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MKSAP: 25-year-old woman with ankylosing spondylitis

mksap

Conditions and Diseases

January 5, 2019

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

A 25-year-old woman is evaluated during a follow-up visit for an 18-month history of ankylosing spondylitis. She has minimal lower back pain with morning stiffness lasting 20 minutes. She is able to pursue her activities of daily living without any restrictions. She has been taking etanercept for 1 year with good results.

On physical …

Conversation with older patients is common sense

John A. Dodson, MD

Physician

January 4, 2019

My 81-year-old patient came in several weeks ago and disclosed that he had stopped taking his aspirin after watching a news report on television. “They said I didn’t need it anymore,” he told me. I gently informed him that this news didn’t apply to him.

He was responding to a recent study in the New England Journal of Medicine, which showed that aspirin failed to prevent …

Non-therapeutic relationship or human kindness?

Anonymous

Physician

January 4, 2019

About two months ago, a 15-year-old Native American male was riding around in a stolen car on the reservation. “M” and the driver were drinking. And somehow, after he exited the vehicle at 4 a.m., the car struck him. Hours later, it became clear that something was wrong. M was transferred to our pediatric hospital as a trauma and was found to have an unstable vertebral fracture. Conservative treatment with …

It is time for emergency medicine to expand its circles

Alison Gardner, MD

Physician

January 4, 2019

2016, Kenya

I arrived in casualty (the emergency department) to see a minimally responsive Kenyan boy with a body wasted from malnutrition. His mother stood at the bedside cradling his head, her eyes full of fear. His parents had traveled for days over rugged mountain roads in the rains to get to the hospital. My colleague told me his blood sugar was 10 mg/dL, and the nurse had gone to gather …

What’s the biggest problem with medical education?

The Curious Radiologist, MD

Medical Education

January 4, 2019

There has been a profound deterioration in the education of our medical students. I only make this contention after having taught over a hundred medical students across five continents, often one-on-one and for extended periods. Although the majority of those I’ve taught have been students educated at international medical institutions, a substantial number have been those from U.S. medical schools. While I do recognize that those that find their way …

It’s time to study firearm morbidity and mortality as we do any other public health issue

Charles Nozicka, DO

Health Policy

January 4, 2019

Among modern industrialized nations, only the United States endures the current public health epidemic of firearm-assisted injury and death. In 2017, nearly 40,000 people were shot to death in the U.S., while proponents of the Second Amendment continue to protect it at all costs — fighting even common sense measures such as limiting access to felons and the mentally ill. On both sides of this debate, opinions are lobbed as …

A radiologist saved my father’s life

Barbara Hamilton, MD

Physician

January 4, 2019

My dad flew to California in the spring to meet his grandson, who was about five months old at the time. He wasn’t that interested in baby care. He mostly wanted to sight-see and spend the evenings watching TV. One weekday morning, he ventured out on a hike alone, while I was at work. He left at 9 a.m. and never came home.

We live at the base of a dusty …

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A radiologist saved my father’s life

What’s barbaric in medicine?

Lisa Masson, MD, MBA

Medical Education

January 3, 2019

Late one evening, I received a text from my oldest daughter.

“What in medicine, that we do now, will we think is barbaric in 50 years?”

Wow. They play more provocative bar games now than they played when I was in my 20s.

I promptly texted back my knee-jerk response: “chemotherapy.” As we are on the brink of precision medicine, what will the next generation think of our “slash, burn and poison” paradigm …

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What’s barbaric in medicine?

What do you do when all else fails with a patient?

Zachary Reese, MD

Physician

January 3, 2019

“Does a rock float on water?” I asked the haggard woman lying in the ICU bed.

I was an intern, in the first rotation of my medical residency, and Mrs. Jones had been my ICU team’s patient for the past week. Over that time, she’d looked more and more uncomfortable, constantly gesturing for her breathing tube to be removed.

Mrs. Jones tried to form words in response to my question, but the …

Average physicians are extraordinary

Amy Cho, MD

Physician

January 3, 2019

I am just another average physician.

It wasn’t my first return from maternity leave, but this busy ED shift wasn’t going well. I kept putting off breast-pumping to complete “just one more thing.” Then my son’s school secretary called. I had told our nanny the wrong pick-up time. She wasn’t answering her phone. I was disappointed in myself and frustrated that I couldn’t leave. But I am a physician — I …

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Average physicians are extraordinary

Is this cost-saving Medicare proposal doomed?

Martha Rosenberg

Health Policy

January 3, 2019

The Trump administration has proposed that insurance plans providing drug coverage to Medicare beneficiaries will no longer be forced to cover six hitherto “protected” drug classes. The classes — which include drugs for psychiatric conditions, cancer and immune diseases –– are among the priciest of all drugs and account for as much as 33 percent of total outpatient drug spending under Part D of Medicare.

Under the proposal, …

68 laws of the ER

Rada Jones, MD

Physician

January 3, 2019

1. Murphy’s Law as it applies to the ER: If something can go bad, it will do so in a hurry. If it can’t possibly go bad, it will still find a way.

2. Clock’s First Rule: All the patients will crash at the same time. Usually when the computer system goes down.

3. Clock’s Second Rule: The sickest patients will come just before the shift change.

4. Haste’s Theorem: The healthier the …

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68 laws of the ER

Medical school isn’t like an Instagram feed

Batoul Harissa

Medical Education

January 2, 2019

For some reason, social media does a good job with sculpting our lives into perfectly organized displays that are available to look at during every breathing second of our lives thanks to the revolutionary invention called the smartphone. I look at pictures of people studying with beautifully organized desks, smiles, intricately designed planners and captions about how wonderful their day at home was with those planners.

And I completely understand and …

Go quiet into the night

Debbie Moore-Black, RN

Conditions and Diseases

January 2, 2019

I know what you’re thinking: She’s cold-hearted, cruel, and unkind.

But am I? Or are you?

Grandma Lilly is 87-years-old and in the ICU. She’s on a ventilator with her wrists restrained to the side of the bed. Grandma can barely see because her eyes are puffy: scleral edema. And her heart races: 140 beats per minute. Her blood pressure is low and Levophed and vasopressin drips are ordered.

Her family can’t talk …

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Go quiet into the night

The myths and truths about med-peds physicians

Andrea Lauffer, MD

Physician

January 2, 2019

Yes, med-peds is a real residency! It is a real specialty! And it is a practicing profession by many physicians today! It can open doors for so many wonderful professional opportunities. It is a discipline that can provide patients and communities extremely comprehensive medical care. People need to know more about this unique and sometimes under-recognized field. And here is why:

Like many people today, I didn’t even know what med-peds …

My family was traumatized twice by the death of my dad

Iris Kulbatski, PhD

Patient

January 2, 2019

Part 1 of a series.

The battle

I walk into my parents’ home to pick my mom up for a family gathering. And like most days over the past few weeks, palpable sorrow greets me at the door. Our old dog lies sleeping on the couch, heavy with years, she’s difficult to rouse. She finally welcomes me with a geriatric tail wag and labored breathing. I glance at the …

The generational differences of physicians

Xrayvsn, MD

Physician

January 2, 2019

It is a known fact, but every generation feels that they had it worst and that other generations have it made.

“When I went to school we had to walk uphill in the snow both ways!” says every grandparent

I identify myself with the Generation X physicians, finishing medical school in 1997 and my radiology residency and fellowship training in 2003.

During this time I have seen quite a change in the medical …

Not all pathologists are created equal

Celina Nadelman, MD

Conditions and Diseases

January 2, 2019

Pathology and laboratory medicine services play a vital role in global health care and continuously improve patient care around the world. When it comes to your medical care, you have many options, and choosing the right professional could improve your health. So what exactly does a pathologist do, and do I have the power to choose my own pathologist?

The pathologist’s role

A pathologist is a medical doctor who studies the causes …

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Not all pathologists are created equal

The Apple Watch’s ECG feature could save many lives. But only if it has something else.

Nirav Shah, MD and Tanzid Shams, MD

Health Technology

January 2, 2019

Recently the Apple Watch’s latest feature went live – an electrocardiogram (ECG) app that monitors irregular heart rhythms. The internet is overflowing with reports from people didn’t know they had irregular heartbeats until they took their data to their doctors and received diagnoses of atrial fibrillation (AFib), a common cause of stroke.

As neurologists who treat stroke patients, we welcome technology that enables patients to receive faster diagnoses and better treatment. …

Why managers will never be a source of disruptive innovation in health care

Richard Young, MD

Physician

January 1, 2019

I have had several dealings with the benefits managers/HR managers of large corporations and other large organizations over my career. I have one over-arching conclusion about what motivates these people: They will never be a source of disruptive innovation in health care.

I find them to be passive people. They are fundamentally people pleasers. They derive joy from helping their employees navigate their insurance plans, figure out deductibles and co-pays, explain …

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