MKSAP: 74-year-old woman with fatigue, anorexia, and weight loss

Conditions
December 7, 2013

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 …

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An anesthesia practice is sold, and a warning to young doctors

Physician
December 6, 2013

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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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The personal costs of a living donor liver transplantation

Physician
December 5, 2013

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. …

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Standardize drug names and reduce the risk of medication errors

Meds
December 5, 2013

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 …

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I see chest pain all day, every day

Conditions
December 5, 2013

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 have a shellfish allergy. Can I have contrast?

Conditions
December 2, 2013

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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Is health care a right or a business? It’s time to make a choice

Policy
December 1, 2013

The recent health care discussion in the media has centered around the implementation of the Affordable Care Act, now no longer a lengthy, inert document but rather a living, breathing manifestation of what should be a collective, unambiguous vision for the delivery of care in the United States. It is, however, anything but comprehensive in scope, and the coverage has primarily focused on crashing websites, politics, calls for resignations, and …

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Patients must be given the results of their tests

Physician
November 28, 2013

Just the other day one of the medicine residents presented a case to me, and mentioned that in looking through the patient’s chart he noticed that the patient had undergone a prostate biopsy 1 month prior to this visit, with a follow-up appointment in urology scheduled next month. The result of the biopsy was positive for cancer, but that had not been communicated to the patient. His first instinct, he …

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The human side of medicine that no computer can ever touch

Tech
November 27, 2013

As I look back all those years ago to when I chose medicine as a career, I suspect that my motives were similar to most people who enter this wonderful profession. I wanted to become a doctor because I had a genuine and sincere desire to help people. I also liked the idea of a busy and energetic job, one where I was comfortably as far away as possible from …

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Who do you want reading your EKG?

Tech
November 27, 2013

I know what you’re thinking, punk. You’re thinking “did he fire six shots or only five?” Now to tell you the truth I forgot myself in all this excitement. But being this is a .44 Magnum, the most powerful handgun in the world and will blow you head clean off, you’ve gotta ask yourself a question: “Do I feel lucky?” Well, do ya, punk?
– Harry Callahan (played by Clint …

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Doctors who call patients hypochondriacs are committing malpractice

Physician
November 25, 2013

There’s one question I get asked a lot: “I research my health problems on the Internet. Am I a hypochondriac?”

First, we should ban that word when talking about ourselves. No one wants to be called that, and doctors who use that word are committing malpractice. Everyone has some range of complaints and worries in life, often physical and mental together, and this is our job as doctors: to hear them …

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Can student run free clinics help the health care safety net?

Education
November 23, 2013

While interviewing for medical schools last fall, I observed a strange phenomenon: every institution I encountered would underscore its student-run free clinic as a major highlight of the medical education they could offer. First- and second-year students would speak rapturously about the experience they gained from clinic. Working there, they said, reminded them of why they wanted to become doctors in the first place.

Today, the majority of all U.S. medical …

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To put patients’ interests first, we have to put our own aside

Policy
November 23, 2013

I first read Dr. Matthew Moeller’s piece from this past March for the first time this week after a classmate of mine passed it on to me. I’m a first-year medical student — bright-eyed but sleep-deprived, trailing the smell of the cadaver lab everywhere. I entered medicine fully aware of the long, arduous road ahead, almost exactly as Dr. Moeller described it; with many of my classmates in my …

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Don’t resign your professional license in the midst of an investigation

Physician
November 23, 2013

Do you have a medical, pharmacy or nursing license in several different states?  Do you have a license in more than one health profession?  Have you been notified that an investigation has been opened against you?  Are you thinking about resigning your professional license or voluntarily relinquishing such a license?  Then you must be aware of the following.

First, you should never voluntarily relinquish or resign your license after you know …

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Going the extra mile for patients: How friendly is too friendly?

Physician
November 22, 2013

Recently, a family in my practice decided to move out of state, back to where they had lived before. When we said goodbye, the mother said that she was sad to change pediatricians. The pediatrician they would be returning to, she said, “only takes care of strictly medical things.”

Clearly, she meant that I take care of more than the strictly medical things. I was flattered, especially since this was something …

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What is the best metric to measure a hospital?

Policy
November 20, 2013

If you had to pick a single metric to a measure a hospital, which would you choose?

Of course, you can’t boil everything about a hospital down to one, single data point. Defining quality, throughput, and other factors used to evaluate a hospital is difficult business. The Centers of Medicare & Medicaid Services (CMS) tracks dozens of core metrics related to both quality and process, both inpatients and outpatients. As a practicing …

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The focus on patient satisfaction is enough to make you sick

Physician
November 19, 2013

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All patients should be treated with professionalism and respect.  We all want our patients leaving our care happy, healthy and satisfied, if at all possible.  However, sometimes patients don’t leave an emergency department very happy or satisfied.  Sometimes the doctor could have prevented it, but many if not most times, such dissatisfaction has little if anything to do with what the …

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Why physicians are hesitant to take Medicaid patients

Policy
November 18, 2013

In an earlier post, I presented some data on which kind of physicians in the United States are most and least likely to see new patients who receive Medicaid, the state/federal program to pay healthcare costs for low income people. Now a recent study lays out some reasons why many physicians are so reluctant to see such patients.

Not surprisingly, it starts with low reimbursement rates. Medicaid pays about 61% …

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How to know whether antidepressants will help

Meds
November 18, 2013

It seems to be trendy these days to say we’re all overmedicated. People say we  swallow a pill to try to escape any fleeting negative feeling, or that we throw them at our kids for any bad behavior. To be honest, there are times I agree.

However, sometimes people take the anti-medication thing way, way too far. They say antidepressants are a conspiracy of the drug companies to make us all …

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Boxer at Rest: A physician’s interpretation

Physician
November 16, 2013

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Recently, an ancient sculptural masterpiece has been on temporary display in the Metropolitan Museum of Art’s Greek and Roman halls. On loan from Rome’s Museo Nazionale Romano, “Boxer at Rest” depicts a battered pugilist immediately after a fight. His face bears evidence of broken nasal bones, swelling and hematoma under his right eye, and multiple lacerations and abrasions to his nose, cheeks, and forehead. One secret …

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