I was up helping my son for the majority of the night. He’s got a stomach bug (which he got from his brother) therefore I was up dealing with the enormous mess that comes with vomiting in the middle of the night. I know you know my woe. This is the second round of this bug at our house so I was clearly exhausted when 6am rolled around.
First thing I …
What to remember about children and caffeine
Hot oil splatters as thick fatty fish slips into the smoking pan, next to boiling rice and simmering garlic greens. Quickly golden, she flips the fillet and turns down the heat. Small feet pound down the stairs, drawn by the crackling aroma, but it’s a mother’s trap; she motions the child to set the table. One by one, the family gathers, as plates and utensils clatter onto the wood and …
To every cancer patient: You give us courage
When someone asks me what a developmental pediatrician does, I tell him or her that I treat children who have a variety of developmental problems, such as attention deficit hyperactivity disorder (ADHD). Without fail, that disclosure elicits some sort of an emotional reaction.
Many people have strong opinions about whether the disorder really exists. Parents are still being told, by family and so-called friends, that it’s “their fault,” and that all …
It seems lately that questions of medical ethics are coming up more and more in the news, things like the rights of patients to make decisions, definitions of futile care, and end of life care. The way to look at these things is not in a vacuum. All of us may have our own opinions about right and wrong, but the field of medical ethics is actually one that has …
Framing an ethical dilemma: 4 basic concepts of medical ethics
I have been thinking a lot about cancer screening tests. It seems that there has been a constant stream of articles about screening in both the lay press and professional journals — as well as the inevitable stories in the lay press about the reports in professional journals — but this is more personal. I have had two recent experiences that …
Cancer screening comes down to personal preferences
Sometimes, we play a little politics on this blog. I am a student of current events and enjoy following the dysfunction and absurdities in American politics. To paraphrase the legendary former British prime minister, “never has so little been done by so many to benefit so few.”
Readers know how skeptical I am about medical dogma. When I was an intern a quarter century ago, I didn’t grasp why routine measurement …
Save mammography or save women? Supporters face a quandary.
I gotta say, the daily commute has been feeling a bit hairy lately. Seems like I’m passing accidents more frequently. Watching a bit more weaving. I can’t be sure that it’s all related to distracted driving, but sure seems like a lot of it is. Every day I witness drivers looking down at phones at stoplights, missing the change to green. I even saw a smartphone mounted to one car’s driver side dash and the driver scrolling through websites …
Education on distracted driving can’t start early enough
The BMJ recently published the latest results from the Canadian National Breast Screening Study (CNBSS). A brief summary of the CNBSS: Women were randomly assigned to annual mammography or breast exams and then the outcomes tracked. The results in the BMJ: mammography did not improve survival.
This is a very interesting study and when I first started working on this post I wanted to delve more into the science of …
Radiologists on the new mammogram study. Who’s right?
Mr. Heim Stillear, at 70-years-old, seems older and less intelligent to his family, since he was hospitalized for a stroke about two months ago. They come to the appointment with him and help him into the exam chair. When I ask Heim what is going on with him, the long pause before his strained answer begins makes his family uncomfortable.
His daughter interjects, “We are having a very difficult time understanding …
What’s the difference between speech and voice?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 32-year-old woman is evaluated following a diagnosis of chronic fatigue syndrome. She has a several-year history of chronic disabling fatigue, unrefreshing sleep, muscle and joint pain, and headache.
A comprehensive evaluation has not identified any other medical condition, and a screen for depression is normal. Her only medications are multiple vitamins and …
MKSAP: 32-year-old woman with chronic fatigue syndrome
Recently I reviewed my son’s high school essay on To Kill A Mockingbird. I was surprised and pleased to rediscover, or perhaps discover for the first time now that I was viewing it from the perspective of over 50 years of life experience, the profound wisdom of the book.
In one of the novel’s most famous quotes, Atticus tell his daughter Scout, “you never really understand a person until you consider things …
Perhaps ADHD is a problem of not listening
I’ve been a doctor for twenty years. I’ve not lost a single patient to suicide.
I’ve lost only colleagues, friends, lovers — all male physicians — to suicide.
Why?
Here’s what I know:
A physician’s greatest joy is the patient relationship.
Assembly-line medicine undermines the patient-physician relationship.
Most doctors are burned out, overworked, or exhausted.
Many doctors spend little time with their families.
Workaholics are admired in medicine.
Medicine values …
Two big studies have been published in the last few weeks, both of which have confirmed previous data: home birth is not as safe as hospital birth. These studies show that having a baby at home increases the risk of your baby dying by about 4 times. That really is a big increased risk — especially considering that most home births are supposedly low-risk pregnancies. Those babies …
Where is the safest place to have a baby?
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Alzheimer’s disease is the uninvited guest that crashes all of my family gatherings. It relentlessly pursues my grandfather’s brain, unraveling more threads from the tapestry of his memory each year. Although it causes him no physical pain, it sows guilt, sorrow, frustration, and a sense of deep loss in all of us.
Like all diseases, this one seems entirely unfair. My grandfather was a sharp attorney, a witty, silly champion of …
Alzheimer’s disease is the uninvited guest
There are few professional careers centered around protecting and caring for others that garner so much verbal and physical abuse than a career in emergency medicine. Mental health workers, police, fire, and EMS personnel are the other fields that come to mind when I think of a service that “helps” people yet gets abuse dished upon them on nearly a daily basis.
A 2006 survey of emergency nurses showed that 25% …
When patients abuse emergency department workers
As I finished surgery on a beautiful 10-year-old girl from a local orphanage with a secondary cleft lip deformity, I did not realize how this tiny little Filipino girl was about to humanize me and my entire team involved in her care. When I met her the day before with her caretaker from the orphanage, it was obvious that she had …
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
February is American Heart Month. Unfortunately, heart disease is a major problem in the United States that can result in surgery. In addition to discussing your procedure with your surgeon, you want to be sure to discuss your anesthesia care with your physician anesthesiologist.
Here are …
10 things to know about anesthesia and heart surgery
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 50-year-old man is evaluated for persistent heartburn and regurgitation despite taking a high-dose proton-pump inhibitor twice a day for 6 months. His symptoms have improved, but he continues to have symptoms many times a week. He has not had dysphagia, chest pain or weight loss. He has significantly modified his diet. …
MKSAP: 50-year-old man is evaluated for persistent heartburn
A paper published in the Journal of the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) highlights the importance of nutrient fortification to the diets of our children. The researchers used data from the National Health and Nutrition Examination Survey to determine the sources of micronutrients in the diets of over 7,000 kids ages 2 to 18, and assessed overall dietary intake in this cohort assembled …
Fortification masks our deplorable dietary circumstances
In the medical world, when a physician, a scientist, a hospital, a drug company or a panel of experts issues a report, the games begin. If one agrees with the statement or benefits from it, then the report is heralded as breakthrough brilliance.
If, however, the report suggests a new medical pathway that diminishes your relevance or reimbursement, then the report and its authors are regarded as misguided. Yes, I am …
A 2 question strategy to assess the worth of medical tests
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