| KevinMD.com

December 5, 2016Dec 5, 2016

It’s hard to find time to pay attention to all the messages I receive. There are voicemails, emails (work, blog, and personal), and the nonstop notifications from Facebook and Twitter. Post-it Notes on the desk and the refrigerator. I am…

Urban Meyer, head coach of the Ohio State football team, doesn’t have a lot of time to leave messages. Right now, he’s gearing up for a likely bid in the …

Physician

The division in our country is barely visible in the hospital

Andrew Cruz, MD

December 4, 2016Dec 4, 2016

In a time when the deep divisions in our country have become increasingly apparent, I, perhaps like you, have been seeking hope. I supposed hope would come in the form of an enlightened article or a profound speech, but it…

The division you have been seeing in our country is barely visible in the hospital. Here, patients are assigned …

Physician

We need to know these 3 facts to fight to opioid crisis

Mehul Desai, MD, MPH

December 4, 2016Dec 4, 2016

Dear President-elect Trump, On the campaign trail, you referred to the opioid epidemic plaguing the nation a “tremendous problem” -- and it is. You claimed that this crisis could be mitigated by building a wall between the U.S. and Mexico…

Dear President-elect Trump,

On the campaign trail, you referred to the opioid epidemic plaguing the nation a “tremendous problem” — and it is. You claimed that this crisis could be mitigated by building a wall between the U.S. and Mexico to “cut off the source.” You promised to dedicate resources to get afflicted Americans treated. You pledged to take addicts and “work with them” to ensure they are “gonna get that …

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Physician

Give the outside hospital the respect it deserves

Jaan Peter Naktin, MD

December 4, 2016Dec 4, 2016

OSH, or "outside hospital," is one of those abbreviations that has crept into the lexicon of hospital jargon that merits additional scrutiny. What are the implications of calling another health care facility “outside”; does that make your hospital the “inside”…

OSH, or “outside hospital,” is one of those abbreviations that has crept into the lexicon of hospital jargon that merits additional scrutiny.

What are the implications of calling another health care facility “outside”; does that make your hospital the “inside” hospital? I suspect that it is, as many patient-related conditions are described, multifactorial. Or, if you like the band Fort Minor, “Remember the Name” (apologies to the band):

This is ten percent …

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Give the outside hospital the respect it deserves

Physician

A physician who lost a patient to home birth

Anonymous

December 4, 2016Dec 4, 2016

There is a strange feeling that every kid has experienced: the flip-flop sensation of your stomach dropping while you careen down the descent of an enormous roller coaster; the sinking swoop of a high-speed elevator dropping to the ground floor. My children find it hiding along a rolling country road, driving to the lake in our jeep. With the top down and the sun shining, they shriek and beg for …

Medical Education

The uncertain diagnosis is difficult for everyone involved

Michael Nguyen

December 3, 2016Dec 3, 2016

It is frustrating for patients to have unanswered questions, and it is equally frustrating for doctors to not have answers to their questions. In the past month, I have cared for three patients who have stood out to me because…

“I have had crushing 10/10 chest pain since this morning,” Ms. A tells me at the urgent episodic appointment she scheduled in my …

Physician

The complexity of the white coat

Chiduzie Madubata, MD

December 3, 2016Dec 3, 2016

I remembered staring at the computer screen with the radiologist hoping that by staring at the images, they would change in some way. It did not seem fair that a nice lady that I was evaluating in the emergency room would be consigned to such tragic images. I was rotating through the emergency room during my second year of residency, and one of the patients had come in just for …

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The complexity of the white coat

Physician

When you place your faith in another surgeon

Nariman Heshmati, MD

December 3, 2016Dec 3, 2016

It was Thanksgiving morning. My wife was standing in the living room when she received a text message from her father. Her face went pale, and her expression turned to one of anger and disbelief. She cursed. She cried. Her mother had complained of chest pain and stroke-like symptoms and was being rushed to the hospital by ambulance.

Many hours went by with few answers and endless speculation. We had moved …

Conditions and Diseases

MKSAP: 47-year-old man with a bicuspid aortic valve

mksap

December 3, 2016Dec 3, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 47-year-old man is evaluated during a routine examination. He has no symptoms. Medical history is significant for a bicuspid aortic valve. He is…

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

A 47-year-old man is evaluated during a routine examination. He has no symptoms. Medical history is significant for a bicuspid aortic valve. He is not taking any medications.

On physical examination, he is afebrile, blood pressure is 130/70 mm Hg, pulse rate is 56/min, and respiration rate is 15/min. Cardiac examination reveals a grade …

Health Technology

Be wary when a non-clinician talks about acute kidney injury

Joel Topf, MD

December 2, 2016Dec 2, 2016

Acute kidney injury (AKI) is hard. Things that seem like they should work often don't. Just ask Perry Wilson. And even the most predictable cases of AKI are resistant to intervention. Look at bypass surgery. We know days in advance…

Acute kidney injury (AKI) is hard.

Things that seem like they should work often don’t. Just ask Perry Wilson.

And even the most predictable cases of AKI are resistant to intervention. Look at bypass surgery. We know days in advance the time and place the AKI will occur and despite that foreknowledge, like Cassandra, we are powerless to prevent the AKI. Same with contrast administration (or not). Same with AAA …

Physician

An open letter to America’s white working class

Keith Pochick, MD

December 2, 2016Dec 2, 2016

What an upset, right? Your voices were heard, loud and clear. The current system wasn’t working for you, and you won a major paradigm shift. The insulting irony of the word "progress" hidden in "progressive agenda" wasn’t lost on you.…

What an upset, right? Your voices were heard, loud and clear. The current system wasn’t working for you, and you won a major paradigm shift. The insulting irony of the word “progress” hidden in “progressive agenda” wasn’t lost on you. You looked around your respective communities and what you saw sure didn’t seem like progress. Employment opportunities were scarce, your health insurance costs had risen, and your infrastructure had eroded. …

Physician

Atheist doctors must come out of the closet

David Mann, MD

December 2, 2016Dec 2, 2016

Reading about the opening of the Noah’s Ark Theme Park in Kentucky brings to mind the days when I worked as a physician in that state. I had moved from an academic position in Colorado and joined a large group of private practice cardiologists in Louisville. I found that people in Kentucky were different from those in Colorado. They were much more overtly religious.

As an interventional electrophysiologist, I would meet …

Conditions and Diseases

Does the increased frequency of repair of AAA in the United States reap benefits?

Dr. Saurabh Jha

December 2, 2016Dec 2, 2016

A popular meme is that the U.S. spends more on health care than other developed nations but has nothing to show for that spending. This is different from saying that the U.S. spends more, but achieves something, but the something it achieves is so little that it isn’t worth the public purse. The latter is difficult to assert because the asserter must then say how little is too little in …

Health Technology

My dentist’s EHR system is better than mine. Here’s why.

Toni Brayer, MD

December 2, 2016Dec 2, 2016

Imagine my surprise and delight when I saw my dentist this week for a check-up and found the electronic health record (EHR) to be both informative and patient friendly. As I sat in the dental chair, the large monitor screen was swung over in front of me, and my dentist was at my side going over it. The monitor was not a barrier; it was part of my exam. The …

Physician

When should you talk to your teenage daughter about sex?

Fatu Forna, MD

December 2, 2016Dec 2, 2016

So, have you talked to your teenage daughter about sex? Have you really talked to her about sex? I’m not talking about the superficial birds and the bees conversation; I’m talking about using words like vagina, penis, and condom. Yes,…

So, have you talked to your teenage daughter about sex?

Have you really talked to her about sex?

I’m not talking about the superficial birds and the bees conversation; I’m talking about using words like vagina, penis, and condom. Yes, those words!

As an obstetrician-gynecologist and a mother of girls, I know the challenges that our daughters face as they navigate their teenage years. I know how critical it is to have real …

Physician

Identifying patients by more than their names

Skeptical Scalpel, MD

December 1, 2016Dec 1, 2016

The wrong body was cremated by the county coroner’s office in Los Angeles. Jorge Hernandez died of an overdose, and the body of another Jorge Hernandez, an indigent patient, scheduled for cremation, was also present in the morgue. The distraught…

The distraught family of overdose victim Jorge Hernandez had planned a funeral with a viewing and were shocked when they were told his body had been cremated by mistake because a morgue attendant …

Physician

Are nudists, nature, and hippies the cure for an uptight doctor?

Anonymous

December 1, 2016Dec 1, 2016

When I was heading to a retreat held by the physician who started the ideal medical care movement, Dr. Pamela Wible, I expected an orderly and structured program on how to improve the current culture of medicine. I knew, with about 40 physicians and 10 other medical students, there would be a lot of Type A personalities since that’s typically the sort of people that go into medicine. While I …

Physician

Be the kind of parent you wished yours were

Hans Duvefelt, MD

December 1, 2016Dec 1, 2016

A young man with chest pains, shortness of breath and heart palpitations had come back for his follow-up visit. His thyroid test and blood count were well within the normal range. His EKG was normal, and his chest X-ray was…

A young man with chest pains, shortness of breath and heart palpitations had come back for his follow-up visit.

His thyroid test and blood count were well within the normal range. His EKG was normal, and his chest X-ray was declared normal by the radiologist.

We talked some more about his anxiety and poor sleeping habits. We talked about his late shift at work, and we talked about his late gaming habits …

Conditions and Diseases

Sleep deprived and exhausted? These tips will help.

Katie Fortenberry, PhD

December 1, 2016Dec 1, 2016

I’m just coming out of two years of sleep deprivation. Due to some sleep apnea issues (hopefully finally resolved), my now two-year-old daughter slept like a newborn until this summer. Which means, like the mom of a newborn, I was…

I’m just coming out of two years of sleep deprivation.

Due to some sleep apnea issues (hopefully finally resolved), my now two-year-old daughter slept like a newborn until this summer. Which means, like the mom of a newborn, I was up every three hours at night for the last two years.

This has given me more experience in living with sleep deprivation than I ever wanted and plenty of time to think …

Health Technology

Where does health care IT hurt? Everywhere.

John Halamka, MD

December 1, 2016Dec 1, 2016

Over the past few months, I’ve been in England, China, Denmark, New Zealand and Canada. Each of them is rethinking their health care IT strategy and is not entirely satisfied with past progress. I’m often asked by senior government officials…

Over the past few months, I’ve been in England, China, Denmark, New Zealand and Canada.

Each of them is rethinking their health care IT strategy and is not entirely satisfied with past progress.

I’m often asked by senior government officials to help harmonize IT strategy at the country level. That — I can do.

I frequently say that health care IT issues are the same all over the world. Here are a few …

Real physician voices, twice a week

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