MKSAP: 25-year-old woman comes for a preconception evaluation

Conditions
January 24, 2015

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

A 25-year-old woman comes for a preconception evaluation. She has a history of hypertension that is well controlled with lisinopril. Medical history is otherwise unremarkable.

On physical examination, blood pressure is 134/86 mm Hg in both upper extremities; other vital signs are normal. Results of the cardiovascular examination are unremarkable. There is no …

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This is exactly why surgeons are so fragile. All of them.

Physician
January 23, 2015

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You are human and fallible.
– Charlotte Bronte, Jane Eyre

Alas, the frailty is to blame, not me — for such as we are made of, such we be …
– William Shakespeare, Twelfth Night

Sha-doo-bee, Shattered …
– Mick Jagger, “Shattered”, The Rolling Stones, Some Girls (1978)

The image of the surgeon is synonymous with strength. Surgeons are stereotypically charismatic, commanding, confident, even arrogant. Strong minds, strong bodies, strong wills. Leaders, especially …

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Professionalism: A commitment to lifelong learning aimed at the care of the patient

Physician
January 23, 2015

I am a doctor today because of Dr. J.W. Epstein, my pediatrician in Cleveland in the 1950s. An immigrant from the Nazi terror in Europe (it was family lore that he had escaped the Holocaust), he had trained in Vienna and spoke English with a Germanic accent. His house calls are etched permanently in my memory. His visits were heralded by a fury of activity, led by my mother. “The …

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The profound wisdom of the nursing diagnosis

Conditions
January 22, 2015

When I was in nursing school there was always a lot of eye-rolling when it came time to discuss nursing diagnoses.  This was mostly because nursing diagnoses were followed by book-length nursing care plans that we had to produce for various imaginary patients. There was also a faction, including myself, who thought a medical diagnosis was just fine, thank you, no need to reinvent the proverbial wheel.

For example, for a …

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A resident working in the ICU: What you cannot control scares you

Education
January 19, 2015

In respectful memories of Benson, Rose, and Sandy. I want to thank each one of them for helping me become a better physician.

I stepped into the intensive care unit with a feeling of apprehension. I knew deep down, the patients I was going to care for were sick patients. Their status could change at any time. This was my first week on the ICU as a resident physician.

Benson needed emergent …

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What I learned from medical school scholarship and award recipients

Education
January 17, 2015

As a faculty member, I’ve encountered many medical students excelling inside and outside of the classroom. Students can be recognized for their contributions through scholarships, awards, and grants. Whenever I can, I try to direct students to these opportunities. It’s been a great joy for me to help students win scholarships, and here’s what I’ve learned from award recipients.

1. Your ability to develop strong relationships with faculty mentors is crucial …

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Why is diagnosing ear infections so hard?

Conditions
January 17, 2015

Ear infections (or, what we like to call “acute otitis media”) are one of the staple diagnoses of pediatrics. Most kids have at least one before their third birthday.  And most pediatricians see at least one every day by 11. You would think we would always get it right. But I have a confession — we don’t. In fact, children are misdiagnosed and over-treated at an alarming rate.

There are several reasons for …

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Why other professions can’t relate to medicine

Physician
January 15, 2015

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Doctors have a difficult time adjusting to other cultures and because of this flaw, patients, and the medical profession suffer.  By culture, I do not mean religious or philosophical background, socio-economic difference, country of origin, nor even the silence created by language and education barriers.  I am referring to the communication and comprehension chasms that exist between different occupations and physicians.

What …

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Stuart Scott and his fighting words

Physician
January 15, 2015
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ESPN sportscaster Stuart Scott’s recent death has given the American public a chance to reflect on what it means to live with a cancer diagnosis. His speech at the ESPY awards in the summer of 2014 was widely hailed as an inspiration to people with cancer. Obviously, the Jimmy Valvano Award for Perseverance with the ties to cancer research (Jimmy V Foundation) and Scott’s public image as someone being …

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Scared of the flu vaccine? Let’s see what’s really inside it.

Meds
January 14, 2015

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Dangerous ingredients, like toxins, antifreeze, and mercury, are touted by many as reasons to decline vaccination against influenza. However, toxin is an inaccurate term regarding vaccines (a toxin is a poisonous substance made by cells or organisms and is definitely not in any vaccine), mercury is a non-issue (see below), and there is no antifreeze in vaccines (although some contain propylene glycol, …

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What does it mean to be a competent psychiatrist?

Physician
January 13, 2015

What defines a competent psychiatrist?  To staunch critics of the field, perhaps nothing.  Some believe psychiatry has done far more harm than good, or has never helped anyone, rendering moot the question of competency.  What defines a competent buffoon?  A skillful brute?  An adroit half-wit?  Having just finished Robert Whitaker’s Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, a reader might easily conclude that psychiatric competency is …

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Physicians must unionize. Here’s why.

Physician
January 12, 2015

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If F. A. Hayek were alive today, he would support the revival of labor unions in general and professional labor unions in particular. Towards the end of the Second World War, Hayek wrote a book warning us all that allowing governments to engage in extensive central planning of economic activities is nothing more than a road to serfdom for humanity. F.A. …

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EMRs can hurt physicians during lawsuits. Here’s how.

Tech
January 10, 2015

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While the electronic medical record (EMR) has advantages, it also has introduced liability risks. EMRs can lead to lawsuits or result in a weak defense by casting the physician in an unfavorable light.

For example, examine these exchanges in a recent malpractice trial:

  • Plaintiff attorney: Doctor, if the emergency renal consult was called in at 11:30, why did you wait until 6 p.m. …

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Why is it so hard to define what professionalism is?

Education
January 9, 2015

A while ago, I wrote about a medical student whose school tried to dismiss him just prior to graduation for unprofessional behavior.

A judge ruled that the school could not do so because it had tolerated some similar behavior earlier in his medical school career and had not considered it important enough to mention in his letters of recommendation.

In that post, I said, “‘Professionalism’ is difficult to define, especially when trying to …

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Joan Rivers: What should the anesthesiologist have done?

Physician
January 8, 2015

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New York Post reporter Susan Edelman revealed the name of the unfortunate anesthesiologist allegedly present on August 28 at Yorkville Endoscopy, during the throat procedure that led to the death of comedian Joan Rivers. She is reported to be Renuka Reddy Bankulla, MD, 47, a board-certified anesthesiologist from New Rochelle, NY.

Having her name made public will be a nightmare for Dr. Bankulla, as …

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3 ways to use bacon as medical treatment

Conditions
January 8, 2015

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You might think of bacon, that thing of gustatory beauty that is salted, cured pork, as just pleasure for your taste buds. However, one of the first medical facts I learned in 2015 was that bacon has medicinal purposes (apart from making you feel better after eating it). With this new knowledge at hand, the time just seemed right for a …

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What I learned after going through the fellowship match

Education
January 7, 2015

You’ve made it. Four years of college, four years of medical school, and three years (sometimes four or five) of residency, depending on the specialty you chose. You’ve earned a prestigious title.

You are a doctor.

But wait, you are not done yet.

Want to be a cardiologist, oncologist, or gastroenterologist? Add another three years to the eleven spent to become an independent practitioner. Another three years of interest accruing on that six-figure …

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A physician investigates the American Board of Internal Medicine

Physician
January 7, 2015

Is it medically professional for a non-profit organization to use physician testing fees to “choose wisely” a $2.3 million luxury condominium complete with a chauffeur-driven BMW 7-series town car? In my view, obviously not. To most people, such an action would conjure up images of hypocrisy, waste, and corruption.

After a review of public and tax records, it appears to me this is exactly what has happened.

Background

In 1999 for reasons that …

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Why can’t more hospitalists and emergency physicians be friends?

Physician
January 6, 2015

One of the things that I love about my job as a hospitalist is the ease with which we can develop friendships with colleagues from other disciplines. Since I am an inpatient physician, it’s not surprising that some of my good friends are cardiologists, nurses, endocrinologists, physical therapists and, of course, other hospitalists. In fact, I met my neurosurgeon husband while co-managing his patients at the hospital. While thinking about …

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