Conditions

What’s the difference between speech and voice?

Conditions

February 22, 2014

Mr. Heim Stillear, at 70-years-old, seems older and less intelligent to his family, since he was hospitalized for a stroke about two months ago. They come to the appointment with him and help him into the exam chair. When I ask Heim what is going on with him, the long pause before his strained answer begins makes his family uncomfortable.

His daughter interjects, “We are having a very difficult time understanding …

Why doctors commit suicide

Pamela Wible, MD

Conditions

February 18, 2014

PAMELA-WIBLE

I’ve been a doctor for twenty years. I’ve not lost a single patient to suicide.

I’ve lost only colleagues, friends, lovers — all male physicians — to suicide.

Why?

Here’s what I know:

A physician’s greatest joy is the patient relationship.

Assembly-line medicine undermines the patient-physician relationship.

Most doctors are burned out, overworked, or exhausted.

Many doctors spend little time with their families.

Workaholics are admired in medicine.

Medicine values …

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Why doctors commit suicide

When patients abuse emergency department workers

Jonathon Savage, DO

Conditions

February 16, 2014

There are few professional careers centered around protecting and caring for others that garner so much verbal and physical abuse than a career in emergency medicine. Mental health workers, police, fire, and EMS personnel are the other fields that come to mind when I think of a service that “helps” people yet gets abuse dished upon them on nearly a daily basis.

A 2006 survey of emergency nurses showed that 25% …

10 things to know about anesthesia and heart surgery

Kent B. Berg, MD, MBA and Gregory M. Janelle, MD

Conditions

February 15, 2014

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

February is American Heart Month. Unfortunately, heart disease is a major problem in the United States that can result in surgery. In addition to discussing your procedure with your surgeon, you want to be sure to discuss your anesthesia care with your physician anesthesiologist.

Here are …

5 truths about fevers in children

Melissa Arca, MD

Conditions

February 10, 2014

shutterstock_84129244

The flu, RSV, colds, croup, strep throat, ear infections. They all have one thing in common: they can cause fevers. And as any parent can attest to, it’s often the fever itself that freaks us out more than anything and prompts many parents to call their child’s pediatrician or hustle them off to the emergency room.

Fever is clearly not a parent’s …

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5 truths about fevers in children

Treating post-viral coughs: This too shall pass

Emily Gibson, MD

Conditions

February 1, 2014

‘Tis the season to be coughing …

It no longer takes an epidemiologist looking at absenteeism rates in schools to predict the start of influenza season. For several years now there have been sophisticated models using search engine terms to monitor increasing incidence of febrile cough illness in regions of the world.

Or just ask a primary care clinic what its waiting room sounds like these days. A chorus of coughs, high, low, dry, …

Use Justin Bieber as a teaching moment for kids

Wendy Sue Swanson, MD

Conditions

January 31, 2014

Justin Bieber was arrested recently in Florida for a DUI. The smirk on his face is a bit misplaced. While it’s no longer a surprise when we hear about a celebrity’s challenge with drugs and alcohol, Bieber serves up a perfect moment for education. I mean this kid (he’s 19-years-old) really could have killed himself last night. Thank goodness he’s …

Refusing the flu shot: Respecting the patient’s right to choose

Jennifer Adaeze Anyaegbunam

Conditions

January 29, 2014

I’ve spent the past four weeks learning about primary care on my family medicine rotation. A significant portion of patient care in this setting is focused on health maintenance or disease prevention. Physicians can provide their patients with evidence-based recommendations for various screening tests and vaccinations, but it is ultimately up to the patient to decide what services he or she will receive.

According to the Centers for Disease Control and …

Mohs surgery is vilified, physicians again fail to respond effectively

Joyce Ho, MD

Conditions

January 29, 2014

An article published in the New York Times last weekend has been circulating widely on the Internet, and I feel that more than ever, physician voices are needed to reach the public and counter certain misconceptions put forth by the media.

The article, “Patients’ Costs Skyrocket; Specialists’ Incomes Soar,” charts the growth of specialist incomes in the past decade, using the case of a patient from Arkansas who had a …

Patients sometimes have good reasons to refuse colonoscopies

Michael Kirsch, MD

Conditions

January 22, 2014

Many times over the years, I have witnessed the following scenario in my exam room.

Here’s the set up of this one act play.

Characters:

Elderly patient
Attentive daughter
The doctor

Scene 1

I’m seated at my desktop computer. The patient is seated before me. The patient’s daughter is seated next to her mother.

A patient comes to see me in the office with medical issues that strongly suggest that a colonoscopy should be performed. As an aside, …

Reflecting on the history of smoking cessation

Janice Boughton, MD

Conditions

January 16, 2014

In 1950 Ernst Wynder, MD and colleagues began to produce convincing data that cigarette smoking caused lung cancer. Over the ensuing many years evidence has arisen linking cigarette smoking to many different cancers, chronic lung disease and heart attacks.

In 1964 the surgeon general reported that cigarette smoking was the most important risk factor for development of lung cancer and that quitting smoking reduced that risk. Since that time a concerted …

Lebron James: The king of junk food

Peter Ubel, MD

Conditions

January 13, 2014

Lebron James makes over $19 million per year playing basketball for the Miami Heat. Not surprisingly, this salary is peanuts compared his endorsement earnings, which in 2012 topped $42 million. Although perhaps peanuts is the wrong word to use when discussing James outside earnings, which to my knowledge have not involved foods anywhere near as healthy as peanuts. Instead, according to …

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Lebron James: The king of junk food

The cost of peace of mind: A case of unneeded bilateral mastectomy

Miranda Fielding, MD

Conditions

January 10, 2014

I don’t have much in the way of eyebrows. They were victims of too much plucking back in the 1960’s and when you do that, sometimes they don’t grow back. There’s a very nice woman in Solana Beach who shapes and darkens what I have left, infrequently, when I bother to think about it which isn’t very often.

I was in there about a year ago when she told me, “I …

Holding children back a grade and ADHD: A problem or solution?

Roy Benaroch, MD

Conditions

January 3, 2014

I’ve been skeptical of the trend of “holding back” children with late birthdays. These are kids, usually born in the summer, who are just a few months short of the next grade cut-off. Some parents wonder whether it would be wise to hold them back a few months, so they end up one of the oldest (rather than youngest) kids in their class. This might seem to confer an advantage …

How to talk to a child with autism

Kathleen O’Grady

Conditions

December 25, 2013

The holiday season means most of us will be socializing with colleagues and neighbors, friends and family. Chances are good this circle of friendly acquaintances and loved ones will include a child with autism.

Why? An estimated 1 in 88 children are now diagnosed with the neurological disorder, with a four times prevalence for boys. Among other challenges, those with autism often have difficulties with social communication (be it verbally or …

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How to talk to a child with autism

Treat your child’s fever before the doctor’s appointment

Natasha Burgert, MD

Conditions

December 24, 2013

It’s the beginning of cold and flu season. That means a lot of kiddos, big and small, are coming to the office with fever.

As docs, we know that fevers can freak moms and dads out. Kids look pretty awful when their temperature climbs, and it is understandable that parents want to bring them to the office for an evaluation.

In the exam room, I often hear worried parents …

The problems with the BRCA test from 23andMe

Nitin Roper, MD

Conditions

December 15, 2013

It’s been very interesting to read the range of responses to the recent FDA recent crackdown on the personal genetic service company 23andMe. Some have decried the FDA as too paternalisticwhile others have said the FDA is rightfully protecting the health of the public.

The evidence, I believe, shows the FDA is correct: 23andMe should not be doing genetic tests that have serious medical implications. Let’s look at an …

Medicine is a universal language

Heather Lee, MD

Conditions

December 7, 2013

This past spring, I went to Dar es Salaam, Tanzania to do an internal medicine elective at Muhimbili University of Health and Allied Sciences. I rotated through two sub-divisions of internal medicine while I was there: infectious disease and cardiology.

The medicine

When I initially stepped onto the infectious disease ward, I saw the janitors mopping the cement floors with soap and water. The ward was crowded and the patients lying on …

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Medicine is a universal language

MKSAP: 74-year-old woman with fatigue, anorexia, and weight loss

mksap

Conditions

December 7, 2013

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

A 74-year-old woman is evaluated for a 2-month history of fatigue, anorexia, and a 6-kg (13.2-lb) weight loss. She was treated with chemotherapy for ovarian cancer 6 months ago. She also has hypertension managed with hydrochlorothiazide.

On physical examination, temperature is 36.2 °C (97.2 °F), blood pressure is 132/75 mm Hg without postural …

I see chest pain all day, every day

Edwin Leap, MD

Conditions

December 5, 2013

Sometimes I feel as if my entire emergency medicine career is dedicated to one patient complaint. And that one complaint is chest pain. It may be that the incidence and prevalence of chest pain was the same during my medical school and residency training as it is now. But I doubt it.

I recall how I struggled to learn the salient questions. ‘Where is your chest pain? Is it heavy, dull, …

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I see chest pain all day, every day