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MKSAP: 27-year-old man with a marked change in overall behavior

mksap

Conditions and Diseases

March 24, 2012

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

A 27-year-old man is evaluated for concerns noted by his wife of a marked change in overall behavior over the past 6 months, including deterioration in his general hygiene and episodes of talking to imaginary people. His employer has also raised concerns about his work performance. The patient has also noted intermittent tingling in the …

How technologists and insurers can help doctors

Wendy Sue Swanson, MD

Physician

March 23, 2012

When I was a medical student and resident physician, those around me taught me how to distrust the pharmaceutical industry and how to distrust the insurance companies. The drug companies just wanted the public to buy their medications (to get rich) and the insurance companies just wanted to block services for my patients (to get rich).

The more I learn as a physician, the more I realize how little I know.

The …

Physicians are gloomy about health reform

Patricia Salber, MD

Health Policy

March 23, 2012

Recently, The Doctors Company (TDC), the country’s largest insurer of physician and surgeon medical liability, decided to survey doctors to determine what they are thinking and feeling about health reform. The results are pretty gloomy.

To put this in context, it is important to understand a bit about how TDC conducted the survey. First of all, the universe of doctors they reached out to were doctors insured by The Doctors Company. That means …

A POLST form documents what patients value

Jim deMaine, MD

Physician

March 23, 2012

Marge was aging and gradually “falling apart”, as she would say. “First it was my back, then my knees, and now my heart is giving out”. She confronted her doctor with this in a frustrated manner, “I’m no good for anything anymore. I can’t really enjoy the things I used to. Most of my friends have died off, so maybe I’m next”.

The doctor in sizing up Marge’s advanced age and …

Don’t give up on your patients, some will absolutely amaze you

Susan Biali Haas, MD

Physician

March 23, 2012

Do you, or people you care about, have a chronic medical condition? There are all kinds of chronic diseases, but the ones that are most aggressively killing us—and the health care system—are heart disease, diabetes, and metabolic syndrome (a deadly combination of excess weight, high blood pressure, increased cholesterol and elevated blood sugar). These are all primarily lifestyle diseases and cancer should probably be on the list, too.

I felt sad …

Let me end my life in peace, surrounded by family

James C. Salwitz, MD

Patient

March 22, 2012

Ok, you caught me. I am mortal. After four score or so years, my body will fail and I will live no longer. Dust to dust. Not thrilled, but I expect most of you are the same. I have but two final requests. Let me end my life in peace, surrounded by family. Second, please, do not let me “pass”… I really want to die.

Like you, I have struggled through …

The secret to successful aging

Rev. Amy Ziettlow

Patient

March 22, 2012

I recently arrived home from a youth service trip to St. Louis. On the 11-hour ride home in a 22-year-old, 15-passenger van with no A/C and no tape deck, and the cigarette lighter powering a small portable fan in the third row of the van, we listened to more radio than I have listened to since I was a sophomore in high school.

Several members in the van love country music, …

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The secret to successful aging

Tips for your online health information search

Toni Bernhard, JD

Patient

March 22, 2012

Last year, I was referred to two different dermatologists because I have two skin conditions and each dermatologist is an expert on one of them. (I know how fortunate I am to have access to this level of medical care.) Something amusing happened at each visit.

After examining me and deciding on a course of treatment, the first dermatologist said, “When you get home, don’t look up this condition on the …

A medical student reflects on the clinical year transition

June-Ho Kim

Medical Education

March 21, 2012

So this is what it feels like to have a rush of adrenaline in crisis—a potent mix of excitement and panic.

I yelled out the patient’s name and shook him. No response. The only sounds were the shuffling of the sole nurse at the foot of the bed and the electronic hum of the myriad medical machines decorating the room. I slammed my fingers into the patient’s carotid arteries. No pulse.

As …

Mexico needs more pediatricians

Cesar Lucio, MD

Physician

March 21, 2012

Being a child in 21st century Mexico utterly differs from any other era. The last decade has been a constant whirlpool for Mexico. Political, cultural and economical changes have shaken the country to its core. Primary care physicians, particularly pediatricians, have a burdensome challenge at hand.

Problems like obesity have quickly emerged in all age groups. Obese children, childhood type 2 diabetes and sedentary lifestyles have invaded Mexican homes. Nutrition related customs …

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Mexico needs more pediatricians

Residency directors and board certification can work together

Thomas Pane, MD, MBA

Medical Education

March 21, 2012

Residency directors have a challenging job. They are entrusted with selecting young doctors and training them over the course of several years. Newly graduated medical students are thereby turned into internists, surgeons, radiologists, pathologists and the like. Fellowship directors build upon this foundation with extra training, setting the stage for these graduates to become clinical experts in their respective fields.

The Maintenance of Certification (MOC) process adds an additional and continued …

Empathy should be the basis of patient care

Kevin R. Campbell, MD

Physician

March 20, 2012

When dealing with patients and families coping with life threatening illness, one of a physician’s greatest interventions may be that of empathy. Defined simply, empathy is the responsiveness to the emotional state of another person—we try to understand another’s experience. It is a process that requires effort and intention. Sympathy is an awareness of another person’s situation and is an almost “autonomic” type response. Sympathy is important and is part …

It’s time for a primary care workforce surge

Andrew Morris-Singer, MD

Physician

March 20, 2012

Primary care residency numbers didn’t change much this year. Depending upon your vantage point, that’s either a good or bad thing. For those who were hoping that the numbers would continue that 2-year steady climb out of the dumps, the 1% increase in FM positions seemed to be a disappointment. But for many of us who work day to day to revitalize the primary care pipeline, we breathed a sigh …

What health care can learn from a Super Bowl loss

Davis Liu, MD

Physician

March 20, 2012

Although my team, the New England Patriots lost Super Bowl XLVI to the New York Giants in one of the most exciting and tense games in recent memory, reviewing both the pre and post game coverage provided even more learning for doctors and healthcare than my prior post. One can demand excellence and still fall short. When one fails to achieve the intended goals, the learnings can be as …

Should medical schools be mandated to teach nutrition?

George Lundberg, MD

Medical Education

March 20, 2012

Doctor, do you know a lot about human nutrition? You said “yes?”

Congratulations, if that is true. But I suspect that South Carolina Congressman Joe Wilson’s infamous quote “you lie” is applicable.

American medical schools traditionally have done a horrible job with their curricular treatment of clinical nutrition. University curricula are controlled by the faculty and, when the faculty don’t know or care much about a topic, it often gets short shrift.

I …

Cancer pain is often undertreated

Jennifer Kelly, MD, PhD

Conditions and Diseases

March 20, 2012

Pain is the result of a physiological series of electrical and chemical events that occur in the body. The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.”

Pain receptors are bare nerve endings that are widely distributed throughout the body in the skin and mucous membranes. When pain receptors are …

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Cancer pain is often undertreated

Will patients accept focused networks in today’s economy?

Kevin Pho, MD

KevinMD

March 20, 2012

In a bid to save money, health insurers are coming out with what’s known as “focused networks,” which typically exclude the highest cost hospitals.

In the Boston area, one such plan comes from health insurer Harvard Pilgrim Health Care, whose plan excludes Partner’s Health Care institutions. That’s significant, since Partners includes the famed Massachusetts General Hospital as well as Brigham and …

When medical students first deal with death

Dr. Irma Faruqi

Medical Education

March 20, 2012

Very few are as starkly aware of the transience of life as those working in the healthcare profession. We are expected to be, for want of a better word, immune to it; as if each death we face is somehow a vaccine that will eventually, with regular booster doses, provide us with enough immunity to be resistant to the Grim Reaper.

We spend years studying, arming ourselves with pages and pages …