MKSAP: 68-year-old woman with exertional leg discomfort

Conditions
July 26, 2014

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

A 68-year-old woman is assessed for a 6-month history of progressive exertional leg discomfort, described as a “heaviness” involving both calves. The symptoms are relieved within 5 to 10 minutes of rest. She has noted the same limiting heaviness with bicycling. Medical history is significant for hypertension, type 2 diabetes mellitus, and …

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The secret lives of doctors

Physician
July 25, 2014

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Recently, when my parents came for a visit, our conversations led me to realize something important: I have been a doctor for more than 20 years, and yet my parents have no idea what my daily life is like. It then occurred to me that if they have no idea, then surely my patients have no idea either.

So, if you’re a …

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Dear patient: Your 5-minute appointment is awaiting you.

Physician
July 25, 2014

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Dear patient:

I am writing to inform you of some recent changes to my practice. These changes have been implemented to improve the quality of your care.

I will no longer be able to see you for a 20-minute or 40-minute appointment. These will instead be shortened to a 10-minute or 20 minute-appointment based on your stated needs. For example, if you just …

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Digging deeper into the Commonwealth Fund health rankings

Policy
July 22, 2014

The Commonwealth Fund just published its fourth Mirror, Mirror on the Wall study comparing the U.S. health care system with other countries, and as in all previous studies, we ranked as the absolutely worst health care system in the developed world, bar none.

Yikes.

The Commonwealth Fund studied many health care domains, and we didn’t rank in first place for anything. The best we managed to do is place a lackluster third …

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Why you should love your doctor

Physician
July 18, 2014

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Doctors spend their 20s and 30s studying while most of their friends are at parties and enjoying their youth.

Doctors may amass up to $500,000 in debt for the honor of one day caring for you and your family.

Doctors delay childbearing and starting their own families so they can care for your family.

Doctors miss their own kids’ ballet recitals and baseball games …

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Stop calling nurse practitioners mid-level providers

Physician
July 14, 2014

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I really hate it when a nurse practitioner is called a mid-level provider.

“Mid-level provider” isn’t even a legal or academic term. It is slang developed to demean or minimize a health professional, who is not an MD.

The term “mid-level provider” is primarily aimed at nurse practitioners (NPs) as well as physician assistants (PAs) and midwives. It is insulting to health professionals …

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A medical student speaks up and saves a life

Education
July 12, 2014

Recently, I was on call for surgery at a hospital in New York City. At 2 a.m. in the morning, we were paged to a trauma in the ED. After we stabilized the patient and moved him for CT scans and x-rays, I noticed a small stretcher tucked away in the back part of the ED, a place typically reserved for overflow patients when we run out of rooms.

The patient …

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Dense breasts on mammogram? Don’t be afraid.

Conditions
July 10, 2014

Only in America can we find a way to scare the bejesus out of a woman with normal breasts and a normal mammogram. Because that’s exactly what happened when New York Times reporter Roni Caryn Rabin read her entirely normal mammogram results letter: “A sentence in the fourth paragraph grabbed me by the throat. ‘Your breast tissue is dense.'”

I can’t really blame Rabin for being afraid. The information about breast density in …

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Doctors must discuss the cost of care with their patients

Policy
July 10, 2014

I have been writing a bit lately on the need for health care providers to talk with their patients about health care costs, if for no other reason than to enable patients to determine whether they can afford to pay for the healthcare that their doctors are recommending them to receive.  I have been criticized for this position, on the grounds that I am rationing care from people with …

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Why are doctors still prescribing Zetia?

Meds
July 10, 2014

A health research company just released a list of the 100 top drugs in America according to sales. 29th on the list, with sales of over $1.8 billion, is the cholesterol lowering drug ezetimibe, brand name Zetia.

This drug was released over 10 years ago because it worked really well in combination with statin drugs such as Zocor (simvastatin) to lower LDL cholesterol levels. It was released as a single agent and combined …

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Learning from and living the triathlon lifestyle

Physician
July 9, 2014

During my third year of residency I trained for and completed an Ironman triathlon. I’ve discovered, despite its growing popularity, many people have no idea what a triathlon is and often nod at me in hesitant approval when I talk about this particular passion of mine. An Ironman triathlon is a 2.4-mile swim, a 112-mile bike ride, and a 26.2-mile run, completed in succession, all in one day.

And it happens …

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Do everything you can not to get admitted to the hospital

Physician
July 8, 2014

Imagine this:  You are sick.  You are the sickest you’ve ever been.  You want to die.  You almost did die.  You want to bury your head in your cozy bed for the next two years.

But you’re not in your bed.  This bed has plastic for covers and sandpaper for sheets.  You need to throw up every thirty minutes but you have to share a bathroom with someone you don’t know, …

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Why premedical students need the liberal arts

Education
July 3, 2014

In his commencement address at Sarah Lawrence College, international affairs journalist and author Fareed Zakaria defended the value of a liberal arts education.  “At its essence,” explained Zakaria, “a liberal education is an education to free the mind from dogma, from controls, from constraints.  It is an exercise in freedom.”  His speech, I imagine, was well received and much appreciated by the over 400 graduates earning liberal arts degrees that day …

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When the Joint Commission is at the hospital, leave

Physician
July 2, 2014

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Here’s a doctor’s health tip for patients that I’ll bet you haven’t heard before.

If you’re a patient who walks into a hospital for an elective procedure of any kind — surgery, or a diagnostic test — and you find out that Joint Commission reviewers are on site, reschedule your procedure and leave. Come back another day, after the reviewers have left.

Why? …

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Should doctors be paid overtime for taking call?

Physician
July 2, 2014

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Taking call is the worst thing about being a doctor. There, I said it. But wait! What about medical malpractice lawsuits? What about dealing with patients’ suffering or dying either from their illness, or far worse, relating to decisions you made or procedures your performed? Certainly these are far worse events than being on call.

Granted. However, these awful events are part of …

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The night when I entered the cult of medicine

Education
June 27, 2014

I was on the cusp of my first year in medical school, and time was running out. Classes started in two weeks. I needed a place to live: Ideally someplace cheap, not too far from school.

There was an opening at Phi Chi medical fraternity, a large brick house of faded elegance located less than a block from my classes at the University of Minnesota. At $75 a month for a …

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A perfect thank you note to an oncologist

Physician
June 26, 2014

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I got a letter the other day from a local urologist requesting clearance for a patient of mine to have surgery.  The doctor wanted to know whether there were any contraindications, from the standpoint of the patient’s cancer, such as bleeding, infection or poor wound healing, which would preclude local anesthesia, bilateral incisions, sharp separation, ligation, and electrocauterization of the vasa …

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