| KevinMD.com

September 28, 2016Sep 28, 2016

When you are 70 years old, you are bound to have some medical problems, so I am not sure why the media and the public are making a hoopla about the medical histories of Hillary Clinton and Donald Trump. For…

For an elderly patient, my usual medical dictation reads “Mr. A is a 70-year-old former truck driver who has hypertension, diabetes, bypass surgery, and who now comes in with a cough and …

Physician

When EMTALA forms meet EMRs, chaos can ensue

Edwin Leap, MD

September 28, 2016Sep 28, 2016

Ah, EMTALA! The revered Emergency Medical Treatment and Active Labor Act! It’s one of those things which is like a nursery rhyme to emergency medicine folks like me. We’ve heard about it from the infancy of our training. “And then the bad doctor sent the poor lady to another hospital because she couldn’t pay! And the King came and crucified him for doing it!” The end.

EMTALA, for the uninitiated, is …

Medications

Sharing medications happens more often than we think

Anne Katz, RN, PhD

September 28, 2016Sep 28, 2016

Many men experience significant erectile problems after having a radical prostatectomy, and many of the men treated by the urologists I work with eventually land in my office. We talk frankly about the quality of their erections before the surgery, what they are like now, and what they have tried to do to resolve the problems they are having. After this, …

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Physician

I wish my patients knew

Niran S. Al-Agba, MD

September 27, 2016Sep 27, 2016

Referencing a recent New York Times article “What Kids Wish Their Teachers Knew” got me thinking about both sides of the coin. Physicians are human beings and sometimes this fact gets lost when a patient is angry or frustrated seeking help from the medical system. Here is a primer on what I wish my patients knew. (This is a companion piece to “I wish my doctor …

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I wish my patients knew

Patient

The value of a spiritually competent doctor

Eric Nelson

September 27, 2016Sep 27, 2016

Whenever he meets with a new patient, Harvey Chochinov likes to ask one important question: “What should I know about you as a person to help me take the best care of you that I can?” It’s a question every…

Whenever he meets with a new patient, Harvey Chochinov likes to ask one important question: “What should I know about you as a person to help me take the best care of you that I can?”

It’s a question every doctor should ask, says Chochinov, author of Dignity Therapy and director of the Manitoba Palliative Care Research Unit; a question he has found helps patient and doctor alike dial …

Physician

Helping a patient is more important than following a policy

Jeff Kane, MD

September 27, 2016Sep 27, 2016

Pretend you're a 30-year-old woman who's 34 weeks pregnant. You develop a cough while cleaning a dusty room. You put up with it for several days. After a week you realize the cough has kept you from sleeping and is…

Pretend you’re a 30-year-old woman who’s 34 weeks pregnant. You develop a cough while cleaning a dusty room. You put up with it for several days. After a week you realize the cough has kept you from sleeping and is creating pain in your rib cage. Time, you think, for medical attention.

That should be an easy thing to do. After all, you have health insurance, and you’re articulate and assertive. …

Medical Education

Medical students need exposure to chronic pain patients

Sarah Cohen Solomon, MD

September 27, 2016Sep 27, 2016

Pain. It permeates every aspect of medicine, crawls into the deepest corners of our practices, sinks its claws in and stays put. Opiates are at the center of a vicious national debate, and our patients are trapped in its clutches. But my thoughts are less on medications, protocols, and procedures and more on how we approach the patient who cries pain. Through everything I have observed, as a caretaker and …

Physician

How primary care is being held hostage to tertiary care

Pamela Wible, MD

September 26, 2016Sep 26, 2016

Illustration by Jorge Muniz, PA-C. Here’s a quick review of health care delivery basics: Primary care. Stuff you can get handled with your primary care doctor in your neighborhood. Example: ingrown toenail. Secondary care. Stuff your primary care doctor refers…

Illustration by Jorge Muniz, PA-C.

Here’s a quick review of health care delivery basics:

Primary care. Stuff you can get handled with your primary care doctor in your neighborhood. Example: ingrown toenail.

Secondary care. Stuff your primary care doctor refers to a secondary specialist down the road. Example: colonoscopy.

Tertiary care. Complex stuff you need to deal with at a big-city hospital. Example: lung transplant.

Simple. Right?

Here’s the problem: …

Medications

The complications of firing patients who won’t vaccinate

Christopher Johnson, MD

September 26, 2016Sep 26, 2016

A manifesto has been making the rounds on Twitter (and other places) over the past year. It has been attributed to Dr. Mike Ginsberg, a California pediatrician. It reportedly was originally a Facebook post that has since been taken down, perhaps because of the controversy it generated. I can understand why; vaccines are a hot button topic, and anyone who writes about them attracts attention, some of it unpleasant. I know …

Medications

This doctor is against medical marijuana. Here’s why.

Michael Kirsch, MD

September 26, 2016Sep 26, 2016

I have already opined on my disapproval of a medical marijuana law recently passed in Ohio. Once of my points in that piece is that I did not want legislators making medical decisions for us. They can’t even do their…

I am not against medical marijuana; I am for science. The currency of determining the safety and efficacy of a medicine should be medical evidence, not faith, …

Health Policy

What’s wrong with socialized medicine, and what we can learn from the NHS

Janice Boughton, MD

September 26, 2016Sep 26, 2016

The British National Health Service (NHS) was born in 1948, based on legislation passed that year mandating free high-quality health care for all paid by taxes. In contrast, the U.S. started Medicare in 1966 to provide health care to the elderly and the State Children’s Insurance Program (SCHIP) in 1993 to fund health care for children whose parents were unable to afford it. Health care in the UK is still …

Physician

Captain Sully and the human factor in health care

Suneel Dhand, MD

September 25, 2016Sep 25, 2016

I recently watched the movie Sully. It was the first time I’d ever watched a movie on its actual release date. Knowing what a legendary actor Tom Hanks is, and what a fascinating and near-tragic story unfolded on January 15, 2009, I felt confident that my choice to venture out to the cinema on a beautiful Boston September evening, would be a good one.

The movie sure didn’t disappoint. Brilliantly directed …

Social Media in Medicine

Have the flu? Tweet it. Diarrhea? Review it. Help identify outbreaks.

Jesse O'Shea, MD

September 25, 2016Sep 25, 2016

When it comes to social media, oversharing is the new norm. When #flu season comes around, everyone on Twitter becomes inundated with talk of runny noses, strangers sneezing on their morning commute bus ride, and avoidance of the airport. People update their statuses on their interactions, frustrations, struggles and even locations. When a friend is not feeling well, they may post about it on social media and get an instant …

Physician

Doctor, take that patient’s call

Madelaine Feldman, MD

September 25, 2016Sep 25, 2016

As rheumatologists, we pride ourselves on spending time with our patients, listening to their problems and their family’s problems, and answering all of their questions. Whenever my husband and I run into a patient of mine on the street, they always tell him that I am the best doctor ever. In spite of these accolades, I realized recently I was guilty of doing something with a handful of my patients …

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Doctor, take that patient’s call

Medical Education

Physician parents, physician children. Why?

Robert G. Dorfman

September 25, 2016Sep 25, 2016

Upon starting medical school, I remember feeling amazed to learn just how many of my classmates had physician parents. I felt like I was in the minority, not having any family members of my own who were doctors. This made me realize: Physician parents tend to breed physician children. But why? I soon discovered that the answer may lie in the genetics of personality.

The academic study of personality has grown extensively over …

Physician

Fibromyalgia: Medicine’s F-word

Ginevra Liptan, MD

September 24, 2016Sep 24, 2016

On my last day of internal medicine residency, as I finished my senior grand rounds presentation, I “came out” to my colleagues and confessed the deep dark secret I had been hiding since medical school: I have fibromyalgia. A few…

A few jaws literally dropped, and there was an awkward silence, then polite applause. Afterwards several of my colleagues came up to talk with me privately and were offended and/or curious as to …

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Fibromyalgia: Medicine’s F-word

Conditions and Diseases

Big data equals big challenges for prostate cancer

Leonard G. Gomella, MD

September 24, 2016Sep 24, 2016

The term “big data” is a favorite mantra of health care today. Big data sets are starting to drive much of what is done in medicine including directing research, drug development, clinical pathways, insurance coverage and public opinion. The official definition of “big data” in health care is subject to interpretation by different sources. One dictionary defines big data as “data of a very large size, typically to the extent …

Physician

The yoga of surgery

Red Hoffman, MD, ND

September 24, 2016Sep 24, 2016

Early on a random Tuesday morning, I walked into the burn unit and found my 87-year-old patient, Mr. Gray, in septic shock. While Mr. Gray’s burn injury was small by our standards, it appeared that the sequelae of the injury might prove fatal. I called Mr. Gray’s wife to obtain consent for a vascular catheter through which I planned to begin continuous dialysis and was surprised when she declared, “No …

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The yoga of surgery

Conditions and Diseases

MKSAP: 68-year-old woman with gradually progressive abdominal distention

mksap

September 24, 2016Sep 24, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 68-year-old woman is evaluated for a 3-month history of gradually progressive abdominal distention. Her medical history is notable for a 20-year history of…

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

A 68-year-old woman is evaluated for a 3-month history of gradually progressive abdominal distention. Her medical history is notable for a 20-year history of obesity, type 2 diabetes mellitus, hyperlipidemia, and hypertension. She also has had a 10-year history of elevation of serum aminotransferase levels, which was attributed to nonalcoholic fatty liver disease. …

Physician

Doctors must preserve their empathy at all costs

Michael Levy, MD

September 23, 2016Sep 23, 2016

It was several years ago. I was a first-year internal medicine resident. Keen, tired, overworked, and still idealistic. Mr. Smith was a 45-year-old lawyer who rolled into St. Paul’s Hospital Emergency room, while our medicine team was on intake. He was a healthy appearing lawyer who noted that for the past month he had become more short of breath performing his regular exercise. Things were especially bad for him during …