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MKSAP: 68-year-old man with dyspnea on exertion

mksap

Conditions and Diseases

January 23, 2016

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

A 68-year-old man is evaluated for a 3-year history of dyspnea on exertion. He experiences no headaches or blurred vision. Medical history is notable for a stroke 2 years ago. He is a smoker with an 80-pack-year smoking history. Medications are hydrochlorothiazide, lisinopril, aspirin, and simvastatin.

On physical examination temperature is 36.7 °C (98.0 °F), blood …

Why the physician shortage in the VA is a sign of things to come

Sarah Mongiello Bernstein, MD

Health Policy

January 22, 2016

The metallic mix of freshly spilled blood and sterile instruments engulfed his nostrils as he shifted uncomfortably in the cracked, worn, brown leather chair where so many others had sat before him. He tried not to sweat as the faceless, gray clinician coaxed the long needle deeper into his fleshy neck and watched as a rogue drop of crimson escaped and marred the otherwise pristine tile floor beneath him. He …

The rise of workplace confrontation in medical practices

Anonymous

Physician

January 22, 2016

The workplace environment can be full of many obstacles, especially in the medical field. These obstacles range from difficult patients, to navigating insurances, to burnout, and so on. One problem, however, appears to be worsening over time and seems to go without discussion. As life has progressed and I have transitioned from a medical student to attending physician, I have noticed an increase in workplace confrontation between employees. Is this …

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Childhood aspiration on food is a public health issue

Nina Shapiro, MD

Conditions and Diseases

January 22, 2016

Recently, new dietary guidelines were released, recommending reducing sugar intake overall, and reducing meat intake in growing boys. Last year, as we remain in the throes of a nationwide obesity epidemic, the FDA changed the nutritional labels we’ve become all-too-familiar with. The emphasis is now on calorie count of an “appropriate” serving size. So much for my pretending that the “appropriately served” pint of ice cream I just downed had 350 …

A hypocrite in a coffee shop

Nina Gaby, PMHCNS-BC

Patient

January 22, 2016

The woman in ill fitting snow pants and parka, as if there is such a thing as well-fitting snow pants and parka, clumps of blonde stuck-together hair poking out of her non-hipster cap, you know exactly what she looks like, stares at me from the sagging mid-century couch across the alcove in the café where I have set up my laptop, a scone, a huge cup of expensive coffee described …

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A hypocrite in a coffee shop

An Uber for health care is closer than you think

Davis Liu, MD

Health Technology

January 21, 2016

Will there be an Uber for health care? Articles are split. The truth is there will be an Uber for health care. It just isn’t here yet. Expect it to be widely available in the next decade and as a result, people will get expert medical care that is more convenient, less expensive, and accessible.

What issues must an Uber for health care solve?

Media articles that have prematurely proclaimed that Uber …

I’m grateful to be open for business. This doctor is in.

Emily Gibson, MD

Physician

January 21, 2016

I have the privilege to work in a profession where astonishment and revelation awaits me behind each exam room door.

In a typical clinic day, I open that door up to thirty plus times, close it behind me and settle in for the ten or fifteen minutes I’m allocated per patient. I need to peel through the layers of each person quickly to find the core of truth about who they …

Healing patients shouldn’t be killing doctors

Amaryllis Sánchez Wohlever, MD

Physician

January 21, 2016

Healing others shouldn’t be killing you. This warning in a physician recruitment ad pulled me in, while an image of a choking stethoscope triggered flashbacks of my years in medicine. Many physicians feel like they’re choking. Squeezed in from every angle. Stretched to the max. Spent.

And they feel this way right as they open the door to greet their next patient.

I know of a prominent office that lost three superb …

This is what you should know about Zika virus

Sarah Kohl, MD

Conditions and Diseases

January 21, 2016

Sometimes as a travel medicine doctor you feel like Red Riding Hood’s mother.

Your patients come in asking for advice about upcoming travels. Much like Red’s mother you want to wrap your patients up in a protective cape and guide them on safe travels.

You want to teach them to avoid any wolves that may be lurking out there. Like impetuous teenagers, your patients don’t always listen.

And Zika virus just made it worse …

The story of how a NICU nurse became a NICU mom

Linda Merritt, RN

Conditions and Diseases

January 21, 2016

My son Acton is truly a miracle baby because he was not even supposed to be here. I had gone through four years of infertility with three miscarriages and an ectopic pregnancy (pregnancy in my fallopian tube), causing my left tube to be removed. After my last miscarriage, I was told I was in perimenopause and had less than 1 percent chance of ever getting pregnant again, let alone carrying …

Dare to make yourself more human

Aleah Chang

Conditions and Diseases

January 20, 2016

“Hey mon, you alright?”

“You have a blessed day.”

“How is your morning walk pretty ladies?”

“Yeah mon, no worries. Everything alright.”

These “stock phrases” are just a few of the things I heard each and every day while staying in Negril, Jamaica. I travelled to the island to take a short vacation and also attend a destination wedding this past month. While on the island, I was pleasantly greeted by the local Jamaicans …

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Dare to make yourself more human

4 reasons to go vegetarian in 2016

Shivam Joshi, MD

Physician

January 20, 2016

If you have been thinking about becoming a vegetarian, there’s no better time to make the switch than the beginning of a New Year. For those of you have been on the fence, 2015 provided us with a few more reasons — like saving money and losing weight — to make the dietary transformation.

Reason #1: Vegetarian diets increase metabolism. Vegetarians have a lower body mass index compared to those eating meat, …

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4 reasons to go vegetarian in 2016

Stop comparing cancer with diabetes

Saurabh Dahiya, MD

Conditions and Diseases

January 20, 2016

It was that time of the year at the cancer center — with treats all around, chocolates, cookies and gingerbread houses, gifted from the patients to their doctors. Yes, it was the excess sugar holiday season. Most of these patients were follow-ups — the already established patients of the cancer center, expressing their gratitude in taking care of them in the tough times earlier in the year. Among all the …

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Stop comparing cancer with diabetes

Reducing hospital readmissions shouldn’t be that difficult

Stephen C. Schimpff, MD

Physician

January 20, 2016

Part of a series.

Among Medicare recipients, those discharged from the hospital incur about a 20 percent risk of an unplanned readmission within 30 days. The number is higher for some conditions such as heart failure. This is the result of a terribly dysfunctional health care delivery system. Of course some patients will need readmission; the number can never be pushed down to zero, but 20 percent is appalling.

Why …

Is the sports physical hazardous to your child’s health?

Hugo Scornik, MD

Physician

January 19, 2016

I am old enough to remember standing shirtless on a chilly afternoon in the school gym lined up with my fellow teammates while a volunteer doctor went down the row clearing us for school athletics in a medical assembly line. This scene has been a familiar rite of passage for generations of student-athletes. However in this day of modern preventative medicine, is the sports physical the best we can do …

My father is no longer a practicing neurologist, but he is forever a doctor

Shoshana Weiner

Medical Education

January 19, 2016

Curiosity and apprehension. I experience this tension as a young man ushers me through large daunting doors with “Authorized Personnel Only” posted in bold red letters. Inside, a massive machine dominates the room, and yet my focus turns to the patient lying on the table, face covered in a white mask holding his head still while the technician targets the malignant brain tumor.

“All right in there?” the specialist asks, and …

Physicians should invest time in work-life balance: It’s priceless

Eve Shvidler, MD

Physician

January 19, 2016

“As a mom and a doctor, what advice would you give a third-year medical student trying to choose a specialty?” the bright-eyed med student asked me.

Her smile was ear to ear, and I didn’t want to burst her bubble. This is a complicated question to ask and the answers change as life changes. I chose OB/GYN because it was the only specialty I truly fell in love with. For me, …

It’s often a bad idea when patients order treatment

James C. Salwitz, MD

Physician

January 19, 2016

I was confused. Perhaps, I needed another cup of coffee. The chart did not make sense. Ellen, who I was about to see because she was transferring her care, was receiving medication for cancer that was a simple pill; inexpensive, with few side effects. What confused me is that it was obvious the therapy would not work.

Baffled, I called the oncologist who had been treating Ellen for two years. A …

Patient satisfaction often forces doctors to “do something”

Marjorie Stiegler, MD

Physician

January 18, 2016

Recently, I read an article about a new mother’s experience taking her toddler to the emergency room after a face-first fall onto an iron table, bleeding profusely. After her child was evaluated, it was determined that no serious injury was sustained, and no further intervention (i.e. stitches) was needed, and the toddler was discharged home with some wound care instructions and a popsicle. When the mother subsequently …

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