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MKSAP: 25-year-old man with swelling of the feet and legs

mksap

Conditions and Diseases

September 10, 2011

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

A 25-year-old man is evaluated in the emergency department for swelling of the feet and legs. He has a 5-year history of HIV infection for which he has refused treatment.

On physical examination, temperature is normal, blood pressure is 128/74 mm Hg, pulse rate is 88/min, and …

The dual tragedy of suffering catastrophic illness and being uninsured

John Maa, MD

Patient

September 9, 2011

An estimated 60% of American bankruptcies result from overwhelming medical costs. My uncle’s tale illuminates the dual tragedy of suffering catastrophic illness and being uninsured.

The 2008 recession claimed my uncle’s job, health benefits, and assets, except for a small inheritance. By 2009 he found work (but not health coverage) as a consultant.

One day he noticed that his eyes were yellow. He emailed a photograph, and I immediately recognized jaundice. I …

The growth of integrative medicine in academic institutions

Robert Donnell, MD

Medical Education

September 9, 2011

The Atlantic published an article about the growth of quackademic medicine in our teaching institutions and it’s celebratory more than critical. It profiles the integrative medicine clinic of Dr. Brian Berman. That’s right, this Dr. Berman. I blogged about him four years ago and it seems his clinic at the University of Maryland is still going strong. Stronger, apparently.

The article, like integrative medicine itself, is a mixture of quackery …

The graveyard hidden in a surgeon’s mind

bongi, MD

Physician

September 9, 2011

This is a difficult story to tell but if I am to be true to the complete experience of a surgeon, I do need to tell it.

One of my seniors used to say that every surgeon has a graveyard hidden away somewhere in the dark recesses of his mind. He went on to say it was unfortunately normal, so long as you remember all the names engraved on the tombstones. …

Human capital makes doctors special

Douglas Perednia, MD

Physician

September 9, 2011

If you’ve ever been sick, especially with anything serious, you quickly realize that doctors, nurses and their ilk are an unusual and precious resource.

First you have to find smart people with personalities willing and able to put up with a lot of guff in the service of their fellow man. Then they have to be willing to (usually borrow, and) spend tens or hundreds of thousands of dollars for …

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Human capital makes doctors special

Patients lose if physicians are expected to practice perfect medicine

WhiteCoat, MD

Physician

September 9, 2011

I discussed whether or not ambulances should be required to add equipment costing $12,000 in order to be able to transport 850 pound patients recently, so I won’t belabor the point here. Providing medical care to morbidly obese patients presents multiple challenges.

Then I read an article in the Florida Sun Sentinel about how some obstetrician-gynecologists in South Florida are refusing to provide medical care to obese women. …

Defining what health truly is

Stewart Segal, MD

Patient

September 9, 2011

I read an interesting article by Jason Luban, a licensed acupuncturist, on why so many patients flock to alternative practitioners. Mr. Luban brought up an interesting question, “What is health?”

Is health simply the absence of disease? If it is, there certainly aren’t very many healthy patients in my neck of the woods. Most of the patients I take care of have something that’s not quite right. I only know one perfect …

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Defining what health truly is

The threat of technology to proper patient care

Josh Herigon, MPH

Health Technology

September 9, 2011

Dr. Abraham Verghese wrote in the New York Times recently about the threat of technology to proper patient care. This is an excellent piece and although I do not disagree with the overall message, I think Dr. Verghese conflates different issues currently plaguing our health care system.

Below, I provide some comments on a few of the major points Dr. Verghese writes about: “This computer record creates what I call an “iPatient” …

A reminder of why doctors do what they do

Gregory Bratton, MD

Physician

September 8, 2011

Residency is hard. The hours are long, the work is grueling, and, simply put, hospital food is not good. Many days, we, as residents, walk the wards in a lifeless haze – coasting on the wings of our white coats, our fuel tanks pointing way past empty.

During these times, we find ourselves sitting in wheelchairs that are stored in dark remote corners, questioning whether or not all of this is worth it. For years, …

Asking patients about their health care financial concerns

Libertad Flores

Patient

September 8, 2011

I remember joking with Dad about how he’d outlive us all. He had gone vegetarian 10 years before I was born, never smoked, took vitamins, and asked for a designated driver after his annual Heineken at the neighbor’s Christmas shin-dig. He flossed, wore a seat belt, and looked forward to annual physicals. If I tried leaving our Michigan house in the winter with more than 3 inches of skin exposed, …

The specialty that makes doctors rich and happy

Paul Sax, MD

Physician

September 8, 2011

A long time ago, I was very close to becoming a cardiologist. Really.

Even though my fascination with ID and microbiology started in medical school — and believe me, not much fascinated me in medical school — the fact that all the top residents in my program were going into cardiology made me feel that somehow I should be doing this too. Plus, the guy who was Chief …

Telemedicine to augment the patient encounter

John Schumann, MD

Health Technology

September 8, 2011

When I use the term “telemedicine,” what does it mean to you?

In current parlance, it usually refers to radiologists looking at digital images of x-rays and other scans from locations remote from the site of acquisition. Think “outsourcing” where the radiologist could even be as far away as India.

But according to a recent conference I attended, telemedicine could mean so much more. It can range from synchronous video chat …

How a doctor reviews cases for both plaintiff and defense attorneys

Charles A. Pilcher, MD

Physician

September 7, 2011

Early in my career, a local defense attorney working with my hospital would occasionally ask me to review a case in which another physician client of her firm was the defendant. As Medical Director of Evergreen Hospital Emergency Department, I was comfortable with hospital records, knowing where to look in a record for information – both recorded and not recorded – that either helps or hurts a case. I found …

An incorrectly coded $1,000 billing error

Michaela Dinan

Patient

September 7, 2011

As a graduate student in the health field I often get phone calls from various family members and friends asking what I happen to know about different drugs, procedures, and devices. I was having one such conversation with my younger sister last spring. She had just completed her undergraduate education, started a new job, and was very proudly financially self-sufficient for the first time.

We were talking about birth control. Her …

When is the right time to introduce solid foods to an infant’s diet?

Michael Gonzalez, MD

Conditions and Diseases

September 7, 2011

Parents often wonder when is the appropriate time to introduce solid foods to their infant’s diet. It seems like a simple question. So simple that the American Academy of Pediatrics (AAP) cannot agree on the answer. The AAP Committee on Breastfeeding recommends starting complementary foods (rice cereal and baby foods) after six months of age and the Committee on Nutrition recommends the introduction of complementary foods between four to six …

Promoting a rational approach for the reduction of cardiovascular risk

Michel Accad, MD

Physician

September 7, 2011

It is a rare occasion nowadays when academic journals treat us to an editorial debate of some substance. The staff at the Journal of the American College of Cardiology can be applauded for publishing last summer two articles representing fundamentally opposed viewpoints on the best strategy to avoid cardiovascular illness. Amusingly, both claimed in the title of their piece the distinction of promoting a “rational approach” for the reduction …

Government austerity with Medicare reform as a top priority

Nathanael Heckmann

Health Policy

September 7, 2011

Medicare needs to be reformed, but there’s no easy solution to the problem. As the average life expectancy increases, more-and-more politicians have proposed an increase in the Medicare eligibility age. This increase in life expectancy, however, is an issue that only affects the wealthiest half of America — the people that need Medicare the least — because the life expectancy has only increased significantly in the richest half of …

When people decide not to vaccinate their children, I take it personally

Michelle Au, MD, MPH

Physician

September 6, 2011

If the media and Internet are to be believed (and these days, really, what is the difference?), the act of parenting has become a full-scale cultural war. How to raise your kids. On what to raise your kids. How your kids sleep, eat, play, and practice “Little White Donkey” on the piano–nowadays, these are all grist for the mill.

But if modern parenting feels like a war, its bloodiest battlefield surely …

Slipping through the cracks in our health care system

Kelly Cheramy

Patient

September 6, 2011

Between the cracks is a frightening place to be.

During the course of trying to improve our family’s financial stability, my husband and I were blind-sided by one hidden detail: We’d face $10,000 in costs to continue my husband’s serious medical treatment because we found ourselves unexpectedly without coverage for 30 days.

This was money we simply did not have. We had been prepared to foot the full bill for good health …