KevinMD.com

MKSAP: 58-year-old woman with acute left-sided flank pain

mksap

Conditions and Diseases

January 28, 2012

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

A 58-year-old woman is hospitalized for acute left-sided flank pain. She has had fever and night sweats for 1 month and a 9.1-kg (20-lb) weight loss over 6 months.

On physical examination, temperature is 37.7 °C (99.8 °F), blood pressure is 135/88 mm Hg, pulse is 88/min, …

Diagnosing an illness is an art

Stewart Segal, MD

Physician

January 27, 2012

Diagnosis is the foundation on which all care and treatments rest. If the diagnosis is wrong, most probably so is the treatment. Diagnosing an illness is an art. A diagnostician needs to be one part scholar, one part detective, and four parts artist. He has to be a good listener, open minded, and capable of assimilating a large amount of sometimes confusing data into an accurate picture of a disease …

Read more…

Diagnosing an illness is an art

Patient engagement is the holy grail of health care

Steve Wilkins, MPH

Patient

January 27, 2012

For health care professionals, patient engagement is the holy grail of health care. It is the key to patient adherence – a prerequisite to achieving better outcomes, fewer ER visits and hospitalizations and more satisfied patients. It is easy to recognize an engaged patient – they do what their health care providers recommends …what their health care team knows what is right for them.

But doesn’t engagement depend upon your perspective?

In …

Physicians have a natural role as advocates

Danielle Rosenman, MD

Physician

January 27, 2012

As physicians, we are often called upon to be advocates for our patients. Sometimes they have no other person to turn to. At those times, in particular, we evaluate their health in the context of relationship, family, and workplace. Having practiced family medicine for so many years, and now in counseling medicine, I have had the responsibility of advocating for my patients with their health insurance companies, within their families, …

Our society expends huge sums on futile care

Jim deMaine, MD

Physician

January 26, 2012

Mike was a runner, outdoors-man, and fitness nut. This was not so much as for health reasons as for “feeling good”, but he did hope that it would help him avoid illness. It was worrisome when he started with some belly cramping and noticed some blood streaks in his stools. It took about a month until he could be scheduled for a colonoscopy. The news was shocking. “There’s a cancer …

How Patrick Swayze died: Why we should care

Barron H. Lerner, MD

Conditions and Diseases

January 26, 2012

When I finished my book on famous patients, the most common question I received was “Are the stories of sick celebrities really relevant to other patients?” My answer was that yes, with some caveats, these experiences are well-worth knowing.

The same can be said for the story of Patrick Swayze’s terminal pancreatic cancer, which has now been told by his widow, actress Lisa Niemi Swayze, in a new book, “Worth Fighting …

Reclaim your life from urinary incontinence

Kevin O'Neil, MD

Conditions and Diseases

January 26, 2012

“I laughed so hard, tears ran down my leg.”

That was a quote from a sign I saw on vacation last summer. While we read it and laugh, we all know what it means. “How’s your bladder working?” is a common question that I ask patients in the office. The responses I get include, “fine, except when I ____”, or, I’m fine as long as I know where the bathrooms are. …

Why the prognosis of patients is difficult

Ken Covinsky, MD

Health Technology

January 25, 2012

Many clinical decisions in older persons are dependent on life expectancy. For example, as life expectancy declines, cancer screening is likely to do more harm than good. Also, persons who have limited life expectancy may want to plan, discuss their values, and consider palliative care approaches of care in addition to care focused on living as long as possible.

But can one actually predict life expectancy accurately in an individual patient? …

Why do doctors delay hospice referrals?

Sheila Carothers

Patient

January 25, 2012

This is a response to Deb Discenza’s article requesting a one page informational sheet informing a patient about hospice or palliative care.

This would allow the patient and their family to make decisions regarding end of life care before it becomes a necessity. I am a crisis care hospice nurse. I am the one who comes to your home, whether it is a million dollar beachfront mansion, or a single wide mobile …

Read more…

Why do doctors delay hospice referrals?

I learned the value of listening to the patient

Peter Elias, MD

Physician

January 25, 2012

William Osler famously said (among other things): “Listen to the patient. He is telling you the diagnosis.”

I was doing my obstetrical rotation as a first year family practice resident. I had done nearly 100 deliveries and was feeling more confident in my skills and knowledge than was justified. Although this rotation did not involve actual care for the recently delivered newborns, I loved pediatrics and frequently stopped by the nursery …

Myths and misses about Alzheimer’s Disease

James P. Richardson, MD, MPH

Conditions and Diseases

January 25, 2012

Mark Twain, the American author and humorist once said, “It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.” In my experience as a geriatrician, I’ve encountered many misunderstandings about this degenerative neurologic disease that devastates both patients and their families. Countering these can help patients, families, professionals, and all those who have someone in their lives with Alzheimer’s disease.

1. …

Repeated experiences of shaming are not good for a young child

Claudia M. Gold, MD

Physician

January 24, 2012

The little boy, who looked to be about two, darted away in a fit of giggles. His young mother, who seemed thoroughly worn out and exasperated, ran after him, grabbed him by the arm and said in a harsh whisper, “You must stand here!”

We were on line waiting to board a Southwest Airlines flight. For those of you not familiar with the Southwest system, there are no assigned seats. Rather, …

Why more primary care doctors are referring patients to specialists

Kevin Pho, MD

KevinMD

January 24, 2012

According to a recent study from the Archives of Internal Medicine, primary care physicians are referring more patients to specialists than ever before. In fact, the rate almost doubled in the 10-year period between 1999 and 2009.

This drives up the cost of care, as specialist consults tend to be more expensive than primary care visits. Furthermore, specialists tend to …

Insider tips to surviving your hospital stay

Happy Hospitalist, MD

Physician

January 24, 2012

Hospital stays can be traumatic for patients and their family members. I give you the top 10 ways to survive a hospital stay while maintaining your sanity.

10. Bring your own pillow. Trust me.

9. Bring a laptop computer or request one from the hospital. Hospitals all have free wireless these days and many will actually provide you with a laptop if you just ask.

8. Bring an accurate and updated medication list …

Being treated like a celebrity when giving birth

Linda Burke, MD

Physician

January 24, 2012

Celebrity is an interesting phenomenon.

On a hot summer night in 1990, my chief resident and I were on call at Harlem Hospital. We were informed that a “guest” was coming to interview us. Hot, sweaty and looking haggard rather than glamorous, we wanted to choke our director when Spike Lee walked through the door with film crew in tow. Lee was there to film the infamous movie, Mo’ Better Blues. …

Why the family meeting is important

Jeffrey Alderman, MD

Physician

January 24, 2012

“Are you saying, doctor, that mom’s not getting better?” Eleanor asked.

“I’m afraid so.” I replied.

“Someone should have mentioned this to me before.” she said, before returning her gaze to my shoes.

We were talking about Eleanor and Roger’s mother, Bertha, who had been hospitalized in our intensive care unit for three weeks. Bertha, 67, had been admitted with an exacerbation of congestive heart failure. Despite everyone’s best efforts, she’d steadily grown …

Read more…

Why the family meeting is important

Incorporating 12-step program concepts into cancer survivorship

Richard Just, MD

Conditions and Diseases

January 23, 2012

The fact that the term “cancer survivorship” is now part of our vocabulary is a testimony to advances made in management of these diseases. Most cancer survivors, however, are not unscathed by the experience. As I tell my patients, they won’t be entirely as they were before treatment. How these issues are dealt with varies from person to person. But, awareness that chronic problems may persist long after treatments end …

Innovative technologies can markedly enhance safety

Stephen C. Schimpff, MD

Health Technology

January 23, 2012

“To Err Is Human” is the title of the now famous book from the Institute of Medicine on patient safety published about a decade ago. From it we learned that anywhere from 44,000 to 98,000 individuals die each year of preventable medical errors (and other sources suggest the number might even be much higher). In this continuing series of posts on disruptive and transformational technologies, there are some that can …

An American ER doctor in Tasmania

Rick Abbott, MD

Medications

January 23, 2012

Beginning work at Launceston General Hospital in Tasmania, orientation really, I noticed a lot of things missing: places to sign my name.

For any given patient I’d sign: the completed chart note, perhaps a lab (sorry, pathology) and imaging slip, a prescription form (in triplicate – ok, so that was weird), and a GP letter.

I didn’t have to sign (physically or electronically) multiple different “attestations,” I didn’t have to generate multiple …

Read more…

An American ER doctor in Tasmania