I have to admit, I’m not the biggest follower of popular culture. I couldn’t pick a Kardashian out of a crowd if my life depended on it. I don’t know who Brad Pitt is currently married to, if he’s married. And I have no idea how many kids Natalie Portman has, if she has any at all. (In full disclosure, I was blanking on names and pulled up People.com to …
On vaccines: 1 pediatrician vs. 13 celebrity opinions
Why do we underestimate risk? This phenomenon isn’t unique to politics or natural disasters, and it contradicts our need to prepare for future events. It explains why it is hard to get healthy “millennial invincibles” to sign up for health insurance, why earthquake insurance policies skyrocket after an earthquake, and why people tend to underinvest for retirement. Two separate biases — availability and recency — explain why we make medical …
2 biases in medicine, and how to avoid them
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 25-year-old man is evaluated for dark-colored urine for 2 days, swelling of the face and hands for 1 day, and severe headaches this morning. He reports having an upper respiratory tract infection 1 week ago with fever, sore throat, and swollen glands, but had otherwise felt well. Medical history is otherwise unremarkable, …
MKSAP: 25-year-old man with dark-colored urine
How do we balance freedom and safety for those with dementia, particularly in the risky domains of sex, driving and money?
In 2014, Henry Rayhons, a 78-year-old Iowan, was arrested because he allegedly had sex with his wife.
Wait. What?
The Rayhonses, both previously widowed, met while singing in a church choir. Over time, Mrs. Rayhons developed dementia and went into a nursing home. At one point, a roommate reported hearing …
The fine line between dementia, sex, driving, and money
In a prior post, I shared my heretofore reluctance to prescribe medications for my hepatitis C (HCV) patients. In summary, after consideration of the risks and benefits of the available options, I could not persuade myself — or my patients — to pull the trigger. These patients were made aware of my conservative philosophy of medical practice. I offered every one of them an opportunity to consult with another …
Why this gastroenterologist decided to treat hepatitis C patients
We’ve all been through difficult times. It may be the death of someone we love or suffering abuse with no one to help. In life, many events fly at us that are hard to manage. Many of us just suffer silently through the pain, not allowing anyone in. And even while we do that, we also know that is not the healthiest response.
Many patients come to me struggling with anxiety …
How to deal with hardships in life
The bedrock requirement to obtain informed consent before patients may be enrolled in research has been eroding. I’ve documented the different ways and different reasons for this several times over the years (“Informed Consent for Babies: When Experts Disagree,” “Informed Consent in Infant Research: Ethical Problems Remain,” “Informed Consent in Comparative Effectiveness Research,” and “The Erosion of Informed Consent in Medical Research”). The latest example is a clinical trial of …
The erosion of informed consent in medical research
Sometimes I wonder if I am wired differently from other doctors, in terms of what I remember on my own and what I need some help with.
The other day I got a “medical call” that simply said, “Mr. Brown called to report his blood pressure is 120/80.”
With more than fifty calls in my inbox and no memory of what the issue was with Mr. Brown’s current blood pressure, I replied: …
The problem with telephone messages in primary care
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 30-year-old woman is evaluated in follow-up after being recently diagnosed with HIV infection. She is asymptomatic. Medical history is unremarkable, and she takes no medications; she has not yet started antiretroviral therapy. She received all scheduled childhood immunizations.
On physical examination, vital signs are normal. She has shotty cervical lymphadenopathy, but the examination …
MKSAP: 30-year-old woman with HIV infection
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 77-year-old woman is evaluated for frequently fluctuating INRs (<1.8 to >3.5) while taking warfarin therapy. She has undergone INR testing every 1 to 2 weeks and frequent warfarin dose adjustments. She reports a consistent dietary intake. Medical history is notable only for recurrent deep venous thrombosis. She takes no other medications.
On physical …
MKSAP: 77-year-old woman with frequently fluctuating INRs
In the second week of April, I headed to San Francisco where I took part in the SWOG Semi-Annual Meeting. To those who might be unfamiliar with us, SWOG is a member organization of the National Clinical Trials Network (NCTN) and is tasked in running clinical trials across disease sites and scenarios, from prevention to …
How clinicians can impede clinical trial recruitment
I’m not much of a tennis fan, but I am a fan of Serena Williams. Who wouldn’t be after hearing her story? Her rise to the upper echelon of athletics was remarkable, and her longevity is incomparable. All the while, she has challenged the sporting world’s notions about who and what an elite tennis player is supposed to be. I watched her interviews after this year’s Wimbledon finals and was …
My story isn’t Serena Williams’ story, but some things sound the same
There are at least 50 words in the Eskimo languages for snow, 25 in mainstream Swedish, and supposedly 180 or so in the Sami language of the nomadic inhabitants of the northernmost parts of Norway, Sweden, and Finland.
But there are even more words than that for “chest pain” among my patients, many of whom do not consistently or fully comprehend the English phrase, “If you have chest pain, call 911 …
The many ways to describe chest pain
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Let’s begin with a quiz question:
Patients may be allergic to:
A. oxygen
B. carbon
C. iodine
D. none of the above
If you answered anything but “D,” better keep reading.
Consider this scenario: If a patient is allergic to penicillin, you would document “penicillin” in the medical records. It would never occur to you to list “antibiotics” as an allergy, and you certainly would not call it a “carbon” allergy for slang, just because penicillin contains …
Think you have an iodine allergy? You may want to reconsider.
Fortnite Season 5 has officially arrived — bringing new features, a new maps, and new skins. Parents can anticipate battles over the amount of time spent playing the game to “level up” with your teens.
If you are not familiar with this game, then it likely means that you are not the parent of a teenager (I nearly wrote “teenage boy,” but it is important to appreciate the growth of female …
Parents vs. Fortnite: tips from a child psychiatrist
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 57-year-old man with a 15-year history of type 2 diabetes mellitus is evaluated for bilateral burning sensation in his feet for the last 6 to 12 months. The sensation worsens at night. His HbA1c levels have remained less than 7.0% for the last 2 years but were between 8.0% and 9.0% before …
MKSAP: 57-year-old man with type 2 diabetes mellitus
“If there is a physician on the plane, please press your call light!”
The vast majority of doctors who have flown on airplanes have heard this, and most of us are willing, if not entirely eager, to respond. What follows is usually a far from ideal encounter with inadequate information, too much noise, a cramped space to work in and little knowledge of what is expected or even possible.
My experiences (I …
How to improve the care of in-flight emergencies
Let’s say your loved one is at the end of life. She’s 84, with advanced cancer that is no longer treatable.
A decision has been made to put her in hospice — which is a level of care more than an actual location. (Most hospice actually occurs at home.)
The patient waxes in and out of consciousness, sometimes lucid, but mostly not.
While no one is ready for her to die, this end-of-life …
Long ago primitive sharks had ridges running down their sides from gill to tail. Later, muscles grew into the folds, and eventually, the central portion of each ridge receded while the ends enlarged to form fins both fore and aft. All was well.
Then one day several hundred million years ago, a fish was swimming blissfully in a shallow pool. The tide went out …
The human hand: not really that good for anything
Physicians on the front lines of health care today are sometimes described as going to battle. It’s an apt metaphor. Physicians, like combat soldiers, often face a profound and unrecognized threat to their well-being: moral injury.
Moral injury is frequently mischaracterized. In combat veterans it is diagnosed as post-traumatic stress; among physicians it’s portrayed as burnout. But without …
Physicians don’t just suffer burnout. They suffer moral injuries.
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