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Saving billions of dollars in health care: The story of Avastin and Lucentis

Peter Ubel, MD

Meds

July 17, 2016

I sometimes worry that my wife Paula won’t be able to see me grow old. Not that I expect to outlive her. She is four years my junior and has the blood pressure of a 17-year-old track star. It’s her eyesight I’m worried about, because she is at risk for a form of blindness called macular degeneration. Paula is the youngest in a long line of redheads, several of whom …

Blood pressure in the elderly: How low is too low?

Steven Reznick, MD

Conditions

July 15, 2016

A recent publication in a fine peer-reviewed medical journal of the SPRINT study proved that lowering our blood pressure to the old target of 120/80 or less led to fewer heart attacks, strokes, and kidney failure. There was no question on what to do with younger people but to lower their blood pressure more aggressively to these levels. Debates arose in the medical community about the ability to lower it …

There are limits to what a careful physician can do

James C. Salwitz, MD

Physician

July 15, 2016

Sometimes, I think that that guiding principal of the medical profession, “first, do no harm,” is hopelessly out-of-date. Clearly, a physician should understand her limits, and never should she give care, which hurts, more than helps. Nonetheless, this axiom implies that the doctor is in control, and decides the treatment. Some of the time, a modern motto, which recognizes the true position and limits of the modern doc, might be, …

Why obstetric anesthesiology is the next frontier in medicine

Cesar Padilla, MD

Physician

July 12, 2016

There’s a lot of fear and anxiety about the job market with recent medical school graduates. The 2008 crisis almost collapsed the housing market and many of our large banks, prized institutions, and beacons of financial stability, dissolved overnight. If you combine these events with the financial burden of student loans that many graduates have, it’s easy to see why many medical students are somewhat skeptical of the job market.

In …

Poised at the abyss: A wife faces her neurologist husband’s brain cancer

Hedy S. Wald, PhD

Conditions

July 11, 2016

My husband, Mark, called me at my practice. “I’ve been working on something; I need you to come home now.” He spoke definitively, urgently. “Is it the kids?” I was instinctively anxious. “No, not the kids, just come home now.”

6 p.m., a cool evening, an ordinary day. The life before the fact. And then life afterward, irrevocably and catastrophically changed.

A tense ride home, then the revelation. “I’ve been having difficulty …

What a medical student learned during his psychiatry rotation

Michael Nguyen

Education

July 10, 2016

Psychiatry was my first clinical rotation, and I did not know what to expect when I began. When I initially got assigned to the dialectal behavioral therapy (DBT) team, I had no clue what that would entail beyond working with some borderline patients and that the preconception of borderline patients is that they can be “the most difficult” patients to help due to their intense emotional instability, chronic feelings of …

The case for teaching medical students about religion

Aamir Hussain, MD

Education

July 9, 2016

Health care providers are often uncomfortable discussing issues of religion with patients, despite studies that indicate nearly 9 in 10 Americans believe in some sort of spiritual power. As a medical student, I have noticed that religion plays an important role in many patients’ lives, and that conversations about spirituality can build rapport between doctors and patients.

As the United States becomes increasingly diverse across religious lines, it is imperative for …

MKSAP: 52-year-old man is evaluated for low back pain

mksap

Conditions

July 9, 2016

A 52-year-old man is evaluated for low back pain of 3 months’ duration that is nonradiating, progressive, and worse with ambulation. He reports no preceding injury. Medical history is notable for smoldering multiple myeloma diagnosed 1 year ago; he has been stable since that time. His only medication is as-needed acetaminophen.

On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 132/82 mm Hg, pulse rate is 70/min, and …

Obesity changes the way our endocrine system functions

Natalie M. Crawford, MD

Conditions

July 8, 2016

A patient of mine brought donuts in yesterday for the staff, and I confess! I had the one with sprinkles.

But with the study published in JAMA reporting that 35 percent of U.S. men and 40 percent of U.S. women are obese, I felt the need to talk a little about obesity and reproduction.

The endocrine system is tightly regulated by hormones which provide feedback to the brain to control their …

A case of abdominal pain in the ER. And a surprising cause.

Raj Waghmare, MD

Conditions

July 6, 2016

(Triage note: 45-year-old male, vomiting for two days. Abdominal pain.)

Dr. Stephen Cluff is like Yoda. Judging by body hair, he’s more like Chewbacca. But he’s short, wise, and with his white hair and arthritic limp, he may as well have green skin, poor sentence structure, and a Muppet’s voice. If I’m stumped on a case, I’ll ask him. If I’m pissed off about department politics, I’ll call him for advice. If I want …

The end of residency means difficult goodbyes

Anne Toledo, MD

Physician

July 6, 2016

“It is easy to see the beginnings of things, and harder to see the ends. I can remember now, with a clarity that makes the nerves in the back of my neck constrict, when New York began for me, but I cannot lay my finger upon the moment it ended.”
– Joan Didion, Goodbye To All That

So it feels at the end of residency. Of course, there is a graduation date. …

It’s time to end the medical hierarchy

Jorge Roman

Education

July 6, 2016

I was a few weeks into my surgery clerkship and was on the tail end of a student call shift. I had been at the hospital for almost 24 hours, and the last thing left to do before I embraced the comfort of my own bed was to round with the faculty surgeon on call that weekend. The night had been busy, but I was prepared to update my attending …

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It’s time to end the medical hierarchy

Your daughter is going to medical school. Please don’t worry.

Kathy Stepien, MD

Education

July 3, 2016

Dear parents,

Congratulations on your daughter’s acceptance into medical school. Like the first day of kindergarten, this launch is notable for parents as well as children.

You may have some concerns about the stresses she will face. Having been there, I can tell you there will be many. Not to worry, though. Times are changing. You daughter is free to learn among the brightest of the bright while avoiding problems women before …

Don’t remove your own IUD. Please.

Jennifer Gunter, MD

Conditions

July 2, 2016

Removing one’s own IUD is apparently “a thing.” There are even YouTube videos of women sharing their experiences. If you can get a medical degree from Google then why not get your OB/GYN residency from YouTube?

All kidding aside, I’m a gynecologist and I’m going to explain why you shouldn’t.

It’s not that people can’t technically pull out their own IUDs. It does happen accidentally, albeit rarely. An occasional …

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Don’t remove your own IUD. Please.

Open access endoscopy raises potential ethical issues

Michael Kirsch, MD

Conditions

July 2, 2016

Like nearly every gastroenterologist, we have an open access endoscopy system. This means that patients can be referred, or refer themselves, directly to our office for a a procedure without an office visit in advance.

Why do we do this? We offer it as a convenience, so patients do not need to make two visits to see us when it is clear that a procedure is necessary. For example, a referring …

New doctors may be more unprepared than ever

Chris Tedeschi, MD

Education

July 1, 2016

July is back, and clinical faculty at teaching hospitals have again braced for the annual deluge of new residents just beginning their specialty training. Unfortunately, our new doctors may be more unprepared than ever.

The gap between medical school (the four years leading to the MD degree) and residency (advanced training in a particular field) has widened over the past several years. Changes in the health care system, shifting patient expectations, …

It’s time for physicians to demand a national medical license

David M. Mitchell, MD, PhD

Physician

June 30, 2016

The practice of medicine in the United States is almost entirely based on national guidelines and regulations. Minor, inconsequential differences may exist from state to state, but nothing significant enough to justify the current requirement of comprehensive, redundant licensing of physicians in each individual state in which they practice.

Notably, in an uncommon example of federal common sense, physicians can work at any Veterans Administration facility, in any state, with any …

We need to show empathy for patients who miss their appointments

Jessica M. Yeatermeyer, MD

Physician

June 29, 2016

I have a love-hate relationship with the no-show patient. Like most doctors, I’m a reasonably good multitasker, adept enough at charting while emailing while waiting on hold with insurance companies and planning what to prepare for dinner when I get home. But there are days, more than I’d like to admit, when I feel like I need just a little bit more time, and I find myself compulsively refreshing my …

A culture of misogyny at a VA hospital

Mary Branch, MD

Physician

June 28, 2016

This is a very controversial essay, but I am going to express how some women physicians, like myself, feel at the VA hospital.

I came home one day after my clinic and was perturbed. I called my significant other and the emotion of the day unraveled. I was reporting an uncomfortable interaction I had with an older male patient. During this patient encounter, his tone and comments became sexually charged and …

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A culture of misogyny at a VA hospital

Some doctors do it for the money. Here are some reasons why.

Future Proof, MD

Finance

June 28, 2016

If you stay in medicine long enough, you will encounter physicians who seem to care more about the paycheck than the patient in front of them: think Dr. Farid Fata. You may find those colleagues revolting; I know I did. I despised these physicians and felt nauseated even to be in the same room as them. But as time went on, I realized that almost nobody starts a career …

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