Who works at a hospital? (Again, just indulge me for now.)
Doctors. If you’re a patient at a teaching hospital, this includes medical students (people in school to become doctors), interns and residents (people who have earned the title of “doctor”, but who are still learning their craft), and attendings (people who have completed their formal training as physicians). If you’re not at a teaching hospital, it’s less likely you’ll see medical …
I click open the x-ray viewer. After 4 years in emergency pediatrics, I am not really surprised that a tibia fracture underlies the bruised ankle I unexpectedly encountered on physical exam. Yet I audibly gasp as the chest x-ray loads. The torso in question belongs to a chubby little cherub of a 3-month-old in room 11, brought in for red eyes. I begin to count the fractured ribs — 1, …
The holiday season means most of us will be socializing with colleagues and neighbors, friends and family. Chances are good this circle of friendly acquaintances and loved ones will include a child with autism.
Why? An estimated 1 in 88 children are now diagnosed with the neurological disorder, with a four times prevalence for boys. Among other challenges, those with autism often have difficulties with social communication (be it verbally or …
It’s the beginning of cold and flu season. That means a lot of kiddos, big and small, are coming to the office with fever.
As docs, we know that fevers can freak moms and dads out. Kids look pretty awful when their temperature climbs, and it is understandable that parents want to bring them to the office for an evaluation.
In the exam room, I often hear worried parents …
I nearly died a month ago on a treadmill halfway through a stress test.
The short story is this: I had just gone to bed and was about to go to sleep when I started to have some chest pain that I told myself was just my usual heartburn, only worse. As a gastroenterologist, I knew better. It was bad enough that I couldn’t go to sleep. After two sleepless hours …
When you get frustrated with my interpreting a chest x-ray as “atelectasis at the right lung base, pneumonia can’t be excluded,” trust me, I don’t enjoy it. But when you ask me to rule out pneumonia you leave me no choice but to tell you that pneumonia can’t be ruled out.
To rule out a disease a test must have a sensitivity of 100%, meaning there should be no false negatives. …
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
When you need anesthesia for surgery or a diagnostic procedure, of course you want to know who’ll be giving you anesthesia. If you live in Texas, Florida, the District of Columbia, or 14 other states, you may be lucky enough to have an anesthesia team taking …
If you learn nothing else today, I would ask you to learn that moral hazard is the cause of medical price hyperinflation.
Moral hazard is not just two words that don’t seem to go together. Moral hazard is when the person who bears the economic burden of a decision is not the decision maker. In the health care setting, moral hazard is when the third party payer (insurance/government) bears the …
We can now add vitamin B12 deficiency to the growing list of risks of long term use of the proton pump inhibitors (PPIs).
The New York Times had an article outlining the evidence that prolonged use of both proton pump inhibitors (PPIs) like Prilosec, Protonix, Prevacid and others, as well as the less potent H2 blockers like Zantac and Pepcid, can lead to vitamin B12 deficiency. This is in addition …
Over the years that I’ve worked in acute inpatient rehab centers, I have been truly vexed by a particular type of patient. Namely, the stubborn patient (usually an elderly gentleman with a military or armed forces background). I know that it’s not completely fair to generalize about personality types, but it seems that the very nature of their work has either developed in them a steely resolve, or they were …
To err is human. To really screw things up, you need government.
One half of my patient population and one fourth of my receipts are from Medicaid patients. My state has a mandatory balanced budget, which means in this age of perpetual recession Medicaid runs out of money every year.
Last year, my state capped the monthly brand name prescriptions to 1 for the summer. Apparently the information that asthma inhalers and …
It’s been very interesting to read the range of responses to the recent FDA recent crackdown on the personal genetic service company 23andMe. Some have decried the FDA as too paternalisticwhile others have said the FDA is rightfully protecting the health of the public.
The evidence, I believe, shows the FDA is correct: 23andMe should not be doing genetic tests that have serious medical implications. Let’s look at an …
Practice medicine like the bumblebee.
We also know the basics of the beehive containing a single queen bee, hundreds of worker bees, and several hundred to several thousand drones with their only function is to mate with the queen (and after they perform this function they die!), each with their own degree of specialization and place in the honeybee society. However, there is …
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This past spring, I went to Dar es Salaam, Tanzania to do an internal medicine elective at Muhimbili University of Health and Allied Sciences. I rotated through two sub-divisions of internal medicine while I was there: infectious disease and cardiology.
The medicine
When I initially stepped onto the infectious disease ward, I saw the janitors mopping the cement floors with soap and water. The ward was crowded and the patients lying on …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 74-year-old woman is evaluated for a 2-month history of fatigue, anorexia, and a 6-kg (13.2-lb) weight loss. She was treated with chemotherapy for ovarian cancer 6 months ago. She also has hypertension managed with hydrochlorothiazide.
On physical examination, temperature is 36.2 °C (97.2 °F), blood pressure is 132/75 mm Hg without postural …
We were startled to learn recently that Sheridan Healthcare Inc., a physician services company based in Florida, has bought one of the largest private anesthesiology group practices in California, the Medical Anesthesia Consultants Medical Group Inc. (MAC) of San Ramon.
The deal, which closed November 14, is Sheridan’s first in California, and “provides a platform that will accelerate our expansion in the California …
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Partial liver donation is the only life-saving deed that a non-surgeon can do for another person suffering from end stage liver disease. On the other hand, a major operation on a healthy individual with no indication for surgery has been viewed by society with caution and skepticism.
One could wonder why a young, healthy individual would succumb to an elective high risk procedure. Simple answer: they want to save a life. …
Ever get confused over the names of medicines?
I do.
There’s Zantac and Xanax. Zanaflex and Zaleplon.
But Zanaflex is also known as tizanidine. Tizanidine functions very differently than Zantac and its other name, ranitidine, even though they sound alike.
Every drug has (at least) two names — one proprietary, and one generic. Proprietary names are created to sound catchy by the original manufacturer, almost always under a patent. The generic names are more like chemical …
Sometimes I feel as if my entire emergency medicine career is dedicated to one patient complaint. And that one complaint is chest pain. It may be that the incidence and prevalence of chest pain was the same during my medical school and residency training as it is now. But I doubt it.
I recall how I struggled to learn the salient questions. ‘Where is your chest pain? Is it heavy, dull, …
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I hear it over and over again.
From a nurse, “She can’t have providine prep, she has a shellfish allergy.”
From the patient, “I can’t have the contrast because I’m allergic to iodine and shellfish.”
The list of allergies placed in the chart by a doctor, “Radiocontrast. Iodine. Shellfish.”
It’s not the fault of the patients who are typically repeating the medical misinformation they have been given. However, the medical professionals who perpetuate the …
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