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MKSAP: 49-year-old-man with right arm weakness

mksap

Conditions and Diseases

August 24, 2019

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

A 49-year-old-man is evaluated 1 day after having an episode of right arm weakness without pain that lasted 5 minutes. He is now asymptomatic. The patient has type 2 diabetes mellitus and dyslipidemia. Medications are aspirin, metformin, and atorvastatin.

On physical examination, blood pressure is 126/68 mm Hg, pulse rate …

Doctors can change opioid prescribing habits. Incrementally.

Julie Appleby and Elizabeth Lucas

Medications

August 23, 2019

When they started practicing medicine, most surgeons say, there was little or no information about just how many pain pills patients needed after specific procedures.

As a result, patients often were sent home with the equivalent of handfuls of powerful and addictive medications. Then the opioid crisis hit, along with studies showing one possible side effect of surgery is long-term dependence on pain pills. These findings prompted some medical …

The public health solution to gun deaths

Nancy Dodson, MD, MPH, Jeffrey Oestreicher, MD and Nina Agrawal, MD

Health Policy

August 23, 2019

Last year, the National Rifle Association chided physicians to “stay in their lane” when it comes to gun violence.

Our lane.

We responded, sharing images on Twitter of bloody trauma bays and blood-soaked scrubs. Memories were stirred, like the night one of us spent in an emergency room, waiting for foster care to be arranged for an infant and toddler who were orphaned after the murder-suicide of their …

Quality improvement: Helping boost everyone’s triple aim

Michael A. Weiss, DO

Health Policy

August 23, 2019

Recently, the Pacific Business Group on Health (PBGH), L.A. Care Health Plan, and the Southwest Pediatric Practice Transformation Network (a partnership of CHOC Children’s Hospital and Rady Children’s Hospital) came together to announce some incredible news and set the table for the future. With support from CMMI, over the course of the last four years, our organizations collaborated on a major quality improvement program for both primary and specialty care. …

The power of music in the ICU

Nomi C. Levy-Carrick, MD

Physician

August 23, 2019

“I just don’t know what to do, how to help.” My patient’s wife was slumped in the plastic chair by her husband’s side, fatigued and beleaguered. She had been there for hours, days, as we waited for antibiotics to start fighting back against the infection that had overwhelmed his body.

“What sort of music does he like to listen to?”

“Depends on what he’s doing. Zeppelin to work on the car. Jazz …

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The power of music in the ICU

Who are the real superheroes of medicine?

Batoul Harissa

Medical Education

August 23, 2019

Imagine yourself spending two years of your life indoors with books. Sometimes the only person you speak to for a few days is yourself, as you memorize intricate details of bugs and drugs that you never imagined yourself knowing. And then after these two years, you’re completely isolated from the world for about two months or so, studying for the exam that they tell you determines the rest of your …

Physicians need to stop being so nice

Suneel Dhand, MD

Physician

August 22, 2019

The changes that have occurred in health care over the last few years represent a sea change from the autonomy and clout that physicians once had. It’s no great secret to anybody working in medicine that most of these changes to practice — including the push towards employment instead of private practice, and the need to now spend the majority of the day clicking boxes on a computer screen — have …

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Physicians need to stop being so nice

A physician’s first telemedicine video visit

Fred N. Pelzman, MD

Physician

August 22, 2019

I just did my first telemedicine video visit.

The concept seems so strange, the idea of carrying out an “office visit” without the patient actually being in the office.

Right now we have it structured so that when a patient calls up requesting to see me on a day when I am already fully booked (or, as is usually the case, overbooked), …

Tell your patients these family health tips when they’re headed to a theme park

Johanna Vidal Phelan, MD, MBA

Physician

August 22, 2019

This summer, not unlike many families across the country, we were fortunate enough to visit a theme park while celebrating our break from another challenging school year. Being a mother and a pediatrician, I must admit how concerned I was to witness the number of children with obesity attending the park.

While we waited in line for the various rides, I couldn’t help considering how best to advise families on making …

Don’t make me choose between motherhood and my career

Anonymous

Physician

August 22, 2019

A debate highlighting gender discrimination in medicine currently rages within the pediatric hospitalist medicine community.

The debate centers on the board certification process for “grandfathering” for the new pediatric hospitalist subspecialty which effectively excludes women on the basis of motherhood.

For those not familiar with “grandfathering in,” this is the process by which a new subspecialty may grant board certification to physicians who have been practicing in the specialty. The alternative option …

Who should advocate for older patients in the hospital?

Bonnie Friedman and Sara L. Merwin, MPH

Conditions and Diseases

August 22, 2019

It’s often said that pediatricians and veterinarians have the hardest jobs in medicine because their patients can’t tell them where it hurts. But the same is often true for the health care professionals treating older patients who can’t communicate well or don’t fully understand what’s being explained to them.

So, whose job is it to advocate for these patients? The answer is that everyone on the medical team must play a …

10 questions men must ask about their urinary symptoms

Naeem Rahman, MD

Conditions and Diseases

August 22, 2019

Lower urinary tract symptoms in men are amongst the most common reasons for a urological visit. In this post, I explore ten questions that every man must ask when seeking urological help for these symptoms.

1. Are my symptoms related to my prostate?

The natural assumption is that urinary symptoms in men are related to a growing prostate. This may be true, but other variables need evaluation. First, is there excessive fluid …

Do hospital administrators eat last?

James Turner, MD

Physician

August 21, 2019

A book was recommended to me recently by a resident of mine. It is written by Simon Sinek and called Leaders Eat Last. I already knew that I agreed with a lot of what Sinek says because I’ve seen You Tube Videos by Sinek that feel like he has reached inside my head and ripped my ideas directly from my mind.

Today, I don’t want to deliver a …

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Do hospital administrators eat last?

When patient and surgeon meet in Cancun for surgery

Phil Galewitz

Conditions and Diseases

August 21, 2019

Donna Ferguson awoke in the resort city of Cancun before sunrise on a sweltering Saturday in July.

She wasn’t headed to the beach. Instead, she walked down a short hallway from her Sheraton hotel and into Galenia Hospital.

A little later that morning, a surgeon, Dr. Thomas Parisi, who had flown in from Wisconsin the day before, stood by Ferguson’s hospital bed and used a black marker to note which knee needed …

5 lessons from an emergency physician

Navpreet Sahsi, MD

Physician

August 21, 2019

The emergency room is an interesting place to work. It’s controlled chaos. Walk through the hallways, and you’ll hear people screaming, see others crying, and others wincing in pain.

Over time, you get a unique perspective on the human condition. In my years of training and practice, I’ve seen so much. People experiencing their worst days. Others receiving news that will change everything. Some lives ending. Others returning from the brink.

Certainly, …

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5 lessons from an emergency physician

Gun violence in America is a national emergency

Hussain Lalani, MD and Justin Lowenthal

Health Policy

August 21, 2019

Gun violence in America is a national emergency. We are tired of suturing closed bullet holes that our society refuses to prevent. Congress should return to Washington during the August recess and legislate universal background checks for all gun sales, establish so-called red flag laws nationally, and fund gun violence prevention research.

As medical providers, we are gravely concerned about the impact gun violence has on our patients. Physicians are the …

Anonymous acts of kindness: How this physician connects with every patient

Charlotte Grinberg, MD

Physician

August 21, 2019

The only times I stood in Emily’s room without fear were the day I met her, and the day she died. These days were two long years apart, years of unhealthy snacking and spending most weekends away from my husband and son. When Emily’s name first appeared next to mine as an overnight admission, the resident physician providing the hand-off gave me a clear warning: “Good luck. She is the …

Adopting the DoorDash model to health delivery

Jeffrey A. Oster, DPM

Health Technology

August 21, 2019

I was reading an article in The New York Times entitled, “The Rise of the Virtual Restaurant.” More and more people, particularly in urban settings, are using apps like Uber Eats, Grubhub, and DoorDash to bring fresh, warm food directly to their doorsteps. Mr. Lopez, the virtual restaurant owner featured in the article, had no chairs, no tables, and no menus. His virtual restaurant was actually four restaurants in one that were …

Can the cardiac risk of red meat be measured? And is it useful?

Steven Reznick, MD

Conditions and Diseases

August 20, 2019

Prevention of heart disease has centered on smoking cessation, controlling blood pressure, achieving an appropriate weight, regular exercise, control of blood sugar, and control of your cholesterol. Despite addressing and controlling these items, individuals still have heart attacks and strokes and vascular events. Researchers are now directing their attention to a dietary metabolite of red meat called trimethylamine N-oxide or TMAO.

Recent peer-reviewed and published studies have shown …

Is direct contracting an answer to soaring health costs?

Julie Appleby

Health Policy

August 20, 2019

Colorado’s ski resort areas in Summit County have a high cost of living, among the highest in the country. The people who visit these places — Keystone, Breckenridge and Copper Mountain — can afford it.

Many of those who live and work there can’t, especially when they get sick.

In addition to expensive rent, they pay some of the steepest health insurance premiums in the nation. Hospital costs are …