MKSAP: 52-year-old man with sudden onset of erectile dysfunction

Conditions
April 1, 2017

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

A 52-year-old man is evaluated for the sudden onset of erectile dysfunction that has persisted for 6 months. He reports having erections that are inadequate for vaginal penetration. He feels guilty about not being able to satisfy his wife’s requests for sexual intercourse, although he still has sexual desires. He has been sleeping poorly …

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A physician was the victim of malpractice. Here’s her story.

Physician
March 31, 2017

I’m not here to tattle. No siree, Bob. I’ll save that for my kids. But what I am here to do is spell out a story in which I ended up down in the dumps.

A medical mistake happened. To me. On me.

I’ll never forget it. I can’t because I carry it with me forever.

Here’s the short of the long:

My obstetrician messed up. She took care of my pregnancy during one of the most …

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The physicians who are not called “doctor”

Physician
March 31, 2017

You graduate from medical school and get your MD degree. At first, when someone calls you “doctor,” you look around and wonder who they’re talking to, but after years of hard work and sleepless nights, you realize you really are a card-carrying “doctor.”

If you’re a woman, however, you start to realize that a lot fewer people call you “doctor” than your male colleagues. At first, it’s subtle. And you shrug it …

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Physicians are born to do what they do

Physician
March 30, 2017

I am always fascinated by my colleagues’ stories about why they became physicians and when they knew medicine was the path for them. Some describe a longing to heal, some a love of science, and others a desire for respect. For me, medicine was a calling that revealed itself in my sophomore year of undergraduate studies and was the perfect culmination …

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Let older people talk about sex

Conditions
March 30, 2017

He was referred to me by a colleague with a large geriatric practice for evaluation and treatment for HIV. He was 76 years old and lived in an assisted living facility. He was, however, very independent and only required limited assistance. When asked what he expected from the visit he responded that he had been sent to me by his PCP. Review of his records suggested that in addition to …

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Does tough love equate to wellness or destruction?

Conditions
March 29, 2017

Heroin abuse in the United States is reaching epidemic proportions.  According to SAMHSA, between 2007 and 2012, the number of Heroin users has doubled from an estimated 375,000 to over 665,000.  Additionally, in 2010, the number of deaths as a direct result of overdose surpassed auto accident deaths.

It is impossible to avoid the facts about heroin.  We are bombarded daily by the national and local media and extensive online resources.  …

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3 lessons I learned about domestic violence in the ER

Physician
March 29, 2017

As a first-year oral and maxillofacial (OMF) surgery intern, I was the first responder to any facial trauma at a hospital in Queens, NY. Therefore in the past 12 months, I was a primary care provider for numerous facial lacerations of women due to domestic violence. And was a 1st assistant in providing care to patients (both men and women) with orbital floor fractures and mandible fractures due to domestic …

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The emergency department and “access” to care

Policy
March 28, 2017

The redefinition of a potentially functioning medical system in which each individual is able to utilize financially non-prohibitive care into a disjointed balkanized realm of income-based insurance tribes is aided by the protean definitions of the political buzzword “access.”  Access to medical care does not entail the ability to reliably obtain medical care much as medical insurance reform is not, in point of fact, healthcare reform.  Regardless, the conflation of …

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This doctor gives his cell number out to patients. He explains why.

Physician
March 27, 2017

Contrary to what my wife and colleagues think, it is not all about me. Well yes, I do get lonely sitting at my desk late at night, when my wife is busy, and the long-ago-moved-away kids are not available, and there is nothing running on NASCAR.  Nonetheless, it is not really about my needs.  I am talking, of course, about why I give patients my cell phone number.

It is printed …

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My cold hands met their match

Physician
March 27, 2017

Despite living in Michigan for over 30 years, my cold hands disclose my Southern California origin. As a physician, these cold hands have touched many lives. For my pregnant patients, they usually sigh with relief as I touch their bellies, the coolness of my hands offering them respite from the inferno growing inside them. They smile when I tell them I can feel their baby squirming and how it is …

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Solving the telephone problem in primary care

Physician
March 26, 2017

The phones, the phones, the phones.

Every time we look, everywhere we look, getting the phone answered seems to be a problem we just can’t lick, a continual thorn in the side of our practice, something that’s hindering all the other efforts we try to make things better, to get ourselves to the best care environment for our patients, our staff, and our providers.

Without …

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Let’s pay doctors like we do athletes

Physician
March 24, 2017

 

Think about it; athletes aren’t the ones who document their performance. It’s other people that keep the score. That’s a whole science in itself. People talk for hours after the game or tournament is over about how each athlete did this or that in whatever way they did it, and the numbers are in many cases captured by extremely sophisticated electronic equipment.

Physicians work hard to diagnose and treat their patients, …

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Death is a blessing in its right time and place

Physician
March 24, 2017

I am working hospitalist right now. On Friday, a man in his 80s was admitted with difficulty breathing. He had a complicated history, including a heart attack at age 35 with all the subsequent sequela of heart disease. He had an abnormal heart rhythm and was taking a blood thinner for stroke prevention. In addition, he had scarring of his lungs (cause unknown).

He was transferred to us from another hospital. …

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Sleeping with the enemy: When a physician dates an administrator

Physician
March 23, 2017

“I’m going to write a column about dating you and call it ‘Sleeping with the Enemy,’” I announced from my rocking chair. His rocking stopped. “The enemy?” The rain was falling on the trees in front of my porch and on his parade. “Why am I the enemy?” “You know, clinicians vs. hospital administrators.” “Really?” he naively asked. “Why don’t clinicians like us?”

I was surprised he was so in the …

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A physician-mother on maternity leave learns how she can’t ignore her job

Physician
March 23, 2017

The stretcher was wheeled into the operating room.  I had been in this room on three prior occasions, under very different circumstances. But today, as I lay flat on the table, listening to the small talk around me, I tried to breathe against the weight of the baby and the pressure of the procedure.  My husband will later tell me it happened so quickly, but for me, time stood still …

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Angry? Welcome to being a doctor. And here’s how to fix it.

Physician
March 23, 2017

It will start as a minor curiosity. Maybe a student will seem slightly too close to the resident on your team. When the grades are posted, you’ll wonder why you didn’t get honors, but he did. You might wallow for a few days. Make an offhanded comment to your fellow students. Then you’ll let it go and move on. Or so you think. Until during surgery when the scrub nurse …

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Here’s how to help create the future of medicine

Education
March 22, 2017

As the millennial presence in health care becomes more prominent, the climate of the health care system will inevitably change. Speaking from a personal perspective, there is a growing emphasis on lifestyle in the conversation of career choice. Medicine is becoming less and less of a life, and more of a part of life, a part of the work-life balance. We (millennials) also place emphasis on impact. We want to …

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In the hospital? Here are 7 things you must keep in mind.

Physician
March 22, 2017

Being in a hospital is a scary and frightening time, and it’s easy for those of us at the frontlines — doctors and nurses — to forget that as we go about our busy work days. Patients are at a very low point in their lives and will remember everything about their hospital stay, including all their interactions, for a very long time.

As someone with a keen interest in improving …

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Why physician-led organizations work

Policy
March 21, 2017

I’ve had many opportunities to address physicians across the spectrum of health care settings, from those who run private practices, to those who work in large and small groups, to those who are hospital affiliated and employed. I often ask them the question “who controls the practice of medicine?” The answers I receive vary: government, insurance companies, hospitals, health systems, lawyers, employers and, rarely, patients. But one answer I never …

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