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MKSAP: 66-year-old man with vague abdominal pain

mksap

Conditions and Diseases

January 3, 2015

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

A 66-year-old man is evaluated for vague abdominal pain of several months’ duration and a 10-kg (22-lb) weight loss. He drinks alcohol socially but does not smoke. The patient is otherwise well, has good performance status, and takes no medications.

On physical examination, vital signs are normal. No lymphadenopathy is noted. Cardiopulmonary examination …

The risks of water births cannot be dismissed

Jennifer Gunter, MD

Conditions and Diseases

January 2, 2015

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Water births, delivering a baby so it is born underwater, are controversial medically because while they are promoted as safe and natural by some midwives and lay midwives they are not recommended by the American Academy of Pediatrics and the American Congress of OB/GYN. (Laboring in a tub in an entirely different thing.)

The January 2015 issue of Emerging Infectious Diseases is reporting the …

3 ways to help reduce hospital readmissions

Suneel Dhand, MD

Physician

January 2, 2015

The enormous push continues to reduce readmissions, due in no small part to stiff financial penalties from CMS for the worst performing hospitals. The most commonly cited statistic is that about 1 in 5, or 20 percent, of Medicare patients are readmitted within 30 days. A staggeringly high number when you think about it. Having discharged thousands of patients and seen the characteristics of those patients that are frequently readmitted …

You could get fat from eating healthy foods. Here’s how.

Peter Ubel, MD

Conditions and Diseases

January 2, 2015

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Have you ever eaten a healthy meal, maybe some brown rice and stir-fried veggies, and found yourself ready for another meal just a short while later? Or, more often couldn’t overcome a hankering for a satisfying dessert to top off (and undermine the healthiness of) that meal?

As it turns out, this lack of satiety is not merely a function of the …

Serving for the Navy: The global force for good

Ira Nash, MD

Physician

January 2, 2015

A few years ago, the United States Navy launched a new recruiting and marketing campaign using the slogan: “America’s Navy: A global force for good.” The line was apparently a flop, and the Navy threw it overboard for “protecting America the world over,” but I liked it. I thought it captured a deep truth about the Navy, which is that it is undoubtedly a global force and that the force exists for …

Being a patient made me a better doctor and physician leader

Craig Mittleman, MD

Conditions and Diseases

January 1, 2015

It was last summer in July when I became sick. It was a range of not unusual upper respiratory symptoms, but as time progressed and my symptoms didn’t respond to the usual combination of steroids and antibiotics, I became concerned. I’d developed a more distinct pain in my chest and became increasingly mindful about those bad things we see from time …

The microbiology versus the psychology of kissing

Manoj Jain, MD, MPH

Conditions and Diseases

January 1, 2015

This year, we celebrated our 25th wedding anniversary. So, last week, one evening, I told my wife about a news story I heard on National Public Radio (NPR) about the microbiology of a kiss. My wife smiled.

A group of researchers, I said, looked at the oral bacterial flora of 21 couples to determine how many bacteria were transferred by a kiss. …

Remember to hold on: Navigating the waters of medicine

Starla Fitch, MD

Physician

January 1, 2015

In the world of medicine, we often feel like we’re swimming upstream without a paddle. Like we’re the only ones having problems out there. With no one to lend a hand. No wonder health care providers suffer from major burnout.

You would think when one is away on a great vacation, it’d be easy to rein in that feeling, to appreciate what truly matters.

Not always. Until it is presented to you …

Return the clinician to the center of the health care experience

Fred N. Pelzman, MD

Health Policy

January 1, 2015

I recently spent time at the New York eHealth Collaborative’s Digital Health conference.

The meeting was full of interesting seminars, informational sessions, presentations on innovative technology looming on the horizon, and talk about the future digital face of health care.

The hallways outside the conference rooms were full of administrators, legislators, consultants, and representatives of companies building and designing new resources to help transform the health care system as they see it.

Over and …

Stop the hyperbole when it comes to breastfeeding

Roy Benaroch, MD

Conditions and Diseases

December 31, 2014

Look here: I am a breastfeeding supporter. I regularly help new moms breastfeed successfully, and I even took a special class to learn how to do a brief procedure to help babies overcome breastfeeding problems caused by tongue-tie. I’ve got a happy breast support sticker, right on my AAP card.

But I think honesty is (or should be) the breast policy. Some …

It’s time to train physicians to practice in nontraditional settings

Elaine Khoong, MD

Medical Education

December 31, 2014

Despite the changes around us, the training of physicians has stayed much the same. Sure, there are new work hour limitations and a push to move towards competency-based assessments, but the overall structure of our training remains largely untouched. We spend the vast majority of our time training in hospitals, with the remaining time spent practicing in traditional outpatient clinics.

However, health care is being increasingly delivered outside these two arenas. …

KevinMD’s most popular posts of 2014

Admin

Potpourri

December 31, 2014

Thanks so much for visiting and reading KevinMD.com! 2014 was the busiest year yet.

Below are the most popular posts of the year, measured by number of shares on Facebook, Twitter, LinkedIn and Google+. Enjoy.

1. Frozen in the hospital! Watch medical students sing Let It Go. The University of Chicago Pritzker School of Medicine Class of 2016 sings “Let It Go,” or …

Read more…

KevinMD’s most popular posts of 2014

Is it time for a suicide certificate?

James C. Salwitz, MD

Physician

December 30, 2014

Physician–assisted suicide: the collaboration of two through a professional relationship, to cause the death of one.

Ever since Socrates took hemlock, suicide has been part of society, sometimes supported, often condemned. Today, many argue that we have a right to die, sort of an infinite extension of free speech or thought. Regardless, to actively involve doctors is a unique distortion of the medical arts, as if stopping a beating heart can somehow …

Read more…

Is it time for a suicide certificate?

How the kind, humble physician met his demise

Jordan Grumet, MD

Physician

December 30, 2014

There once was a kind, humble physician who worked for years in an office building across the street from the hospital, toiling day to day to take exceptional care of his patients. He was open and deliberate, calm and thoughtful. He himself hired every secretary and medical assistant, every nurse, and biller. His staff formed a protective family who fiercely advocated …

Fixing our broken health care system: Sometimes David wins

Allen Frances, MD

Health Policy

December 30, 2014

You couldn’t invent a worse health care system than the nightmare we have created in the U.S. Our medical costs are almost twice as high per person as they are in most other similar countries but produce only mediocre outcomes.

There is massive overtreatment of people who don’t need it, while many who desperately do have no coverage at all.

The payment incentives …

Improve the diversity of physician assistants

Richard Bottner, PA-C

Medical Education

December 30, 2014

The issues around race and how it plays out in modern day American society are numerous, deeply personal to many and utterly complex to most. The incidents in Ferguson, Mo., which began in August and erupted late November in nationwide protests, are an example of the many problems with race relations that persist in our country. While I believe we have made significant progress since the civil rights movement began, …

Will the psychologists involved in torture be held accountable?

Bob Doherty

Health Policy

December 30, 2014

Whatever happened to “first, do no harm?”

One of the findings included in a Senate investigative committee’s report on the U.S. government’s post-9/11 torture program was that it was designed by two psychologists. They were paid “$80 million to develop torture tactics that were used against suspected terrorists in the wake of the September 11 attacks on the Pentagon and the World Trade Center” — including “waterboarding and mock burial on some of the …

How much more would you pay for hospital safety?

Peter Pronovost, MD, PhD

Physician

December 29, 2014

What is it worth to be treated in a hospital with a stellar patient safety record rather than one with lower performance?

For a large majority of survey participants in a recent study by researchers from the Altarum Institute and Drexel University, the answer is quite a lot. Published online last month in the Journal of Patient Safety, the study found that most respondents would choose a hospital with a …

Why you can’t believe all the health articles that you read

Shirie Leng, MD

Physician

December 29, 2014

I have recently become a card-carrying member of the Association of Health Care Journalists. Lofty title for a lowly blogger, but I’ll take it. There are two main advantages to this membership, at least that I can see so far. The first is access to the full text of online journals, key to actually discussing research intelligently. The second is the …

How medical students can change the culture of medicine

Pooja Yerramilli, MD

Medical Education

December 29, 2014

“All of you want to help people and save the world now. But, by the end of medical school, only two of you — if we’re lucky — will remain idealistic.”

Within the first three days of medical school, I had heard three different lecturers tell me that I would lose my compassion and empathy. By the end of the first three weeks, that number had grown to six. During the …

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