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MKSAP: 63-year-old man with mid-upper back pain

mksap

Conditions

December 23, 2017

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

A 63-year-old man is evaluated for severe mid-upper back pain following a minor fall 1 day ago. He also notes progressive fatigue of 6 months’ duration and a 6.8-kg (15-lb) weight loss. Medical history is notable for an 80-pack-year smoking history, although he is currently a nonsmoker.

On physical examination, temperature is 37.3 …

What it’s really like in a post-baccalaureate program

Neil Kondamuri

Education

December 21, 2017

More than 15 percent of last year’s new crop of first-year medical students completed a post-baccalaureate program. These programs exist in two flavors: one type helps students who want to improve their undergraduate academic record, and the other helps those who want to redirect their careers toward medicine, like me. Both are growing rapidly in number.

With so many future doctors launching …

End the resident physician abuse now

Anonymous

Physician

December 21, 2017

Let’s talk about the cycle of abuse. No, I am not referring to the very serious issue of domestic violence. Instead, I am talking about the graduate medical education system. No one is a resident forever: the duration of each residency is predetermined with a wide range of three to nine years. The self-limited nature of this experience decreases the incentive for participants to advocate for changes. And the attitude …

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End the resident physician abuse now

Are post-apocalyptic disaster films inspiration for doctors?

Seiji Yamada, MD, MPH

Physician

December 20, 2017

What would medical education that is relevant for the here and now — for America in the early 21st century — address? It is impossible to teach the content relevant for an entire career. It is important to educate practitioners able to adapt to the changing landscape of medicine. We must consider what the future might hold.

Watching science fiction may serve to prompt future physicians to practice preventive medicine for …

Why nurse practitioners train on the backs of physicians

Lynn McComas, DNP, ANP-C

Policy

December 19, 2017

“Nurse practitioner (NP) education is seriously underfunded. The profession is attempting to saddle private physicians with this cost.”

That is how “Dr. X” replied to my email asking whether he would be willing to precept a nurse practitioner student for her clinical rotation. I read through his clearly disgruntled letter and wanted to explain to him why NPs have to train “on the backs” of physicians and why funding for nursing …

A doctor saved a patient’s life. Twice.

Rob Lamberts, MD

Physician

December 18, 2017

I have good days and bad. Some days I am content, connected, focused, and motivated. On those days I enjoy my job, I enjoy the people I’m with, I am willing to be inconvenienced by interruptions.

On other days, not so much. I wake up as grumpy Rob and (despite multiple cups of coffee) the old codger doesn’t leave me alone. I keep score of all the ways in which life …

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A doctor saved a patient’s life. Twice.

The CVS merger with Aetna: What does it mean?

Sharona Hoffman, JD

Policy

December 18, 2017

The announcement that CVS plans to acquire Aetna for US$69 billion raises hope and concerns.

The transaction would create a new health care giant. Aetna is the third-largest health insurer in the United States, insuring about 46.7 million people.

CVS operates 9,700 pharmacies and 1,000 MinuteClinics. A decade ago, it also purchased Caremark and now operates …

The Good Doctor shows us the value of time

Suzanne Fiscella, PA-C

Physician

December 17, 2017

In a recent episode of the television series, The Good Doctor, a patient played as Robbie Ato does not tell his doctors he has a history of cancer. You can see his surgeons stare in disbelief as one consulting surgeon recognizes the patient’s name and then alerts the team leader that she treated him three years ago for cancer.

This is one of the very most troubling and dangerous acts of …

Getting it right: the challenge and reward of clinical diagnosis

Philip A. Masters, MD

Physician

December 17, 2017

A guest column by the American College of Physicians, exclusive to KevinMD.com.

It was actually a great diagnosis that led me to become an internist.

I distinctly recall a patient admitted to my service during my third-year internal medicine clerkship inpatient rotation. He was extremely sick and what was wrong with him had eluded multiple other …

The myth of multitasking in primary care

Hans Duvefelt, MD

Physician

December 15, 2017

Primary care doctors don’t usually have scheduled blocks of time to read incoming reports, refill prescriptions, answer messages or, what we are told the future will entail, manage their chronic disease populations. Instead, we are generally expected to do all those things “between patients.”

This involves doing a little bit of all those things in the invisible space between each fifteen-minute visit, provided we can complete those visits, their documentation and …

The first rule of medical school interviews: Don’t talk about cost

Nicholas S. Tito, MBA

Finance

December 14, 2017

The fall is over, and winter has come, which means I have just wrapped up a busy season of medical school interviews. Most interviews are conducted in a similar fashion with an hour of introduction, speeches by the dean, presentations of facts I already knew from the website, and finally the interviews.

Within the first hour, I understand the reason: “We are the best medical school at (fill in the blank).” …

What’s in a woman physician’s last name? A lot.

Veronica Maria Pimentel, MD

Physician

December 13, 2017

A recent post about a physician using her maiden name professionally generated major controversy on a physicians’ group. Hundreds of comments later, it became evident that female physicians who chose to use their maiden names are subjected to negative judgment.

I am a physician married to a supportive man who understands my choice to keep my last name. I am not unique in my circle. Most of my female physician friends …

Insurance and the destruction of our health care system

Peggy A. Rothbaum, PhD

Policy

December 11, 2017

When interviewing for my book, I asked about insurance, but the topic came up even when I didn’t specifically ask about it. It was never positive in relation to practice.

A doctor said, “I expected to be around tough and hard cases. I expected it to be hard. I did not expect to have to think if the insurance company will not pay for it.”Another one said, “This completely changes the …

The moment I became a passionate doctor

Jo Ann Gates, MD

Physician

December 9, 2017

I was nearing the end of my pediatrics rotation as a third-year medical student when the senior resident asked me to admit a patient to the general pediatrics floor. The only information I had as I headed down to the intensive care unit was that she was a ten-year-old girl who had survived an extensive resuscitation at home.

By this point in my education, I was certain that I wanted to …

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The moment I became a passionate doctor

Here’s how to be a good mom and good doctor

Foreign BornMD

Physician

December 8, 2017

Go to college, go to medical school, start and finish residency and fellowship, get married, settle down and have children …

There is a certain expectation of what a “successful life” would look like for a physician mom. Some may even choose to stop work and become a full-time stay-at-home mom.

Even when my spouse, who works part-time for most of our marriage, took a year off work to be the stay …

An eye-opening rotation at the Indian Health Service

Eric Schmidt

Education

December 8, 2017

For the month of September, I embarked on the experience of a lifetime, living and working on the largest Native American reservation in the United States. Sprawled across the four corners region of Utah, Arizona, New Mexico and Colorado, the Navajo Reservation in Chinle, Arizona, encompasses an area as large as the entire state of West Virginia. Its population, however, is only about 300,000, making it extremely rural. To leave …

4 reasons why patients don’t take their medications

Linda Girgis, MD

Physician

December 7, 2017

I often see patients for follow-up and learn they are not taking the medications either I or another health care provider prescribed. Sometimes the reason is obvious, and other times the patient is reluctant to give up the information. Patients have the right to take or not take medication that was prescribed. But, sometimes by not doing so, they are putting their health at risk.

As a doctor, I want my …

A patient called me the N-word

B. Cameron Webb, MD, JD

Physician

December 7, 2017

Editor’s note: This article contains a racial slur crucial to the writer’s story.

It took only 57 hours of working as a new attending physician in Charlottesville, Virginia for a patient to call me the N-word.

Fifty-seven hours. In fact, a racial slur found me before I found the shortcut to the hospital cafeteria. So, when torch-bearing White supremacists gathered downtown earlier this year, I saw more confirmation of my conclusion that …

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A patient called me the N-word

Leonardo Da Vinci and health care: a matter of perspective

Neil Baum, MD

Physician

December 6, 2017

Recently, a Leonardo Da Vinci painting, Salvator Mundi (Savior of the World), was sold for $450 million, making it the largest fee for a painting ever sold. Was it a good investment? The painting was sold by Leonardo’s heir to King Francis I of France for 4000 gold ducats in 1519, which according to the American Numismatic Society would be equivalent to $575,000 at today’s price of gold at $1277 …

5 challenges of working in a county hospital

Pranav Sharma, MD

Policy

December 6, 2017

As a trainee at a large private health system (residency) followed by a NCI-designed comprehensive cancer (fellowship) in two large metropolitan areas in the United States, I was not prepared to face the challenges of working at a university setting affiliated with a county (public) hospital in more rural west-Texas. After one and a half years of experience as a practicing urologic oncologist, these are the five challenges I have …

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