It all started out seeming like a pretty routine visit. My patient was in her early 30s and had come into the emergency department for weakness and was in no distress.
As I was talking with her about her symptoms she would flash the occasional smile. It was then I noticed that she had fangs. Not the kind that some people naturally have from misaligned teeth, but she had really long, …
The day I went to work and met a real vampire
Recently, Pope Francis visited Philadelphia to finish out his five-day visit to the United States. Prior to his visit, many hospitals in the city were preparing for possible emergencies involving visitors from many countries around the globe, particularly elderly visitors. On-call teams were present in these hospitals, and contingency plans were in place in case people needed to be transported emergently to different hospitals despite the high level of security …
An emergency in public: When should doctors help?
Overtesting and over treatment are big problems in modern medicine. It sometimes goes like this: Have a minor complaint? It’s probably nothing, but we should do an exhaustive workup because there is a 0.00001 percent chance it could be cancer, maybe.
However, if you happen to be that one patient in 10 million that had cancer, and we actually found it early by aggressive testing, then you would be glad you went for …
A young woman with anemia. A colonoscopy reveals a surprise.
It’s a change in nomenclature that’s come a bit out of the blue over the last few years. The forces appear to be aligning to gradually push the word “doctor” out of the center and towards the periphery of health care. Whether we are talking about administrative communication or health care information technology order entry — it seems that we are no physicians or even clinicians, but we have all …
Why we need to stop calling physicians “providers”
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 55-year-old man is evaluated during a routine examination. He feels well other than mild knee pain. He drinks six to eight cans of beer per night. He has no personal history of liver disease, but his older brother was recently diagnosed with hereditary hemochromatosis.
On physical examination, vital signs are normal; BMI is 24. He …
Test your medicine knowledge: 55-year-old man with elevated liver enzymes
As a physician, you are required to have keen senses. Touch, smell, hearing, and sight are absolute necessities for most practicing physicians while we can only hope that taste is reserved for meals and non-professional situations. I recently returned from a week of vacation in the great outdoors and found myself wishing that I had more olfactory agnosia. Olfactory is a Latin adjective from olfacere that translates “of or relating …
The aroma of medicine can be found everyday in hospitals
I have previously written about a patient on this site: “How elderly patients can be stubborn to their own detriment.” In that post, I discussed how the patient repeatedly turned down appropriate therapy for her hypertension, saying she didn’t need the help. Now I’m writing an update.
Due to the patient’s refusal to accept treatment for her hypertension, despite counseling on the part of her cardiologist and primary care …
A patient turns down hypertension treatment. What happens next is tragic.
My father suffered a massive stroke on a September night not long after his 83rd birthday. It left him conscious yet unable to talk and communicate, unable to swallow and almost completely paralyzed.
After numerous scans and other tests, his doctors determined that there was no chance of recovery. My father would never walk, talk, or swallow food again. With nothing more to do for him in the hospital, we — …
Terminal dehydration: A gentle way to die?
An excerpt from 11 out of 10: A Collection of Humorous Medical Short Stories.
When I was 16, I got a job as a “standardized patient.” My neighbor worked for a medical school, and they needed standardized patients for their medical students to practice talking to. Because apparently you can …
The time I was a 16-year-old standardized patient
Theresa arrived in a cloud of noise and commotion.
She had called after four o’clock the day before, but I hadn’t noticed the new message in my electronic inbox before I left the clinic.
Her almost brand new alprazolam bottle and her pain pills were missing, and Theresa was reeling. As she walked down the hall to the exam room, I heard her explain to Autumn how she had been to Walmart …
The surprising reason behind an early refill of alprazolam
A recent CMS proposal to bundle payments for doctors and hospitals for hip and knee replacements in 800 model centers has hit a roadblock. The five-year program would have begun January 1, 2016, and nearly 300 comments were received by CMS earlier this month. Apparently most of the comments were not, shall we say, favorable. Even the Federation of American Hospitals protested
For those who are unaware, “bundled payments” means that …
Bundled payments means the death of quality medical care
I recently read an article in Politico entitled “Doctors barred from discussing safety glitches in U.S.-funded software.” The article states that, despite massive public funding of electronic health records (EHR), the EHR corporations (including Epic Systems, Cerner, Siemens, Allscripts, eClinicalWorks and Meditech) routinely attach gag clauses to contracts with the hospitals and medical groups who purchase their systems. We are talking about gag clauses that prevent criticism by …
It’s time to remove EHR gag orders. For patient safety’s sake.
Confession time: I despise presentations that involve the use of a PowerPoint Jeopardy! game. To be clear, I get uncomfortable when any game-like activity appears in a medical teaching presentation.
Not that I don’t think games can have an important role in education — far from it. Heck, I once worked on a presentation that turned our residency conference room into a giant Game of Life board with …
Medical Jeopardy is a terrible way to learn. Here’s why.
This story is a great one.
It’s about a female dog with only three legs. Her fourth leg was amputated following a traumatic accident as a puppy.
Now, when she walks, she has a hitch in her step. And, when she hitches, she kicks the stump of her injured leg outward.
Step, step, hitch. Step, step, hitch.
One day, the female dog has puppies. And, her puppies do what all puppies do. They nurse. They watch. …
Health inspectors should be trained to do what doctors do
An intern pushed open the call room door so that twelve medical students could crowd their eager faces together to see where we might sleep for the next three years. Only a few months away from medical school herself, the intern acted as if sleeping in such quarters were second nature. She gestured to the fluffy quilts the residents had brought from home to adorn their beds and giggled about …
How call rooms reflect the personality of residency programs
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 27-year-old woman is evaluated for a 1-week history of an intensely pruritic rash on her eyelids. She applied a new brand of eye makeup just prior to the onset of the rash. She immediately discontinued its use and has been applying a moisturizing lotion to both eyelids since then without improvement in her symptoms. …
Test your medicine knowledge: 27-year-old woman with an intensely pruritic rash
It’s amazing how quickly my role changed from physician to patient, thanks to a silent assailant: osteoporosis.
I went to the gym in the morning before work 12 days ago, as I often do now that my children are all grown up and out of the house. First, a couple of light sets of leg exercises served as a warm-up, and then I started a set with a barbell on my …
Osteoporosis: A silent assailant turned me from physician to patient
Medical oncologist, Dr. Ranjana Srivastava wrote on the subject on how doctors treat doctors may be medicine’s secret shame in the Guardian back in February 2015.
About a month later, vascular surgeon Dr. Gabrielle McMullin used a book launch speech to expose the problems of sexual harassment in the surgical profession. She highlighted a story of where a neurosurgical trainee had refused sexual advances and subsequent to launching a formal complaint, …
Do patients contribute to the God complex in surgeons?
There are two, old, particularly nasty rumors, about cash and cancer. The first, which seems to be fading, is that scientists cured the disease long ago, but the pharmaceutical industry suppresses the cure so they can get rich selling worthless therapies. This never made sense to me, since the company or person that cures cancer will be rich beyond anyone’s wildest dreams. In addition, I have personally known several thousand …
It is time for an honest conversation about money and cancer
“I’d like an MRI for my leg pain. I haven’t had an MRI for many years, and I’m worried.”
These were some of the first words I heard from a patient I was seeing for a new patient visit. Based on this patient’s story and physical exam, her pain was most consistent with a muscle strain. My preferred approach to manage this complaint was to ask the patient to rest her …
When patient-centered care becomes patient-dictated care
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