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MKSAP: 60-year-old woman with gastroparesis

mksap

Conditions and Diseases

December 5, 2015

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

A 60-year-old woman is evaluated during a routine follow-up appointment. She has gastroparesis associated with long-standing type 2 diabetes mellitus. Improved blood sugar control and efforts to eat small, frequent meals did not result in symptom improvement. In addition to these interventions, metoclopramide was started 6 months ago, after which her nausea and periodic vomiting …

What it’s like to talk to patients, then cut them open

Anonymous

Physician

December 5, 2015

Every time I walk through the automatic sliding doors, that strong smell of ammonia stings my nose. The lobby is clean — too clean — with a vast amount of open space leading to the front desk. The just-below-comfortable air brushes against my skin, raising the hair on my arms and legs. Almost cold enough to be a morgue — but that’s later. The room is silent, except for the …

The general radiologist is still valued. Here’s why.

Dr. Saurabh Jha

Physician

December 4, 2015

In times of shortage, we find out what we value most. And in these times of relative penury in the job market for radiologists, it appears that employers value — above and beyond anything else — the general radiologist.

Yes, the general radiologist. The radiologist who is able and willing in one shift to perform a barium enema, follow the intricate anatomy of the inner ear on an MRI of the …

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Why EMRs require cloud-based solutions

Tashfeen Ekram, MD

Health Technology

December 4, 2015

In a recent post Rocky Bilhartz outlined some of the challenges health care providers face when working with software. Health care providers are spending more time in the digital world and less time interacting with patients. The problem of less patient contact, in part, accounts for their complaints leading to the desire to streamline repetitive tasks so they can get back to why they really choose to be …

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Why EMRs require cloud-based solutions

Use the power of psychology to ace your medical school interview

Shirag Shemmassian, PhD

Medical Education

December 4, 2015

Receiving medical school interview offers simultaneously provides relief, justifies the incredibly hard work you’ve put into your primary and secondary applications, and confirms that you are indeed cut out for medicine.

In other words, you’ve convinced them — at least on paper — that you will succeed in their program and make an excellent doctor.

So why do they even want to interview you?

Consider what schools can only learn about you in …

Physicians need to recognize the power of vulnerability

Sanj Katyal, MD

Physician

December 4, 2015

One of my best friends from high school is battling with leukemia. I remember days hanging out in my room, listening to music (we were both huge REO Speedwagon fans), shooting Nerf hoops and talking about life (mainly girls at that time). We were not sure of what life would bring, but we knew we were destined for big things.

Denny was always more confident than I was at the time …

You have a dysfunctional hospitalist group. Can it be fixed?

Tracy Cardin, ACNP

Physician

December 3, 2015

I was talking with a colleague in another section today, and she was noting the difference between our hospitalist group and her section. She has somewhat intimate knowledge of our section because she did a year with us before moving on to her specialty fellowship. She is a bit frustrated with her new home and its team members because she feels like there are a lot of “B’s.” You know …

The child is father of the man

Samuel M. Chen, MD

Physician

December 3, 2015

It was several decades ago when my father, not long retired from a lifetime of denominational service as a chemistry professor, noticed pain in his abdomen. Initially attributing this to ingestion of some excessively hot tea, he ignored it for a time, hoping that, like many ailments, it would dissipate on its own. When it did not, he sought medical attention.

He ended up at the hospital where I worked, and …

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The child is father of the man

A medical student resents having to make smart choices. Here’s why.

Anonymous

Medical Education

December 3, 2015

The human experience is an exercise in connection. Nothing is seen, heard, or felt in isolation. This is what can make womanhood in a large urban city so challenging. A catcall is not a single comment, heard on a single morning about the tightness of your jeans or the way your hair falls; but instead carries with it every unsolicited thing you’ve ever heard about your body, a shadow of …

Dealing with my patients’ losses. And the losses in my own life.

Monisha Vasa, MD

Physician

December 3, 2015

My patient sat in front of me, silent. She was a beautiful, elderly woman, always well dressed in bright, matching outfits, and not a single hair out of place. Her lipstick was perfectly applied. She normally had a quick wit, joking about how she might drop a few knickknacks from my office into her handbag on her way out.

Not today. Today her tears flowed. Today was the day she grieved …

5 health questions every presidential candidate should answer

Robert Pearl, MD

Health Policy

December 2, 2015

With fewer than 100 days until the first primaries, the leading candidates have received ample airtime to address the important issues our nation faces. But even though health care accounts for around 18 percent of our nation’s GDP and consumes close to half of the total tax revenue collected by the federal government, their silence on providing solutions to the most pressing health care challenges our nation faces continues with …

Doctors are growing uncomfortable with procedures. Is training to blame?

Briana Buckner, MD

Medical Education

December 2, 2015

It’s 2 a.m., and the patient’s blood pressure is beginning to rapidly decrease. Every IV line is occupied by an antibiotic or IV fluids, and we are in need of a vasoactive medication. The nurse comes to my computer and sternly states, “We can no longer avoid it. I think the patient needs a central line.” I quickly say “OK,” but I don’t move. I am momentarily frozen by my …

Cheerios recalled for not being truly gluten free. An overreaction?

Michael Kirsch, MD

Conditions and Diseases

December 2, 2015

Gluten is in the news again. Gluten and probiotics are among the two dietary issues that most consume my patients. I am asked for my opinion on them several times each week. Although my opinion is solicited, these patients have largely already made up their own minds as they are often avoiding gluten and swallowing zillions of “good bacteria” with zeal and enthusiasm.

Why do they do this in the absence …

Do psychiatrists have value? Yes, they do.

Maria Yang, MD

Physician

December 2, 2015

While slogging through a crappy first draft of a document about the value of psychiatrists in mental health and substance use disorder services, I did a literature search for supporting evidence.

I found nothing. (1)

“So how exactly are we helpful?” I mused out loud. Maybe we aren’t: There are groups out there who do not believe that psychiatrists can or do help anyone.

I am an N of 1. …

Listening to the patient is the first part of the physical exam

Ira Nash, MD

Physician

December 1, 2015

The first posting on my blog explained why I chose to name it “Auscultation.” I wrote that I wanted to promote a conversation, and that listening was essential to doing so. I went on to write: “With an obvious nod to my being a cardiologist, I believe auscultation has long been an act that defines us as physicians and connects us in a profound way with our patients. The act of …

When applying for residency, should medical students be quantified?

Heather Alva

Medical Education

December 1, 2015

It is the fourth year of medical school, and I have been dreaming in the language of ERAS (electronic residency application service). In less than one month, I will put my name into the sorting hat of applications as part of the match’s algorithm to interview, and hopefully I’ll be matched to a pediatric residency position.

Based on 2014 program director survey data published by the National Residency Matching Program (NRMP) …

With some planning and collaboration, small practices don’t have to sell to a hospital

Yul Ejnes, MD

Physician

December 1, 2015

A guest column by the American College of Physicians, exclusive to KevinMD.com.

Recently, I rummaged through some old files to throw out things I did not need. While marveling at how we stored documents back in the 20th century (and how little of what I saved I ever used), I came across a couple of interesting items. …

Social media is a powerful way to humanize physicians

Kevin Pho, MD

KevinMD

December 1, 2015

A continuing series on physician online reputation. Created in partnership with the Doctors Company as part of their social media resources for physicians.

It’s important to share the stories of health care professionals, because sometimes the media paints a negative portrayal of the medical professional.

I once wrote a column in USA Today talking about chronic pain management and how both doctors and …

This holiday season, ask the elderly what they’re thankful for

Edwin Leap, MD

Physician

November 30, 2015

It’s a well-known reality of health care economics that Americans spend a lot of money in the last year of life. I suppose that almost goes without saying, since serious illnesses and injuries that result in death are costly, at whatever age they occur. Being hit by a car and dying means you were hit by a car … in your last year of life. And that two weeks in …

Physicians are not providers: An open letter to the AMA and medical boards

Suneel Dhand, MD and William J. Carbone

Physician

November 30, 2015

Dear AMA and state medical boards,

The last few years have been a period of unprecedented change in the world of health care. The need to reign in costs, expand access, and ensure higher quality care — all at a time of rapid medical and technological advancements — has changed innumerable aspects of the practice of medicine.

Throughout this, one common theme has been the dedication and determination of hundreds of thousands …

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