Conditions

The questions surgeons need to ask their seniors before surgery

Conditions
August 13, 2019

The decision seemed straightforward. Bob McHenry’s heart was failing, and doctors recommended two high-risk surgeries to restore blood flow. Without the procedures, McHenry, 82, would die.

The surgeon at a Boston teaching hospital ticked off the possible complications. Karen McHenry, the patient’s daughter, remembers feeling there was no choice but to say “go ahead.”

It’s a scene she’s replayed in her mind hundreds of times since, with regret.

On the operating table, Bob …

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What are patients’ responsibilities for their health?

Conditions
August 11, 2019

I expect my patients to develop or sense responsibility in connection to their health because I believe personal responsibility creates the basis for a constructive, therapeutic relationship and healing process.

My experiences as a patient have made me understand how difficult it can be to maintain a sense of responsibility. I often yearn for clarity and a “gameplan,” but instead find myself confronted with medical guideline gray areas and conflicting treatment …

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Elon Musk’s girlfriend had eye surgery for depression. Is there science behind that?

Conditions
August 7, 2019

Claire Elise Boucher, 31, known professionally as Grimes, is a Canadian singer, songwriter, record producer, and visual artist. Her music incorporates elements of varied styles, including dream pop, R&B, electronic music, and hip hop. Since 2018, Boucher has been in a relationship with technology entrepreneur Elon Musk.

Grimes recently became the star of a new Adidas advertising campaign. In announcing this new …

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The importance of patient education before surgery

Conditions
August 6, 2019

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

For years, research and common belief have supported the concept that patient education alters patient behavior and improves patient outcomes. For instance, lifestyle changes, implemented after improved physician-patient engagement and education, have demonstrated clinical benefits in a wide range of chronic illnesses, …

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UpToDate? Information my cardiologists didn’t have.

Conditions
August 4, 2019

I have always felt lucky and relieved when a cardiologist told me I seemed to be fine despite my heart condition. My condition, referred to as congenital, complete AV block, is estimated to affect between 1 in 15,000 to 22,000 live-born infants. The electrical block is more commonly seen among older, adult patients where it presents an acute pacemaker indication.

Researchers do not know very much about what causes the condition …

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A critical discussion is needed about planned death

Conditions
August 4, 2019

“Planned death.”

When you put it like that, this can only mean one of two things: suicide or murder. For most of us in medicine, the very idea of “planned death” seems safely outside our purview. After all, the bulk of medicine is concerned with staving off death. And the very nature of death’s uncertain timing enables practitioners of everyday medicine to take refuge in its mystery.

When necessary, we prognosticate. But …

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Beware the hidden agenda of free hernia screenings

Conditions
July 31, 2019

Some hospitals are trying a curious new tactic to attract patients: free hernia screenings.

One Illinois hospital raffled off tickets for a smart speaker to entice people to get their abdomens checked by a surgeon, while an Indiana hospital offered a chance to win dinner at a chophouse.

Announcements for screening events in Colorado and Maryland warned about “life-threatening” complications that could arise if hernias are left untreated. And hospitals in Read more…

Paltering: When the truth is used to deceive

Conditions
July 28, 2019

One evening in the clinic’s bullpen provider office, a colleague of mine wondered aloud how to respond to a difficult question a patient asked via patient portal message. A physician within earshot responded, “Just because someone asks you a question doesn’t mean you have to answer that question.”

I tried to empathize with where the physician was coming from. Surely after decades of practicing medicine, one might become weary of spending …

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Don’t lower the voting age, says this neurosurgeon

Conditions
July 19, 2019

On several occasions, most recently during a press conference in March 2019, Speaker of the House Nancy Pelosi has advocated changing the voting age to 16. Pelosi told reporters that lowering the voting age would increase engagement in politics among younger Americans and would help drive a higher level of voter awareness and turnout.

Speaker Pelosi is not the only prominent lawmaker to advocate for a lowered voting age. Also in …

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The default for psychiatric patients: “Send them to the ER”

Conditions
July 15, 2019

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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MKSAP: 69-year-old man with chest pressure and dyspnea

Conditions
July 6, 2019

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 …

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How climate change affects your skin

Conditions
June 27, 2019

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 …

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Concussion treatment centers: 5 red flags to watch for

Conditions
June 25, 2019

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 …

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How to have an exciting death: 5 tips from a palliative care physician

Conditions
June 25, 2019

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 …

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What should a cure for cancer look like?

Conditions
June 23, 2019

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 …

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Are antibiotics needed for your child with an ear infection?

Conditions
June 22, 2019

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. …

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Steadying patients’ fears about shaking hands

Conditions
June 21, 2019

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. …

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