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MKSAP: 58-year-old man is evaluated for increasing fatigue

mksap

Conditions and Diseases

August 27, 2011

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

A 58-year-old man is evaluated for increasing fatigue of 2 months’ duration. The patient has hypertension and hyperlipidemia treated with lisinopril and atorvastatin. A sister has hypothyroidism.

On physical examination, temperature is normal, blood pressure is 135/80 mm Hg, pulse rate is 72/min, and respiration rate …

Intuition saved this patient from a potentially fatal diagnosis

Sharon Bahrych, PA-C, MPH

Conditions and Diseases

August 27, 2011

I was working in a rural health clinic when I went into to see a new patient. Amy was 18 years old, with her 6 day old newborn son by her side.

I introduced myself and then asked, “what brings you into the clinic?”

Amy responded, “Shortly after giving birth, I started having problems with shortness of breath, ankle swelling, and high blood pressure. I told the OB residents and they brushed …

Your consumer powers when choosing a hospital

Steven Kussin, MD

Patient

August 26, 2011

An excerpt from Doctor, Your Patient Will See You Now: Gaining the Upper Hand in Your Medical Care (Rowman & Littlefield).

The casual attitude people demonstrate when choosing doctors incurs a steep price. Let’s direct our attention to your consumer powers when choosing a hospital.

The imperative ‘caveat emptor’ (let the buyer beware) carries the most consequence when you purchase health care. When it comes to hiring a hospital’s services, it’s more …

Work hour restrictions seem painful now, but are a gift

Vipan Nikore, MD

Physician

August 26, 2011

When I completed my overnight shift and left the medical ICU the morning of July 1, I raised my arms victoriously. I uttered, “Finally, internship is done!” I may have been one of the last to speak such words.

As of July 1, 2011, intern year forever changed. In the world of medicine the first year of residency, or intern year, is when doctors earn their stripes. Traditionally it is …

Fair balance gives natural pills and supplements an advantage

Stewart Segal, MD

Medications

August 26, 2011

The reality is that my job constantly challenges my sanity. Sometimes, I just want to scream.

Patient: “Doc, I don’t want to put any poisons in my body! Isn’t there a ‘natural’ remedy I can take?”

Doc: “No, I want you to take my poison! I haven’t poisoned my quota of patients this month and need to reach my goal.”

Poisoning patients really isn’t good for business. Why would a patient believe that …

Why patients flock to alternative medicine providers

Jason A. Luban, LAc

Patient

August 26, 2011

As medical practitioners, we are trained to fight disease, becoming familiar with all the metaphors of war, victory, failure, and the Cartesian views of deductive reasoning and mind being separate from body. Through said reasoning, we come to believe in a passive view of health; that health is an absence of something, in this case dis-ease. From that vantage point, it is no wonder medical practitioners have such high rates of burnout, …

Malpractice risks with special needs patients

Jock Hoffman

Physician

August 26, 2011

Can you properly examine and treat a 400lb patient in your office setting? How about a four-year-old in your ED? A deaf woman in Labor and Delivery? An 82-year-old in the endoscopy clinic? Do patients who present with challenges beyond their immediate health issues increase your risk for a diagnostic or treatment error?

Once-accepted practices, e.g., jerry-rigging adult medical equipment for a toddler, guesstimating the weight of a patient who exceeds …

Does acupuncture work for headaches?

Dana Winegarner, DO

Conditions and Diseases

August 26, 2011

One interesting therapy for headaches, which generates a lot of questions from patients, is acupuncture. Acupuncture is a traditional Chinese therapy which has been around for centuries but only came around to wide spread use in the West (United States and Europe) in the 20th Century.

There are many misconceptions about acupuncture. One question I get regularly is “Do you think acupuncture works?” This is a difficult question to answer because …

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Does acupuncture work for headaches?

Making life meaningful despite a debilitating disease

Bobbi Emel

Patient

August 26, 2011

I worked with Joe over a year ago and now he returned to see me with a new problem. He had just been diagnosed with a rare degenerative disorder that would eventually rob him of the use of his limbs as his muscles weakened over time. Joe wanted to talk about how he could prepare himself for this decline.

Joe is in his sixties and has worked in high tech for …

Hurricane tips that patients and health professionals should know

Katherine Ellington

Patient

August 26, 2011

If you’ve seen the news recently, you know that emergencies can happen unexpectedly in communities just like yours, to people like you. We’ve seen tornado outbreaks, river floods and flash floods, historic earthquakes, tsunamis, and even water main breaks and power outages in U.S. cities affecting millions of people for days at a time and now Hurricane Irene is coming. Health care professionals should be ready too.

I was …

Talk to your patients before sending them home from the ED

Charles A. Pilcher, MD

Patient

August 26, 2011

So you’re not having a heart attack like your wife thought. That’s the good news. But what is wrong, what did cause that pain, and what should you do from here on out?

That’s the purpose of discharge instructions, and it’s not enough for the ED staff to just print out some forms, say “sign here,” and send you on your way.

What constitutes good discharge instructions, and why are they critical …

Why specialists should join primary care to end the RUC

Paul Fischer, MD

Health Policy

August 25, 2011

The old doctors know. The practice of medicine has changed in a very basic way over the last 20 years. Physician relationships have lost their civility and have been replaced by a level of tension that takes the fun out of collegial interactions. I remember my first year of family medicine as the only doctor in Weeping Water, Nebraska. My personal medical community had gone from an entire medical …

Will patients trust sociable humanoid robots?

Kent Bottles, MD

Health Technology

August 25, 2011

Within in five years primary care providers will begin being replaced by sociable humanoid robots, avatars, and computer programs. Within ten years you will no longer hear any complaints about medical students choosing specialty residencies over family practice because the role of the physician will be completely redefined to complement a rules based approach to the diagnosis and treatment of many diseases. This transformation is inevitable because of demographics, economics, and …

Converting a practice to a no insurance accepted model

Robert Tomsett, PA-C

Physician

August 25, 2011

Not long ago, I was working for a pain management firm with 19 clinics scattered throughout three states. I was fast approaching my three year mark as the travel PA and more recently, the compliance officer. Little did I know that my career path was about to go off-road, into a new world of clinic ownership coupled with the unchartered territory of no-insurance accepted.

What a difference a few months can …

Top 10 musts for your hospital visit

Mitchell Brooks, MD

Patient

August 25, 2011

Whether you are going to the hospital for an outpatient procedure or whether you will be admitted to the hospital for medical illness or surgical procedure, there are certain things you must know and certain things you must do in order to ensure that your reasonable expectations will be met.

You must become informed about the terms and limits of your health insurance policy. See if the fees you are being …
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Top 10 musts for your hospital visit

Implementing the Affordable Care Act will increase physician tension

Jeffrey Hall Dobken, MD, MPH

Health Policy

August 25, 2011

It’s really quite an ancient debate: 400 to 500 years before the birth of Christ, on the island of Kos (home of Hippocrates) originates the myth of Aesculapius, god of healing, son of Apollo and the nymph Coronis.

As is not unusual in Greek mythology, Coronis meets a violent death, but the infant Aesculapius is saved. He is raised by a wise centaur, becomes skilled in healing arts, and succeeds in …

Why technology should never takeover the patient encounter

Neil Baum, MD

Patient

August 25, 2011

Today, healthcare is criticized by the public as too high on technology and too low in touch. Computers take patients histories, provide differential diagnoses, and even supply educational materials to patients. A new specialty, tele-medicine, offers healthcare services to rural areas that were previously underserved or couldn’t afford the latest diagnostic technology.

A humorous story about technology occurred when a patient’s secretary called to say that her boss was too …

Patient advocacy groups should help support research

Christopher Johnson, MD

Patient

August 25, 2011

I was a medical researcher for several decades, investigating an unusual, but not rare, condition called infective endocarditis. I found the disease fascinating, primarily because of how understanding it could unlock many secrets of the endothelial cell, the cells lining all our blood vessels. I chose my research subject because it interested me and I thought I could do some good studying it. This is the case for …

Medicare patients should bring a companion to office visits

James Haddad

Patient

August 25, 2011

When a patient shows up for a doctor’s appointment with a companion, I often find myself studying (and later, interacting with) them as much as I do the patient. Most times, a quick review of body language is all I need to make an assessment – is this person looking out for the interests of the patient? Are they here begrudgingly, or out of concern? Are they indifferent, or …

Should pediatricians be punished for asking about guns in the home?

Ricky Choi, MD

Physician

August 24, 2011

Far be it for me, a Bay Area pediatrician, to tell Floridians about how to keep their kids safe. But having spent half of my life in the south (and I don’t mean LA), perhaps I am only partially carpetbagging.

Florida’s Governor Scott has signed a law that penalizes doctors for asking about guns in the home. It shockingly included a $5 million fine and a five year prison sentence if …

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