I recently listened to DDx, a new podcast from Figure1. In their third episode, a 37-year-old man presents to the emergency department in the middle of the night with persistent vomiting and retching. He is highly vocal and agitated. Upon questioning, he reveals that he experiences these episodes frequently and previous investigations have all been inconclusive. His skin is noted to be flushed and his father …
Several years ago, a colleague of mine did a procedure on my daughter. What was supposed to be routine has become a nightmare for her. When he saw her post-op, he told her she was fine. Because of this obfuscation, years went by before she really understood how damaged she was. By then, the statute of limitations had lapsed and she had no recourse.
Still seeking closure on this disaster, my daughter …
The keto diet has recently garnered much fame for its apparent ability to improve diabetes and obesity – results so impressive the Journal of the American Medical Association recently highlighted the diet and thereby christened it as something more than a low-carb craze. However, not all the evidence supports such a positive outlook, leading the diet to straddle the increasingly blurred lines between faddist snake oil and …
In the article, Michaeleen Doucleff repeatedly trivializes the danger of parents co-sleeping with their baby. She uses anthropological evidence to reassure parents that sleeping with their infant is safe if parents don’t drink, smoke, or use illicit drugs. She makes light …
People with liver failure and cirrhosis die every year because there are not enough livers available. Who should receive the treasured life-saving organ? There is an organ allocation system in place, which has evolved over time, which ranks patients who need liver transplants. Without such a system, there would be confusion and chaos. How can we fairly determine who should receive the next available liver? What criteria should move a …
A 68-year-old man is evaluated at a follow-up appointment. He has a 7-year history of heart failure secondary to ischemic cardiomyopathy. Over the past 6 months, he has had three hospitalizations for exacerbations of his heart failure. He currently has exertional dyspnea while getting dressed, and his maximal activity level is limited to riding to …
Kate Spade. Anthony Bourdain. Two celebrity icons splashed the headlines recently as both figures committed the unthinkable act of suicide. Both left behind young daughters and significant others reeling in the background wondering what had just happened. Kate Spade was the colorful fashionista of purses and dresses. Anthony Bourdain was the connoisseur of delectable eats traveling the world. How could such successful personas mask the pain hidden within? Even Robin …
I had not one, but two suicidal teen patients today. This is only one day after I had an eight-year-old suicidal patient come to see me. Three weeks ago, a 17-year-old female walked in, she had hung herself in her closet one month earlier — saved only by the timely breaking of the crossbar of her closet — passed out on the closet floor by her mother. A 16-year-old male …
As I begin my overnight pediatric emergency department shift, there is one patient waiting to be seen: a six-year-old male with autism who is alleged to have experienced sexual assault. In my first year of pediatrics residency, I haven’t yet managed a sexual assault case, but it’s time for me to learn. I sign up to see the patient and move to find them in the sub-waiting room.
Many people in our country, or I should say in this world, have been shocked and devastated by recent celebrity suicides. Many wonder how can someone whose life looks so perfect be depressed? Well, people are starting to recognize that anyone, no matter how successful, how rich or how attractive can experience severe depression.
Many of our well-known adages acknowledge the fact that anyone can be vulnerable to depression. We have …
This straightforward assertion gets complicated when we discuss the treatment of depression. Depression is common, part of a family doctor’s daily schedule; it can affect anyone, although certain groups are at higher risk. There have been many hypotheses as to why we as a species are susceptible to depression (and its frequent companion, anxiety), but in the day to day practice of medicine, those proposed etiologies end …
Chronic pain is a significant public health burden, but one that is not talked about enough. In 2011, the Institute of Medicine estimated that approximately 100 million Americans suffer from chronic pain. But chronic pain is not just …
These recent weeks have been hard for me, and I suspect for a lot of other people as well. Not because I spent it in a board review course listening to lectures for 12 hours a day, and not because I drank enough coffee to practically burn a hole in my stomach, but because the world lost two amazing people all too soon.
A 70-year-old man is admitted to the hospital with a 1-hour episode of left arm and left leg weakness. He is diagnosed with a transient ischemic attack. The patient has a history of hypertension and type 2 diabetes mellitus and a 30-pack-year history of smoking. Family history is noncontributory. His medications are metformin and lisinopril.
He spoke with an aura of superiority, in a slightly nasal voice, and his topic was migraines. It was in the late 70s, a time when there were few options to treat migraines.
“Most people who claim to have migraines just have simple tension headaches,” he scoffed. And in a move that seemed unorthodox at the time, he disclosed that he suffered from “real migraines,” so he knew all about this …
I have written previously about the raging opioid epidemic in Ohio. Attacking and reversing this tidal wave will require many weapons, resources and time. Opioid addiction is a crafty and elusive adversary that will be difficult to vanquish. Our battle plan will have to be nimble and adjusted over time, much as military leaders must do in actual armed conflict.
Here in Ohio and elsewhere, physicians must abide by new …
“Some data is better than no data at all.” Do you believe that?
I heard it frequently when the infamous ProPublica’s Surgeon Scorecard first appeared three years ago. Back then I blogged about it saying “To me, bad data is worse than no data at all.”
A recent study in BJU International confirmed my thoughts about this type of publicly posted data and identified a previously unreported issue. The paper attempted to …
It has become a sign of legitimacy to call a personal problem “medical.” This aims to distinguish the problem from those of morality or character. It implies both that the problem is serious, and that it is unbidden and largely out of the sufferer’s control. Unfortunately, it isn’t clear what exactly qualifies as “medical,” so this label serves more as a rhetorical device than a scientific finding.
In an era where health information is freely flowing thanks to the internet and Dr. Google, I’ve come to expect that patients who see me for the first time will have done their homework — about their cancer, treatment options, and yes, even about me. To be frank, it’s not uncommon for patients to mention they’ve …
The recent suicides of an NYU resident and a medical student highlight the growing mental health problem among physicians and physicians-in-training in this country. This crisis is certainly not exclusive to physicians, as evidenced by the suicides of designer Kate Spade and television personality Anthony Bourdain. However, suicide among physicians is of particular concern. A literature review of physician suicide in Medline and PubMed yielded alarming results …
