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MKSAP: 54-year-old woman with shortness of breath

mksap

Conditions and Diseases

April 12, 2015

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

A 54-year-old woman is evaluated for shortness of breath of 3 months’ duration and a 4.5-kg (10-lb) weight loss over the preceding 2 months. She has a 35-pack-year smoking history.

On physical examination, temperature is 36.9 °C (98.4 °F), blood pressure is 145/82 mm Hg, and pulse rate is 108/min. Oxygen saturation is …

Abortion: Caught between an oath and beliefs

Anonymous

Medical Education

April 11, 2015

Medicine is an area of study that is bursting with countless gut-wrenching ethical debates. Throughout our medical training, even in some medical school interviews, we are asked and tested on how we would personally navigate the delicate tightrope of right and wrong.

Trying to maintain equilibrium between our personal beliefs and those that are best for our patients can often be difficult. On one side of our acrobatic act, we are …

In the midst of child abuse, the face of an angel

Lawrence R. Ricci, MD

Physician

April 11, 2015

Angel was then, and is even now, one of the most beautiful babies I have ever seen and I have seen many in my thirty years as a child abuse pediatrician. Yet, to look at her today, asleep against her foster mother’s shoulder, one could never guess at the devastation wrought upon her.

I first met Angel, then only a few months old, in the pediatric intensive care unit just before …

How doctors and families can work together in patient care

Ravi Parikh, MD

Physician

April 11, 2015

Mr. U* came to the hospital overnight with severe heart failure. His breathing was supported by a ventilator and he was sedated. Thus, our primary means of communication was via his daughter. His daughter, distraught, stayed awake through most of the night. She appeared suspicious about her father’s care, immediately asking my credentials when I entered the room and demanding that we discuss treatment decisions with her alone. The next …

MKSAP: 28-year-old man with pain on the radial aspect of the right wrist

mksap

Conditions and Diseases

April 11, 2015

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

A 28-year-old man is evaluated for pain on the radial aspect of the right wrist that occurs with use of the thumb. The pain has been present for 2 weeks. He has never had this pain before and has not had any trauma. He works as a computer programmer and plays video …

Can I add you to my list of medications?

Jacques Balayla, MD, MPH

Physician

April 10, 2015

Medicine is filled with intricacies and subtleties about the human condition. Within these nuances, and embalmed with the science of the profession, lies the true art of medicine, a concept not hastily understood, nor easily defined. Although the practice of medicine continually changes in response to new biological understandings, novel technologies, and evolving cultural contexts, the ethical foundations of the clinical relationship between patients and physicians paradoxically remain constant. …

Alternative vaccine schedules dilute the vaccine message

Justin Morgan, MD

Conditions and Diseases

April 10, 2015

An increasing amount of parents are choosing to delay or spread out vaccines for their infants and toddlers. Dr. Allison Kempe and her colleagues at the University of Colorado School of Medicine found that in a typical month, 93 percent of pediatricians and family physicians reported that some parents of children less than 2 years of age requested to spread out their vaccines. The findings, published in the April 2015 edition …

What does it mean to be a health care leader?

James D. Grant, MD

Physician

April 10, 2015

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

Clearly, physicians are the leaders of the health care team. We were educated and trained for that role.

But on the business and political sides of health care, maybe not so much.

One reason is that the word “leadership” has a lot of different meanings. A leader in one …

Does the attire determine professionalism?

Adam Bitterman, DO

Physician

April 10, 2015

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I recently sat down with a well-known physician within the orthopedic community as well as among the medical socialites of social media. When I walked into his office, the first words out of his mouth were about my attire. As I was concerned about first impressions, I broke out the fancy suit, custom tailored, of course, a matching shoe and belt …

Are we ordering too many food allergy tests?

Roy Benaroch, MD

Conditions and Diseases

April 10, 2015

People like tests. You get numbers, and maybe a printout, and there’s science and blood and things just feels more … serious, when testing is done. You can picture Marcus Welby (or perhaps a more modern physician), looking solemn, declaring “We’d better run some tests.”

Are medical tests magical and mysterious, and can they unlock the secrets of life? Usually, no. And among the worst and most misunderstood tests we do are …

What does meaningful use stage 3 mean to you?

Margalit Gur-Arie

Health Technology

April 10, 2015

On March 20, 2015 the stars aligned to produce four simultaneous events that will never again coincide during the life of human civilization. The first three, the vernal equinox, a total solar eclipse and a new supermoon, were brought to us by the stars themselves, and the fourth one was thrown out there by the government. The regulations for meaningful use stage 3 were finally published. Meaningful use of electronic health …

Obamacare re-enrollment: What can patients do?

Kevin R. Campbell, MD

Health Policy

April 9, 2015

As the Obamacare machine continues to grind forward, many patients have re-enrolled in a second year of coverage. While most have not had to use their insurance (the young and healthy crowd), others have found their newly minted coverage to be far less than promised. High deductibles, and up front out of pocket expenses, forced many covered by the exchanges to avoid seeking regular preventative care. Prevention was one of …

5 tips to maintain work-life balance as a medical intern

Joyce Ho, MD

Physician

April 9, 2015

I was asked by one of my readers recently to write a post on how I maintain work-life balance during the all-consuming intern year of medical training. I love this idea because keeping myself sane while spending 80 percent of my time in the hospital has proven to be a constantly challenging task, and I’ve come up with a few ways …

Feeding tubes and the culture of patient safety

Michael Kirsch, MD

Physician

April 9, 2015

“Safety first” is a mantra of today’s hovering parents. It’s the default explanation that a parent invokes when an edict has been issued that cannot be challenged or reversed.

“Mommy, can I please have a water pistol?”

“I’m sorry, honey. You know how Daddy and I feel about guns. This is a safety issue. Now go and practice your violin and afterwards help yourself to some kale chips.”

The safety concept has crept …

Disease can humble any doctor

Jordan Grumet, MD

Physician

April 9, 2015

I remember being more confident that most of my peers. The look of dread on my fellow interns face pre-call, and the fatigue post-call always seemed unnatural to me. Maybe it was on account of my lifelong pursuit of medicine. I felt nothing but elation at the newly branded “M” and “D” that came after my name on the hospital badge. I was no longer a volunteer, no longer a …

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Disease can humble any doctor

The old school physician is who we should aspire to be

Suneel Dhand, MD

Physician

April 9, 2015

A couple of weeks ago I was on-call and had to go down to the emergency room to see a patient. Before I entered the room, I was told that the patient was accompanied by her long-time physician who was a bit “crazy and old school.”

“Hmm … that’s strange … why would her physician be in the room with her?” I …

To my patients: An apology and a thank you

Abraar Karan, MD

Medical Education

April 9, 2015

As a third-year medical student, I realized one particular morning on rounds that I had let the demands of the job overtake the joys of why I went into medicine at all. I found myself running behind my team, barely even able to say goodbye to the last patient we had seen. The human interaction had become an afterthought in the …

The Uber lessons for medicine

Regina Druz, MD

Health Technology

April 8, 2015

As the rugged beauty of the Pacific Coast unfolded in all of its splendor, I was in awe of the entirely different experience: the one created by our Uber driver, Calvin (name changed to protect anonymity).

My friend and I, attending our annual cardiology meeting in sunny San Diego, carved out a few hours of rest and relaxation. We were heading to La Jolla, a scenic seaside community about 20 minutes …

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The Uber lessons for medicine

A global perspective can change how you diagnose patients

Vincent DeGennaro, Jr., MD, MPH

Physician

April 8, 2015

“Doctor, I have trouble breathing when I walk up stairs, and I cannot lie flat in bed, so I have to sleep sitting in a chair. I feel much worse than before I got pregnant.” I recognized the diagnosis at that point, but I continued the appointment to confirm my suspicions and to revel in the art of medicine.

I listened to the young woman’s lungs, full of crackles from fluid backup, …

I inwardly watch my life’s blood flow away. And no one notices.

Maureen Hirthler, MD

Physician

April 8, 2015

I’m walking very slowly with my dad down the produce aisle at the local supermarket, past the colorful waxed apples, Mexican mangoes and Rainier cherries, and imagining my life’s blood trickling onto the floor from an invisible wound.

As I pass by the misting system spraying the bins of green, red, yellow and orange peppers, past the lady reaching for carrots, past the stock guy balancing the heirloom tomatoes into a …

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