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MKSAP: 55-year-old man with gout

mksap

Conditions and Diseases

February 25, 2017

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

A 55-year-old man is evaluated during a follow-up visit for gout. Two years ago, he had been treated with allopurinol and developed a hypersensitivity reaction. Over the past several months, he has had recurrent attacks of acute, episodic swelling of the first metatarsophalangeal joints with increasing involvement of other joints, including the ankles …

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MKSAP: 55-year-old man with gout

Tips for physicians thinking about working part-time

Warren Holleman, PhD and Marsha C. Holleman, MD, MPH

Physician

February 24, 2017

Sure, it’s nice to think about cutting back on the work hours and spending more time at home with the kids. Or out on the running trails getting fit and enjoying nature. Or singing in a chorus. But how do you really make that decision? And if you do decide to work part-time, how do you make the most of it?

After struggling to juggle two full-time health care careers with …

Retooling the future physician

Kiran Raj Pandey, MD

Health Technology

February 24, 2017

A computer algorithm learning how to play StarCraft like a champ may raise some eyebrows, but when algorithms start to give the skills of a trained physician a run, job security becomes a futile construct. An algorithm now diagnoses melanoma as well as a dermatologist: A consolation for the dermatologists, though: Folks across the hallway — the radiologists and the pathologists — are feeling the heat as well. …

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Retooling the future physician

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The EpiPen debacle may be the shot heard around the world

Niran S. Al-Agba, MD

Medications

February 24, 2017

The Mylan EpiPen debacle may have inadvertently weakened the grip of big pharma on U.S. lawmakers. Recently, a bill proposed by Senator Bernie Sanders was narrowly rejected by a vote of 52 to 46. Unexpectedly, 12 Republicans and 1 Independent voted with Senator Sanders in favor of allowing pharmacists and distributors to import cheaper prescription drugs from foreign countries. The winds of change may finally blow in a bipartisan direction. …

The importance of being present

Ronald Epstein, MD

Physician

February 24, 2017

An excerpt from Attending: Medicine, Mindfulness and Humanity.

Sometimes a simple gesture and a few well-placed words can signal presence. One day on rounds in the hospital, as we walked into the room, Laura Hogan, a nurse-practitioner on our palliative care team, said three words to the patient: “What beautiful flowers.” The patient looked at the flowers and smiled. The previous day the patient had had a biopsy …

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The importance of being present

How journaling can help physician wellness

Amanda S. Cuda, MD, MPH

Physician

February 23, 2017

Health behavior was my emphasis in my MPH. Add a faculty development fellowship, time as residency faculty, work in a private practice, and increasing interaction with medical students now as faculty at a medical school; the outcome is not just an emphasis, but a mindset. A mindset of health behavior that is not just for patients, but for physicians, as well.

I must have company in this concept as ten invitations …

How to ease your transition home from the hospital

Raissa Hacohen

Patient

February 23, 2017

A hospital stay is a right of passage for any patient, but the road to health is often a marathon and not a sprint. Discharge is an essential step in the patient journey, but it can be as exciting for a family as it is daunting. Families can prepare ahead and put all the right pieces in place in order for a “soft landing” home. Here are some of our …

12 steps to make America’s health care great again

Michael F. Weisberg, MD

Health Policy

February 23, 2017

America’s health care system is broken and no longer works. Many practicing physicians are unhappy with the way insurance companies control medicine. Most patients are unsatisfied with the benefits they receive from the health insurance companies and with the lack of choice they have in who cares for them. Patients are frustrated with the exorbitant cost of prescription medicine. They wonder why this system often doesn’t allow them to receive …

Perioperative brain health: The need to better understand this public health problem

Lee A. Fleisher, MD and Roderic G. Eckenhoff, MD

Conditions and Diseases

February 23, 2017

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

During the course of our careers as physicians, we have cared for or are aware of an elderly patient in the intensive care unit or ward who has exhibited delirium, or an acute confused state. This is particularly common after surgery and anesthesia. While simply being …

Having a baby during medical school wasn’t such a bad idea

Allison Lyle

Medical Education

February 22, 2017

My stomach had been in knots that morning.

“Are you pregnant?” my classmate laughed after I returned to the gross anatomy lab for the second time after leaving for fresh air.

“No,” I spat, dissection through fat and fascia, teasing out muscles from nerves.

But, I wondered.

After lab, I bought a pregnancy test. I began medical school in my late 20s, already having discussed with my husband appropriate times to start a family during …

How to publish as a medical trainee

James E. Siegler, MD

Physician

February 22, 2017

With all this talk about medical student, resident, and fellow burnout, I thought we might take a break to discuss the small delights that sprinkle throughout medical training. This is not a “You should publish as a trainee” manifesto. It’s more of a DIY guide for those who are interested but can’t find the time or the mentor. And after a decade of rejected manuscripts, unfortunately, I’ve …

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How to publish as a medical trainee

We need to pay better attention to medication side effects

Marlene Beggelman, MD

Medications

February 22, 2017

Years ago, after I suffered a deep personal loss, my doctor prescribed Prozac, and I joined the millions of Americans who have taken an antidepressant. A few weeks later, I had my first panic attack — heart racing, sweating profusely, gasping for breath — sensations of terror normally reserved for life-threatening events. Attacks continued every half-hour and were so incapacitating that I could not even leave my house. My doctors …

Every doctor needs a moment like this

Andrea Eisenberg, MD

Physician

February 22, 2017

My car says it’s 2:10 a.m., 17 degrees. I just left my warm bed — and snoring husband — threw on scrubs and my contact lenses and quickly brushed my teeth and hair. I’m shivering as the car warms up and I hear the crunch of the snow as the car rolls out of the driveway. I’m the first one out on the fresh snow, and it glistens in the …

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Every doctor needs a moment like this

The patent protection in the drug industry is out of control. Here’s why.

Robert Pearl, MD

Medications

February 21, 2017

In the United States, the patent protection process — as it relates to the drug industry — has been distorted by the political system, intense lobbying and large campaign contributions. The result has been pricing contrary to the greater good of the nation.

Patents originated in ancient Greece. This legal protection assumed greater importance in 15th-Century Venice as a means to protect the nation-state’s glassblowing industry. The first patent granted in …

It’s time we face it: Fossil fuels are killing us

James C. Salwitz, MD

Physician

February 21, 2017

When we think of pollution, we think of our planet: stripped forests paved asphalt black, sterile red rivers, brown-gray skies and creeping slums over once virgin land. We imagine massive dumps of civilized waste, the extermination of species and temperatures which bake the earth like a neglected oven. We mourn the global home in which we live, neglected, abused, in ruin. Do we ever think about ourselves?

That is one of …

Some “natural” remedies aren’t natural

Roy Benaroch, MD

Medications

February 21, 2017

My daughter and I were talking the other day and saying we would like to ask a doctor what his thoughts are about all these ‘natural’ remedies that are available. Recently a friend made the remark, ‘I do everything I can to avoid a doctor.’ I lean more toward the medical system and the knowledge they have acquired over the years rather than relying on these home remedies. What are …

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Some “natural” remedies aren’t natural

Overdiagnosis harms kids. Here’s how to avoid it.

Christopher Johnson, MD

Conditions and Diseases

February 21, 2017

A fairly recent article in the Journal of Pediatrics is both intriguing and sobering. It is intriguing because it lays bare something we don’t talk much about or teach our students. It is sobering because it describes the potential harm that can come from it — harm I have personally witnessed. The issue is overdiagnosis, and it’s related to our relentless quest to explain everything.

“Overdiagnosis” is the term the authors …

Place emotional harms on par with physical ones

Diane W. Shannon, MD, MPH

Physician

February 20, 2017

Why would a well-respected, venerable health care organization adopt a soft and squishy approach — tracking disrespect and other forms of emotional harm — to monitor its performance?

In 2007, Beth Israel Deaconess Medical Center (BIDMC), a 672-bed health system affiliated with Harvard Medical School, adopted the audacious aim of eliminating all preventable harm by January 1, 2012. According to Kenneth Sands, MD, chief quality officer of BIDMC, the organization has …

A positive visit with a patient with chronic pain

Danielle Ofri, MD, PhD

Physician

February 20, 2017

We have two ears and one mouth so we can listen twice as much as we speak,” said Epictetus. It’s clear that the Greek philosopher wasn’t a physician in 21st century America. If you watch doctors — and many researchers do — they speak more than listen.

Studies have shown that doctors interrupt or redirect patients within the …

Primary care today is like squeezing blood from a stone

Fred N. Pelzman, MD

Physician

February 20, 2017

In these strange days of unsure future health care policies, shrinking budgets, and significant belt-tightening, as we look for ways to improve access for our patients, we need to reevaluate how we to get them into care, making sure we see them in a timely and efficient manner.

We have always said that in this topsy-turvy time, in the crazy state of health care, what we really need is more primary …