It was late afternoon. The woman who had seen my colleague, Dr. Wilford Brown, a few days earlier was sitting in my exam room. Her chart note read like a typical unnameable virus: headache, body aches, fatigue, low grade fever. She had always seemed like a level-headed resolute woman, but she had called three days in a row for medical advice because she felt so poorly. And it all sounded …
A lesson learned after seeing a tick-borne illness
An excerpt from The Other Side of the Bed: What Patients Go Through and What Doctors Can Learn.
As soon as I’d opened my mouth, I regretted it. In the hospital, it’s bad luck to say “It looks quiet,” or anything to that effect. At the sound of those words, …
A code in the cath lab that was unlike anything I had ever seen
Victim: Female nurse, age 25
Time: circa 1980
Place: A hospital in a sleepy Southern town with fifty beds, six emergency department beds, one nurse, one doctor and one secretary.
It was an unusually quiet Friday night in this small emergency department.
We all knew Friday was “party day”: pay day, play day, alcohol, pills, drugs, loud music and lots of really bad decisions.
Not only did we cover the entire city, but we also …
A nurse was attacked in the emergency department. This is her story.
My partner Judith had pain in her sinus cavity caused by a tumor called a plasmacytoma. After her biopsy, her surgeon called Friday afternoon with the results. She asked him to wait fifteen minutes until I could be home with her to get the news. He had no flexibility and said he could speak either then or Monday. She chose to speak with him then on the phone still alone. …
12 tips for giving patients bad news
We cannot let the anecdote rule over us. We don’t make sound policy if we are swayed by isolated emotional vignettes. Of course, a vignette describes a living, breathing human being, but we must consider the greater good, the overall context and the risk of letting our hearts triumph over our heads when making general policy. Consider these examples.
If an expensive drug treatment program keeps five addicts clean for six …
The risk that genetic engineering will be used to achieve non-medical results
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 54-year-old man is evaluated for a 4-month history of intermittent, nonprogressive solid-food dysphagia. He has a long-standing history of heartburn that has been well controlled with once-daily proton-pump inhibitor (PPI) therapy for the past 5 years. Results of a screening colonoscopy 4 years ago were normal. There is no family history …
MKSAP: 54-year-old man with dysphagia
Eighteen months ago, I wrote about my plan for maximizing menopause preparedness. As with so many missions, this one has experienced both successes and failures. Since January 2016, I have grooved my exercise routine in the most awesome way. I am all over the TRX, doing Spiderman push-ups, incline presses, pistols and more. I …
Doctors have weight problems, too. Here’s my story.
“I think my friend has attempted suicide” an 11-year-old child haltingly admitted after I introduced myself as a crisis counselor with a national hotline and asked how I could help.* Over the next half hour I learned that this child and her friend had been facing ongoing cyber- and face-to-face bullying at school that was such a common occurrence the caller sounded nonchalant. The caller’s friend, however, had already attempted suicide at least …
How the show 13 Reasons Why can help you in the exam room
Here’s what you need to know about the upcoming solar eclipse and how to safely view the eclipse without losing vision from solar retinopathy.
A solar eclipse occurs when the moon passes between the Sun and the Earth, and the Moon casts its shadow, known as the umbra, on Earth. Partial or total eclipses occur somewhere on Earth about every 18 months as …
How to safely view the solar eclipse without losing vision from solar retinopathy
Most people reading this would love to lose weight, feel better and live longer. Doctors are a smart and motivated group of people. Unfortunately, that intellect and drive has not prevented us from avoiding an increasing incidence of obesity, diabetes, and hypertension identical to the general population.
While this article may have started out sounding like an infomercial, I promise it will not end like one. …
Doctors: You’re just as unhealthy as your patients. Here’s why.
“Can you hear it?” she asked with a smile. The thin, pleasant lady seemed as struck by her murmur as I was. She was calm, perhaps amused by the clumsy second-year medical student listening to her heart.
“Yes, yes I can,” I replied, barely concealing my excitement. We had just learned about the heart sounds in class. This was my first time hearing anything abnormal on a patient, though it was …
Sometimes high-tech care can be high value
Advocacy groups have been busy lately with their fancy-pants chemical detection science instruments, and their press releases have made it into the news. But is there news here, and are these chemicals something parents really need to worry about?
First it was a big lead from the New York Times called “The Chemicals in your Mac and Cheese.” The article started:
Potentially harmful chemicals that were banned from children’s teething rings and …
Chemicals in your food? Please don’t panic.
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 67-year-old woman is evaluated during a routine examination. She has a history of hip and knee pain related to degenerative joint disease. The joint pain is now well controlled with diclofenac, which was started 3 months ago. A previous trial of high-dose acetaminophen was not effective. She does not have any …
MKSAP: 67-year-old woman who takes diclofenac
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In the spirit of World Breastfeeding Week, I want to highlight all we can about breastfeeding; why it’s great for you and your baby, some ways to make it easier, and how to manage common challenges.
But one challenge that often gets ignored in the offices of doctors and lactation consultants is the issue revolving around the ethics of breastfeeding. That is, addressing uncomfortable questions like these:
Let’s talk about the ethics of breastfeeding
Dear Sen. McCain,
I was saddened to hear that you received a diagnosis of glioblastoma. I also live with this particularly aggressive type of brain cancer. On the surface, you and I are very different. I am a 35-year-old dad with three sons aged 5 and under. I have a beard and listen to indie rock. I hold …
Dear Sen. McCain: 9 ways to live with glioblastoma
As the kids say, it’s complicated. Practicing physicians are seeing an ever increasing list of protocols and pathways coming their way. These arrive in several forms — order sets for medications, guidelines in how to proceed for various conditions, when to do this, when to do that, and when not to do either one. They generally are the product of various committees trying to synthesize what these days we call …
A physician’s mixed feelings about clinical pathways
I began medical school, like many of my peers, with some experience working with patients. I worked as a volunteer EMT with Cornell University EMS for four years during my undergraduate years; shadowed a cardiologist and an anesthesiologist through Cornell’s Urban Summer program at NYP Hospital–Cornell and worked with patients during Global Medical Brigade trips to rural Honduras. All of this sparked my interest in medicine, but to claim I …
A medical student is diagnosed with cancer. Here is his story.
There are two schools of thought about how to extubate patients at the conclusion of general anesthesia:
Allow the patient to wake up with the endotracheal tube in place, gagging on the tube and flailing like a fish on a line, while someone behind the patient’s head bleats, “Open your eyes! Take a deep breath!”
Or:
Remove the endotracheal tube while the patient is still sleeping peacefully, which results in the smooth emergence …
Deep extubation is a useful technique for any anesthesiologist to master
In Sweden, back when I trained, three blood tests were the “routine labs” done at most doctor visits: hemoglobin, white blood cell count, and erythrocyte sedimentation rate. I’m trying to remember, but I don’t think everyone waited an hour to see the doctor, so they must have used a modified rapid sedimentation rate.
The “sed rate,” or “sänkan” as we call it, was invented by Robin Fåhraeus, a relative of one …
When an erythrocyte sedimentation rate leads to a serious diagnosis
Over the past decade, I have thought often about the benefits and the problems of clinical guidelines.
The first concept that attracted my attention was reading about conflicting guidelines. Given the same data, different guideline committees would have significantly different recommendations. At the least, this problem raises questions about guideline validity. It makes clear that committee perspective could influence recommendations. Guideline recommendations sometimes are clear and demonstrably evidence based, but too …
Guidelines are wonderful. Guidelines are dangerous.
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