Another crazy three days at work and I begin to think about the similarities of Seal Team 6 and nurses. Methodical. Precise.
Nursing is not a glorious profession. Even though my father thinks I sit at the bedside of the sick and dying and hold their hands all day, the fact of the matter is, I simply do not have the time. We run around attempting to tread water with …
Nursing is methodical and precise, like military special ops
One of my professors teaches psychology, but he was hired as a “generalist” meaning that he has no area of specialization when he’s teaching. He ends up with all the 101 classes. And I love that. Trained as a biopsychologist, he’s now known as a clinical psychologist and is one of the best in the area.
As I walked into the class the first day and he was going over standard …
3 easy ways for doctors to respect patients
I’ve spent a lot of space on this site writing about participating in your healthcare so you get the right care.
And, I talked about developing a “relationship” with your doctor so you can effectively communicate. Relationship does not mean drinking buddy, golf partner, or someone to do shopping with. What is meant by “relationship” is developing a trust that allows you to effectively and unashamedly discuss your medical concerns and question treatment options …
Why developing trust with your doctor is important
“Mom’s been writing goofy checks…”
“Dad stopped paying his bills….”
“Grandma wired her savings to Nigeria…”
Have you heard these phrases from the family caregivers of your elderly patients? Have you ever been concerned that your patient may lack capacity for financial decision making? How do you decide if they lack capacity? What is the clinician’s role in making these decisions? What is their responsibility?
These important questions are addressed in a terrific new article in …
Alzheimer’s inevitably leads to loss of financial capacity
Someone has gone and rained the facts down on what is generally considered a feel–good story in American medicine, the dramatic increase in female doctors in America.
In response to Dr. Herbert Parde’s “The Coming Doctor Shortage” article in the Wall Street Journal, Dr. Curtis Markel pointed out that there is a difference between the raw, gross number of physicians in America, and the effective number of practicing physicians. Not only …
Female doctors and the physician shortage
The HIV pandemic in the US has developed a stable appearance over the last few years, and that appearance is notably non-white and non-wealthy. When the pandemic was discovered nearly thirty years ago, it was—in the US—primarily a disease of gay men. In Africa, the disease is everyone’s. Women make up significantly more than half of HIV cases in Africa, and tens of thousands of children are infected during …
HIV is devastating poor and minority communities
We hear that doctors do not like “protocol medicine” – they do not want to follow a “cookbook” when every patient is different. It is not a good understanding of the issues.
Some years ago when I worked in a branch of he National Cancer Institute and then the University of Maryland Cancer Center, we admitted many patients with acute leukemia. The treatment approach including the necessary special tests to …
Why doctors should accept protocol medicine
I was asked recently to predict the practice of medicine in 20 years. After stating that any such prediction is massively speculative, I indulged because it is massively fun.
I am persuaded by Clayton Christensen’s arguments in The Innovator’s Prescription that healthcare will go the way of other massively disrupted industries, wherein healthcare will follow the arc of decentralization.
Using the music industry as an example, the arc begins …
What medicine will be like 20 years from now
As a nurse, I spend a lot of time with other nurses. When they ask me to explain why I think the iPad is great, I respond with the following metaphor: imagine that you are a nurse who has been asked to design a new hospital from scratch. You are free to question every prior assumption, to throw out old ideas that no longer fit, to redesign everything according …
Why is the iPad be revolutionary for doctors and nurses?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 64-year-old man is evaluated for a 3-month history of abdominal bloating and mid-epigastric discomfort associated with a 6.8-kg (15-lb) weight loss. The patient has no significant medical history and takes no medications.
On physical examination, vital signs are normal, and the only significant finding is mild …
MKSAP: 64-year-old man with abdominal bloating and epigastric discomfort
I had a patient once—a fellow physician—who came to see me complaining of mid-back pain. When I examined him, I found I could reproduce his pain by pressing firmly on the spot he said was hurting him. He said pressing there also made the pain radiate around to his stomach, a phenomenon known as “referred pain” that meant his pain was almost certainly caused by a trigger point. I …
How early closure can cause doctors to misdiagnose
Patients want to know why they can’t get a return call from their doctor’s office – here are six reasons why the calls have increased and physician offices are having trouble meeting the needs of their patients.
1. Medication questions and requests for a prescription change. The average number of retail prescriptions per capita increased from 10.1 in 1999 to 12.6 in 2009 (Kaiser Family Foundation calculations using data from …
6 reasons why doctors won’t call patients back
I’ve been sick since 2001 when I failed to recover from what appeared to be an acute viral infection. It has left me mostly house-bound, often bed-bound. In effect, I’ve had the flu without the fever for almost ten years: the aches and pains, the dazed sick feeling, the low grade headache, the severe fatigue. It cost me my career as a law professor; it cost me the ability to …
An apology to patients with chronic fatigue syndrome
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A reader writes, “Can you do a post on what procedures constitute a thorough physical, in your opinion? I haven’t had one in several years and thinking of making an appointment now. The last doctor I went to didn’t even listen to my heart or go though the motions with feeling my belly and that stuff. And of the last 3 doctors I went to, I realized they didn’t …
There is no such thing as a complete physical examination
A cover story by Gardiner Harris in the New York Times spotlights the changes in modern psychiatry, from extensive, psychotherapy-based interaction to brief, medication-oriented “psychopharm” practice.
The article shares nothing new, particularly to anyone who has paid any attention to the rapid evolution of the psychiatric profession over the last ten years (or who has been a patient over the same period). While the article does a nice …
Do patients accept hurried, fragmented, disconnected care?
Doctors use laboratory values to interpret your medical condition. With respect to kidney disease, the BUN and the creatinine help your nephrologist (as well as your internist and family physician) determine if your kidneys are working correctly. These two tests are commonly ordered for many reasons and are invaluable tools to help your doctor assess your condition. Let’s define what BUN (pronounced by spelling out the letters “B”, “U”, …
How a nephrologist assesses your kidney function
Ok, imagine this.
You take a video of your little girl’s soccer practice with your iPhone. Within moments it’s posted on YouTube for the grandparents to see.
Minutes later search engines called spiders begin to crawl across the data set of images on your upload. Face recognition technology identifies a face on the video and, with some assistance from the geo-tagging of the built in GPS metadata that accompanied the upload, …
Are our privacy rules robust enough to protect our patients?
Doctor D has been blogging about the doctor-patient relationship for a while now. It’s sort of the thing I’m known for. I’ve usually been on the doctor side of this equation. Most of my blogging, however, is to help patients figure out the weird world of medicine.
Doctor D recently found himself on the patient side of a nasty injury.
Even as Doctor D looked down and realized his leg wasn’t …
What this doctor learned when he was a patient
A guest column by the American Medical Association, exclusive to KevinMD.com.
Health IT holds the promise of improving the efficiency of a physician’s practice, but physicians can easily become overwhelmed by the broad range of products and the multiple, varying federal incentive and penalty programs currently underway. The American Medical Association (AMA) continues to be in close contact with the Centers for …
AMA working to improve e-prescribing incentives and help physicians adopt health IT
For most women, a couple of irregular menstrual cycles or an occasional yeast infection are just a part of life — nothing that time or simple treatment won’t cure.
However, there are a few symptoms that warrant a call to the doctor. This article will cover when you should call your doctor for problems “down there”?
1. Pelvic pain. Pain at the time of ovulation is referred to as Mittelschmerz. However, if …
Women with these 5 pelvic symptoms should call their doctor
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