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Test your medicine knowledge: 48-year-old woman with fatigue

mksap

Conditions and Diseases

October 17, 2015

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

A 48-year-old woman is evaluated for fatigue and intermittent abdominal discomfort of 2 months’ duration and occasional dark urine. Medical and family histories are unremarkable. Her only medication is an oral contraceptive pill.

On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure is 125/74 mm Hg, pulse rate is 68/min, and respiration rate is …

Lab coats and scrubs don’t make the physician

Edwin Leap, MD

Physician

October 16, 2015

I was working at a small hospital when I heard the nurses talking about a new rule. The rule was that the only people who could wear lab coats would be physicians and administrators. It made me laugh a little. I’ve hated lab coats since medical school.

I currently sport what a family medicine resident told me was the ER mullet: khakis and polo shirt. (Who knew?) I find it much …

Learning to become a doctor is like panning for gold. Here’s how.

Jessica Sallstrom

Medical Education

October 16, 2015

Throughout most days of clinic rotations, I envision myself panning for gold. Just like I pretended to do as a young child. I am standing in a river that courses through a mountainside somewhere in West Virginia. It is a warm August afternoon; I roll up the pant legs of my overalls and wade into the water, which is just cold enough for you to keep noticing it. As each …

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Why did she want to become a doctor? Read her personal statement.

Jennifer Chevinsky, MD

Medical Education

October 16, 2015

Alright, here you go future medical school applicants. Here it is. My personal statement for medical school, written four years ago.

***

Strolling down busy, student-filled Rue Mouffetard, I was surprised to turn around and see my friend’s swollen eye as he ran off; he had been punched in the face. Thirty seconds later, his cousin was attacked and pushed against a car. Initially confused and terrified, I sprinted across the narrow …

When doctors stalk their patients

Kunmi Sobowale, MD

Health Technology

October 16, 2015

I peeked. Several months ago, I met a 60-year-old woman with shortness of breath. Her hospital stay was a whirlwind. She had lost weight, and a test detected her stool had blood in it. This was an ominous sign. Within a few hours, she underwent a colonoscopy that revealed she had colon cancer. The colorectal surgery team whisked her away from my general medicine team. I soon left that hospital for …

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When doctors stalk their patients

Our training, ourselves: The impact of defunding Planned Parenthood

Kira Neel and Jennifer Tsai

Physician

October 15, 2015

Approximately one in three women under the age of 45 have had an abortion.

Approximately one in three women under the age of 45 have a tattoo.

Think about your community. How many tattoo parlors can you think of? How many can you easily access?

How many abortion clinics can you think of? How many can you easily access?

A cursory, ten-second search for “tattoo” yielded more than 40 results within a 5-mile …

Primary care doctors love their work. It’s time for America to love them back.

T. R. Reid

Health Policy

October 15, 2015

“I love my job.”

Throughout the year 2015, a national campaign called Health is Primary has held seminars with primary care doctors around the country. The point was to remind Americans of a basic truth about health care: Primary care physicians are the lynchpin of any health care system. In every country, more emphasis on primary care leads to better health outcomes at lower cost.

I got to be the moderator for …

What health care can learn from forest preservation

Birju Rao

Health Policy

October 15, 2015

Health care providers and patients alike have been physically and emotionally frustrated when dealing with health care’s rising cost. Legislative restrictions based on cost often defy logic and common sense in a way that most people have never encountered. But what is it specifically about the health care market that gives us these fundamentally perverse situations? Many point fingers at insurance companies, big pharma, hospitals owned by private equity firms, …

The NIH meets Kickstarter: DreamRCT is back for 2015

Joel Topf, MD and Jordan Weinstein, MD

Conditions and Diseases

October 15, 2015

dreamrct

The most valuable assignment I received in fellowship was to write a few textbook chapters. I wrote on sodium, calcium, potassium, phosphorus, and magnesium for three different chapters. I had already developed deep knowledge of electrolytes writing “The Fluid and Electrolyte Companion,” but writing these chapters forced me to look beyond how things work and dive into how we know how things …

The day I went to work and met a real vampire

Archana Reddy Shrestha, MD

Conditions and Diseases

October 15, 2015

It all started out seeming like a pretty routine visit. My patient was in her early 30s and had come into the emergency department for weakness and was in no distress.

As I was talking with her about her symptoms she would flash the occasional smile. It was then I noticed that she had fangs. Not the kind that some people naturally have from misaligned teeth, but she had really long, …

Tips for patients to help ensure an accurate diagnosis

Martine Ehrenclou, MA

Patient

October 14, 2015

If you weren’t aware of the prevalence and severity of diagnostic errors, (misdiagnosis, missed diagnosis, delayed diagnosis) maybe you should be now.

The Institute of Medicine (IOM) released a new report called, Improving Diagnosis in Health Care. The report cited that most people will experience one or more diagnostic errors over their lifetimes. It also revealed that diagnostic errors contribute to 10 percent of patient deaths and account for up …

Who’s to blame for the price Daraprim? It’s not who you think.

Brian C. Joondeph, MD

Medications

October 14, 2015

Daraprim is a drug that no one ever heard of unless they are taking it. It is used to treat toxoplasmosis, a parasitic infection, has been around for decades, and is prescribed typically in patients with weakened immune systems, such as those with AIDS. Daraprim has been newsworthy because a small company, Turing Pharmaceuticals, recently purchased the drug from Impax Laboratories for $55 million, and promptly raised the price of …

Can we blame Martin Shkreli for succeeding in a system that we created?

Peggy Bui, MD, MBA

Medications

October 14, 2015

Recently, public outrage over Daraprim’s price hike from $13.50 to $750 was loud and clear — so loud that its CEO Martin Shkreli had to rescind it. In the business world, he might be praised as a savvy investor. He saw a product that was drastically undervalued and priced it at a level that the market was willing to bear, reaping huge profits. This type of mentality is a trait many …

3 successful physician social media stories

Kevin Pho, MD

KevinMD

October 14, 2015

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

During my social media journey, I’ve gathered a few anecdotes that I’d like to share with you. The first story is an internal medicine physician in Las Vegas, Zubin Damania. You may have heard of him, because he’s also known as Read more…

3 successful physician social media stories

We need full transparency for hospital chargemaster prices. Here’s why.

Peter Ubel, MD

Health Policy

October 13, 2015

If she had been eligible for Medicare, the hospital would have charged the government $10,000 for the services it provided to her, with Medicare picking up most of the tab. But lacking insurance, she was billed directly from the hospital, and not for a mere $10,000. The total charge: $120,000!

That 1,200 percent markup is extreme. But out of the 50 U.S. hospitals with the largest price markups, 49 are for-profit …

A nurse by herself. At the end of a life.

Amanda Anderson, RN

Conditions and Diseases

October 13, 2015

I softly scrub blood from the teeth of a man who died moments ago. From the chair where I sat quietly writing nursing notes while he quietly ended, my patient’s sallow skin and sunken cheeks looked so peaceful. But the weeks of stagnant residue on his teeth bothered me.

To brush the teeth of someone who was in the process of dying would have contradicted my orders to provide comfort care, …

The people who changed the world may surprise you

Michael Kirsch, MD

Physician

October 13, 2015

Patients are cool. I did a colonoscopy on a hospitalized man who was saddled with the ravages of obesity, diabetes, sleep apnea and respiratory disease. My partner had performed the initial consultation, and it was my task to bring light into a dark place by performing a colonoscopy. I engaged in some conversation prior to the procedure, not simply to acquire relevant medical facts, but also to establish some rapport …

The world of the eager medical intern is one that I am accustomed to

Jordan Grumet, MD

Physician

October 13, 2015

He squeezed into the elevator just as the door was closing. There was a lightness about him, an excitement. His jacket was newly pressed and uncomfortably free of nicks or stains. He stood at attention with perfect posture. There was no sign that working at this early hour on a Sunday morning, nor even being awake, was something out of the ordinary. Extraordinary.

He glanced over at my tattered lab …

People are people — whether manic, suicidal, or delusional — and it is a privilege to care for them

Kristin Prentiss Ott, MD

Conditions and Diseases

October 12, 2015

It’s not always obvious. Sometimes patients register with a chief complaint like “headache.” They tell the nurse their head has been hurting for months and deny fevers, etc. They get put in a room, and when you take the history, there’s nothing remarkable until you ask just the right question:

“So, what do you think is wrong? Are you worried about anything in particular?”

“Well, I think it’s probably the plate they …

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People are people — whether manic, suicidal, or delusional — and it is a privilege to care for them

A surgeon conquers her anxiety. See how she did it.

Heather Fork, MD

Physician

October 12, 2015

Can anxiety be severe enough to cause a physician to leave medicine? Absolutely. I know a number of physicians who have left for this reason. In my coaching practice I am increasingly aware of the toll anxiety takes on many doctors and am making it my mission to bring more attention to this problem and to find solutions. The physicians I have talked to are just the tip of the …

Real physician voices, twice a week

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