“In the beginner’s mind there are many possibilities, but in the expert’s view, there are few.”
Shunryu Suzuki was writing about Zen beginners and masters, but this concept applies to the practice of medicine as well. Experienced physicians are slow to accept a new paradigm, while medical students and new physicians are more open.
Sometimes, what we “know” to be true is not. Despite clinical trials to the …
Do medical experts really know best?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 40-year-old woman is evaluated for amenorrhea of 4 months’ duration. She has had weight gain, facial hair, alopecia, and debilitating fatigue. Her medical history is significant for psoriasis. She seems to be gaining weight in her face, abdomen, and neck. She also bruises easily. Her only medication is clobetasol for psoriasis.
On …
MKSAP: 40-year-old woman with amenorrhea
Patsy loved playing bingo every Wednesday night. Her boyfriend of three years loved watching her daughter Jenna who was a tiny and pretty six-year-old her momma called “princess.”
Even though they weren’t related, Jenna called Patsy’s boyfriend “Uncle Billy” at her mother’s behest.
And Uncle Billy made Jenna shyer and quieter than she usually was. He’d walk in on those Wednesday nights and demand a big hug and kiss on the cheek …
I’ll never forget the eyes of a 6-year-old sexual assault victim
Triage Note: Fish hook in eye. No bleeding. Tetanus up to date.
It’s a sunny weekend during cottage season. A young woman is rushed into the ER as she cups both hands over her left eye. She’s in shorts, and flip-flops, and she’s hyperventilating. Her friends follow, hands similarly cupped over their mouths. I read the triage note. I’ve never seen this before. I’ve removed dozens of fish hooks — it’s …
The case of a fish hook in the eye
My young daughter will be entering middle school in another year. However, she still likes coloring books. If she watches a scary movie, I have to lay with her in bed until she falls asleep.
She is still just a kid. Should I really be worried about HPV? Is this something you should consider for your daughter?
As an OB/GYN doctor, I know about the HPV virus and have seen so many …
Why your child should get the HPV vaccine
Diana Feliz Oliva, a 45-year-old transgender woman who grew up outside Fresno, Calif., remembers being bullied when she was younger and feeling confused about her gender identity. She was depressed and fearful about being found out, and she prayed every night for God to take her while she slept.
“I was living in turmoil,” said Oliva, who now works as health program manager in a clinic for transgender people at St. …
Mental health problems in the transgender population
Women who lose part or all of one or both breasts due to breast cancer surgery may choose to have new breasts created with their own tissue — a process that also may or may not involve breast implants. A wide range of reconstruction procedures is available, including a variety of flaps and options to use either implants or what is known as autologous fat transfer.
Each surgery has its own …
Involve plastic surgeons early in breast cancer treatment
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 45-year-old man is evaluated during an annual routine health maintenance visit. History is notable for type 2 diabetes mellitus (diet controlled) diagnosed 3 months ago. Family history is significant for his father who developed end-stage kidney disease due to diabetes at age 68 years. He reports no symptoms and takes no …
MKSAP: 45-year-old man with type 2 diabetes mellitus
We have all seen and heard the story: a patient who is overweight and has heart problems (or arthritis, diabetes, low back pain or any number of other chronic conditions) is told by their doctor that they need to exercise.
The patient agrees, “Yes, I really will try to start an exercise program.”
Six months later, the patient is back in the doctor’s office, and the conversation goes something like this:
“Well, I …
Prescribe exercise like you prescribe medicine
The hospital I work in used to have posters hanging up, describing patients’ rights. The right to have their medical care explained to them, the right to refuse treatment, the right to be treated courteously and the right emergency care regardless of the circumstances.
These posters are no longer displayed, but the concept hasn’t gone away. The health care team I work with makes every effort to treat people fairly and …
Patients’ rights? What about the nurses’ rights?
Years ago in a 15-bed acute medical-surgical ICU, the nursing supervisor contacted me about a special assignment. Once I knew what it was, I said, “Absolutely.”
We were about to admit a patient in his 40s with end-stage AIDS/HIV. He asked to be a DNR, but his MD wanted to admit him to the ICU for close monitoring. But the patient had a special request. Even with IV antibiotics and pain …
What man’s best friend taught me during a patient’s death
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 32-year-old man is evaluated for a 2-week history of a rash on his face and midchest. He describes the rash as consisting of small, reddish “lumps” that are intensely itchy; they develop and begin to resolve with development of new lesions. He otherwise feels well. Medical history is significant for a …
MKSAP: 32-year-old man with a rash on his face and midchest
There are some questions in health care that can’t be answered with a randomized controlled trial. We can’t randomize babies to inhale secondary tobacco smoke or not to test its health effects. We can’t randomize people to a different number of hours sitting the ER before receiving antibiotics after the decision is made that the patient has a bacterial infection requiring antibiotics. There are some questions where the best available …
Colonoscopy after a positive stool test: Does the time frame matter?
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As a medical student, I immortalized myself with my classmates when I informed a lecturing psychiatry professor that I considered Freud’s theories slightly more credible than the nuns’ tales about guardian angels. The lecturer ignored my obnoxious comment and continued his lecture. But Freudians have been on the defensive for the past decade. This trend culminated when the Library of Congress was forced to cancel a tribute to Freud in …
My grandmother was filled with grief as she told me by phone about life on the island of St. Thomas after Hurricanes Irma and Maria had blasted through it. “Tears keep running from my eyes uncontrollably because everyone on the island is suffering,” she lamented, then paused, too sad to continue. I could picture her in her …
Psychological first aid can mitigate the effects of overwhelming trauma and loss
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 35-year-old man is evaluated for a 2-month history of upper abdominal discomfort after eating. He has recently returned from working in a rural area of a developing country. He takes no medications. There is no family history of esophageal or gastric cancer.
On physical examination, vital signs are normal. BMI is 40. …
MKSAP: 35-year-old man with upper abdominal discomfort
How would you like to double your chances of winning the lottery? Just buy two tickets!
Statistically, this is true, but is that a reason to spend more money on something that most likely offers no return on investment?
Yet, in medical research, study after study shows impressive improvement in relative risk for this, that and the other intervention but a small or even negligible effect on absolute risk.
For example, I just …
Never forget to consider the number needed to treat
As a practicing OB/GYN, I feel lucky to be working in a field so full of promise and with space for advancement of medical technology. Although prospects of improved fetal imaging, cervical cancer prevention, and techniques of minimally invasive surgery are game-changing, new discoveries in the genetics arena of our field strike me as simply incredible.
Prenatal genetic testing has only been reasonably available to mothers since about 1970, and at …
Why the cell-free fetal DNA test is a game-changer
Diverticulitis is a common and sometimes serious problem that affects several hundred thousand people each year. Diverticulitis is the condition where small outpouchings or “pockets” in the wall of the large intestine called diverticula become inflamed and infected, and typically presents as a constant lower abdominal pain, associated with fever or chills, and often bloating or constipation symptoms. Despite becoming even more common in recent years, not much is understood …
Seeds, popcorn, and nuts in diverticulitis: fact and fiction
Part of a series.
Cognitive decline is a normal process of aging; Alzheimer’s is a disease.
Cognitive decline due to aging can be slowed but not halted with appropriate lifestyle approaches. The “big four” are equally important to slow cognitive decline: Don’t smoke. Reduce stress. Exercise often. And eat a quality diet in moderation.
Good sleep and brain stimulation need to be added for maintaining good cognition. Some form of …
Want to slow cognitive decline? Here’s how.
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