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.

ALS and the ice bucket challenge: A matter of priorities

Janice Boughton, MD

September 9, 2014

The ALS Association, and the British version, the Motor Neurone Disease Association, have made boatloads of money off of the ice bucket challenge. Originally the idea was that a person would challenge another person to donate money for ALS research and if they hadn’t done so in 24 hours, they would dump a bucket of ice water over their head. It turns out that people like dumping ice buckets over …

4 reasons why the Ebola vaccine won’t matter

Mike Sevilla, MD

Conditions and Diseases

September 8, 2014

“Dr. Sevilla, what do you think about the Ebola virus,” a patient recently asked me. My patient and I talked about the recent news reports stating that over 1,500 people have died because of the virus.

“There’s a vaccine that’s being developed,” I told my patient.

“Well, that’s great. I’m definitely going to get it, if …”

“If?” I asked my patient.

“Well, you know how these things go. If it’s covered …

MKSAP: 42-year-old woman with crampy abdominal pain

mksap

Conditions and Diseases

September 6, 2014

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

A 42-year-old woman is evaluated for an 8-month history of crampy abdominal pain and three loose bowel movements per day. The pain is relieved by a bowel movement. There are no nocturnal bowel movements, and there is no blood or dark tarry material in the stool. She has not had fever, night …

A physician is now biased towards over-testing. Here’s why.

Val Jones, MD

Conditions and Diseases

September 5, 2014

Health screening is part of good preventive care, though over-screening can lead to increased costs, and potential patient harm. Health care professional societies have recently developed excellent public service announcements describing the dangers of over-testing, and new research suggests that though additional medical interventions are associated with increased patient satisfaction, they also lead (ironically) to higher mortality rates.

And so, in a system attempting to shift to a “less is more” …

Thinning hair, and a heavy soul

Samyukta Mullangi

Conditions and Diseases

September 5, 2014

My patient suddenly leaned forward, swung her hair up, and began to push it this way and that, determined to find and show me the partitions that her hair made when rested in a new equilibrium.

It was a warm Thursday afternoon and we were in dermatology clinic. This 20-something young professional had come to have her scalp examined. She’d noticed a sudden increase in the quantity of hair follicles that …

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Thinning hair, and a heavy soul

Will lower prices for genomic tests raise medical costs?

Peter Ubel, MD

Conditions and Diseases

September 3, 2014

The first time scientists sequenced a person’s entire genome, it took more than a decade and cost hundreds of millions of dollars. Currently, such sequencing takes less than twenty-four hours and costs less than $5,000.

To put that into perspective, Myriad Genetics charges $3,000 to test for mutations in just two genes associated with breast cancer. The days of affordable genomic sequencing are rapidly approaching. But will such testing bankrupt us?

In most consumer …

Ebola in the United States: A reason not to panic

Manoj Jain, MD, MPH

Conditions and Diseases

September 3, 2014

If an ill patient, who unexpectedly has Ebola, landed in Memphis, it is likely that my partner or I would see him. We work as infectious disease doctors at the hospital closest to the airport.

The Ebola patient would present with fever, nausea and vomiting, indistinguishable from a flu or a viral illness that hundreds of patients present with each day at our hospitals. But over a few days of the illness, …

Cancer screening in the elderly: Don’t be stupid

Kenneth Lin, MD

Conditions and Diseases

September 1, 2014

The electronic medical record that my office uses features a clinical protocol button that we are encouraged to click during patient visits to remind us about potentially indicated preventive services, such as obesity and tobacco counseling and cancer screenings. I once tried it out while seeing a 90-year-old with four chronic health problems. The computer suggested breast cancer, colorectal cancer, and cervical cancer screenings: three totally inappropriate tests for the …

Was the death of Robin Williams preventable?

James Katz, MD, MPH

Conditions and Diseases

August 31, 2014

In his piece on Robin Williams, Andrew Solomon of the New Yorker states that every 40 seconds, someone commits suicide. Actually, it’s every second of every day, as people choose the action, or inaction, that will end their lives sooner. When the patient with metastatic melanoma, who is quite capable of getting to the refrigerator, refuses to take food or liquids, she is taking her life. Her body will …

Palliative care: A medical student’s reflection

Justin Wang

Conditions and Diseases

August 31, 2014

Jack was the very first palliative care patient I met. Visiting him in his home, I feared the worst: emaciation, pain, a fluxing state of consciousness, and the otherwise bed-bound shadow of a former life. Instead, the first sight I was greeted with was a beaming smile beneath a bushy moustache. But for his IV lines and analgesia pump, Jack might have passed for a completely well middle-aged man, certainly …

Can the Ebola epidemic promote the development of medicine?

Chiduzie Madubata, MD

Conditions and Diseases

August 31, 2014

Having been born and raised in the United States, I have become accustomed to the reputation of the U.S. as being ahead of the curve in terms of advances in numerous fields including medicine, and the research that we produce in these fields strongly backs up this claim. I have been reminded of this over the past few days while following coverage of the Ebola outbreak in West Africa.

American health …

How many servings of fruits and vegetables should we eat a day?

James McCormack, PharmD

Conditions and Diseases

August 30, 2014

Many organizations cook up recommendations for the number of fruit and vegetable servings you should eat every day. Well known examples include the USDA which suggests two cups of fruit and two and a half cups of vegetables daily (approximately 8 to 10 servings), the American Heart Association which recommends 8 to 10 and the Harvard School of Public Health suggests somewhere between five and 13 servings of fruit and …

MKSAP: 55-year-old man with a wrist fracture and anemia

mksap

Conditions and Diseases

August 30, 2014

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

A 55-year-old man is reevaluated during a follow-up examination for a wrist fracture and anemia. The patient is otherwise asymptomatic. He was treated in the emergency department 2 weeks ago after he slipped in his driveway and sustained a right wrist fracture; mild iron deficiency anemia was detected at that time. He …

Why Liberians raided the Ebola clinic

Kristin C. Prewitt

Conditions and Diseases

August 29, 2014

“No Ebola in West Point” was the reported cry of the local crowd that attacked a quarantine center and freed patients in a township near Liberia’s capital. Their words signaled skepticism toward the Liberian government and disbelief in the spread of the Ebola virus.

The cries of the crowd were met with cries of shock and dismay on Twitter and other social media. “Are they crazy or just stupid?” one …

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Why Liberians raided the Ebola clinic

Lying to receive pain medications hurts patients in true pain

Kenneth Lin, MD

Conditions and Diseases

August 28, 2014

My patients lie to me every day. Some tell me that they have been taking their medications regularly when they haven’t. Some say that they have been eating a healthy diet and exercising for at least 30 minutes every day and don’t know where the extra pounds are coming from. Some lie that they are using condoms every time they have sex, that they have quit smoking, and if they …

7 assumptions about end of life care

Lizzy Miles, MSW

Conditions and Diseases

August 27, 2014

The worst thing anyone ever said to me was, “You think you know everything, but let me tell you: You don’t know jack!” I was six weeks into my social work internship at a hospice and it was my student supervisor who decided I needed an attitude adjustment. Needless to say, I didn’t stay there. I was angry and hurt for a long time but now I’ve come to realize …

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7 assumptions about end of life care

Sleep apnea in children: A primer from a pediatric intensivist

Christopher Johnson, MD

Conditions and Diseases

August 26, 2014

Earlier this year a child died following a surgical procedure in California for a condition called obstructive sleep apnea. The case generated a great deal of concern among parents about both this condition and the surgery often done to treat it. I wrote a post myself about it at the time. I still get questions about it because I care for quite a few children immediately after they have had …

When medications devalue the opportunity to listen

Claudia M. Gold, MD

Conditions and Diseases

August 25, 2014

When I hear debate over the association between SSRIs (selective serotonin re-uptake inhibitors, a class of antidepressant medication) and suicidal behavior in children and adolescents, I am immediately brought back to a night in the early 2000s. As the covering pediatrician I was called to the emergency room to see a young man, a patient of a pediatrician in a neighboring town, who had attempted suicide by taking a nearly …

Recognize the potential victims of human trafficking

Alberto Hazan, MD

Conditions and Diseases

August 24, 2014

If you’ve ever worked in an emergency room, you’ve likely treated a victim of human trafficking.

We all have, often without knowing it.

With nearly thirty million people in modern-day slavery around the world, there are more slaves today than at any point in history.

Human trafficking is defined as “the recruitment, harboring, transportation, provision, or obtaining a person for labor or services, through the use of force, fraud, or coercion” for the …

Sleep isn’t a luxury. It’s a medical necessity.

Drew Kotler

Conditions and Diseases

August 24, 2014

Most hospitals are strapped with a massive amount of debt. Not monetary debt, but sleep debt. Amongst both the staff and patients, sleep is severely lacking. In our busy society, we associate sleep with leisure and relaxation; a reward at the end of a long day. But sleep isn’t a luxury. Rather, it’s a medical necessity.

Sleep deprivation has widespread consequences, causing cognitive dysfunction, weakened immune system, impaired healing, increased blood …