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.
There’s been a push lately for more explicit labeling of foods — to make sure that consumers know that what they’re buying is organic, or free-range, or natural, or GMO-free, etc. But these labels don’t tell the whole story. Sometimes, they’re outright lies.
For instance, “organic” veggies still contain plenty of pesticides. There are the natural pesticides that ordinarily occur in food, plus the organic-OK chemical pesticides that are …
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Confused by food labels? You’re not alone.
I saw a patient last week for her chest pain. A 60-year-old woman came into the hospital because her chest tightened every time she went running. The pain would last about 20 minutes, centered on the left side of her chest, and radiated to her left arm. It lasted until she would finally take a break from running and sit down.
“This is classic,” I thought. “Stable angina.” I could now …
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It’s time to treat mental illness as seriously as we treat heart disease
In the last month, I have used the ICD-10 codes Z59.0 (homelessness), Z59.1 (inadequate housing) and Z59.9 (unspecified housing or economic problem) far more than I ever would have imagined. Several patients came into my urban clinic with varied chief complaints, including issues with uncontrolled asthma, chest pain, stress, worsening knee pain and sciatica. However, after listening and asking questions, I quickly realized that all of these initial complaints shared a …
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Why doctors should care where their patients live
It is a common experience to feel that our body has let us down when we get sick. We may feel it is broken or flawed in some way and if only it was better designed we wouldn’t have to suffer illness and disease. Likewise, we tend to consider illness and disease as something bad that has happened to us and which we associate with suffering of some kind, be …
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The way we are living is killing us
This Medcomic highlights some of the main features of multiple sclerosis (MS). Although the exact cause of MS is unknown, the disease is thought to occur as an immune-mediated attack on the central nervous system (CNS). As you can see in the illustration, the white blood cells are attacking the neuron and causing inflammation, demyelination, and axonal degeneration that can manifest through …
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Learn multiple sclerosis with the power of comics
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 49-year-old man is evaluated during a routine examination. He is asymptomatic but is concerned about his risk for cardiovascular disease. Medical history is notable for hypertension. He is a nonsmoker, and he works as an executive at a highly successful company. Family history is noncontributory. His only medication is hydrochlorothiazide.
On physical examination, the patient …
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MKSAP: 49-year-old man is evaluated during a routine examination
Every month or two I see a patient, usually a man with prostate cancer, who is concerned that if he has intercourse with his spouse, he will give her cancer. The question is asked with sincerity, and I can see the worry in the man’s eyes. His spouse is often equally worried but she often looks embarrassed too, almost as …
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Shame and stigma in patients with HPV-related oral cancers
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 55-year-old man is evaluated in follow-up after a recent routine screening for antibody to hepatitis C virus (HCV) was positive. His medical history is unremarkable; he has not used illicit drugs or had any history of blood transfusions. He currently feels well and takes no medications.
Vital signs and physical examination are normal.
Laboratory studies reveal …
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MKSAP: 55-year-old man with hepatitis C virus (HCV)
The United States Preventive Services Task Force (USPSTF) was created by the federal government in 1984 to provide recommendations to primary care practitioners on the scientific efficacy of screening. In 2010, the federal government linked USPSTF recommendations with national healthcare policy when the Affordable Care Act mandated free coverage by Medicare and private insurance for all screening exams that receive a USPSTF recommendation of A or B. …
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Should the USPSTF include specialists?
It’s still flu season, although the flu gods have shown a bit more mercy than in years past. So many variables determine whether each winter brings a relatively mild flu season, a “flunami,” or something in between. I’m a country boy doing primary care in the city, and I have only a modest understanding of which influenza strain is circulating, the concepts of antigenic drift and shift, and how the …
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An ounce of influenza vaccine is worth at least a few tons of Tamiflu
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 53-year-old woman is evaluated for a slowly enlarging, telangiectatic, pearly, ulcerated 1-cm plaque on the left temple. It bleeds periodically when traumatized. Medical history is significant for atrial fibrillation. She takes warfarin daily. She is otherwise in good health.
On physical examination, vital signs are normal. Cardiac examination shows an irregular heart rate but is …
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MKSAP: 53-year-old woman with a skin lesion
The Zika virus in the news these days reminds us of another microcephaly-causing virus which scourged our world in the not-so-distant past. In the years right before we were born (the late 1960s), the virus rubella routinely swept through the United States and the rest of the world. The airborne germ rubella, just like the Zika virus, caused most people just a mild illness that they usually never even knew that they …
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The future of Zika virus? How rubella provides clues.
Potential patients — usually parents — occasionally ask me if I am “vaccine-friendly.” After having this question posed to me numerous times, I’m prepared for the conversation that follows. I’ve tried to ease into it in various ways, but none has proven universally comfortable.
The question’s phrasing is telling about a person’s perspective. It implies that their previous experiences with physicians were perceived as “unfriendly.” Also, my defensive side infers it …
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Don’t deny access for vaccine skeptics. Here’s why.
It is easy to lose oneself while swimming in a sea of medical facts surrounded by overburdened physicians and high-acuity cases. Initially, it is difficult taking care of one patient, much less a whole service. The transition from student to student-doctor is not as homophonic as the semantics would suggest — and this transition affects the mental health of thousands of medical students each year.
Medicine is less a profession and …
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Reduce physician burnout with meditation and mindfulness
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 42-year-old woman is evaluated for episodes of palpitations that last several seconds in duration. They occur once or twice a month and are accompanied by lightheadedness and mild dyspnea. She has not experienced loss of consciousness. The episodes are not precipitated by any particular activity, including exercise. She takes no medications.
On physical examination, the …
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MKSAP: 42-year-old woman with palpitations
Disclaimer: I have never had cancer. Therefore, at the most basic level, I do not have the right to pontificate about dealing with the dread disease. Rather, I have been the servant and support of those that struggle with cancer. I thought it might be of some assistance to share my observations from the other side of the bed rail. Perhaps, their secrets of survival may help you.
Cancer is a …
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A doctor shares the secrets of cancer survivors
I recently told you of my admiration for Dr. Mona Hanna-Attisha, the Michigan pediatrician and epidemiologist whose strong research and advocacy was able to finally bring a shining light to the problem of lead in the water supply of Flint.
Continuing with a theme, I now bring you the story of Dr. Adriana Melo of Campina Grande, Brazil.
Dr. Melo is an OB-GYN who subspecializes in maternal-fetal medicine (MFM), the branch …
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This inspiring doctor proved Zika virus doubters wrong
February is American Heart Month, and the Go Red For Women campaign reminds us to bring awareness to cardiovascular disease in women all month long. Today in the U.S., nearly 44 million women are living with heart disease. Even though heart disease is quite prevalent in women, only 1 in 5 women are aware that they are at risk for developing a cardiovascular problem in their lifetime.
Cardiovascular disease is the #1 …
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4 questions every woman should ask about heart disease
With the Supreme Court in the balance, every aspect of the unexpected demise of U.S. Supreme Court Justice Antonin Scalia has received intense scrutiny, from the cause of his recent death to the politically charged choice of his successor. An autopsy was not performed on the 79-year-old jurist, who was found dead in his room in a West Texas hunting resort, and that too has become a lightning rod for …
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Justice Scalia: Why didn’t they perform an autopsy?
