KevinMD.com

“I want to give up my son”: Is that child abuse?

Physician

September 24, 2014

The case

A thirty-five-year-old female presents to the emergency department on a weekend afternoon with the following chief complaint: “I want to give up custody of my son.”

The patient is well dressed — and so is her four-year-old son, who is sitting comfortably on the bed playing a video game on his mother’s cell phone.

According to the patient, she is a single mother with no support system. Her son’s father deserted …

Responding to a medical student in pain

Abigail Schildcrout, MD

Education

September 23, 2014

shutterstock_100742404

This evening, I read a post written by a woman who finds herself feeling alone, depressed, desperate, and afraid of losing herself as she goes through medical school.

This post is my response to that woman.

Dear colleague and friend,

You are not alone.

You are far from home. You are far from your family. You are far from the desert, the open …

Read more…

Responding to a medical student in pain

How do you know when a hypochondriac is really sick?

Lucy Hornstein, MD

Physician

September 22, 2014

I have a patient who is a full blown sufferer of health anxiety. He firmly believes he has full-blown AIDS after a single extramarital sexual contact (non-genital) one month prior with a woman not known to have HIV. (Reality check: The other person didn’t have HIV, the specific contact as described was ridiculously unlikely to have transmitted the virus had it been present, and AIDS takes months to years to develop …

Deactivating a pacemaker: Is it euthanasia?

Eric Widera, MD

Conditions

September 18, 2014

“He’d feel okay about not replacing the pacemaker’s battery when it ran down, he said. But turning it off, he said, would be ‘too active.’ Later he would tell me that it would have been “like putting a pillow over your father’s head.”

These are the words of Katy Butler in her book Knocking on Heaven’s Door – The Path to a Better Way of Death in which she writes about her …

Abortion or ectopic pregnancy? When politicians confuse medical terms.

Jennifer Gunter, MD

Conditions

September 17, 2014

Wendy Davis, gubernatorial candidate for Texas, has a new memoir Forgetting to Be Afraid. In it she describes terminating two pregnancies. One termination appears to have been in the second trimester for fetal indications and the other she describes as an ectopic pregnancy. She writes, “The only medical option was to have surgery to terminate the pregnancy and remove the affected fallopian tube — which …

The worst-case scenario: When patient satisfaction goes too far

Suneel Dhand, MD

Physician

September 15, 2014

Everyone involved in health care, and particularly hospital care, has witnessed a sea change over the last decade. Things that were never even thought about, let alone formally taught to frontline doctors and nurses, have now come to the forefront.

Chief among these is the drive towards improving patient satisfaction and delivering a more optimal hospital experience. True, a large part of this is due to federal incentives and tying reimbursements …

5 things people get wrong about Canada’s health system

Kathleen O’Grady and Noralou Roos, PhD

Policy

September 14, 2014

The Canadian health care system is often held up as an example to model or to avoid at all costs in the debates on health care in America, and elsewhere. Yet there are a startling number of misconceptions — on both sides of the partisan divide — about how the Canadian health system actually works, often from experts who should know better. Here are the facts.

1. Doctors are self-employed, not …

What is a gomer? And why should you know about it?

Admin

Video

September 12, 2014

Ever wonder what a “gomer” is? While certainly passé and unprofessional, does it shed light into the frustrations both doctors and patients have with end-of-life care? Emergency physician and author Brian Goldman explains the origins and use of such medical slang in his book, The Secret Language of Doctors.

What is a gomer? And why should you know about it?

Value-based care: Bad for doctors, bad for patients?

Margalit Gur-Arie

Policy

September 11, 2014

shutterstock_18346579

Value-based health care is antithetic to patient-centered care. Value-based health care is also diametrically opposed to excellence, transparency and competitive markets. And value-based health care is a shrewdly selected and disingenuously applied misnomer. Value-based pricing is not a health-care innovation. Value-based pricing is why a plastic cup filled with tepid beer costs $8 at the ballpark, why a pack of gum …

What’s it like to be an oncologist? This is just one day.

James C. Salwitz, MD

Physician

September 10, 2014

7:00 a.m. Lights on.

Coffee, black and a banana. Paperwork. 27 patient visits, 3 emergencies, 35 phone calls. Lots of computer time. Some laughs and a few tears. Paperwork. Last family meeting. Coffee, black. In between: Thursday.

Was not completely successful in explaining to my frantic patient with the multi-page lab printout, how the problem was not that her tests were bad, but that the computer had used the wrong “normal” range …

Appreciate your NICU nurse: A letter from a neonatologist

Sue Hall, MD

Physician

September 7, 2014

Dear NICU nurse,

I couldn’t have done what I do without you, and the time to thank you publicly for all the ways you have helped me is more than overdue.

Thank you for teaching me how to handle 500 grammers when I was a medical student and had no clue. This showed me your tolerance and good nature.

Thank you for speaking up …

Want to become a doctor? 5 criteria you should consider.

Robert Centor, MD

Education

September 4, 2014

While running several times over the past week, I have thought carefully about our profession. I cannot imagine having chosen any other profession than medicine, nor any specialty other than internal medicine.

But that is me, is it you?

A medical tweeter than everyone should follow @medicalaxioms had these tweets recently:

If you become a doctor for wealth or prestige, you are going …

Read more…

Want to become a doctor? 5 criteria you should consider.

Beware your doctor’s knee-jerk reflex: 3 questions to ask

David L. Katz, MD

Physician

September 3, 2014

We are, I trust, all but universally familiar with the knee-jerk, or patellar, reflex. A doctor taps the patellar tendon with a rubber mallet, and our leg kicks forward in response.

The reaction is famously unthinking. In fact, it is literally so. What makes a reflex a reflex is that the brain is substantially uninvolved. The stretch of a tendon by the mallet …

Lying to receive pain medications hurts patients in true pain

Kenneth Lin, MD

Conditions

August 28, 2014

My patients lie to me every day. Some tell me that they have been taking their medications regularly when they haven’t. Some say that they have been eating a healthy diet and exercising for at least 30 minutes every day and don’t know where the extra pounds are coming from. Some lie that they are using condoms every time they have sex, that they have quit smoking, and if they …

Solving the mid-level dilemma: Call them what they really are

Jim Pagano, MD

Physician

August 26, 2014

Dr. Michael Pappas hates it when a nurse practitioner is called a mid-level provider: “Stop calling nurse practitioners mid-level providers.” So do I, though my reasons are a bit different. In order to understand them it will be necessary to revisit those dark ages, a time when such individuals were few and the roles played in the drama we know …

DNR/DNI: More code than status

Dan Chen, MD

Physician

August 25, 2014

“If a tree falls in a forest and no one is around to hear it, does it make a sound?”

Chances are that many of you have duked this out with your college roommates back in the day, but how about this one? “If a doctor and a patient make an advance care plan, but when an emergency happens, nobody can find a copy of it, the proxy doesn’t know what’s …

Read more…

DNR/DNI: More code than status

Direct primary care and concierge medicine: They’re not the same

Samir Qamar, MD

Physician

August 24, 2014

Direct primary care (DPC) and concierge medicine are rapidly growing models of primary care. Though the terms are used interchangeably, both are not the same. Such liberal use of terms, many times by even those within the industry, confuses those who are attempting to understand how these primary care models operate. As former concierge physician for the Pebble Beach Resorts, and subsequent founder of one of the nation’s largest direct …

MKSAP: 59-year-old man with intermittent itching

mksap

Conditions

August 24, 2014

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

A 59-year-old man is evaluated for a 3-month history of intermittent itching on the forearms. He describes the itch as deep, with a burning or tingling sensation. Scratching helps somewhat, but over-the-counter topical corticosteroids have not helped. Cooling the skin soothes the itch. He did not notice a rash until he started …

MKSAP: 21-year-old man with a heart murmur

mksap

Conditions

August 23, 2014

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

A 21-year-old man is evaluated during a medical examination for health insurance. The patient is a weight lifter. He has no medical problems and takes no medications or illicit drugs.

On physical examination, blood pressure is 128/73 mm Hg, pulse rate is 56/min, and respiration rate is 16/min; BMI is 30. Increased skeletal …

Top 10 ways to know it’s time to quit your job as a doctor

Pamela Wible, MD

Physician

August 21, 2014

Attention all doctors: The first three are mine. The rest are from miserable colleagues. All true. And common. If you’re a doctor and you recognize anything on this list, please quit your job.

10. You feel nauseated when you see your clinic logo; you alter your commute to avoid streets with your clinic’s billboard.

9. Discouraged by the general despair among staff, you …