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.

How much breast cancer chews up your schedule

Conditions and Diseases
November 6, 2010

Whether you’re newly diagnosed with DCIS or a more advanced form of breast cancer, you’ll notice it has a big time impact. One of the things that surprised me was just how much breast cancer chews up your schedule. I had something like 38 appointments in 20 weeks, and this did not include radiation, which was not in my treatment plan.

In case you’re wondering what all those appointments were for, I had two …

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How much breast cancer chews up your schedule

Tinnitus highlights poor doctor patient communication

Conditions and Diseases
November 4, 2010

I’m both interested in and disturbed by what some doctors have said to patients at the first consultation for tinnitus,  an annoying perception of sound that comes from somewhere within their heads.  Not many of these patients are referred to me – most come of their own accord for a second opinion.  What they tell me their doctor said is a lesson in how not to communicate with patients, and …

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Tinnitus highlights poor doctor patient communication

Induction of labor should be restricted to medical indications

Conditions and Diseases
November 2, 2010

It seems rather obvious that medical procedures should be reserved for medical indications. Why? Because almost every medical procedure, even some of the simplest, have small but real risks of complications. And risking complications can only be justified if the medical benefit outweighs the risk.

That rule applies to labor inductions, although many obstetricians have forgotten it. Induction of labor for non-medical reasons, primarily convenience, is attractive, but labor induction is …

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Induction of labor should be restricted to medical indications

Case reports continue to be an important part of journal publication

Conditions and Diseases
November 1, 2010

I am teaching a new course entitled “Turning your Clinical Cases into Scholarly Work.”

I hope to draw on my own experiences through the years mentoring students and residents in writing up several clinical cases, but also in making diagnoses.  In preparing for this course, I have also learned quite a bit about the controversy surrounding case reports and the challenges that they face in today’s healthcare system.

Unfortunately, case reports have …

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Case reports continue to be an important part of journal publication

Few health benefits from genomic discovery

Conditions and Diseases
October 23, 2010

by W. Gregory Feero, MD, PhD

Recent high-profile articles in the lay press have criticized the lack of immediately tangible health benefits from genomics research investment.

Expectations for immediate clinical benefit from genomic discovery, fueled by both scientists and the media, have outstripped even the blistering pace of genomic discovery. The gap between discovery and application is particularly notable in general medical practice, where only a …

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Few health benefits from genomic discovery

Is the critical value reporting system truly life saving?

Conditions and Diseases
October 18, 2010

We at the Los Angeles County/USC Medical Center are generally credited with having created the “Panic Value” or “Critical Value” laboratory reporting system in 1969.

A Panic or Critical Value is a laboratory finding at such variance with normal as to be life-threatening if something is not done quickly, and for which there is a corrective action that can be taken.

We determined that it was the laboratory’s responsibility to recognize such …

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Is the critical value reporting system truly life saving?

Common throat problems that sleep apnea sufferers face

Conditions and Diseases
October 17, 2010

If you wake up every morning needing to hack up lots of thick mucous or have throat pain, hoarseness, or a chronic cough, you’re not alone. You may think it’s the beginning of a cold, but a cold doesn’t continue for weeks to months without progressing into full-blown viral symptoms.

Instead, these symptoms are the beginnings of the most common throat problem sleep apnea sufferers face. And as I explain below, …

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Common throat problems that sleep apnea sufferers face

MKSAP: A 70-year-old man with a history of a systolic murmur presents with exertional dyspnea

Conditions and Diseases
October 16, 2010

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

mksap 15A 70-year-old man with a history of a systolic murmur presents for further assessment of exertional dyspnea. He has had dyspnea his entire life, but has noted a recent deterioration in his exercise capacity. He has no other medical conditions and is on …

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MKSAP: A 70-year-old man with a history of a systolic murmur presents with exertional dyspnea

Breast cancer and understanding your breast type

Conditions and Diseases
October 15, 2010

What does your breast type say about your cancer risk? Quite a bit, actually.

Whether you have large, small or lumpy breasts, self-awareness is very important. Getting to know how your breasts look and feel can help you recognize possible red flags.

Large vs. small breasts

When it comes to cancer risk, size really doesn’t matter. But, size can affect your mammogram and clinical breast exam.

For example, women with large breasts may need …

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Breast cancer and understanding your breast type

How time can be used as a diagnostic tool

Conditions and Diseases
October 10, 2010

I can’t remember which lecture it was, or even just when in my first two years of medical school the lecture was given, but I do remember how the concept struck me as really important.

The gist of the message was that the timing of onset of a patient’s symptoms is a key part of understanding the nature of the patient’s diagnosis. Symptoms from a neoplasm come on gradually, tend to …

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How time can be used as a diagnostic tool

Watchful waiting is underutilized for most men with prostate cancer

Conditions and Diseases
October 8, 2010

NPR has a great blog on their website called Shots about current events in health care. Recently, Scott Hensley, the main blogger there, posted a recent article on treatment of prostate cancer from the Archives of Internal Medicine.

If you look at the article, you may notice a very small subheading above the article’s title. It reads “Less is More.”

Very telling.

The thrust of the article and the …

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Watchful waiting is underutilized for most men with prostate cancer

When parents should be concerned about a lump on their child

Conditions and Diseases
October 8, 2010

I was recently scanning an online forum about pediatric health concerns. (What can I say? I sometimes need inspiration.) One thread within the forum was significantly longer than any other. Parent after parent posted about how they had noticed a knot on their infant or toddler. This concern parallels what I see in practice. An unexplained knot on the head is a common reason parents bring their child to be …

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When parents should be concerned about a lump on their child

Early diagnosis of panic disorder can improve quality of care

Conditions and Diseases
October 7, 2010

by Stephen R. Blumberg, PhD

As a panic disorder specialist, I take an active responsibility in helping my patients feel confident that their physical complaints have no organic etiology. 

My day is filled with my patient’s reporting symptoms of heart palpitations, shortness of breath, chest pressure, rubbery legs, lightheaded feelings, inner trembling, numbness and tingling in the extremities, lump in the throat, knot in the stomach and head pressure, to name …

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Early diagnosis of panic disorder can improve quality of care

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10 good things that can happen from cancer

Conditions and Diseases
October 6, 2010

The following list is from a cancer survivor, Judy Engibous, posted on Hester Hill Schnipper’s blog Living with Breast Cancer.

We first published it back in March of 2009 but are “reloading” it in recognition of Showtimes’ The Big C starring Laura Linney. We were wondering if the story could be considered an example of “Participatory Medicine” with Linney’s character being an “e-patient.”

10. Being able to shamelessly make fun …

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10 good things that can happen from cancer

Patients and physicians should screen for cancer, but cautiously

Conditions and Diseases
October 6, 2010

To screen or not to screen? That is not the question.

The question is not whether to screen, it is why, what, where, when, how, and how much, how often, and at what cost for what benefit.

Patients and physicians must and do screen. The issue is cautious appropriateness. Self-screening by patients is easy, free, and fundamentally harmless. Look at your skin for potential melanomas, be alert to warning symptoms of a …

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Patients and physicians should screen for cancer, but cautiously

Catherine Zeta-Jones blames doctors for Michael Douglas’ throat cancer

Conditions and Diseases
October 6, 2010

Why is Catherine Zeta-Jones so mad?

It’s a facetious question. Her husband, Michael Douglas, was recently diagnosed with throat cancer he described at “stage 4.”

She was quoted by People magazine as saying, “It makes me furious they didn’t detect it earlier.” They have young children, and anyone who hasn’t personally been faced with this threat can only imagine her fear and anxiety. I suspect no number of large houses, expensive cars, …

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Catherine Zeta-Jones blames doctors for Michael Douglas’ throat cancer

Pfizer spending money to train journalists in how to cover cancer

Conditions and Diseases
October 5, 2010

The National Press Foundation is sponsoring a four-day, all expenses paid trip to Washington for 15 reporters to learn how to improve their coverage of cancer issues. Pfizer is funding the seminar.

Former University of Minnesota journalism professor Gary Schwitzer writes:

Even if National Press Foundation staff choose the speakers and set the agenda, even if the Pfizer “guy never even showed up” last year, even if one reporter doesn’t recall Pfizer …

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Pfizer spending money to train journalists in how to cover cancer

We’re not ready for do it yourself genetic analysis

Conditions and Diseases
October 5, 2010

You may be wondering why Stanford Medical School’s new genetic interpretation class – the one that offers medical students the opportunity to study their own genes – has made the news. After all, what better genes are there to study than your own? And if you were a medical student, wouldn’t you want to have your medical school subsidize 80% of an $800 test as part of your curriculum – …

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We’re not ready for do it yourself genetic analysis

Cake with a terminal cancer patient

Conditions and Diseases
October 4, 2010

by Krupali Tejura, MD

A fellow physician called me with a consult this afternoon.

He described the case as a 60 year old who had stridor (difficulty breathing) for the past week and was admitted to the hospital recently. A CT scan showed lymph nodes in his neck which was compressing the trachea, and other scans didn’t show much better. A biopsy was done but the final results were …

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Cake with a terminal cancer patient

Children who are difficult may not be simply toxic

Conditions and Diseases
October 2, 2010

As a pediatrician I have listened to many parents speak of their child in very negative terms. Dr. Richard Friedman, in his New York Times article entitled Accepting That Good Parents May Plant Bad Seeds shares his patient’s description of her “rude and defiant” teenage son. Like the parents in his piece, the parents of my patients have other children with whom they have had no such …

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Children who are difficult may not be simply toxic

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