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MKSAP: 29-year-old woman with nodules over her lower extremities

mksap

Conditions

April 29, 2017

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

A 29-year-old woman is evaluated for a 5-day history of nodules over her lower extremities. She reports that she regularly visits a local spa that uses whirlpool footbaths during her pedicure procedures; she always shaves her legs with a razor before these visits. Medical history is unremarkable, and she takes no medications.

On …

Are patients with minor ailments visiting the doctor too often?

Yul Ejnes, MD

Physician

April 28, 2017

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

Lately, I’ve been asking myself whether today’s patient is less able to self-manage minor illnesses than their parents or grandparents. That question was inspired by my review of notes from my patients’ visits with my nurse practitioners or to our after-hours clinic, as …

What medical school fails to teach

Caroline Humphreys

Education

April 28, 2017

This May, I will graduate from medical school. I will also be part of the first group of medical students to graduate from its new Literature and Medicine track. To me and the other participants, this has been one of the most important components of our medical education. In many ways, it has kept us grounded, serving as a constant reminder that there are experiences different from our own.

We know …

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What medical school fails to teach

Face it, doctors are bad leaders

Maiysha Clairborne, MD

Physician

April 27, 2017

As physicians, we are seen as leaders whether we like it or not. And as such, we are charged with modeling greatness. But do we? Our training, while teaching us to be experts and authorities, does not teach us how to be leaders. However, somehow we get out into practice and are automatically seen as leaders, and thrown into positions that require a skill that we don’t have. And we …

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Face it, doctors are bad leaders

“I hate myself. I don’t deserve to be a doctor.”

Pamela Wible, MD

Education

April 27, 2017

Dear Dr. Wible,

We’ve talked before. To catch you up, I’m in my clinical years now and I keep waiting to feel the same starry-eyed excitement I felt during the first months of med school, when I thought that becoming a doctor would finally give me a tangible purpose and make me a better person by helping me do right by others in …

5 things I learned while having 3 kids during medical school

Habiba Tunau, MD

Physician

April 27, 2017

During medical school, I made it a goal to graduate with a degree in one hand and a baby in another. I had a supportive husband, so we started trying to conceive when I was in my third year of medical school. We didn’t get pregnant as quickly as I thought, and we almost gave up on the idea of having a baby at that time. I was already 28 …

The hardest thing to do as a physician

Kitae Chang

Education

April 26, 2017

I’ve been told that one of the hardest things that a physician endures is the passing of her first patient. However, what I imagine to be even more challenging than this is pronouncing the death to the patient’s family for the first time. Although I find myself in a similarly intimidating and burdensome position of addressing the loved ones of our gracious donors tonight, for my first time, I feel …

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The hardest thing to do as a physician

Top 5 reasons why doctors lack self-confidence. And how to fix it.

Pamela Wible, MD

Physician

April 26, 2017

In the podcast below I interview a dear friend and therapist, Sydney Ashland, who shares the top 10 fears that hold doctors back.

What prevents us from being the doctors we always imagined? We enter medicine as inspired, intelligent and compassionate humanitarians. Soon, we’re cynical and exhausted. How did all these totally amazing and high-functioning people get screwed up so fast? Attention, medical …

The dangers of being overly apologetic

Theresa Hsiao, DO

Physician

April 26, 2017

“Sorry, excuse me, can I get through please?” I wiggled my way to the head of the bed. Quickly, I set up the necessary intubation tools as the patient arrives shortly thereafter. A frenzy ensues, tubes flying over the patient, people talking over each other.

“Can you draw me up some RSI meds? Let’s get this guy intubated now. Sorry, but I need it quiet in here.” Tube placed, a wave …

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The dangers of being overly apologetic

If she gets pregnant, she might die. Do I help?

Andrea Eisenberg, MD

Physician

April 26, 2017

When I started out in practice, I worked at one of the few hospitals in the area that accepted Jehovah Witness patients. Their beliefs prohibit them from accepting blood transfusions or blood products. Many hospitals are concerned about the liability of allowing a patient who refuses necessary blood products to die. For this reason, these institutions are not welcoming to Jehovah Witnesses. This is of special concern in surgical specialties …

A letter from my med student self to me now

Danielle Bottalico

Education

April 25, 2017

Dear Me, MD:

Now that you have opened this letter, you may have graduated or maybe you just matched into residency — somewhere, anywhere, hopefully?! As you read this, it should be some time during spring 2017. But, you never know, sometimes the train derails, and it takes a little longer than expected, so forgive yourself if that is the case. You learned a while back that the fast lane is …

It is not a great time to be a pharmaceutical rep

Martha Rosenberg

Meds

April 24, 2017

More than a decade ago, the job of the pharmaceutical rep was enviable. Direct-to-consumer advertising pre-sold many drugs so doctors already knew about them. Medical offices welcomed the reps who were usually physically attractive and brought lunch. In fact, reps sometimes had their own reception rooms in medical offices.

By 2011 thanks to drug safety scandals and new methods of marketing, the bloom had fallen off the pharma …

How I went from the bottom to the top 1 percentile on board exams

Kenneth Acha, MD

Education

April 24, 2017

Most doctors are very bright people. I believe that what often sets apart those who perform well on the job and on exams isn’t raw intelligence but rather the ability to learn effectively.

In the MCAT and USMLE steps 1, 2, and 3, I did poorly and barely passed. In 2009, I took my family medicine in-training exam and fell below the minimum passing score. After taking almost five years away from residency …

A cancer scare changed my life in 7 seconds

Starla Fitch, MD

Physician

April 23, 2017

So there I was — in deep denial. Maybe you’ve been there: Ignoring the symptoms. Hoping and praying that it would just “go away.”

A little knowledge is a dangerous thing. And as a doctor, I like to think I can Google with the best of them.

So when I had a persistent scary symptom (full disclosure: it was bloody discharge from my left breast. Not subtle. Not intermittent. Not OK, even …

Watch what you say to patients

David Mann, MD

Physician

April 22, 2017

Cardiac neuroses are often iatrogenic in origin. A well-meaning but careless comment by a physician can change a person’s sense of well-being in an instant. The effect can be permanent and devastating. Many clinicians who complain about overly anxious patients don’t appreciate their personal role in the genesis of this problem. Our words matter. They can reverse the good we do with our medications and procedures.

If you are a heart …

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Watch what you say to patients

MKSAP: 68-year-old man with new-onset ascites

mksap

Conditions

April 22, 2017

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

A 68-year-old man is evaluated for new-onset ascites with lower-extremity edema. Symptoms have increased gradually over the past 4 weeks. He has consumed three alcoholic beverages per day for many years. His medical history is notable for coronary artery bypass graft surgery 8 months ago and dyslipidemia. His medications are low-dose aspirin, atorvastatin, …

Welcome to planet medicine

Bevan Johnson, MBA

Education

April 21, 2017

Welcome to planet medicine, where four rides around the sun earns you a golden ticket to study more, to train more, and to enjoy splicing two sacred letters onto the end of your title. The days are long, the weeks go fast, and sleep is optional. In this world, all-star draftees leave their immaculate collegiate careers as masters of memorization and intellectual puzzle solvers only to still be no more …

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Welcome to planet medicine

Normal aging: A steady loss of organ and process function

Stephen C. Schimpff, MD

Conditions

April 20, 2017

Part of a series.

The percentage of the population that will be “elderly” is rising fairly dramatically. In 1900 only four percent of the population was over 65 and only one percent over 75. By 1950 it was eight and three percent, respectively. By 2000 it was thirteen and five percent, and now it’s about fourteen and six percent. By 2030 it will be substantially more again.

There are many …

An emergency physician frozen by fear, and what she learned from it

Sandra Scott Simons, MD

Physician

April 19, 2017

Am I the only emergency physician who sometimes wonders who left me in charge of an ED? I should be confident in managing whatever comes through those ED doors after more than ten years of single-coverage night shifts, but each night I hear a little voice in my amygdala questioning whether tonight will be the night I won’t be able to handle something. Sometimes I feel afraid of the unknown …

How useful is a cardiac calcium CT scan?

Dr. Saurabh Jha

Conditions

April 19, 2017

Being a radiologist, I rarely speak to patients, but I was asked to counsel Mrs. Patel (not her real name), who was worried about the risks of radiation from cardiac calcium CT scan. Because of her risk factors for atherosclerosis, her cardiologist wanted her to take statins for primary prevention, but she was reluctant to start statins. They eventually reached a truce. If she had even a speck of calcium …

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