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MKSAP: 52-year-old man with fatigue and fever

mksap

Conditions and Diseases

June 29, 2013

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

A 52-year-old man is admitted to the hospital with fatigue and fever of 3 days’ duration. He is a health care worker and has a bicuspid aortic valve. He takes no medications.

Blood cultures are obtained at the time of admission, and he is started on empiric vancomycin for possible endocarditis.

On hospital day 2, …

Some patients are receiving too little care

Trudy Lieberman

Health Policy

June 28, 2013

Twelve years ago, in its landmark study Crossing the Quality Chasm, the Institute of Medicine (IOM) found that “the health care industry is plagued with overutilization of services, underutilization of services, and errors in health care practice.” In simple English, the IOM reported that health care was riddled with overuse, underuse and misuse of medical services.

The IOM also defined quality health care as “the degree to which health services for …

For some, a loss of independence is a worse fate than falling

Suzanne Koven, MD

Physician

June 28, 2013

A moving van pulled up to my house the other day. It contained the last of my mother’s belongings, a few pieces of furniture that neither my brothers nor I nor our children had wanted. It’s been over four years since Mom died and we finally gave up trying to sell the things down in Florida, where they’d been sitting in storage.

Among the items was a china cabinet fashioned from …

How should we be training the next generation of doctors?

Janice Boughton, MD

Medical Education

June 28, 2013

I have been spending time at an academic medical center lately and I’m noticing some obvious flaws in our method of shaping the doctors of the future.

When I went to medical school I was trained by physicians who were eminent in their areas of specialty and also did some research. They taught in classrooms and as attending physicians when we were working on the wards as doctors in training. I …

Obamacare fails by not listening to the voices of the caregivers

John Mandrola, MD

Health Policy

June 28, 2013

When an employee leaves a position, management might conduct an exit interview. The idea is obvious: one can learn a lot from those who are free to speak candidly.

This is why I think it’s worth listening to doctors who no longer practice medicine.

Enter Dr. Ed Marsh, a former pediatrician, who writes this poignant and relevant essay. His tone and candor is one of a man who still cares about …

Nelson Mandela: His doctors and nurses also need our thoughts

Dr. Martin Young

Physician

June 28, 2013

Mandela_2_0

If I had to choose the way I could die, I would probably like to go peacefully in my sleep. It seems that Nelson Mandela no longer has that option. He may have had, and perhaps even been on that trajectory when he was rushed to hospital in the middle of the night more than two weeks ago. It would not have …

What being a primary care patient has to do with home renovation

Leslie Kernisan, MD, MPH

Physician

June 28, 2013

shutterstock_136905509

In 2006, as I was starting my geriatrics fellowship, we started renovating our home.

This took almost two years from start to finish. It was a long, arduous, expensive, and often stressful process. And this experience ended up profoundly influencing my philosophy as a primary care physician, and my approach to practicing medicine.

To this day, I’ve had minimal experiences as a primary care …

Why shared decision making is difficult in practice

Davis Liu, MD

Physician

June 27, 2013

As a practicing primary care doctor, I very much believe that better care is when patients are engaged and share decision making with their doctor. Though in the past doctors treated patients in a paternalistic manner, my generation of doctors has been taught to uphold a balanced doctor-patient relationship and partnership. This change in balance of power has accelerated with the ease and availability of information via the internet. More …

Family physicians are more comfortable with uncertainty

Richard Young, MD

Physician

June 27, 2013

Family physicians told us they are more comfortable with uncertainty than the “ologists.” For a little history, the Future of Family Medicine project published in 2004 identified this mental attribute as an important defining skill of family physicians.

This ability manifests itself across the entire spectrum of family medicine.

An example is reassuring a young mother that her infant with a fever will probably be fine – and ordering no …

Listen to the stories behind substance dependence

Arjune Rama, MD

Physician

June 27, 2013

“You don’t have any idea what you’re dealing with, do you?” asked Mr. Johnson a mere two minutes into my interview. The scene is the Crisis Intervention Unit. The time is 3:00am. I have a feeling my breath is terrible. The hospital pizza I engulfed earlier in the evening has decided to stage a churning acidic protest in my guts. However, far worse than my half-closed eyes, my halitosis or my …

Chronic care at Walgreens: Should we see how this plays out?

Ishani Ganguli, MD

Physician

June 27, 2013

Walgreens, the country’s largest drugstore chain, announced that its 330+ Take Care Clinics will be the first retail store clinics to both diagnose and manage chronic conditions like asthma, diabetes, high blood pressure, and high cholesterol. The nurse practitioners (NPs) and physician assistants (PAs) who staff these clinics will provide an entry point into treatment for some of these conditions, setting Walgreens apart from competitors like Target and CVS whose …

We vastly oversimplify the reason that people become obese

Barbara Berkeley, MD

Physician

June 27, 2013

The AMA recently announced that they now considered obesity to be a disease. This announcement set off the usual firestorm: swarms of posts and comments on the internet and elsewhere by highly opinionated people, each of whom was certain of his or her position.

There were those who were predictably outraged (“obesity is solely the result of gluttony and lack of will power!”) and those who welcomed the new label as …

What will health care teams mean for patients?

Jessie Gruman, PhD

Patient

June 27, 2013

Have you heard that soon most primary care in the U.S. will be delivered by teams?

Yep. Team-based care is one of the characteristics of the patient-centered medical home, a way of organizing the care of patients that allows primary care clinicians to see more patients in a day while at the same time delivering better care. This move toward team-based care started long before health care reform and was embedded …

How the purpose of primary care is defeated

Deepika Srinivasan

Health Policy

June 26, 2013

My friend Anne loves her primary care doctor.

“He is a really good guy,” She recently told me. You can just tell. You can hear his big booming laugh in the waiting room, the examination room, the bathroom. You don’t even mind waiting for him when his last appointment runs over because you know that he will give you his undivided attention when you’re with him. And you know that if …

Violence against women: Save her life and treat her injuries first

Mona Singh

Patient

June 26, 2013

According to a WHO report, more than a third of women experience sexual or physical violence around the world. At such pandemic proportions, violence against women is a serious global health and public policy problem.

In addition to increasing a women’s vulnerability to depression, alcohol use disorders, pregnancy-related complications, and STIs, including HIV, intimate partner violence is a significant cause of death and injury:

42% of women experience injuries from physical or …
Read more…

Violence against women: Save her life and treat her injuries first

The early success of a new practice model

Rob Lamberts, MD

Physician

June 26, 2013

It feels dangerous to write this, but … my practice seems to be working.

But as afraid as I am to admit it, the thing that was once just a good idea is now actually growing and improving. We are up to about 300 patients (with a big infusion when a local TV network did a story on my practice) and have enough money to pay bills without a visit from …

Why EMR companies don’t care about usability

David Do, MD

Health Technology

June 26, 2013

I overheard nurses praising the pilot of a new technology with the promise of improving communication, safety, and saving on healthcare spending. The innovation: two-way texting. That’s one of the many indicators that hospitals are stuck the technological stone age.

Imagine how many eyes light up when you offer providers fewer logins, autopopulating forms, and uncluttered menus. There’s an assumption that technology, in the context of healthcare, has to be bad …

When a child can’t feel his poops

Roy Benaroch, MD

Conditions and Diseases

June 26, 2013

Kathy wrote about her son: “What can cause a 9-year-old boy to poop in his pants occasionally and not feel it? He was completely potty trained at age three. I have found dirty underwear and poop on the bathroom floor–and it just concerns me that he is unaware of it. It has been suggested at checkups that he may be constipated. My mother suggests he may simply not be paying …

Read more…

When a child can’t feel his poops

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