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.
I’m in the ICU and was just back from an incredible tropical vacation. Nine days of vegging out on the beach. The glistening ocean was just steps away from the five-star hotel I was staying in, where doormen greeted me with fruity daiquiris and a staff that couldn’t wait to serve my every whim.
I was in paradise, and far, far away from the reality of my day-to-day existence as an …
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A nurse returns from vacation. And she’s thankful to the ICU she came back to.
This is by no means a scientific study, just some thoughts on what I have seen in my 22 years as a nurse and the loss of bedside nurses who hate it. I think the advent of nurses leaving the bedside will cause a greater crisis for the nursing profession.
I obtained my ADN in 1995 after having worked as a computer operator for 16 or so years in the defense …
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Here’s why this nurse really retired
As a pediatrician in training, I’ve seen countless instances in which parents, in both the ED and inpatient/outpatient care settings, have presented with deep concern regarding their child’s fever. It’s an age-old concern. But why exactly does fever cause so much distress in a parent’s world?
As a medical student, I distinctly remember rotating with an attending physician who had strong feelings regarding fever. He became angry with me when I …
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This pediatrician doesn’t fear fevers and neither should you
Part of a series.
Can we slow the aging process? The answer is a definite yes. It’s not easy and requires some real diligence, but aging can be slowed.
When thinking about a car we all know “old parts were out.” It is equally true for the human body. But less appreciated is the fact that we can either slow or speed up the process, just as good preventive …
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Can we slow the aging process?
A study published in JAMA looking at the brains of former football players donated to a brain bank, a highly selective sample, found signs of chronic traumatic encephalopathy (CTE) — a degenerative neurological disease — in nearly all deceased players examined.
The mainstream media converged towards numerical consensus.
- Fox News reported players in a study had CTE.”
- CNN reframed the headline, “CTE found …
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Are CTE headlines overblown? A radiologist investigates.
I’ve known that I’ve had tumors in my pancreas since 2009. Until now I’ve done nothing about them.
This might sound like a counter-intuitive, even foolhardy strategy, especially for an oncologist, who should surely know better than to let his disease gain an advantage through his own inaction. But I don’t have the “usual” type of pancreatic cancer, the kind that claimed the life of Patrick Swayze and has sentenced many …
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After 8 years, this doctor is finally treating his pancreatic tumors
Cold, sterile and well … clinical. Three words that neatly describe hospitals as many of us know them. In books, on TV and in movies, we see and experience hospitals as impersonal, solemn and sterile institutions — designed only to treat disease.
Interestingly enough, while our society has begun shifting away from thinking of health as just the treatment of disease, our hospitals fail to reflect these changes. This is particularly …
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The surprising way that architecture and the art of healing intersect
Patient psychology is increasingly recognized as an important contributor to health outcomes. What patients believe about their health and their providers can significantly affect their initiative and their adherence.
It is important to recognize that factors that appear to be unrelated to medical care can influence feelings about that care, as well as outcomes. The reason this occurs is that the brain is not designed to parse out each element of …
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3 unconscious things you might be doing that affect your patients
I was rotating through an infectious disease elective at an outside hospital during my fourth year of medical school when I encountered a startling situation. We were called to evaluate a patient who was suffering from an infection called Haemophilus influenzae. Now, I knew that most children were vaccinated against this pathogen, so I was surprised by the consult.
I was working on a team with three others: one attending, one …
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Stories to help parents think critically about the importance of vaccinations
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 38-year-old woman is evaluated after laboratory study results show an HbA1c value of 9.1%. Her HbA1c goal is less than 7% because she has high function, long life expectancy, few comorbidities, good support, health literacy, and access to care. Medical history is significant for morbid obesity, obstructive sleep apnea, hypertension, and …
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MKSAP: 38-year-old woman with a HbA1c value of 9.1%
When health officials learned that the 2015 measles outbreak was caused by clusters of unvaccinated children, Americans once more wanted to understand why some parents do not vaccinate their children. In our highly polarized culture, media commentators and even academics began to connect opposition to vaccination to either the left or right of politics.
So a question arises: Who is more likely to be opposed to vaccination, liberals or conservatives? As …
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Anti-vaccination beliefs don’t follow the usual conservative and liberal lines
Words matter. At some point, we all may have casually tossed a psychiatric adjective to describe a situation or person. There is usually no malicious intent behind the use of these colloquialisms. However, during these strange and unprecedented political times, psychiatric terms seem to be thrown around more so by those trying to paint a picture of current prominent figures. A late-night show host referred to someone as “being off …
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“That’s crazy”: Stop using psychiatric words as insults
I bought a pocket ultrasound in 2011, determined to learn how to perform and interpret ultrasound at the bedside and thus transform my internal medicine practice. I bought it new, and it cost over $8,000. That was a staggering amount of money to spend on something I knew very little about. In 2015 after having performed many thousand ultrasound exams with my little GE Vscan with the phased array transducer, …
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4 times a bedside ultrasound made a difference this week
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 58-year-old man undergoes follow-up evaluation for cancer of the ascending colon diagnosed 3 weeks ago. Colonoscopy at that time revealed a fungating mass in the ascending colon. Biopsy revealed adenocarcinoma, and additional studies showed no evidence of metastatic disease. Right hemicolectomy was performed. The pathology report showed a 4-cm primary adenocarcinoma …
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MKSAP: 58-year-old man with cancer of the ascending colon
For many, American football is a beautiful game that is simple to enjoy but complex to master. Choreographed with a mixture of artistry and brutality, it features the occasional “big hit” or bone-jarring tackle, forcing a fumble and turning the tide of the game.
But with this part of football comes justified concern about the long-term health effects of engaging in this type of activity over time, concerns that abound in …
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Concussions and CTE are more complicated than even the experts know
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 36-year-old man is evaluated for a 1-year history of fatigue, intermittent headaches, sore throat, and joint and muscle pain. He reports no difficulties falling asleep and gets 10 hours of uninterrupted but nonrestorative sleep each night. He has seen several physicians over the past year. Evaluation has included a complete blood …
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MKSAP: 36-year-old man with history of fatigue
Sheila’s jaw is clenched. Sweat is beading on her forehead. I make a slow audible inhale, non-verbally inviting her to do the same. We’ve been talking about the nightmares which started shortly after she began receiving help with personal care. I remind her that she is safe — the day she was raped is decades in the past. Her conscious mind knows this, of course, but for people with posttraumatic …
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PTSD can happen at the end of life
The Society to Improve Diagnosis in Medicine has on its website this quote:
- 1 in 10 diagnoses are incorrect.
- Diagnostic error accounts for 40,000-80,000 U.S. deaths annually — somewhere between breast cancer and diabetes.
- Chances are, we will all experience diagnostic error in our lifetime.
The current focus on diagnostic error raises an interesting question: Is this a larger problem in 2017 than in the 1970s and 1980s?
In this post, I …
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We must make the word “diagnostician” the most prestigious term in medicine
