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MKSAP: 36-year-old woman with facial pain

mksap

Conditions and Diseases

May 20, 2017

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

A 36-year-old woman is evaluated for a 1-week history of recurrent episodes of facial pain that are 1 to 3 seconds in duration and occur spontaneously dozens of times throughout the day. The pain is sharp, severe, and located in the right infraorbital area. During this same period, she has developed worsening …

What do physical gait, movement, and apparent drive tell us about each other?

Greg Smith, MD

Physician

May 19, 2017

Two sisters (religious order, not biological relation, as far as I know) live in one of the condos across from us. They are very nice, older ladies, warm and pleasant, always ready with a kind word and a smile as they see others in the complex come and go. They seem, at least on casual observation, to lead very busy lives. They rise early, heading out to do whatever it …

This physician won’t tell his alcoholic patients to stop drinking. Here’s why.

Michael Kirsch, MD

Physician

May 19, 2017

When I am facing an alcoholic in the office, I do not advise him to stop drinking.

Other physicians may advocate a different approach. We live in a free society and individuals are free to make their own choices. I have decided, for example, not to own a firearm, ride a motorcycle or bungee jump as these activities are not only beyond my risk tolerance threshold, but are also activities that …

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Here’s what opioid guidelines fail to mention

Cynthia Kay, MD and Joanne Bernstein, MD

Medications

May 19, 2017

Opioids have become so closely associated with chronic pain that it is nearly impossible to talk about one without the other. When we look back just five years ago, when we were still in residency, news stories about chronic pain and opioid overdoses were not commonplace. Now, we find ourselves almost desensitized to each new opioid headline. We are general internists, primary care providers and junior faculty. We practice at …

We need fewer rules, less regulation, and more time with patients

Matthew Hahn, MD

Health Policy

May 19, 2017

A physician friend commented recently that practicing doctors and nurses, the highly trained professionals who understand health care better than anyone else, are always too busy working to be involved in health care administration and reform. It is one of the most basic and profound problems affecting our health care system — one of the reasons that health care in America does not get better. And it got me thinking.

Once …

Let’s get rid of the review of systems

Shabbir Hossain, MD

Physician

May 19, 2017

When it comes to the review of systems, I’ve been a natural, a savant — a prodigy you might say.

During my first few weeks of medical school, I remember doing mock interviews with fake patients. This was long before I learned anything about “HPI,” “ROS,” physical exams, billing or anything medically relevant for that matter. As other students stuttered, trying to figure out what to ask a lady pretending to …

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Let’s get rid of the review of systems

7 lessons I’ve learned from my friends not working in medicine

Samantha Nazareth, MD

Physician

May 19, 2017

During medical school, my head was buried in the books while I was studying pharmacology and pathophysiology. In residency, my body remained in the hospital for most of my waking hours while I was caring for patients. And, during fellowship, my hands were busy learning how to perform endoscopic procedures.

All the while, my friends working in other industries were tapping into a different kind of skill set. They learned how …

The hands tell us the most about a cadaver

Karen Yeter, MD

Physician

May 18, 2017

“OK, it is time to move on,” my professor claps his hands together and yells above the chatter. We all look up from our Netter’s anatomy books and our cadavers. The smell of formaldehyde burns my nose as the fluorescent lights flicker above.

“We have explored the chest cavity and the abdominal cavity. It is now time to move onto the extremities, starting with the arms. I want you to unwrap …

What surgeons do is a violent act

Bruce Campbell, MD

Physician

May 18, 2017

“I like good strong words that mean something.”
– Louisa May Alcott

My resident and I are removing a large, recurrent cancer from the neck. Dense scar tissue is everywhere from prior surgery and radiation therapy. The going is slow. Each move is arduous, and bleeding obscures the view of the anatomy.

“Watch out,” I tell her. “The jugular vein is nearby, probably buried in that scar.”

“Yeah,” she responds. “Look at this nerve! …

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What surgeons do is a violent act

Cops and doctors have the same problem: People don’t trust them

Jarret Patton, MD

Physician

May 18, 2017

Hardly a week goes by without hearing about another case of police brutality. Many times, seemingly unnecessarily lethal force has been used, and these incidents have sparked protests across America. Each case is unique with differentiating circumstances, but the result is all too often — death. Many people have grouped these incidents together concluding that white officers have unnecessarily killed black men. This has initiated and reinforced mistrust of the …

Facebook may fuel new mothers’ insecurity. Here’s why.

Sarah Schoppe-Sullivan, PhD

Conditions and Diseases

May 18, 2017

You haven’t showered in a few days, and you haven’t brushed your teeth yet this morning.

But, your baby is one month old today! You picked out the perfect outfit and made sure the lighting was just right for the perfect photo. You posted the best one on Facebook this morning, and you keep checking to see if anyone has “liked” the picture.

But, after …

The unlucky privilege of seeing someone’s last moments

Michael Tien

Medical Education

May 18, 2017

“sonder – noun. the realization that each random passerby is living a life as vivid and complex as your own.”
– from the “Dictionary of Obscure Sorrows,” a compendium of invented words written by John Koenig.

I followed the chaplain into the patient briefing room, not quite sure what to expect. The room was dimly lit. The overhead lights were off, and only one small lamp gave off a weak glow, with …

Opioid prescribing: Doctors need to do a better job, but they can’t do it alone

Fred N. Pelzman, MD

Medications

May 18, 2017

I recently took a three hour online course on something I learned to do when I was a medical student.

And I thought it was something I had been doing fairly well for the past 20 years.

New regulations have come down requiring all practitioners to take a CME-certified course on safe and effective management of opiates for acute and chronic pain. This has clearly …

Physicians have to stay in their lanes

Jordan Grumet, MD

Physician

May 17, 2017

I drive a fast car. Which if you know me, is quite uncharacteristic. I would say that it is one the few possessions that generally doesn’t reflect upon who I am. How I chose this car, the make, and model, are a long story not to be discussed here. But let’s just say that it has quite a kick.

These thoughts jostled through my mind this morning as I pulled into …

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Physicians have to stay in their lanes

Revamp health regulations to reduce cost and improve patient safety

Peter Pronovost, MD, PhD

Health Policy

May 17, 2017

Johns Hopkins ophthalmologist Oliver Schein has found a simple way to save a half a billion dollars a year from our country’s health care bill, with no negative effect on patient health. The only thing standing in the way is a stubborn government requirement.

Seventeen years ago, Dr. Schein and colleagues published a study finding that cataract surgery patients who underwent routine preoperative testing — such as …

Instead of value-based care, how about giving clinicians the resources they need?

Matthew Hahn, MD

Physician

May 17, 2017

With the ruination of American teaching using “value-based” purchasing and payment concepts virtually complete, the U.S. government is now training its sights on medicine with similar intentions. With the new MACRA pay-for-performance program, CMS bureaucrats believe they can force health care providers to practice better “quality” care by collecting clinical performance, practice-related, and cost data, and basing payment increases and penalties on the results.

There is one big problem associated with …

Your next doctor, powered by artificial intelligence

Dinesh Rai

Health Technology

May 17, 2017

Although every technology product released today seems as if it is “powered by artificial intelligence,” the actual AI revolution is ahead of us. When it arrives, it will be on par with the industrial revolution in changing our lives, especially in the world of medicine.

John McCarthy, a legendary computer scientist, coined the term “AI” in 1955. He defined it as “the science and engineering of making intelligent machines, especially intelligent …

Confessions of a criminal doctor

Max Kepler, MD

Physician

May 17, 2017

An excerpt from Confessions of an American Doctor: A true story of greed, ego and loss of ethics.

The Medical Board of California attorney, Mr. Arnold, proceeded to read the discussion I had with the undercover agent regarding the source of the human growth hormone, including the part where she specifically asked whether the drug was from China, and I replied, “No.” When he finished reading, Mr. …

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Confessions of a criminal doctor

The promise and pitfalls of evidence-based medicine

Christopher Johnson, MD

Physician

May 17, 2017

For many centuries medical practice was a black art. What physicians did was based upon theories of how the body worked that turned out to be fanciful at best, dangerous at worst. The late nineteenth century brought breakthroughs in the biological sciences, such as the identification of bacteria and new understandings of physiology, which increasingly placed medical practice on a scientific basis. That process has continued over the past 150 years, …

The doctor shortage is worse than it has to be

Hans Duvefelt, MD

Physician

May 17, 2017

Now, I’m just a country doctor, but I have to say I find it very hard to understand why folks in this country, on one hand, keep talking about a doctor shortage in primary care and, on the other hand, keep piling sillywork on those of us who are still here.

The net effect is that the doctor shortage is going to be a whole lot worse than it has to …

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