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.
A reader I respect asked me for my thoughts on trigger warnings.
Per Wikipedia, trigger warnings are “warnings that the ensuing content contains strong writing or images which could unsettle those with mental health difficulties.”
Let’s put aside the last part of that definition, “those with mental health difficulties”, as some articles suggest that trigger warnings are not limited to those with mental health difficulties. Part of …
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The controversy that surrounds trigger warnings
Young women get gynecologic cancers, and I have had my share of conversations about ovarian cancers with women in their 20s and 30s. It rarely happens, but when it does, it is devastating. I make it a point to talk with them about their present and their future; although it is something I try to do with all …
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A story that showed me how cancer is a social disease
A new study was released on weight loss and maintenance that has been covered on many sites. Researchers from the National Institutes of Health (NIH) evaluated contestants from Season 8 of the TV show the Biggest Loser. They found that 13 of the 14 contestants studied regained some or all of their weight that was lost during the show. All the contestants studied also had slower metabolic rates than expected; …
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Don’t lose weight the Biggest Loser way. Here’s why.
The medical profession must play a lead role in reversing the opioid epidemic that, far too often, has started from a prescription pad.
For the past 20 years, public policies — well-intended but now known to be flawed — compelled doctors to treat pain more aggressively for the comfort of our patients. But today’s crisis plainly tells us we must be much more cautious …
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An open letter to America’s physicians on the opioid epidemic
It was 2 a.m. on a typically hectic Friday overnight shift in the emergency department.
A young woman, Kelly, checked into triage, accompanied by her older boyfriend Jim, who explained that Kelly had abdominal pain and some vaginal bleeding. Jim wanted her checked out and maybe some pain medicine to help her rest at home.
Kelly had no identification. She appeared younger than her stated age of 18. I also noticed track marks …
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Doctors need to recognize the signs of human trafficking. Here’s how.
“If it walks like a duck and quacks like a duck, it is probably a duck. ”
At 62 years old, Roberta had been healthy. She walked three miles a day, stayed up late and enjoyed events with her three grandchildren. She had no history of significant surgery, and took only a single pill for blood pressure. The only health tragedy in her life was the death of her last child, an …
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Dancing the anemia waltz. With a surprise ending.
A reader writes: “Grunting baby syndrome. Is this really a thing? My 6-week-old son grunts, strains, and writhes from approximately 3 to 6 a.m. every night. Most of the time he sleeps through it. My GP suspects reflux but ranitidine has not helped. Also, he’s very happy/calm all day rarely fusses or cries. My Google searching came across grunting baby syndrome. Is that a real thing? When do babies grow out of …
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Is grunting baby syndrome a real thing?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 52-year-old man is evaluated during a follow-up visit for a 2-year history of progressively symptomatic rheumatoid arthritis. He reports increased difficulty with his job due to persistent pain and swelling in the first proximal interphalangeal joints, second and third metacarpophalangeal joints, and bilateral wrists. He also has increased difficulty climbing stairs due …
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MKSAP: 52-year-old man with rheumatoid arthritis
We stand outside in the heat. We swat at the occasional persistent mosquito. We try to ignore the sweat beading down our foreheads and the backs of our necks. We retreat to the deepest recesses of shade we can find. We wish for a hint of a wisp of a smidgen of a breeze. We hold court on life and love. We laugh and tease and are determined to have …
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We pretend that we’re not afraid
I recognized a glitch in my electronic medical record’s decision support software when it prompted me to consider prostate and colorectal cancer screening in a 93-year-old man, who, though remarkably vigorous for his age, was unlikely to live for the additional 10 years needed to benefit from either test. Although deciding not to screen this patient was easy, determining when to stop cancer screening in older patients is often more …
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How to discourage overuse of cancer screening in older adults
Aggressive control of blood pressure has saved millions of lives and has prevented millions of people from experiencing heart attacks, strokes, and kidney failure, among other things. Admittedly, controlling blood pressure is not the sexy part of medical care, but when primary care doctors like me help people get their blood pressure under control, we do just as much good as any of our colleagues who practice as cardiovascular surgeons. …
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Aggressive blood pressure control: Too much of a good thing?
Life as a resident doctor can bring some of the most memorable patients encounters of our career. After all, this is the time in our training when we are the most naïve, vulnerable and most importantly impressionable. There is a certain patient scenario, however, which has changed the way I view one the most important experiences a patient can have: labor.
Let me explain.
I get paged for an epidural. Once I …
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Don’t be ashamed to receive an epidural during childbirth. Here’s why.
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 61-year-old woman is evaluated for a 4-month history of progressive dyspnea and fatigue without chest pain. Eighteen months ago, she was diagnosed with liver cirrhosis due to nonalcoholic steatohepatitis (NASH). Medical history is also significant for obesity. Medications are propranolol, spironolactone, and lactulose.
On physical examination, temperature is 36.4 °C (97.5 °F), blood …
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MKSAP: 61-year-old woman with progressive dyspnea and fatigue
When it comes to cancer, I’m neither physician nor patient, nor even a policy expert. But being both a critical thinker and a feminist, I’m struck by what the juxtaposition of two seemingly unrelated new oncology studies, published in highly respected medical journals a month apart, can tell us about how gender shapes the way we perceive (or misperceive) illness, and the impact that has on patients’ well-being.
On April 14, …
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Are we practicing medical misogyny?
I was 13 years old when I first had thoughts related to suicide. While my thoughts never really included calculated ways of ending my life, I remember such a profoundly overwhelming desire to be anesthetized to all of my emotions and worries. In the medical field, that kind of thinking is classified under the label of “suicidal ideation,” which is often accompanied by other diagnoses of mental illness. I have …
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My double life: Mental illness in the health care
Two weeks before my oldest cousin’s twenty-third birthday, he shot and killed himself. It scarred our family. The kind of jagged, gnarled scar, like a poorly-filled pothole, that — even though it’s been nearly twenty years — you still run your fingers across from time to time and feel the sting of a fresh wound.
We weren’t all that close, but as a 14 year old, sorting through my own perceptions …
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Our country should keep talking about guns
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 50-year-old man is evaluated for a 1-year history of increasing urinary frequency and urgency and occasional urge incontinence. He has no symptoms of urinary hesitancy or incomplete emptying. The patient has primary progressive multiple sclerosis. Medications are dalfampridine and vitamin D.
On physical evaluation, temperature is 36.8 °C (98.2 °F), blood pressure is 120/55 mm …
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MKSAP: 50-year-old man with increasing urinary frequency and urgency
I was at a meeting in 2014, called the REV Forum; its objective was to rethink cancer care delivery by gathering patients, advocates, thought leaders, and entrepreneurs. Even now I am struck by some of the things I learned that day. One that stays in mind is when a woman who looked like she was in her …
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Oncologists teach and comfort. Patients need both.
