Conditions and Diseases

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.

Take the time to understand patients’ goals when giving treatment recommendations

Peter Ubel, MD

October 17, 2016

A recent study of men with early-stage prostate cancer found no difference in 10-year death rates, regardless of whether their doctors actively monitored the cancers for signs of growth or eradicated the men’s cancers with surgery or radiation.

What does this study mean for patients? Based on research we have conducted on prostate cancer decision-making, the implications are clear: Patients need to find physicians who will interact with …

Physicians must prevent domestic violence at all costs

Eric S. Donahue

Conditions and Diseases

October 15, 2016

Domestic violence is ubiquitous in our society. Few are untouched by the physical and emotional consequences of abuse — whether they were directly abused or know others who were. However, little has been done to prevent it.

We’ve recognized prevention as critical to national health. This awareness has led to everything from decreased vehicular deaths by 90 percent since 1925 to millions of lives saved from vaccines. But even with all …

MKSAP: 54-year-old man with low-risk myelodysplastic syndrome

mksap

Conditions and Diseases

October 15, 2016

A 54-year-old man is evaluated during follow-up consultation regarding laboratory studies completed for a life insurance policy. He reports no symptoms.

On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure is 131/76 mm Hg, pulse rate is 88/min, and respiration rate is 15/min. No splenomegaly is noted.

Laboratory studies:

Hemoglobin 8.9 g/dL (89 g/L)
Leukocyte count 3000/µL (3.0 × 109/L) with 30% neutrophils, 10% monocytes, and 60% lymphocytes
Mean corpuscular volume 105 fL
Platelet count 75,000/µL …

What can the Amish teach us about asthma in children?

Christopher Johnson, MD

Conditions and Diseases

October 13, 2016

Asthma is a complex, chronic lung problem that now affects nearly 10 percent of all children. Both the incidence of new cases and the prevalence of ongoing cases in the pediatric population have been rising steadily for years, although there are hints these increases may have leveled off.

A wealth of research suggests a huge part of asthma causation comes from the environment the child lives in, things like air quality and exposure to various …

Did a prostate cancer test save actor Ben Stiller’s life?

Dr. Saurabh Jha

Conditions and Diseases

October 12, 2016

Ben Stiller—one of the few comedians on this side of the pond who can make me laugh—said prostate-specific antigen (PSA) testing saved his life. I suspect he wasn’t being funny. Stiller had Gleason Grade 7 localized prostate cancer.

Is he right?

The honest answer is that we don’t know for certain. Before I get granular, we must visit proof, level of proof and burden of proof. The statement, “there’s …

The integration of psychiatry with neuroscience, biochemistry, and genetics

Mark Rubinstein, MD

Conditions and Diseases

October 11, 2016

As a forensic psychiatrist, I have testified in courtrooms, at depositions, legal hearings, and inquests. I’ve been cross-examined by attorneys whose agenda was to discredit my testimony or demean psychiatry as a medical specialty. Two criticisms frequently leveled at psychiatry are: 1) Psychiatry has not changed significantly for the last sixty years and, 2) Psychiatry is the least scientific of all medical specialties.

These beliefs are not true.

Over the last few …

Doctors should not blindly extrapolate data from research studies

Robert G. Dorfman

Conditions and Diseases

October 9, 2016

It is common practice in health care today for physicians to read articles published in leading journals within their fields and extract what they think is important for their patients. Though in most cases it is to the patient’s benefit that their physician stays up to date with the latest scientific advances, it is nonetheless important that doctors pay particular attention to research methodology and how generalizable these studies are …

A story for those who pontificate about patient behavior

Patricia Salber, MD

Conditions and Diseases

October 8, 2016

I was offered my choice of bisphosphonates after breaking my shoulder and ended up with a diagnosis of osteoporosis. I initially opted for Reclast, a drug that only requires one dose a year albeit by IV infusion. I made an appointment to get the drug several weeks later. I wanted to have time to research my options. After reading as much as I could during that time, I made an …

MKSAP: 26-year-old woman is evaluated during a routine examination

mksap

Conditions and Diseases

October 8, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 26-year-old woman is evaluated during a routine examination. Her last Pap smear was performed 1 year ago and was normal. She has received a complete human papillomavirus (HPV) quadrivalent vaccine series. Medical history is unremarkable. Family history is noncontributory. She takes no medications.

On physical examination, temperature is normal, blood pressure is 110/72 …

How clickbait headlines affect prostate cancer diagnosis and management

Matthew N. Simmons, MD, PhD

Conditions and Diseases

October 6, 2016

Our culture has taken a strange turn where the truth is relative, and where conspiracy theories rule the day. News sources and social networks are rife with political agendas, fake articles, and disguised advertisements. This chaos harms our social welfare, but can also impact physical health. Misleading news reports of new clinical studies make it difficult to discern medical fact from fiction.

I spend hours in clinic justifying recommendations to patients …

Stop with the unnecessary questions

Susan Turner, LICSW

Conditions and Diseases

October 3, 2016

When I find a lump in my left breast, I am stunned. I probably shouldn’t be surprised, but I’m immobilized. It takes me several days before I tell my partner, who has to push me into action. I get the referral from my doctor and schedule a mammogram. The radiology practice fits me into their schedule that same week, but I still have several days to sit with the unknown.

Finally, …

Read more…

Stop with the unnecessary questions

5 cases where bedside ultrasound helped this doctor

Janice Boughton, MD

Conditions and Diseases

October 3, 2016

After five years of doing bedside ultrasound, I’m still excited about it. Bedside, or point-of-care ultrasound is using an ultrasound machine during the physical examination of a patient in order to make a diagnosis. I use a pretty tiny machine that fits in my pocket. As an internist who works in the hospital and in rural clinic outpatient settings, I get to use my ultrasound all the time, and it’s …

MKSAP: 51-year-old man with newly diagnosed hypertension and diabetes mellitus

mksap

Conditions and Diseases

October 1, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 51-year-old man is evaluated during a follow-up visit for management of newly diagnosed hypertension and diabetes mellitus. He has started a program of lifestyle modification for his diabetes but has not yet started antihypertensive therapy. He is currently taking no medications.

On physical examination, blood pressure is 148/92 mm Hg, and pulse rate …

Big data equals big challenges for prostate cancer

Leonard G. Gomella, MD

Conditions and Diseases

September 24, 2016

The term “big data” is a favorite mantra of health care today. Big data sets are starting to drive much of what is done in medicine including directing research, drug development, clinical pathways, insurance coverage and public opinion. The official definition of “big data” in health care is subject to interpretation by different sources. One dictionary defines big data as “data of a very large size, typically to the extent …

MKSAP: 68-year-old woman with gradually progressive abdominal distention

mksap

Conditions and Diseases

September 24, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 68-year-old woman is evaluated for a 3-month history of gradually progressive abdominal distention. Her medical history is notable for a 20-year history of obesity, type 2 diabetes mellitus, hyperlipidemia, and hypertension. She also has had a 10-year history of elevation of serum aminotransferase levels, which was attributed to nonalcoholic fatty liver disease. …

We have no answers to these unbearable algorithms in life

Debbie Moore-Black, RN

Conditions and Diseases

September 23, 2016

Jim Morrison of the Doors once sang, “Petition the Lord with prayer … You cannot petition the Lord with prayer.”

But we did that. We petitioned.

On one side of the ICU, we had an 18-year-old girl, upper middle-class family, had everything. Beauty, brains, money, supportive parents, and she was off into this new bright world, choosing her college of choice. A simple surgery led to sepsis, severe sepsis that raged through …

Reflecting on sepsis: Definitions, new ideas, and a continued commitment to patient care

Steven Q. Simpson, MD

Conditions and Diseases

September 19, 2016

sepsis-blog-9-2016

September is Sepsis Awareness Month, a month which aims to raise awareness of sepsis and strategies for prevention and treatment. Sepsis is a potentially life-threatening complication of an infection. Sepsis occurs when the body’s response to infection becomes dysregulated and white blood cells and chemicals cause injury to organs throughout the body.

Earlier this …

Does psychiatry worsen mental illness stigma?

Christine B. L. Adams, MD

Conditions and Diseases

September 19, 2016

When a person gets depressed over their divorce, they are said to have a mental illness. When a person becomes psychotic from a manic episode due to their bipolar disorder, they are also said to have a mental illness. But are both of these illnesses mental illnesses? The definition of mental is that which relates to cerebral, brain, cognitive or intellectual processes.

Many disorders occur from problems in the anatomy or …

MKSAP: 64-year-old woman with an incidental pituitary adenoma

mksap

Conditions and Diseases

September 17, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 64-year-old woman is seen for follow-up evaluation. Two weeks ago, she was in a car accident, and an incidental pituitary adenoma was found on a cervical spine CT scan. She has no residual injuries from the car accident.

She is otherwise healthy and takes no medications. She went through menopause at age 51. …

An inhumane way to help those in greatest need of immediate intervention

Ilene Benator, MD

Conditions and Diseases

September 12, 2016

Imagine losing your grip on reality; your only place to turn is the local hospital. Once there, you give up your personal effects, your clothes, and often, your right to leave. You wear paper scrubs in a sparse room, lay on an uncomfortable bed, and have a guard nearby preventing your escape. In seeking help, you have become a prisoner. This is done for your and for the hospital personnel’s …

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