I stood in line behind a physician, slightly balding and in a long, starched lab coat at the coffee shop in our hospital. As he paid and took his coffee, I noticed that he smiled and called the clerk by name, “Thank you, Terri.” He went on about his day, and I was left to wonder about the man, his practice and what type of person he was.
My friend has …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 28-year-old man is evaluated for recurrent nephrolithiasis. Medical history is significant for Crohn disease complicated by multiple small bowel strictures requiring resection. He began developing kidney stones 3 years ago following his last bowel surgery. Analysis of the stones has consistently shown calcium oxalate, and he has been adherent to a …
Recently, a nurse at Children’s Hospital Los Angeles noticed that comedian Jimmy Kimmel’s newborn baby had a murmur and was cyanotic and brought it to the newborn intensive care unit for further evaluation. That triggered a rush of activity that led to a diagnosis of a congenital heart defect and heart valve problem and surgery to save the baby’s life.
Here’s what the public doesn’t understand: Nurses do this every day. …
As a consultant in gynecologic pathology, I receive requests for second opinions from patients who have been diagnosed with endometrial hyperplasia. My opinion is based upon correlating the relevant clinical history with a review of the patient’s pathology slides and report. In my experience, there is a difference of opinion that leads to a change in treatment in about half of the cases. 75 percent of cases with changed diagnoses …
No matter how well the one you love ornaments your life, they should never be an ornament. Meaning — you should never have to find them hanging in the closet like it’s some tree where each broken branch represents sadness, sickness and issues that only make sense in hindsight.
That metaphorical tree was as astonishing as Christmas morning yet as terrible as a Halloween horror. And although surreal — like Dali …
An excerpt from Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery.
Near my office, there’s a breakfast-and-lunch joint where strangers sit down at shared tables. When Joseph, an attorney …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 29-year-old woman is evaluated for a 5-day history of nodules over her lower extremities. She reports that she regularly visits a local spa that uses whirlpool footbaths during her pedicure procedures; she always shaves her legs with a razor before these visits. Medical history is unremarkable, and she takes no medications.
On …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old man is evaluated for new-onset ascites with lower-extremity edema. Symptoms have increased gradually over the past 4 weeks. He has consumed three alcoholic beverages per day for many years. His medical history is notable for coronary artery bypass graft surgery 8 months ago and dyslipidemia. His medications are low-dose aspirin, atorvastatin, …
Part of a series.
The percentage of the population that will be “elderly” is rising fairly dramatically. In 1900 only four percent of the population was over 65 and only one percent over 75. By 1950 it was eight and three percent, respectively. By 2000 it was thirteen and five percent, and now it’s about fourteen and six percent. By 2030 it will be substantially more again.
There are many …
Being a radiologist, I rarely speak to patients, but I was asked to counsel Mrs. Patel (not her real name), who was worried about the risks of radiation from cardiac calcium CT scan. Because of her risk factors for atherosclerosis, her cardiologist wanted her to take statins for primary prevention, but she was reluctant to start statins. They eventually reached a truce. If she had even a speck of calcium …
Those of us who work in pediatric intensive care have frequent encounters with the problem of suicide and attempted suicide. It has seemed to me for some years that the numbers are increasing, and this has been shown to be the case. After years of declining, the suicide rate in our country has been increasing, now at about 125 percent of the rate of several decades …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 79-year-old man is evaluated for a 3-month history of right hip pain. He points to the center of his right buttock when asked to identify the location of the pain. He has no radicular symptoms. He reports no focal trauma but believes his symptoms began after he stepped off a curb that …
What can I tell you? It started out innocently. College exams were over. And that meant one thing — party time! Bubbly, shots, beer, cocaine and Percocet. Everyone was happy. It was a celebration.
Pam came from a pretty strict religious family: no alcohol, no premarital sex and no crazy music in her house growing up. It was church every Wednesday and Sunday. And if you missed a Sunday, you were …
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 52-year-old man is evaluated for the sudden onset of erectile dysfunction that has persisted for 6 months. He reports having erections that are inadequate for vaginal penetration. He feels guilty about not being able to satisfy his wife’s requests for sexual intercourse, although he still has sexual desires. He has been sleeping poorly …
He was referred to me by a colleague with a large geriatric practice for evaluation and treatment for HIV. He was 76 years old and lived in an assisted living facility. He was, however, very independent and only required limited assistance. When asked what he expected from the visit he responded that he had been sent to me by his PCP. Review of his records suggested that in addition to …
Heroin abuse in the United States is reaching epidemic proportions. According to SAMHSA, between 2007 and 2012, the number of Heroin users has doubled from an estimated 375,000 to over 665,000. Additionally, in 2010, the number of deaths as a direct result of overdose surpassed auto accident deaths.
It is impossible to avoid the facts about heroin. We are bombarded daily by the national and local media and extensive online resources. …
“Why do you eat so healthy?” or “Where’s your kale today?” I would hear regularly.
For as long as I can remember, my colleagues and friends have often smirked at my lunch choice. To me, I always ate what I enjoyed (even if it was the occasional french fry), and my diet and lifestyle were all about balance. Growing up, I played competitive soccer for 10 years and knew my performance …
Many patients are referred to me as a psychiatrist to treat their depression. The new patients that come to me for depressive symptoms usually expect that I will be recommending and prescribing an antidepressant for their depressive symptoms because that is what a psychiatrist does, right? Not always.
Often times these patients come to me having gone through several antidepressant trials without any successful resolution of their depressive symptoms. Well, sometimes …
One evening this past week, after my wife finished feeding our 5-week-old daughter, I took over baby duty. I sat her up on my lap and gave her a few thumps on the back. Not hard enough to hurt, obviously, but just to make her burp.
She didn’t burp. So I gave her a couple more gentle-but-firm whacks, still without a result.
And then I remembered the phone call I got a …
It’s almost 7 p.m., and I’m handed the chart of a man in his sixties. “Can you see this one first,” the nurse says, “he needs an ultrasound.” I skim the triage note, which is often like reading the blurb at the back of the DVD. If it says “pain all over for eight months,” it’s not likely to be a hot new rental.
Frank Martin (name changed) has been sent from a walk-in …
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