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MKSAP: 28-year-old man with left calf deep venous thrombosis

mksap

Conditions and Diseases

February 23, 2013

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

A 28-year-old man is evaluated 24 hours after a new diagnosis of a left calf deep venous thrombosis. One week ago, he underwent orthopedic surgery. Two weeks ago, he returned from vacationing in Italy on an 8-hour flight. Current medications are enoxaparin, 80 mg subcutaneously twice daily, and warfarin, 5 mg/d.

On physical examination, temperature …

Raising a child alone in a culture of quick fixes

Claudia M. Gold, MD

Physician

February 22, 2013

Sam burst into the office, a two-year-old wild bundle of energy. Squealing with delight — or was it distress; it was hard to tell — he ran from toy to toy not looking at me or his mother, Jane. He was unable to engage with anything. Jane had brought him to see me in my pediatric practice because, “he hits me, has explosive tantrums, and I can’t take him anywhere.” …

Why the American problem with opioids and chronic pain is here to stay

Jennifer Gunter, MD

Physician

February 22, 2013

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America consumes 80% of the world opioid supply (99% of the world hydrocodone supply), but has about 5% of the world’s population. If you don’t think America has some kind of opioid problem, then move along because this rational, evidence-based, experience-laden way in which I’m going to discuss opioid use and misuse will not interest you.

To combat our opioidification the Read more…

Why the American problem with opioids and chronic pain is here to stay

The ethical breach surrounding the first test tube baby

Peter Ubel, MD

Physician

February 22, 2013

The first test tube baby was born July 25th, 1978 in the north of England. Louise Brown was called the “baby of the century” by some and a “moral abomination” by others. It wasn’t Brown who critics accused of being immoral, of course. She was just a blameless infant. Instead, it was her doctors who came under fire for their new fertility treatment—in vitro fertilization (or IVF). Roman Catholic theologians …

Filling out a death certificate: A better way is needed

John Schumann, MD

Physician

February 22, 2013

I’ve always had nagging doubts about filling out death certificates.

An excellent article in American Medical News explores the “inexactitude” of the custom.

Doctors are never taught how to fill out the documents. The article quotes Randy Hanzlick, MD, chief medical examiner for Fulton County, GA:

Training is a big problem. There are very few medical schools that teach it,” he said. “For many physicians, the first time they see it is when …

Read more…

Filling out a death certificate: A better way is needed

Why physicians tend to decline CPR and other heroic measures

Maria Yang, MD

Physician

February 22, 2013

Radiolab recently aired a show called “The Bitter End” that discusses the end-of-life care preferences of physicians and non-physicians. Physicians are much more likely to decline “heroic” measures, such as CPR, mechanical ventilation, feeding tubes, etc. This comes as a surprise to the hosts and, presumably, to other non-physicians. It’s a good show. I recommend it. (Full disclosure: I like Radiolab.)

In the show, Ken Murray argues that …

Why don’t doctors talk about death with their patients?

James C. Salwitz, MD

Physician

February 21, 2013

The failure of doctors to talk to their patients about end of life decisions perplexes me. This gap in vital communication results in poor care, uncontrolled pain, futile treatment and death in hospital or nursing home, where no patient wants to be. Certainly, for oncologists, every patient they see is concerned about dying and by not opening the topic it leaves each isolated.

I have generally taught my students that this …

Medical education: Reform the investment of tuition and time

Kevin R. Campbell, MD

Medical Education

February 21, 2013

When I was in medical school in the 1990s, students were given a bleak picture of the life of a subspecialist. We were told that there would be few job opportunities and that the only way to ensure a job was to pursue a career in primary care. Many of my classmates did go into primary care but the majority of us accepted residency positions in surgery, neurosurgery and other …

Can you really choose a hospital based on the best price?

Trudy Lieberman

Patient

February 21, 2013

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Consumerism in health care is coming to mean patients must shop around for the best price — for a doctor’s visit, Cipro, health insurance and maybe even your next operation. The marketplace gurus are telling us we can buy health care like TV sets and search for the lowest price tag.

But can you really choose a place for surgery based on the …

The path to data driven public policy: Ask the right questions first

David L. Katz, MD

Health Policy

February 21, 2013

Should marijuana be legal, for either medical or recreational use? I think the best initial answer to this is: It’s a crummy question! We are good at those.

It’s a crummy question, because it calls for answers based on unsubstantiated opinion. Answering it does not invoke or even encourage any relevant evidence, or precedent. So what would a better question be? How about: On what basis should any particular substance be …

Stop blaming patients for not doing enough to stay healthy

Bob Doherty

Physician

February 20, 2013

“Discrimination against heavy people, by the general public and medical professionals, might be a greater health and social problem than any extra pounds they may be carrying” argues UCLA Professor Abigal Saguy, PhD, in a provocative essay in the Washington Post.

“Despite the fact that body weight is largely determined by an individual’s biology, genetics and social environment, medical providers often blame patients for their weight and blame their …

Downton Abbey: Medicine then and now

Suzanne Koven, MD

Physician

February 20, 2013

If you have not yet seen the fourth episode of the third season of Downton Abbey and wish to be surprised by it, read no further. And if you aren’t watching PBS’s addictive costume drama currently set in 1920–and, seriously, why aren’t you?–read on anyway.

This is about medicine, then vs. now.

First, to recap the medically relevant aspects of the story: Lady …

Read more…

Downton Abbey: Medicine then and now

Make patients more accountable for their own health

Shirie Leng, MD

Physician

February 20, 2013

Let’s talk a little about health accountability. Two news items have provoked the following rant: why is it always someone else’s responsibility?

The first item was on NPR. The FDA, reacting to the epidemic of prescription drug abuse in this country, is offering incentives to the pharmaceutical company that can come up with a less addictive painkiller. Such a drug would be a gold-mine for that pharma company because it could …

The myth about screening for heart disease

Davis Liu, MD

Conditions and Diseases

February 20, 2013

An excerpt from The Thrifty Patient – Vital Insider Tips for Saving Money and Staying Healthy.

In the spring of 2008, NBC’s Meet the Press moderator and Washington bureau chief, Tim Russert, died suddenly of a heart attack at the age of fifty-eight. Time magazine identified him as one of the one hundred most influential people in world in 2008. His …

The young and healthy can die from influenza complications

Emily Gibson, MD

Conditions and Diseases

February 20, 2013

Nothing was helping. Everything had been tried for a week of the most intensive critical care possible. A twenty year old man, completely healthy only two weeks previously, was holding on to life by a mere thread and nothing and no one could stop his dying.

His battle had been lost against MRSA pneumonia precipitated by a brief influenza-like illness. Despite aggressive hemodynamic, …

Teaching children how to behave: 5 essential principles

Roy Benaroch, MD

Physician

February 19, 2013

Young children are naturally petulant, noisy, and self-centered. We’re all born with ourselves in the center of the universe, an impression reinforced by parents who must cater constantly to their young babies. But babies become toddlers, and toddlers become children. Sometime during this transition, parents have to teach their children that they are part of a family. For a family to function …

Anesthesiology and the heart: Working together for the best outcomes

John R. Rotruck, MD

Conditions and Diseases

February 19, 2013

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

February is a little more than candy hearts and heart-shaped arrows—February is prominent as American Heart Month, helping doctors and patients better understand cardiac health and how to best care for one of the most important organs.

Each medical specialist takes great care to focus on …

What would you do if this was your parent? I honestly don’t know

Miranda Fielding, MD

Physician

February 19, 2013

Yesterday I saw a 90-year old woman in consultation. She presented to the emergency room in September with abdominal pain, and in the process of working her up, a chest x-ray was taken which showed an infiltrate in her lingula, part of the left lower lobe of her lung.

As it turned out, there was nothing wrong with her belly, but a follow up CT scan of her chest showed this …

Academic promotion criteria should include social media

Wes Fisher, MD

Medical Education

February 19, 2013

“Doctor, could we have a copy of your most recent CV.”

“Sure,” I said, realizing it hadn’t been updated recently.

It is interesting how I approach my academic pursuits now. It used to be that it was “publish or perish” in the world of academic medicine. Of course, even now the only “publishing” that counts to the academic world is that of conventional peer-reviewed journals with high impact factors (or grant applications that …

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