Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 75-year-old man is seen for routine follow-up for very severe COPD. He has constant dyspnea and air hunger and spends most of the day in a chair. He has had no change in baseline cough and sputum production. He has had multiple COPD exacerbations that required ICU admission and intubation. He …
MKSAP: 75-year-old man with very severe COPD
Technological advancement often outpaces society’s ability to understand how to use new advances. Direct-to-consumer genetic testing (DTC-GT) is one such technology whose true power far exceeds our collective mental bandwidth to comprehend.
Home testing kits have come into mainstream culture over a short period of time. In 2010, the direct to consumer testing market was valued at $15 million. It grew almost nine times to $130 million in just five years …
At-home genetic testing might revolutionize medicine. And not in the way you think.
Doctors at some of the largest U.S. hospital chains admit they went overboard with opioids to make people as pain-free as possible, and now they shoulder part of the blame for the nation’s opioid crisis. In an effort to be part of the cure, they’ve begun to issue an uncomfortable warning to patients: You’re going to feel some pain.
Even for people who’ve never struggled with drug abuse, studies …
Stop opioid addiction where it starts: in the hospital
You’ve probably already seen the news: A 6 year old boy in Florida has died of rabies. He had handled a sick bat (some reports said he was trying to rescue the critter), and that was enough contact to transmit the virus. Once symptoms begin, rabies in almost always fatal — so the only way to prevent this from happening again is to avoid contact, and get rabies …
Your questions about rabies: answered
Talk of the widespread and dangerous flu circulating this year has the public on edge and hungry for quality information about how to protect themselves.
ABC’s Good Morning America isn’t helping with this segment featuring chief medical correspondent Jennifer Ashton, MD, titled “3 complementary natural remedies for the flu.”
It’s a mess of conflicting messages about herbal approaches to managing flu symptoms. And it positions Ashton — an ABC …
Complementary remedies for the flu: How Good Morning America failed
So you heard the flu shot is 10 percent effective.
With so many sources of information available, the primary care provider’s role increasingly becomes that of educator. It is important to me that the parents of my patients make informed decisions, so when I have a parent decline the influenza vaccine, I make an effort to ask why. The number one response I hear has been “What’s the point? The flu …
So the flu shot is only 10 percent effective. Here are 5 reasons to still get it.
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 22-year-old woman is evaluated for a 2-year-history of abnormal involuntary movements. She describes these movements as a quick elevation of the left shoulder followed by a rolling movement of the neck from side to side. The patient is able to suppress the movements completely for brief periods but then feels pressure building at the …
MKSAP: 22-year-old woman with abnormal involuntary movements
Cancer screening can save lives. Mammographies reduce the chance women will die of breast cancer; and colonoscopies reduce the chance people will die of colon cancer.
But should my 93-year-old father receive a screening colonoscopy? The test is uncomfortable, carries risks, and costs money. Even more importantly, my dad probably won’t live long enough to benefit from the test. That’s why most medical experts think people like my dad—people unlikely to …
How to tell seniors they’re too old for cancer screening
It was a long December.
A few years ago, my husband of 37 years got his death sentence: recurrence of liver cancer with mets to his lungs and lymph nodes.
He had a “Whipple” — a surgical procedure for pancreatic cancer — on Dec 24, 2015, and the surgeon discovered liver cancer too. So it was a 16-hour surgery. We were told he might die on the table.
His eyes haunted me as …
My husband was dying. I was being ignored.
Many of my readers do not know who Barry Goldwater was, let alone of the Goldwater Rule established by the American Psychiatric Association in 1973. The rule advises against psychiatrists commenting on the mental health of public figures they have not examined. Obviously, a psychiatrist or any physician who has treated a public figure is prohibited to offer any public comment unless he has been authorized by the patient to …
Diagnosing the president disrespects those who truly have mental illnesses
If we want to talk about the opioid epidemic as an actual epidemic, let’s use the same terms we use for communicable disease: agent, vector/environment, host. Virulence. Transmission. Immunity.
The media has done a great job of providing descriptive statistics of the epidemic. And recent oversight, both legislative and advisory, have attempted to focus on altering vector (prescriber) behavior in the wake of apparent failed attempts to reduce agent virulence. What …
Opioid addiction is an epidemic. Let’s treat it like one.
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 55-year-old woman is evaluated during a routine examination. She underwent biliopancreatic diversion with duodenal switch 8 years ago for treatment of obesity-related complications and lost 68.0 kg (150.0 lb) in the first year following surgery. Her weight has been relatively stable for the last year. She has had chronic nonbloody diarrhea since her bariatric …
MKSAP: 55-year-old woman after bariatric surgery
It started slowly. My former resident and present colleague, Terry Shaneyfelt first authored “Are Guidelines Following Guidelines? The Methodological Quality of Clinical Practice Guidelines in the Peer-Reviewed Medical Literature.”
This paper alerted us to the problem. But guideline fever continued to rage. Almost every specialty and subspecialty society decided that they needed to join the guideline movement. They needed to tell us the right way to practice medicine.
While …
A physician’s descent into guideline fatigue syndrome
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We’ve known for some time the prevalence of obesity is growing among Americans — not just adults, but children, too. Obesity is associated with a long list of medical problems, including heart and other vascular diseases, diabetes, and joint problems. It is encouraging that recently the seemingly inexorable growth of pediatric obesity prevalence seems to have reached a plateau. But we still have a future problem looming for population health as …
Childhood obesity is a grave threat to our nation’s health
I am in the privileged and humbling position of hearing the stories of patients’ pasts. Sometimes the stories are so horrendous that it takes all my energy to stop myself from crying as they recount the brutality of their experiences. I have heard harrowing descriptions of all manner of abuse done to patients when they were children. The abuse was …
How cancer treatment is affected by past abuse
Anxiety is an epidemic. An estimated 40 million adults have symptoms of anxiety. America spends $42 billion a year on treatment of the condition. Women are 60 percent more likely to develop anxiety than our male counterparts. The average age of onset is 11 across genders. These numbers are terrifying to me as a clinician, a woman, and a mother.
But is there anything we can do to slow these statistics …
Deconstructing the anxiety epidemic
The kids were asleep, and I could hear a muted, distant moaning coming from our bedroom. It reminded me of labor pains, but there were three things making labor unlikely: my wife’s IUD, the absence of a gravid abdomen and the kind of unintentional celibacy that occurs between working parents raising two toddlers. I tried to ignore the moaning. In part, because it was a Sunday night, and the sound …
Pediatric physeal fractures have traditionally been described by the five-part Salter-Harris classification system.
Type I fractures occur through the growth plate. These injuries may present with normal radiographs, and the diagnosis is often made clinically when tenderness is palpated over the growth plate.
Type II fractures occur through the growth plate and metaphysis. Type II injuries are the most common physeal fractures.
Type III fractures occur through the …
Learn about Salter-Harris fractures with a Medcomic
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 65-year-old man is evaluated during a follow-up visit for stage G3b/A3 chronic kidney disease due to diabetic nephropathy. He reports doing well with good baseline exercise tolerance and no shortness of breath. Medical history is also significant for type 2 diabetes mellitus and hypertension. Medications are basal bolus insulin and lisinopril, 20 mg/d.
On physical …
MKSAP: 65-year-old man with chronic kidney disease
As we continue to lead longer and healthier lives, too many Americans aren’t taking advantage of an easily accessible set of tools that could protect their well-being into old age: adult vaccines. As a nation, we’ve embraced a regular schedule of vaccines for our children. But science shows that they are proven life-savers for us grown-ups, too.
The numbers are staggering: tens of thousands of Americans die each year from flu …
Success stories in driving up adult immunization rates
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