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MKSAP: 38-year-old woman with fatigue and dyspnea on exertion

mksap

Conditions

July 13, 2013

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

A 38-year-old woman is evaluated for a 6-month history of progressive fatigue and dyspnea on exertion. Over the past 2 years she has noted episodes of hand swelling, joint pain, blue color change of her fingers with cold exposure, and difficulty swallowing. She takes no medications.

On physical examination, temperature is 36.9 °C (98.4 °F), …

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Should drug testing be considered screening tests?

Chris Rangel, MD

Conditions

July 12, 2013

cropped-clean_urine

Tests like cholesterol levels are considered screening tests because they are cost effective, have high sensitivities (a low rate of false negatives), and have been proven to be beneficial in the identification of conditions that may require treatment before symptoms occur. The vast majority of medical tests are not considered to be “screening” because they violate one or more of these principles, …

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Primary care doctors need 35 hour work weeks

Leslie Kernisan, MD, MPH

Physician

July 11, 2013

Jeff Goldsmith recently opined on why practice redesign isn’t going to solve the primary care shortage. In the post, Goldsmith explains why a proposed model of high-volume primary care practice — having docs see even more patients per day, and grouping them in pods — is unlikely to be accepted by either tomorrow’s doctors or tomorrow’s boomer patients. He points out that we are replacing a generation of workaholic boomer …

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A ruptured eardrum turns out to be something much more

Physician

July 9, 2013

My shift is over, and I’m ready to head out the emergency department door. When I walked in 12 hours ago, the department had 20 waiting patients. I look up at the monitor and after 12 hours of trying to wrestle the department under control, not only is it not under control, now we’re 25 patients deep in the weeds. My partner Dr. Jim looks at me and says, “Get …

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When does a teen girl need a pelvic exam?

Wendy Sue Swanson, MD

Conditions

July 8, 2013

Typically, teen girls do not need a pelvic exam until they are 21. Most parents are surprised to hear this, especially if they know their teen is sexually active.

About 1/2 of teen girls are sexually active during high school which puts them at risk for sexually transmitted infections (STI) and unwanted pregnancy. However, for routine prevention and care, girls rarely need an internal pelvic or speculum exam during high school. …

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Should the Sunshine Act be celebrated?

Policy

July 8, 2013

Do you want to know if your doctor has been eating pizza for lunch that was purchased by Pfizer as she listened to a drug rep describe a new medication? Do you want to know if your endocrinologist has been paid $1,500 to give a brief talk about a new injectable diabetes medication to his colleagues as they gobble down filet mignon? If the answer is “yes,” then you are …

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Declining board exam pass rates: Blame millennial doctors?

John Schumann, MD

Education

July 8, 2013

An interesting conversation recently took place among residency program directors in my field of internal medicine.

At issue was the declining pass rate of first-time test takers of the ABIM Certification Exam.

It’s a mouthful to say, but the ABIM exam is the ultimate accolade for internists. One is only eligible to take the exam after having successfully completed a three-year residency training period (the part that includes “internship,” right after medical …

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It’s hard to grasp the experience of being a patient

Madeline Sterling, MD

Education

July 7, 2013

My time as a medical student has quickly come to an end. This past winter, with nearly four years of arduous study, countless examinations and numerous clinical rotations under my belt, I couldn’t help but think, Yes, I’m ready to be a doctor.

And then I became a patient.

I’d always thought I knew what it’s like to be the patient. For much of my childhood, my father suffered from chronic fatigue syndrome, …

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This is why you should wear sunscreen

Conditions

July 5, 2013

I recently celebrated my birthday with a 9-hour picnic and for the first time in my life I was aware that some of my friends were starting to wear large hats and sunscreen. In fact, one of my friends was asking me about tinting her windows to block out excess sun.

Finally we are all now realizing what our mothers have been telling us since day 1 and what was popularized …

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Why doctors should take sabbaticals

Janice Boughton, MD

Physician

July 5, 2013

In October of 2011, I left my job of 17 years, which I loved, mostly, and started a 2 year sabbatical. Since sabbatical implies that there is one year of rest every 7 years, I have built up at least 2 years since finishing medical school in 1986. Nobody in my office or medical community did sabbaticals, but we discussed that it would be a great idea when we first …

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The truth about guar gum

Meds

July 4, 2013

image_01_b

It is increasingly difficult to find real ice cream. When reading the ingredient list it is discouraging how many cheap fillers, consistency modifiers, and shelf life extenders are included. One ingredient, namely guar gum, seems fairly ubiquitous. So what is guar gum, and why is it found in so many products including ice cream? Is it “bad” to eat?

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Herbal medicine: 6 tips to consider when talking to your patients

Robin Friedlander, MD

Meds

July 4, 2013

Herbal medicines make most doctors cringe, laugh, or want to put blinders on and pretend they don’t exist. This is understandable. While allopathic medical education hammers pharmaceutical formulas and mechanisms of action into our brains, we learn little-to-nothing about herbs in medical school. Quite the opposite – we are most often told to uniformly discourage our patients from taking herbs out of concern for safety; a conversation stopper with little …

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Reflections after 4 years of emergency medicine training

Physician

July 3, 2013

On July 1st, four years ago, I walked through Massachusetts General and Brigham and Women’s Hospitals with an odd mixture of fear, relief, and excitement. Now, as I leave the hospital after my last shift of emergency medicine residency training, I am filled with a similar hodgepodge of emotions and reflections.

1. “You were terrified of being a doctor!” I mentioned this article to the attending who oversaw my first shift as …

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The powerful effects of culture and lifestyle on health

Kevin R. Campbell, MD

Policy

July 2, 2013

As Americans we spend more money on healthcare per capita than any other nation in the world. We have the latest medical innovations and for decades have been able to provide cutting edge therapy without regard to cost. However, as a profession, doctors are not doing nearly enough when it comes to prevention of disease. Certainly, costs will be reduced if we are able to prevent chronic illness and associated …

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A powerful address to graduating medical students

Education

July 1, 2013

Dear Graduating Class of 2013,

I appreciate the opportunity to address such an impressive pool of medical school attendees. From the first day of medical school when you were introduced to your cadaver, you have endured countless lectures and lab hours, physical examination and sensitivity training sessions, and ward rotations under the watchful eye of senior residents and attendings. Today, you will hold something that few people are privileged to …

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4 complaints of physician employees and 1 solution to fix them

Dike Drummond, MD

Physician

June 30, 2013

Medscape published an article titled, 4 Top Complaints of Employed Doctors, and it was a very interesting read. Turns out the things employed physicians complain about are basically that they are employees.

Let me lay out these employed physicians gripes for you with a little detail so you will see what I mean. I will finish this article with a solid way to address all of them. These …

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A surgeon deconstructs bowel surgery

Conditions

June 29, 2013

Next in a continuing series.

Let’s make it easy on ourselves. I haven’t yet established why — other than liking the particular operation — we’re removing this nice person’s colon. So since our patient has agreed to remain exposed and to do so for all to see, I declare s/he has diverticulitis. (Were it cancer, the operation would be largely the same, taking a bit more out.) Most likely …

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Why EMR companies don’t care about usability

Tech

June 26, 2013

I overheard nurses praising the pilot of a new technology with the promise of improving communication, safety, and saving on healthcare spending. The innovation: two-way texting. That’s one of the many indicators that hospitals are stuck the technological stone age.

Imagine how many eyes light up when you offer providers fewer logins, autopopulating forms, and uncluttered menus. There’s an assumption that technology, in the context of healthcare, has to be bad …

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When a child can’t feel his poops

Roy Benaroch, MD

Conditions

June 26, 2013

Kathy wrote about her son: “What can cause a 9-year-old boy to poop in his pants occasionally and not feel it? He was completely potty trained at age three. I have found dirty underwear and poop on the bathroom floor–and it just concerns me that he is unaware of it. It has been suggested at checkups that he may be constipated. My mother suggests he may simply not be paying …

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