Here is a standard emergency department situation, played out all across America today.
Patient X has schizophrenia. He takes medication, but only until he feels better. He is calm when he takes it, but sometimes aggressive and assaultive when out of treatment and off medications.
Patient X decides to leave town and drive somewhere else because he is angry at 1) family 2) significant other 3) health care system 4) situation.
He is …
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A 23-year-old woman is evaluated for 2 weeks of painful lumps on her legs. The lumps persist for several days and make it difficult for her to go to work as a waitress. She is a college student in Ohio where she has lived her whole life. She has …
It’s become a common practice in oncology institutions across North America: A patient completes their prescribed course of treatment and they ring a bell. Usually, it’s a large bell, like one that used to be rung in schools signaling the end of recess. Or it’s a ship’s bell, attached to a wall outside the radiation department or the chemotherapy unit. …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 69-year-old man is evaluated during a follow-up visit. He initially presented with a 3-month history of chest pressure and dyspnea that occurred primarily with exertion. Despite maximal medical therapy, his symptoms have not abated and adversely affect his quality of life. Medical history is significant for type 2 …
Global climate change is reaching a critical mass.
Since the advent of the industrial revolution, we have seen the global mean temperatures increase by 1°C (1.8°F), and significant steps must be taken by 2030 to mitigate an even larger global temperature increase of 1.5 to 3C as predicted by 2030. In other words, we are in dire need of change.
This change is not only reliant on governmental policy change but is …
The incidence of brain trauma has been rising in recent years. According to the Centers for Disease Control and Prevention (CDC), emergency department visits related to traumatic brain injury (TBI) increased by 53 percent in the U.S. from 2006 to 2014. For 2014 alone, the CDC reported about 2.87 million TBI-related visits, hospitalizations, and deaths. Reports of concussions in high school athletes have also increased in recent …
We’re all gonna die.
It’s a simple truth that an astounding number of people neglect to acknowledge or accept. Some people die sudden, unexpected deaths, but most eventually fall victim to chronic or terminal conditions like COPD, heart failure or cancer. As a palliative care physician, I often meet patients who have had conversations with their families about their end of life wishes and have completed supporting legal documents.
While I appreciate …
Words have meaning. And when it comes to cancer, especially advanced cancer, there aren’t many words that have more meaning than the word “cure.” It is that very word and concept that is top of mind for some of us these days.
We clinicians are guilty as charged when it comes to reluctance declaring those who have had a remarkable response to treatments for advanced cancer “cured.” Experience has taught us …
The common practice in this country (although not everywhere — Europe, for example) has long been to treat all acute middle ear infections (otitis media) with antibiotics. This is not necessarily needed. We now know that for many children another reasonable approach is to wait a day or so to see if the symptoms get better on their own without antibiotics. Parents have an important role in making this choice. …
A patient walks into the doctor’s office and says:
I hate feeling this way. Yes, I know it’s not cancer and it won’t kill me, but this shaking has made me a different person. I can’t sign my name. I drop and spill things all the time. I’m afraid to pick up my baby grandson. I don’t go out anymore because I’m embarrassed. And I don’t know what can be done. …
In a recent People article, Jeopardy! host Alex Trebek shared some good news. Diagnosed with stage 4 pancreatic cancer in March, Trebek said he was told that he has been responding very well to his chemotherapy regimen, and that he’s in “near remission.”
He went on to say, “It’s kind of mind-boggling. … The doctors said they hadn’t seen this kind of positive …
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A 63-year-old woman is evaluated at a follow-up appointment after undergoing right hemicolectomy for colon cancer 1 year earlier. Her paternal grandfather had colon cancer diagnosed at age 75 years. She reports that she has been feeling well and takes no medication.
All physical examination findings, including vital signs, are …
Recently, a friend’s mother asked me how to best support her daughter’s decision to breastfeed her first grandchild. The new grandmother questioned her ability to encourage her daughter’s decision because she had not breastfed her own child, and this lack of experience made her feel unqualified to provide support. With mixed emotions and a lingering sense of guilt, this new grandmother wanted to learn, from a pediatrician friend, how best …
Two recent patient experiences prompted this post. In the Wall Street Journal, Dana Hawkins-Simons described several years of being seen by specialist after specialist for her complaints of tiredness, dizziness, ringing in the ears, palpitations, shortness of breath and “brain fog.” She finally researched her symptoms and demanded that she be checked for vitamin B12 deficiency, which turned out to be the cause of her symptoms.
Recently, the …
Most Saturdays, I join a therapy session down the hall from where I do my walk-in clinic. A patient of mine has a weekly session just before the Alcoholics Anonymous meeting at noon in our big conference room.
Last weekend he told my behavioral health colleague that the people in the AA group who have the most solid recovery seemed to be the ones who claimed to carry a lot of …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 48-year-old woman is evaluated at a follow-up appointment for elevated liver chemistry tests over the preceding 6 months. She reports no symptoms. She has type 2 diabetes mellitus and hypertension. Her family history is unremarkable. She drinks two glasses of wine one or two times per month. Her …
Samuel was an English gentleman hailing from London. Close to 10 percent of the U.S. population, over 30 million people, lives with diabetes. Five years ago, Samuel was diagnosed with type 2 diabetes. Taking lisinopril and glipizide, he also goes on hour-long walks every morning at 6:30 a.m. to keep his A1c at his comfort number of 5.5. It has not always been this way for Samuel as he was …
There is a condition known as cyclic vomiting syndrome which causes people to develop episodes or “attacks” of frequent vomiting lasting for a few days at a time without an apparent cause. Sufferers of cyclic vomiting are totally fine between episodes … it’s kind of like a migraine of the upper gastrointestinal tract! Just like treating migraine headaches, treatment of cyclic vomiting syndrome is aimed at identifying and removing triggers, and using …
It was the first time the young woman had come to the health center in a suburb just north of Chicago. When the 26 year old walked into the exam room back in 2008. There was no paper chart or electronic health record (EHR) accompanying her, no background information — nothing to indicate anything but a routine annual gynecological exam.
She and her husband were about to try to have their …
A wag once said: “There is no such thing as a healthy person, just one who has not had enough tests.”
As we make every minor deviation from the average into a disease, that jest is becoming uncomfortably close to the way our current medical system behaves.
Part of the problem is that many diseases represent an arbitrary cut-off of a number. Thus, hypertension is defined as a blood pressure above a …
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