atypical kids are more difficult and less likely to be fully addressed by general pediatricians and society at large.
1. Understand the ABCs of behavior. Antecedent = What happened immediately before the behavior? Behavior = A description of the …
Working as a psychiatrist is very rewarding. It’s stressful in a unique way, and some people may look at me strangely for having an unusual job. But overall I really enjoy it. Here are some of the aspects of psychiatry that I really appreciate.
1. Being trusted. Psychiatrists meet people when they are at their most vulnerable points, and we are entrusted with extremely …
I decided to dedicate a medical blog on smoking cessation after realizing that too many people in Douglas County (Omaha, Nebraska) smoke. Did you know that despite a smoking ban in restaurants and bars, 18.3% of people in Nebraska are smokers? That’s one in five people. And this number contributes to Omaha’s health ranking of 142 out of 182 cities in …
For Christmas Eve dinner, our family congregated at Café Opera, in the Intercontinental Hotel for a scrumptious seafood buffet. Going to a buffet is a little bit evil, as you know that you’re about to commit the sin of gluttony.
I usually tell my patients who suffer with gout to avoid buffets. That 3rd mountain of prawns may precipitate an acute episode of gout. Christmas party season is a dangerous time.
Overindulgence …
What, exactly, is a difficult patient?
Doctors can tell many tales of what they term as a difficult encounter. Just as many patients can recall doctors whom they would say are difficult to work with as well.
According to a study from the Journal of General Internal Medicine, here’s a definition:
Patients deemed difficult included those with more than five symptoms, severe symptoms or an underlying mental disorder or were less functional. These …
If one of your patients asked your opinion of another doctor whom you know to be incompetent what would you tell your patient?
Incompetence in a physician is a scary thing! Doctors deal with problems of life and death and try to heal you with dangerous tools. A doc that isn’t competent can be seriously dangerous.
But how do you know who’s on their game and who’s falling down on the job? …
A decade and a half ago, when I moved to Memphis, I proudly hung a sign outside an office I shared with another doctor. It had my name followed by an MD. I had started my own small business as a solo practitioner in medicine.
Over the years, the practice has grown. I now have several employees and my own office, with the names of several other doctors alongside mine on …
Coverage requests get rejected when the requested service does not fit within an insurance company’s initial guidelines for approval.
This happens for a number of reasons, but usually it comes down to poor documentation or inappropriate care, or in some cases care that is appropriate but can’t be supported in the literature. When a denial occurs, the physician or patient has several opportunities to appeal this decision. The first appeal is …
Prostate enlargement, or benign prostate hyperplasia (BPH), is a common, non-cancerous condition affecting nearly 14 million men over the age of 50.
The symptoms of prostate gland enlargement include a decrease in the force and caliber of the urinary stream, frequency of urination, urgency, a feeling of not emptying the bladder despite urination and nocturia, or the need to get up at night to urinate. Although lifestyle changes will not cure …
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 new right-sided headache that began 1 day ago. He awoke yesterday with a dull ache over his right forehead that has gradually increased in intensity. He also notes some right eye discomfort, sensitivity to light, and that his eye …
One of the benefits, or aberrations, depending on your point of view, of the fee-for-service model is that we surgeons are remunerated for correcting our mistakes and complications.
At first glance this seems wrong. But perspectives differ, and when a doctor has to deal with serious, undeserved complications and is self-employed he deserves to be compensated adequately. So what really is the difference between the two?
A complication may be described as …
Lack of sexual interest is the most common sexual complaint in women.
The latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), which defines psychiatric disorders, defines Hypoactive Sexual Desire Disorder (HSDD) as ‘‘persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity’’ that causes ‘‘marked distress or interpersonal difficulty.’’ Epidemiologic surveys have suggested that from 25 to 50 percent of women report prolonged periods …
“I have bipolar disorder. Can I be a doctor?”
It’s one of those questions to which there is no real answer. Being a doctor takes a long time, it requires reliability, diligence, and a willingness to learn things you may not want to learn and do things you may not want to do. It requires endurance and passion. You need to be tolerant of many things: arrogant supervisors, irritable colleagues, sick …
Recently, a female patient saw me in the office for the first time to discuss her chronic digestive issues. Luckily for her, my recommendations did not include probing into her alimentary canal with the endoscopic serpents that we gastroenterologists rely upon.
As the visit concluded, she advised me that she intended to have a gastric bypass (GIB) procedure performed, and even used the medical term of bariatric surgery. I suppose that …
Should medical students receive immunity from malpractice liability?
That’s an interesting question that’s raised in a bill from Arizona.
According to the Arizona Daily Sun,
State lawmakers are moving to keep patients injured by medical students from being able to sue them.
But proponents said that won’t leave victims without recourse.
SB1429, awaiting full Senate action, would spell out that students are not liable for malpractice if they are under the supervision of a …
It’s a bit ironic that pilots, the people who spend the most time traveling above the magnificent landscape that is our planet earth, spend very little time appreciating the scenery.
That’s because they are trained to always be on guard for unexpected emergencies. While the passenger in a jumbo jet traversing the continent can admire the majesty of the Rocky Mountains, the desolation of the Great Salt Lake or the endless …
This semester is coming to an end and we are almost halfway done with first year. I say semester, but technically we use the block system. What’s the block system? Here, it refers to dividing the academic school year into single subject blocks. Instead of taking concurrent, year-long courses, we spend several weeks on one course. For instance, we started off with 5 weeks of only biochemistry, then 8 weeks …
I just finished another inpatient service stretch at our community hospital with some great cases and lots of good medicine. While attending rounds may have changed a lot in the last 40 years as highlighted in a recent Annals of Internal Medicine article, some things have not changed – the focus on medical student presentations during attending rounds.
Students spend hours through their call nights preparing for …
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