Physicians writing on KevinMD about the diseases they treat and the people who have them: cancer and its screening arguments, pain and the drugs that treat it, diabetes and the obesity argument, mental illness and who gets treated for it, and the decisions at the end of a life. Five maintained records draw on this archive: Cancer: what physicians say, in their own words, Opioids: what physicians and pain patients say, in their own words, End of life: what physicians say, in their own words, Diabetes and obesity: what physicians say, in their own words, and Mental health: what psychiatrists and physicians say, in their own words.

MKSAP: 79-year-old man with progressive malaise and weakness

Conditions and Diseases
December 7, 2019

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 2-month history of progressive malaise and weakness, aching bilateral shoulders and hips, and stiffness for 2 hours in the morning and after immobility. He recently noted aching in his jaw when chewing. He also reports new left-sided headaches. Last week he had …

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MKSAP: 79-year-old man with progressive malaise and weakness

Most new cancer treatments haven’t been proven to help patients live longer or feel better

Conditions and Diseases
December 5, 2019

Most new cancer treatments haven’t been proven to help patients live longer or feel better. Instead, they delay the growth of tumors — which may be faster to measure but doesn’t necessarily indicate a tangible benefit for patients.

But you wouldn’t grasp that sobering fact from some recent news coverage:

  • A headline in the UK’s Telegraph about the drug olaparib (Lynparza) read: “Revolution’ in prostate cancer care as off-label …

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Most new cancer treatments haven’t been proven to help patients live longer or feel better

Why abortion care is women’s health care

Conditions and Diseases
December 4, 2019

On January 22, 1973, Roe v. Wade established a woman’s fundamental right to abortion nationwide. Roe v. Wade should not be overruled because women having universal access to abortion services means women have the right to choose what is best for their health care. This is how health care should be in that if there is a viable medical option for the patient to pursue, the patient should have the …

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Why abortion care is women’s health care

Mindfulness training should start as soon as kids can grasp the concept

Conditions and Diseases
December 3, 2019

An excerpt from Mind Bubbles: Exploring mindfulness with kids.

I am not a pediatrician.  My training as an OB/GYN taught me to care for mothers-to-be and bring their babies safely into the world—and then hand them over to the waiting pediatrician.  I am also a mom and mindfulness teacher, however, …

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Mindfulness training should start as soon as kids can grasp the concept

How to overcome the gaps in behavioral health

Conditions and Diseases
December 2, 2019

National attitudes have greatly shifted over the last 25 years towards the idea that mental and emotional well-being are vital to a person’s overall health. Today, nearly six in ten Americans have sought or want to seek mental health care for themselves or someone they love. While stigma and costs persist as primary barriers to progress for solving the mental health crisis, the key issue—as we have increasingly come to …

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How to overcome the gaps in behavioral health

When physicians deviate from evidence-based medicine

Conditions and Diseases
December 1, 2019

From time to time, patients ask my advice on colonic hydrotherapy, vigorous sessions of enemas that aim to cleanse the body of toxins that are reputed to cause a variety of ailments. The logic sounds plausible to interested patients. Over time, toxins accumulate and leech into the body, wreaking havoc. Indeed, using the label “toxins” already suggests that these are noxious agents. If one accepts this premise, it is entirely …

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When physicians deviate from evidence-based medicine

MKSAP: 38-year-old man with dyspnea on exertion

Conditions and Diseases
November 30, 2019

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

A 38-year-old man is evaluated for a 6-month history of dyspnea on exertion. He has gastroesophageal reflux disease and Raynaud phenomenon. He does not smoke and has no cough or wheezing. Current medications are lansoprazole and amlodipine.

On physical examination, vital signs are normal. Oxygen saturation is 91% breathing ambient …

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MKSAP: 38-year-old man with dyspnea on exertion

The myth of resilience in preventing burnout

Conditions and Diseases
November 26, 2019

With 44% of physicians self-reporting burnout in the 2019 Medscape National Physician Burnout, Depression & Suicide Report, most will agree the profession is in crisis. Of the 29 specialties included, all had at least 1 in 4 members reporting burnout, many with more physicians suffering from burnout than not. Hardly a U.S. problem, burnout affects physicians around the world as well as medical students, and I …

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The myth of resilience in preventing burnout

What to do when chronic illness is a source of embarrassment

Conditions and Diseases
November 26, 2019

Embarrassment is a feeling of awkward self-consciousness or shame. It manifests as a sense of discomfort or even foolishness around others. Feeling embarrassed is emotionally painful because it means you feel uncomfortable with yourself.

The problem with embarrassment is that it adds a layer of mental suffering to the difficulties you’re already facing with your health. Here are four reasons why those of us who are chronically ill feel embarrassed at …

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What to do when chronic illness is a source of embarrassment

Are teenagers more vulnerable to the effects of opioids?

Conditions and Diseases
November 24, 2019

The younger you are when you are exposed to opioids, the higher the likelihood of addiction later in life. The prefrontal cortex is not fully formed until the age of 25. This means that alterations in the “feel-good” neurotransmitters, specifically dopamine (released by opioids), can have an effect that predisposes the person towards future opioid use.

Because teenagers have an overactive impulse to seek pleasure and less ability to consider the …

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Are teenagers more vulnerable to the effects of opioids?

MKSAP: 67-year-old man with a carotid bruit

Conditions and Diseases
November 23, 2019

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

A 67-year-old man is evaluated for a carotid bruit detected on routine medical examination. He reports no history of previous focal neurologic symptoms or visual loss. He has type 2 diabetes mellitus and hyperlipidemia treated with metformin, moderate-intensity pravastatin, and aspirin.

On physical examination, blood pressure is 128/64 mm Hg, …

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MKSAP: 67-year-old man with a carotid bruit

A call to increase the availability of the Butrans patch

Conditions and Diseases
November 20, 2019

Janelle had overdosed 32 times.

Fentanyl coursed through her veins as she was given naloxone (Narcan) for the 32nd time in the ER, from the police, from a bystander. She could never get off of fentanyl. It had made her feel warm and numbed her from the trauma and horrors she had grown accustomed to. When she would wake up in the hospital, sore and discombobulated, she would beg for help. She …

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A call to increase the availability of the Butrans patch

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Physician-assisted suicide is a collaborative process

Conditions and Diseases
November 17, 2019

Who remembers Jack Kevorkian, Doctor Death? He was found guilty in 1998 of second-degree murder. Still, it was because of his advocacy that the terminally ill patient’s right to die by physician-assisted suicide was propelled into the public arena. And who can forget Brittany Maynard? It was her advocacy for physician-assisted suicide that reignited the debate on its legality in 2014 — …

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Physician-assisted suicide is a collaborative process

MKSAP: 38-year-old woman with primary membranous glomerulopathy

Conditions and Diseases
November 16, 2019

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

A 38-year-old woman is evaluated during a follow-up visit for primary membranous glomerulopathy. Diagnosis was made by kidney biopsy 4 months ago, and she was found to be positive for anti–phospholipase A2 receptor (PLA2R) antibodies. Medications are furosemide, losartan, and simvastatin. Recent age- and sex-appropriate cancer screening tests were …

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MKSAP: 38-year-old woman with primary membranous glomerulopathy

I’ve prescribed opioids to patients. And I’m not a villain.

Conditions and Diseases
November 13, 2019

You’ve probably heard this one in one format or another: kid gets wisdom teeth yanked, dentist prescribes a handful of Vicodin, next thing you know, he’s on the street busking for change to pay the man for the big H.

Meanwhile, the dentist is on cruises paid by Big Pharma and taking kickbacks from his local drug dealers.

This author is here to tell you that such yarns have probably been verified, …

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I’ve prescribed opioids to patients. And I’m not a villain.

A possibly fishy complication of an Alaskan cruise

Conditions and Diseases
November 13, 2019

A 69-year-old man with a medical history of hypertension, diabetes, and obesity with a body mass index of 33 was admitted with altered mental status. He and his wife were returning from a 14-day Alaskan cruise. On their return, the wife started noticing that her husband was behaving strangely and acting forgetful and had short-term memory loss. This gradually progressed to generalized confusion and altered mental status leading him to …

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A possibly fishy complication of an Alaskan cruise

Should speed-eating contests be banned?

Conditions and Diseases
November 12, 2019

This eating contest season, there was only one death this year, as far as I can determine. A 41-year-old California man died in August while participating in a taco eating contest at a minor league baseball game. The coroner said he choked to death. In case you were wondering, the Associated Press thoughtfully stated: “It was not immediately known how many tacos the …

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Should speed-eating contests be banned?

What a cardiologist wants you to know about loneliness

Conditions and Diseases
November 12, 2019

What is the unspoken fatal epidemic of our time? And the greatest predictor of overall health, happiness, job satisfaction, and resiliency? Loneliness.

As a clinical cardiologist, I am committed to the health and well-being of my patients.

As a recovering burned-out physician who suffered in silence for years while hiding this so well from others, I am committed to finding solutions to help my partners suffering so often in silence.

As a husband, …

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What a cardiologist wants you to know about loneliness

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