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MKSAP: 52-year-old man with gradually progressive left knee pain

mksap

Conditions and Diseases

May 4, 2013

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

A 52-year-old man is evaluated for a 5-year history of gradually progressive left knee pain. He has 20 minutes of morning stiffness, which returns after prolonged inactivity. He has minimal to no pain at rest. He reports no clicking or locking of the knee. Over the past several months, the pain has limited his …

The Affordable Care Act: Spinning reform without real reform

Wes Fisher, MD

Health Policy

May 3, 2013

It’s been three years since the Patient Protection and Accountable Care Act (PPACA) became law. There have been widely divergent opinions published by journalists on the impact of the law for Americans: from a rose-colored account from the New York Times, to a not-so-peachy account published at Reason.com. Few doctors have ventured into this discussion.

The need for health care cost reform

I should start by saying that I am biased. I grew up in …

Is a board certified surgeon a safer one?

Chris Porter, MD

Physician

May 3, 2013

funny-bone

Am I safe surgeon, or merely a board certified one?

I usually spend Tuesdays fixing elective hernias. But the other day I was asked to clear a c-spine, handle an unexpected gynecologic finding, manage a pediatric trauma, resuscitate a septic ICU patient, and opine on a neck dissection. No, I wasn’t in Africa or 1985; I was sitting in front of a computer …

When should drivers retire from driving?

Juliet K. Mavromatis, MD

Conditions and Diseases

May 3, 2013

When should drivers retire from driving? This question is always difficult to answer. In our suburban car culture driving allows seniors to maintain their independence and prevents social isolation. However, at what point does it become unsafe for the elderly to drive and what are the risks?

One month ago my fit and about 80-year-old in-laws were involved in a serious car accident. A young …

Why family medicine was the best choice for me

Anoop Raman, MD, MBA

Medical Education

May 3, 2013

When I came to medical school, I was certain I wanted to do primary care. Despite the forces that steer many of us off the path – how many times have we heard, “but you’re too smart to do primary care!”? – after three years of medical school, I was still committed to primary care.

But I struggled with which type of program would be best for me. I applied to both …

Treating obesity: Comfort, affliction, and confusion

David L. Katz, MD

Conditions and Diseases

May 3, 2013

Perhaps you already know the behind-closed-doors guiding principles of the news media, but if so, I suppose I’m a bit naïve in comparison. I thought they would be all about reliably reporting the news. Instead, I learned this guiding principle during my days working as an on-air contributor for ABC News’ Good Morning America: “Comfort the afflicted, and afflict the comfortable.” This is by no means an ABC mantra; …

After the Boston Marathon, a reflection on New York

Don S. Dizon, MD

Physician

May 3, 2013

On April 15, 2013, my kids and I were in Stamford, CT, visiting with my sister, Precy, and her family. I had been reading when an email came up, stating a bomb had gone off at the Boston Marathon. I immediately turned to Twitter where #BostonMarathon had already started trending.

There before me, gruesome details emerged, coupled with …

How the silent exodus will worsen the doctor shortage

Robert Centor, MD

Health Policy

May 3, 2013

American Medical News has an important article – Will a “silent exodus” from medicine worsen doctor shortage?

Frustrated by mounting regulation, declining pay, loss of autonomy and uncertainty about the effect of health system reform, doctors are cutting back the number of hours they work and how many patients they see.

Between 2008 and 2012, the average number of hours physicians worked fell by 5.9%, from 57 hours a week to 53, and doctors …

Read more…

How the silent exodus will worsen the doctor shortage

The 7 point plan to losing weight without relying on willpower

Alex Lickerman, MD

Conditions and Diseases

May 2, 2013

A common belief, even among doctors, is that almost no one succeeds in losing weight in the long term. And for almost two decades, I’ve counted myself among the skeptics, being able to tally on the fingers of one hand the number of my patients who’ve managed to do it—literally less than five out of multiple hundreds, if not a few thousand.

When I stumbled across the ideas put forth in …

4 ways to beat time constraints and guide patients to better health

David B. Agus, MD

Patient

May 2, 2013

As doctors, we’re typically compensated for the work we do, not the hours we spend. Our jobs are structured so that we’re taxed for time, making even the most routine office visit feel like a race against the clock. Trying to develop a long-term strategy with a patient in this context is not time-efficient. It is, in fact, incredibly frustrating.

Yet medicine is a team effort, and we understand that we’re …

You can’t judge a hospital by its press releases

Trudy Lieberman

Patient

May 2, 2013

We in the press are accustomed to PR folks “advising” us of all the good things that hospitals do. They open new pavilions named for wealthy benefactors of new cancer and heart centers and children’s care, with media coverage of the ribbon-cutting ceremonies attended by famous faces. They buy big new machines that smash and diagnose illness and want the world to know about that, too.

But a press release that …

What medical professionalism means to me as a patient

Lisa Miller

Patient

May 2, 2013

As an employee of the ABIM Foundation, I’ve batted around the phrase “medical professionalism” for several years but it didn’t really hit home for me until I encountered it – and the lack thereof – as a patient.

Over the past six months, I’ve logged a few miles in the frequent patient program. I underwent a 13-hour craniotomy to resect a meningioma and woke up from surgery with nerve damage to …

This is what patient engagement really is

Rob Lamberts, MD

Physician

May 2, 2013

“Patient engagement.”

What is patient engagement? It sounds like a season of The Bachelor where a doctor dates hot patients. It wouldn’t surprise me if it was. After all, patient engagement is hot; it’s the new buzz phrase for health wonks. There was a even an entire day at the recent HIMSS conference dedicated to patient engagement. I think the next season of The Bachelor should feature a wonk at HIMSS …

My first day at the pediatric oncology clinic

Ashish C. Massey, PhD

Medical Education

May 2, 2013

“Aren’t those decorations looking nice?” asks a soft voice beside me.

Startled, I turn to find a young woman wearing a red-and-white sari. Her head and face are swathed in the folds of the sari, leaving only the large red bindi on her forehead clearly visible.

We’re sitting on a grassy tuft amid a large campus green. All about us stand buildings with signs in both Hindi and English. Atop the central …

The revulsion about feces: Get over it

Christian John Lillis

Conditions and Diseases

May 2, 2013

I have been struggling with a certain degree of cognitive dissonance following the announcement this winter of a study in the New England Journal of Medicine on the efficacy of fecal transplants as a therapy for clostridium difficile (C. diff) infections. While the study is the first to demonstrate the effectiveness of fecal transplants in treating recurrent C. diff infections (15 of the 16 patients in the group were cured …

Read more…

The revulsion about feces: Get over it

Would an ad influence your decision to go to the ER?

Ishani Ganguli, MD

Physician

May 1, 2013

You get a terrible headache. What do you do next? Take ibuprofen and try to sleep it off? Call your primary care physician (PCP) for an appointment? Dial 911 for an ambulance to take you to the emergency department (ED)? What if that headache comes with a cough and shaking chills?

Would an ad influence your decision?

I came across this image …

Medical residents expect the data to be fed to them

Wes Fisher, MD

Physician

May 1, 2013

“What’s the most important finding on this chest x-ray?”

There he was, standing before 5 ICU residents, each peering at a chest film on displayed on the over-sized computer screen.

“Um, the pleural effusion?” whimpered a third-year resident.

“No!” barked the attending.

The others, standing dumbfounded in front of the computer display, searching for another finding but finding none, stood silently.

“Come on, folks! Look!”

And try as they may, no one saw it.

“The name, folks, …

If only the patient had an advocate

Jordan Grumet, MD

Physician

May 1, 2013

It had all been so easy when Jim was still around. Lisa’s ex-husband had many shortcomings, but being a critical care specialist sure came in handy. Any time her mom or dad had a health crisis, he was right there in the middle of it: advocating, interpreting, breaking down the complexities into easily digestible morsels of information. But then Lisa’s father died, and the emotional and physical stress brought the unstable union …

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If only the patient had an advocate

Prevention isn’t about saving money: It’s about saving lives

David L. Katz, MD

Physician

May 1, 2013

Since an iron lung costs quite a few dollars, the prevention of polio cannot make sense. Right? If that one has you scratching your head, with a “say what?” dangling from your lip, we are on the same page. Let’s populate it accordingly. Of course prevention can save dollars. But that will only be the case when what we refer to as “prevention” really makes sense.

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