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It’s hard to eat less when there is too much on your plate

Conditions and Diseases

February 20, 2016

It’s hard to eat less when there is too much on your plate.

That’s the major reason why America is in the throes of an obesity epidemic, abetted by the aggressive marketing of all things edible.

More esoteric-sounding reasons for this epidemic — such as fat-favoring microbes in your body or hormone-laden foods — shouldn’t even be part of the discussion, because how much we consume largely explains why we’ve put on …

MKSAP: 72-year-old man with acute swelling and severe pain of the right knee

mksap

Conditions and Diseases

February 20, 2016

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

A 72-year-old man is evaluated in the emergency department for acute swelling, severe pain, and warmth of the right knee that woke him from sleep. He does not recall any inciting injury to the knee. Three months ago, he had an acutely swollen great toe that improved within 3 days, for which he did not …

Patients and physicians must advocate for a transformed primary care system

Stephen C. Schimpff, MD

Health Policy

February 19, 2016

Part of a series.

Primary care needs to change. That change will need the concerted efforts of patients, doctors, and other constituents. Many are cynical and believe that no worthwhile change can ever occur; others are simply resigned. But optimism can be realistic with intense advocacy and simply taking the initiative to make change. This may surprise you, but change will only happen when patients along with doctors become …

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A tribute to Paul Kalanithi

Tom Peteet, MD, MPH, MEd

Physician

February 19, 2016

There are few aphorisms in medicine that stand up to reality. Here are two: Physicians get the patients they deserve, and we tend to die like we live.

Paul Kalanithi’s posthumous memoir proves both: As a neurosurgery resident at Stanford, he took on the most challenging cases, and when diagnosed with terminal lung cancer, he lived and died pursuing excellence and truth. I read When Breath Becomes Air …

Read more…

A tribute to Paul Kalanithi

I was unprepared to deal with a homeless patient today. I won’t be tomorrow.

Seema Khosla, MD

Physician

February 19, 2016

I met a woman today who was well-groomed, articulate, insightful and undeniably intelligent. She provided succinct responses and understood the matter at hand. Our ability to treat her, though, will likely be derailed in two weeks when she will once again become homeless.

In the midst of a booming job market in my area lies a cluster of people who are unable to find work — either due to transportation issues, not …

An open letter to my little sister in medical school

Romila Mushtaq, MD

Medical Education

February 19, 2016

Dear LilSis,

Fifteen years ago, I met your father, Dr. Braxton Wannamaker, when I as a neurology resident at the same institution where you are now a medical student. Dr. Wannamaker mentored me in neurology, epilepsy research, and life. I am blessed that the entire Wannamaker family took me in as an adopted daughter, and that is how I got to meet you, sweet Louise.

The fashion we wore, boys we dated, …

What does it mean when a patient calls a doctor by his first name?

James C. Salwitz, MD

Physician

February 18, 2016

Romeo and Juliet, Act II, Scene II: “What’s in a name? That which we call a rose by any other name would smell as sweet. So Romeo would, were he not Romeo call’d, retain that dear perfection which he owes without that title.”

I saw a consult the other day, an older gentleman with a new cancer requiring complex evaluation and extended care. Scary, hard stuff, but with the possibility of …

How to boost your child’s immune system the right way

Chad Hayes, MD

Conditions and Diseases

February 18, 2016

If you’re like most parents, you want your kids to be healthy. And if your kids are like most kids, that isn’t always the case. The most frequent illness of childhood is the common cold, and children — especially those in daycare — can get several of these infections per year. While cold viruses rarely result in significant complications, they certainly cause their share of discomfort, lost sleep, and time …

A heart-wrenching story of pediatric cancer

Jacqueline Dooley

Patient

February 18, 2016

Three years ago I spent the entire month of September by my daughter’s side in her hospital room. From Ana’s window, we watched summer fade into fall as we waited, day after day, for her to be discharged, which finally happened in early October.

During her forty days in the hospital, Ana was diagnosed with an obscure, slow-growing cancer called inflammatory myofibroblastic tumor. The tumor, roughly the size of a cantaloupe, …

In the fight against MOC, physicians are the underdogs

Meg Edison, MD

Physician

February 17, 2016

Wow. For those who think MOC isn’t a big deal, my open letter to the American Board of Pediatrics just hit 70,000 views. That’s stunning.

For those commending my bravery, realize efforts like this are not done in isolation. I am not alone. I have the most amazing partners. I can’t even express how blessed I am to work with the ten doctors in our private practice. Not only do we …

Who is responsible for OR delays? And what can we do about them?

Skeptical Scalpel, MD

Physician

February 17, 2016

Every two or three years, someone, usually a hospital administrator, decides that delays in operating room turnover time need to be looked into. A committee of 20 or 30 stakeholders (love that term) is appointed and assigns someone the job of measuring the time between cases and identifying reasons for delays. In years when turnover time is not being studied, first case starting delays are on the agenda.

In my nearly …

Medical students can’t stop talking about school. Here’s why that’s healthy.

Nathaniel Fleming

Medical Education

February 17, 2016

On a recent Friday, I went out with a handful of classmates for some food to celebrate the end of a particularly long and tiring week of school. Interestingly, although we had spent hours each day shuttling between lecture halls, the hospital, and clinical exam rooms, the conversation kept drifting back to one, very familiar topic: school. We talked about everything we had endured that week, compared notes on our …

Pay primary care doctors what they’re worth

Allen Frances, MD

Physician

February 17, 2016

“It’s more important to know the patient who has the disease, than the disease the patient has.” This was true when Hippocrates said it 2,500 years ago — and it remains true today.

Unfortunately, doctors no longer know their patients. GPs are overworked, underpaid, and must shuttle patients in and out of the office in less than ten minutes. Specialists tend to treat the test, not the patient, and earn their …

The value of moving through grief to healing and growth

Claudia M. Gold, MD

Physician

February 16, 2016

(The following story was told to me by a friend; details have been changed to protect privacy.)

An early winter snowstorm left Janet with an unexpected whole day alone with her 17-year-old daughter Ally. As was typical for the pair, they spent the morning in comfortable separateness. Janet took advantage of the opportunity to catch up on paperwork, while Ally stayed in her room working on college applications. In Janet’s view …

This is what I’m wearing instead of a white coat

Kristin Prentiss Ott, MD

Physician

February 16, 2016

Hospitals are places of long-standing hierarchies where some people are made to feel important and others … not so much. A long time ago, I was told nurses used to stand when a white coat walked into a room. (Imagine that now. Laugh. Snort. Choke. Cough.) In those days, in the patient care setting, white coats were synonymous with importance.

These days, non-clinical hospital administrators, various technicians, and Clinique make-up counter …

Dr. Mona Hanna-Attisha is a hero. Here’s why.

John Schumann, MD

Physician

February 16, 2016

I have a new hero. Her name is Mona Hanna-Attisha, MD, MPH.

Dr. Hanna-Attisha is a pediatrician in Flint, Michigan. She grew up in a suburb of Detroit. She graduated from the University of Michigan before attending medical school at Michigan State University. During her clinical years (the 3rd and 4th years of medical school), she spent many months at Hurley Medical Center in Flint, which serves as a clinical training site …

Do physicians who go on long vacations lose their skills?

Michael Kirsch, MD

Physician

February 16, 2016

Years ago, I was having dinner with two members of the Cleveland Orchestra, one of the finest orchestras in the world. I asked them, with my kids present, how much time they devoted to their craft. As many parents know, getting kids to commit to practicing a musical instrument is about as easy as splitting the atom. The musicians told us how much time they practiced, which was mind boggling, …

Medicine is often more complicated than the first positive finding

Hans Duvefelt, MD

Conditions and Diseases

February 15, 2016

77-year-old Edward Tripp had been to the emergency room with chest pain last Friday night. It was relentless, aching, and involved the upper part of his left chest.

He had no cough, fever or shortness of breath. He was not sweaty or nauseous, and his blood work, EKG and chest x-ray were normal. He was distinctly tender over the part of his rib cage where bone and cartilage join each other …

The racial slurs didn’t hurt. Other things have hurt much more.

Maria Yang, MD

Physician

February 15, 2016

You could feel the air rushing out of her lungs and into your face if she was screaming at you.

“STOP CALLING ME A WHORE! I AM NOT A WHORE, YOU DIRTY N-GGER!”

No one, in fact, was calling her a whore.

“DON’T LIE TO ME, MOTHERF-CKER! I HEAR ALL OF YOU CALLING ME A WHORE! I HEARD IT, JUST NOW!”

Her best defense was a loud offense that included liberal use of racial …

We want access to safe and effective Avastin. Here’s a solution.

Robert Wong, MD

Conditions and Diseases

February 15, 2016

Recently, two states in India halted all use of Avastin for the treatment of eye disease following the report of 15 patients who underwent emergency surgery for potentially blinding infections at the C.H. Nagri Municipal Eye Hospital in Ahmedabad. Though further investigations are ongoing, there is worry that the cluster of infections centered around a tainted lot of compounded Avastin. This most recent event serves as a reminder …

Real physician voices, twice a week

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