A 55-year-old man is evaluated during a routine examination. He has a 2-year history of nonischemic cardiomyopathy. (Echocardiogram 2 years ago demonstrated a left ventricular ejection fraction of 35%.) He is feeling well and reports no shortness of breath; he walks 2 miles daily without symptoms. Medical history is remarkable for hypertension. …
Carl didn’t know what was happening to his wife. The German railway clerk from Morfelder Landstasse and his wife Auguste had been happily married for twenty-eight years. They had one daughter, Thekla, and their marriage had always been harmonious — that is, until one Spring day in 1901 when Auguste suddenly exhibited signs of jealousy.
Auguste accused Carl of going for a walk with a female neighbor, and since then, she …
As we learn of new suspected cases of Ebola infection in the United States, causing worries among the population and renewed efforts by the Centers for Disease Control and Prevention to contain the epidemic.
A student in the postgraduate course in research ethics that I teach at Albert Einstein College of Medicine recently asked whether we could discuss the Ebola epidemic in class. Because I had prepared the syllabus for the course months ago, I hadn’t …
Every time there is a terrorist act or a mass murder, reporters start calling with questions on the psychiatric diagnosis of the perp. The default position seems to be that every religious extremist or political fanatic or mass murderer must be crazy. How else to account for their weird behavior?
Naming a diagnosis somehow satisfies a deep human need to explain what otherwise seems an unexplainable act. But names can only …
While studying for my recertification exam as required by the American Board of Pediatrics, I came across this question:
A 7-year-old girl is having difficulty establishing relationships with other children despite repeated opportunities to do so. The girl prefers to stay near her mother or her teacher and will avoid other children. She sometimes cries and can be difficult to calm down after being dropped off at school, so her mother frequently remains …
A 66-year-old man comes for a preoperative evaluation before total joint arthroplasty of the left knee. He has a 25-year history of rheumatoid arthritis. He has had progressive pain in his left knee with activity, which limits his ability to hike. The patient has similar pain in the right knee, but it …
I was recently injecting anesthetic into a boil for incision and drainage. The abscess swelled and returned an arcing spray of lidocaine laden with blood and pus, soaking the thigh of my cotton scrub pants. A cheap plastic gown would have protected me — I usually wear one. But I couldn’t find one and had other tasks waiting. My mind went to Ebola and exposed nurse necks.
“Traditionally, doctors used to be called in when needed. But this is now changing. Increasingly it is the doctor who calls the person in by issuing an invitation. Healthy people are asked to visit the surgery for a ‘check-up,’ or ‘screening,’ when their computerized records show they are ‘due.’ Non-attendance is known as ‘non-compliance,’ indicating an element of recklessness and irresponsibility.”
“If I get a call about smallpox from the ER I’m not coming in,” an infectious disease doctor said to a colleague in the hospital where I was working. It was the early days of 9/11 and anything seemed possible.
“Are you all OK with providing care for Ebola patients?” our section chief asked. Our ICU is the designated unit to care for all adult patients suspected of having Ebola in our system. We …
The largest challenge facing the infectious disease community in the 21st century is the increasing number of resistant organisms found in various disease processes. The reason is much more complex than the over prescribing of oral antibiotics for sore throats. This is not to say that good antibiotic stewardship is an important concept because it is but it must be recognized that the medical challenges of the human population today is …
The tragic case of Thomas Eric Duncan represents a failure of communication with consequences that extend well beyond the current Ebola crisis. When Mr. Duncan first presented at Texas Health Presbyterian Hospital in Dallas, his recent travel history from Liberia was reportedly ascertained and entered into the hospital’s electronic health record (EHR) system. Somehow, this critical piece of information never registered with the physician who diagnosed Mr. Duncan, and in …
Recently, NPR published the results of a study confirming that removal of both breasts (a double mastectomy) fails to improve the chance of survival compared to breast conserving treatments for breast cancer. The headline of the story was “Double Mastectomies Don’t Yield Expected Results, Study Finds.”
This finding is not actually news to informed physicians. Since the 1980s, there has been widespread recognition that both mastectomies and lumpectomies offer an …
One of the most frequent questions gastroenterologists are asked about is diet, health and disease; and some of the questions gastroenterologists are least comfortable answering are about diet, health and disease. This disconnect occurs for several reasons. Although the subject of nutrition is taught in medical school, it usually covers malabsorption of nutrients, vitamins and minerals that have limited relevance to the concerns of most patients. The modern physician does not see …
Hearing the words “you have cancer” changes everything. In my role as clinical nurse specialist in a busy prostate clinic, I see the effects of these three words on men and their families every day. The shock and disbelief, the fear and confusion as most men feel perfectly well with no symptoms at all. Many men want to do something …
Ebola is a scary topic; there’s no doubt about that. With the onslaught of media coverage that has no end in sight, it’s likely that older children have already heard of the Ebola outbreak or will hear about it in the near future. The question is, what can we do to help our kids work through the confusing and frightening messages they see on television?
When an unconscious person is first brought to the emergency room, there may be little indication if the individual has diabetes or a thyroid condition.
Since millions of people have common hormone health conditions like these, emergency room clinicians and other acute care providers need to watch for cases where an endocrine disorder is causing or contributing to a medical emergency.
More than 29 million people in the United States have diabetes, …
A 72-year-old woman is evaluated during a routine examination. She has very severe COPD with multiple exacerbations. She has dyspnea at all times with decreased exercise capacity. She does not have cough or any change in baseline sputum production. She is adherent to her medication regimen, and she completed pulmonary rehabilitation 1 …
In June, a man became very ill during a flight into Lagos, Nigeria. On the plane, he developed vomiting and diarrhea, and he collapsed in the very busy airport. Contacts on the plane and on the ground had no idea that he had Ebola — initially, he was treated for malaria — and many health care workers and bystanders on the plane and in the airport were exposed to his …
A few weeks ago an emergency room doctor called our infectious disease physician group concerning a patient who had returned from Liberia and was having nausea and vomiting. Several of the patient’s family members had died of Ebola.
As panic struck us, our decisive question was: When did he return from Liberia?
Some years ago I was in Australia’s Northern Territory. The intrepid explorer that I was, I was croc-spotting from the comfortable heights of a bridge over the East Alligator River. The river derives its name because it is east of something. And because it’s croc-infested.
I was reading a story about a German tourist (it’s usually a German) who was attacked by …
