MKSAP: 57-year-old woman with decreased exercise tolerance

Conditions
August 16, 2014

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

A 57-year-old woman is evaluated for a 2-week history of decreased exercise tolerance and substernal chest pain on exertion. She also has an 8-month history of macrocytic anemia.

On physical examination, temperature is 36.7 °C (98.0 °F), blood pressure is 137/78 mm Hg, pulse rate is 104/min, and respiration rate is 17/min. BMI …

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MKSAP: 57-year-old woman with decreased exercise tolerance

Consider the messages that tattoos are sending

Physician
August 15, 2014

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Ink is everywhere these days, and I don’t mean on newspapers or in magazines. Tattoos are far more pervasive than I can ever recall in my fifty years. There was a time, when I was young, that boys were awestruck by the old Navy veterans, whose arms bore anchors, and the Marines with Semper Fi across their battle-scarred chests. Occasionally, when …

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Consider the messages that tattoos are sending

Are American doctors paid too much or too little?

KevinMD
August 15, 2014

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A version of column was published in USA Today on July 2, 2014.

There are some who think that I’m overpaid as a physician, and that my salary fuels rising health costs.  I can understand their point: A May 2014 survey released by the Medical Group Management Association found that internal medicine doctors like myself have a starting median annual salary of $190,000, …

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Are American doctors paid too much or too little?

Chest pain and what we can learn from changing flat tires

Physician
August 14, 2014

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“Daddy, I think we have a flat tire.”

I just rolled out of the garage with my 4th grade daughter. It was Tuesday morning. Usual daily routine. Drop her off at school then go to work. A little different today as I was to lead an important meeting.

How could she possibly know what a flat tire sounds like? Now? Right now? She’s …

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Chest pain and what we can learn from changing flat tires

A letter from a hospitalized patient to a hospital CEO

Physician
August 13, 2014

We are at a pivotal moment in health care. It’s changing so rapidly even the people leading the change can barely keep up. One of the biggest paradigm shifts over the last decade is the focus on quality over quantity. Improving the health care experience and patient satisfaction are also being talked about in boardrooms across the country (largely due to the link with reimbursements, but still unthinkable a few …

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A letter from a hospitalized patient to a hospital CEO

At the hospital, I’m Dr. Nobody

Physician
August 12, 2014

Today I had a very special experience, one which many of my patients have faced: I was treated like a nobody while at the hospital. Yay me.

I went to visit a patient who was admitted over the weekend to see what was going on.  She was a bit upset about the confusion of the hospitalist service and how orders apparently didn’t get written for her care by the admitting physician. …

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At the hospital, I’m Dr. Nobody

A primer on the anesthesia care team model

Physician
August 10, 2014

american society of anesthesiologistsA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

Daily, and often several times a day, I am asked by patients about my role as a physician anesthesiologist.  Occasionally the answer involves reiterating to patients that an anesthesiologist is a physician.  Once we get into the discussion, patients are also surprised to learn that …

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A primer on the anesthesia care team model

10 potential benefits of robot caregivers

Tech
August 10, 2014

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My recent New York Times op-ed on robot caregivers for older adults has elicited curiosity, enthusiasm and controversy.

I have to admit that my own first reaction to the topic was captured in the Times’ letter from Sherry Turkle whom I mention in the piece. I was in a meeting and turned to a colleague, clumsily patted her on the back and said, “It … …

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10 potential benefits of robot caregivers

Are you a medical liberal or a conservative?

Meds
August 9, 2014

Our nation is highly polarized today, and often bitterly so.  Democrats rail against the GOP.  Pro-lifers face down pro-choicers.  Fox News disses MSNBC.  Isolationists push back against expansionists.  Traditionalists disdain the politically correct.  Free marketers duel against government advocates.  Carnivores deride the gluten-free crowd.  Martin Bashir trashes Sarah Palin, two proxies in a culture war.

There’s a philosophical divide among physicians also.  Would you prefer a liberal physician or a conservative …

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Are you a medical liberal or a conservative?

One more thing syndrome: 4 tips for doctors to stay on time

Physician
August 8, 2014

“Doc, can I ask you one more thing?”

These words are classic symptoms for those patients suffering from the “one more thing” syndrome. We’ve all been there. The visit has ended, your hand is on the doorknob, and you’re about to leave the room. Precisely at that moment, your patient stops you and says he has one more thing to discuss.

You think to yourself, “No! I almost made it out of …

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One more thing syndrome: 4 tips for doctors to stay on time

A letter to new medical students

Education
August 7, 2014

Dear new medical student:

Congratulations! You are about to embark upon an exciting, life-altering experience, one you will never forget. You are about to join an elite group of people who will now be your peers going forward.

You will be continually fascinated, and not a single day will go by from now until you retire that you aren’t challenged by something you have never encountered before. You will be solving problems …

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A letter to new medical students

Why do physicians behave badly? Maybe because they’re scared.

Physician
August 6, 2014

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A dozen set of eyes stared upwards.  The nurses ate their pizza and glanced back and forth between me and the dry erase board that I had recently filled with incomprehensible scrawl.  I had given this lecture many times and said the words over and over again.  And yet the response was always surprising.

“Why do you think physicians get angry and …

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Why do physicians behave badly? Maybe because they’re scared.

5 things that make U.S. health care great

Policy
August 5, 2014

Anyone from outer space reading the news and watching TV would think that the U.S. has some of the worst health care possible. The negativity appears to be pervasive. Controversy over this, outrage over that. Whether it’s inadequate health outcomes, policy debate, or scandals with patient care, the stories and discussion abound.

As someone who grew up and went to medical school overseas and then came to the U.S. for medical residency (along …

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5 things that make U.S. health care great

What is the most important trait in a doctor?

Physician
August 3, 2014

Medical errors are estimated to be the third leading cause of death in America’s hospitals. Though some of these errors are beyond physician control, many are the direct result of physician action and inaction. I spend a lot of time thinking about how to reduce these errors and I (like many of my peers) lose sleep over the mistakes I witness.

When you ask patients what quality is most important in a …

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What is the most important trait in a doctor?

What if jet lag was infectious?

Conditions
August 2, 2014

Jet lag, also known as desynchronosis or flight fatigue, is defined as “extreme tiredness and other physical effects felt by a person after a long flight across several time zones.” Besides insomnia, symptoms of jet lag include weakness, fatigue, dehydration, body aches, diarrhea, dizziness, headache, irritability, and memory loss. Jet lag is one of the circadian rhythm disorders; others include shift work disorder, sleep phase disorder, and irregular sleep-wake rhythm.

Symptoms …

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What if jet lag was infectious?

Law and medicine are more intertwined than they should be

Physician
August 1, 2014

I’m a law abiding blogger. Laws are meant to be obeyed. If an individual opposes a law in a free country, then he should operate within the system to modify it. I recognize that even in free societies, certain laws are so unjust and in violation of natural law that that the citizenry may be justified in relying upon other measures to affect necessary reform.

I’m not suggesting that an unwelcome …

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Law and medicine are more intertwined than they should be

Welcome to the world of metamedicine

Physician
July 30, 2014

Knowing what to do when faced with a sick patient is relatively straightforward. We learned a lot of it in medical school, picked more up by experience, and usually have the opportunity to look things up quickly on the Internet. Even when faced with a brand new situation, we can usually fall back on our general knowledge of science and medicine.

But in today’s practice of medicine, that’s not enough. Physicians, …

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Welcome to the world of metamedicine

Doctors are helpers, not healers

Physician
July 28, 2014

It’s a seductive idea.  We doctors possess knowledge and experience which can not only help people, but can save their lives.  We get opportunities to be the right person at the right time to offer the right help that makes all of the difference.  It’s one of the greatest things about our profession.  It’s also one of its greatest traps.

I’ve heard many doctors refer to themselves as “healers,” as if …

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Doctors are helpers, not healers

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