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MKSAP: 53-year-old man with right-sided facial weakness

mksap

Conditions and Diseases

February 6, 2016

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

A 53-year-old man is evaluated for persistent right-sided facial weakness. Three months ago, he first noticed “droopiness” of the right side of his lower face, difficulty closing the right eye and wrinkling the forehead, increased sensitivity to loud noises, and occasional slurred speech. Bell palsy was diagnosed, and he began a 10-day course of prednisone. …

Slow health costs with grade-appropriate body education

Barbara Berkeley, MD

Conditions and Diseases

February 5, 2016

We physicians live in the shadow of rising health care costs. Hospitals want us to cut length of stays and somehow become more efficient. Insurance companies ask us to accept less money for patient visits, forcing us to see more people in fewer hours. The government wants us to check a slew of electronic boxes to prove that we’ve performed what they deem to be best practices, even though there is …

A nurse is confronted with the death of his mother

Dwight Barrett, RN

Conditions and Diseases

February 5, 2016

It will be six months since my mother passed away.

I kept my mother’s illness a secret. Not because I was ashamed and embarrassed but I did not want to advertise to the entire world of what she was going through out of respect to her and my family. So you sit there, put on a front like everything is cool and continue on your daily routine, until one day everything …

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Noise pollution is an epic problem in hospitals

Frederick Gandolfo, MD

Physician

February 5, 2016

Me: Hello Mrs. Smith, my name is [BEEP!] Dr. Gandolfo and I am a [BEEP!] gastroenterologist. [BEEP!] Your doctor wanted me to [BEEP!] talk to you about something that showed up on [BEEP!] your CT scan.

Mrs. Smith: Who are you? I [BEEP!] didn’t hear your name?

Me (louder): It’s Fred Gandolfo, I am the [BEEP!] stomach doctor. [BEEP!] I need to talk to you about [BEEP!] that CT scan you had. You see, there was … [BEEP!] [BEEP!] [BEEP!] Can you straighten your …

How do surgeons deal with their mistakes?

Dr. Eunice J. Minford

Physician

February 5, 2016

As surgeons we are privileged to have our hands work inside someone’s body with the intention of alleviating suffering, removing sources of pain, excising diseased organs, fixing this or that, ultimately to improve someone’s quality of life, prolong it or at times even save it.

Yet we also know that people can suffer complications from surgery, that in some cases are fatal, and where our good intentions seemingly backfire. Patient deaths …

I became a physician when I took off my white coat

Jeffrey McWilliams, MD

Physician

February 4, 2016

I walk out of a room filled with emotion and despair. A battle lost but the war rages on. I’ve seen miracles, often only a daily basis. Life is precious but peculiarly fragile while resilient and strong. Every emergency provider understands the feeling after a patient has passed. It’s the unexplainable reverence and daunting silence as I put on the white coat. It’s the echoing footsteps that never go away …

When doctors from another specialty miss a cancer diagnosis

James C. Salwitz, MD

Physician

February 4, 2016

Despite the years, I have not talked about this case. It is not a privacy/ HIPAA problem; rather, I did not want to upset the patient and family. I am not certain that was the right decision; at the time, it seemed best. Still, the patient died, the family moved on, and I carry a guilty memory.

It was after deteriorating months of corrosive cancer that we met. Multiple systems were …

The single most important lesson for doctors in training

Steven Zhang, MD

Medical Education

February 4, 2016

I recently saw a patient who, against all odds, survived an aortic dissection. Miraculously, he was alive after the wall of his aorta — the largest and most important vessel in the body — began to rip apart. Aortic dissections are so violent and agonizing that a large portion of these patients don’t survive. Yet somehow, my patient was still able to sit upright in his chair and recount his …

The truth about fevers in infants

Chad Hayes, MD

Conditions and Diseases

February 4, 2016

Fever phobia is common among parents. The vast majority of the time, these fears are unfounded, because a fever is very rarely a cause for significant concern. One important exception is in newborns under 2 months of age. Compared to older children, these very young infants are at high risk for serious infections, so any fever in this age group requires urgent medical evaluation. Here’s what parents needs to know …

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The truth about fevers in infants

Why this doctor won’t close her practice to new patients

Lucy Hornstein, MD

Physician

February 3, 2016

Closing a medical practice to new patients is like cutting off the very top of a tree. It’s the beginning of the end.

The top of the tree, the crown, is where the newest leaves are. It’s also the part that continues growing ever upward, at least until it reaches it’s maximal genetic height, depending on environmental factors like the availability of water and sunlight (both of which also depend on …

Anything but dignified: The problem with forced fetal remains arrangements

Jennifer Gunter, MD

Conditions and Diseases

February 3, 2016

Ohio is attempting to introduce legislation that would require abortion clinics to incinerate or bury products of conception from abortion. This legislation is already in place in Arkansas and Indiana. These laws are supposed to afford human tissue a “respectful and proper” end as lawmakers were apparently horrified that products of conception were disposed of as medical waste.

Medical waste is not an …

Physicians: Sometimes it’s not what you say, but how you say it

Val Jones, MD

Conditions and Diseases

February 3, 2016

Most physicians will be thrust into the role of patient or caregiver at some point during their careers. Unfortunately, it’s not until this occurs that many become fully aware of the finer points of excellent care and communication. Take, for example, the simple act of reporting test results to a patient. We do this every day, but may not realize that how we frame the information is as important as …

Celebrate National Women Physicians Day #Iamblackwell #NWPD

Hala Sabry, DO, MBA

Physician

February 3, 2016

It’s amazing what you can learn from the stranger sitting next to you on a flight.

As I wait for my neighbor to grab her seat next to me, I secretly hope she embodies the qualities I hope for in a fellow passenger — keeping to herself and not requiring in-flight medical assistance. I make eye contact with a young woman who gives me the nod that she has the middle …

The interview before transferring to a new doctor

Hans Duvefelt, MD

Physician

February 3, 2016

Today I met a man who wanted to interview me before transferring his records.

He was about my age and seemed polite and pleasant enough. He told me his doctor of a dozen years had started to taper him off his long-term narcotics after he reported some of them missing because of theft. He used to take the equivalent of about 1,200 mg of morphine per day for his back pain. …

The remarkable story of a psychiatrically hospitalized clinician

Liat Katz, LCSW-C

Conditions and Diseases

February 2, 2016

I am a licensed clinical social worker. And, occasionally, a mental patient. Today, in this inpatient psychiatric unit, I am more a patient than a social worker.

It is Monday morning, and I am eating breakfast across from Owen, a muscular, flannel-clad, Paul Bunyan-looking patient. Little pieces of his scrambled eggs keep landing on his copper-colored beard. I sort of want to motion with my hand at where the eggs are …

This is the key to shared decision-making with patients

Don S. Dizon, MD

Physician

February 2, 2016

I like to consider myself an “evolved” clinician — one who believes in the patient’s voice, personally invested in shared decision-making, always ready to support my patient’s decisions, as long as I know it’s informed by the best data I have available, even when it is not the course I would want them to make. Most of …

A kind word at bedside can be life-changing for patients

Jeffrey McWilliams, MD

Physician

February 2, 2016

As a goal-oriented individual, I pack my days with appointments, deadlines, and to-do lists. Unfortunately, the time I spend getting from one task to the next gets lost in my focus on end results — a common blindness of Westerners who measure success or achievement by results and not by how one “plays the game.” As parents, we teach our children it’s not whether you win or lose, but how …

Doctors: Feel like a fraud? You’re not alone.

Arlene S. Chung, MD

Physician

February 2, 2016

Imposter syndrome (n.): Term coined in 1970 by psychologists and researchers to informally describe people who are unable to internalize their accomplishments despite external evidence of their competence.

When I was in medical school, I remember walking outside the library and trying not to glance inside to see how many of my classmates appeared to be meticulously studying for final exams. I remember trying to ignore their off-hand, and occasionally self-congratulating, …

You’re a doctor and you’re sick. Make your health a priority.

Joyce Park, MD

Medical Education

February 1, 2016

Last week I, like many around me, came down with a horrible cold. My husband got sick the week before and was in bed all weekend sleeping and trying to recover, and lo and behold, come Monday, I started having the same symptoms.

I knew the approximate course of the cold since I’m a doctor, and I saw my husband go through it, but I thought I could be strong and push through. I continued …

Don’t rely on Google for medical judgment

Michael Kirsch, MD

Physician

February 1, 2016

You see your gastroenterologist with long-standing stomach pain. You have undergone a reasonable evaluation and all the endoscopic bodily invasions, and imaging studies of your abdomen have been normal. Repeated lab work provides no clue explaining your distress. You have been twice to the emergency room and were sent home with prescriptions that didn’t work. You are frustrated and so is your gastro guy. You are convinced that there is …

Real physician voices, twice a week

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