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MKSAP: 30-year-old woman is evaluated for a 1-year history of fatigue

mksap

Conditions

May 3, 2015

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

A 30-year-old woman is evaluated for a 1-year history of fatigue, headaches, poor sleep, depression, intermittently blurred vision, and weakness when climbing stairs. She takes no medication. Following a physical exam and lab studies, what diagnostic tests should be performed next?

On physical examination, vital signs are normal. Bilateral ptosis and diplopia are …

Fellowship training, as viewed by a physician’s spouse

Ashley Mast

Physician

May 1, 2015

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As a wife and mother, I have days that are very difficult, especially since my husband is in training. I go several days in a row where I only see him right before bedtime, and some days he is unable to see our son at all. I often feel like I have no control of our schedule, and am lucky to …

End-of-life care: What I learned from a pet’s death

Abigail Schildcrout, MD

Physician

April 30, 2015

It has taken me almost two years to be able to write this. We said goodbye to our beloved dog in early May of 2013. I grieved for well over a year.

About a month-and-a-half prior to his death, we had a big medical scare with him. I wrote at that time about how dealing with a veterinary emergency can provide us with some insights and practice parallels to dealing with …

We’re going to need more medical chaperones. Here’s why.

Edwin Leap, MD

Physician

April 29, 2015

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For my entire life as a physician, from medical school, through residency and now until this 22nd year in practice, I have subscribed to the idea that I should have a chaperone when performing breast, pelvic or rectal exams on women. I was taught to do this from the beginning, and I still do it.

Why is this? On some level, the …

Our time on this earth is finite

Jordan Grumet, MD

Physician

April 27, 2015

Everything eventually expires.

I looked down at the bottle of natural spring water in astonishment. It had an expiration date. Scanning the empty hospital cafeteria on an early Sunday morning, I wondered what on earth about spring water could go bad? It had no living parts, Nothing that serves as nourishment for wayward bacteria or fungus. The container was sealed. Pristine.

I figured it was another fiscal hoax, perpetrated on unsuspecting consumers. …

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Our time on this earth is finite

When a CT scan misses cancer

Michael Kirsch, MD

Conditions

April 26, 2015

A female patient came to see me with some difficulty swallowing, a very routine issue for a gastroenterologist. I performed an scope examination of her esophagus and confronted a huge cancer occupying the lower portion of her esophagus.

I expected a benign explanation for her swallowing issue. She was relatively young and not particularly ill. She had seen my partner years in the past for a similar complaint, which he …

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When a CT scan misses cancer

Who gets to call themselves family physicians?

Lucy Hornstein, MD

Physician

April 26, 2015

Who is a PCP? (And does that second “P” stand for “physician” or “provider”?)

Who gets to say? Does it matter?

Perhaps we should start with some basic qualifications: The degree of MD or DO, the satisfactory completion of an accredited residency in family medicine, and successfully passing the written examination of the American Board of Family Medicine (ABFP, an organization distinct and independent of the AAFP). Hard to argue with those.

How …

Stay away from doctors: From a patient who listens

Hans Duvefelt, MD

Physician

April 26, 2015

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Earnest Tipp was very overdue for his blood pressure follow-up. Almost a year and a half overdue, as a matter of fact. The last few times I had refilled his medications, I had added “needs follow-up” to the signum on his scripts.

The other day I finally saw him in my schedule. I thought about him all morning. A tall, muscular 90-year …

IMGs matching into surgery: What are the chances?

Skeptical Scalpel, MD

Education

April 25, 2015

Anyone considering attending a Caribbean or any foreign medical school should do due diligence. An Internet search is step one. If the school does not list residency match statistics, that could be a red flag. It would not be easy to accomplish, but try to speak with some current students or recent graduates of any schools you are thinking about.

If the school won’t give you any names, use caution, and …

So you want to be a female surgeon. Here are 10 tips to make it.

Dr. Nikki Stamp

Physician

April 24, 2015

I am lucky enough, from time to time, to be invited to speak to young women who want to be surgeons when they “grow up.” I always have a hard time striking a balance between what I should share that is positive and inspirational and what I should share that is a little harsh and uncomfortable. Once, I turned to my …

I am a general surgeon. There is no shame in that.

Jeffrey Parks, MD

Physician

April 22, 2015

A few months ago, I was seeing an elderly man in the hospital with a sigmoid mass seen on his colonoscopy that day. He had presented to the hospital with fatigue and anemia, and the long meandering workup eventually zeroed in on this malignant appearing mass as the source. His daughter was in the room while I discussed the results, the …

Dealing with doubts in medical school

Jennifer Tsai

Education

April 22, 2015

For me, hepatitis B booster shots feel pretty much as pleasant as being sucker punched in the arm. You can imagine that it didn’t inspire much elation when I scrolled through my calendar to see, spelled out in big red letters, a reminder for “Hep B #3.”

Now, as I reflect, this reminder feels like a victory of sorts.

When you are told during medical school orientation that you must be reimmunized for …

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Dealing with doubts in medical school

Don’t use essential oils for asthma. Here’s why.

Chad Hayes, MD

Meds

April 22, 2015

Alright, we need to talk. Those of you who follow my blog know that I don’t shy away from controversial topics and that I don’t have a problem speaking my mind. I try to do it in a respectful, informative, and somewhat humorous way. But I saw something this morning that needs to be addressed, and it’s not funny at all.

As I was eating breakfast before work, I saw a …

Doctors sometimes don’t inform patients of bad news. Why?

Kevin R. Campbell, MD

Physician

April 22, 2015

Doctors and patients bond over time. Information exchange, education and sharing of expertise are critical activities that add to the effective practice of medicine.

Delivering bad news is, unfortunately, an unpleasant part of a physician’s job. Honesty, empathy, and clear communication are essential to delivering news to patients and their families — even when the news is unpleasant or unexpected. While communication is an integral part of the practice of medicine, …

The House of God brought attention to medical slang

Brian Goldman, MD

Physician

April 21, 2015

An excerpt from The Secret Language of Doctors: Cracking the Code of Hospital Culture.

When it comes to modern medical slang, there’s Before Shem and After Shem. Shem refers to Samuel Shem, the pen name of Dr. Stephen Bergman, psychiatrist and author of the blockbuster novel The House of …

How are drug companies making millions from generic drugs?

Peter Ubel, MD

Meds

April 17, 2015

It is well accepted among health economics wonks that the lion’s share of pharmaceutical company profits come when these companies hold exclusive rights to their products. Once their blockbuster pills go “generic,” competitors enter the marketplace and profits plummet. Consider captopril, a groundbreaking heart failure medication introduced in the early 80s by Bristol-Myers Squibb under the trade name Capoten. After making a fortune for the company, captopril went generic in 1996. …

My first experience administering injections

Heather Alva

Education

April 16, 2015

My first experience administering injections involved sitting in an ICU room, ten years old, drinking bitter diet Shasta colas and watching thrillers from the 90s starring Sandra Bullock. The nurses started me on oranges. Easy as pie — I could stab away, practicing insulin injections with saline and fruit. The oranges practically squealed with delight upon puncture, rewarding me with the scent of citrus and a plume of juice — …

When examining patients, don’t forget about the feet

Lori Weisenfeld, DPM

Conditions

April 16, 2015

When I was a resident, I saw a middle-aged man, “Charles,” who came into the hospital after playing a round and a half of golf. When I looked at his right foot, he had an ulcer in the shape of a golf tee. He had played the entire day with a golf tee in his shoe and only noticed when he found drainage on his sock. The story sticks in …

Let’s clear up the confusion about what a physical is

Lucy Hornstein, MD

Physician

April 16, 2015

Dear patients,

First of all, thank you for calling for an appointment. Seriously. Ever since I’ve gone open access, if the phone doesn’t ring I’m toast. And thank you for your interest in preventive care. The fact that it’s now free (well, no cost to you at time of service: trust me, it’s not “free”) has probably motivated more of you to call. That’s OK. But sometimes it seems that your …

Should we give patients our cell phone numbers?

Anne Katz, RN, PhD

Physician

April 13, 2015

I recently attended the David Stroud Adolescent and Young Adult [AYA] Symposium at Keck Medicine of University of Southern California. It was a very interesting symposium with experts in adolescent and young adult cancer presenting on many different topics important for this population. There was also a panel of young adult …

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