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Weighing a patient offers a treasure trove of information

Greg Smith, MD

Physician

March 21, 2014

As a psychiatrist, I was trained to begin the mental status examination and overall assessment of my patient as soon as I greeted them in the waiting room. Even now, three decades after finishing medical school, I follow almost the same sequence of actions in my day-to-day interactions with my patients that I did as a resident in training. Granted, there are now electronic medical records and I rarely come …

Young patients with adenomas: Who should get genetic testing?

Patrick M. Lynch, MD

Conditions

March 20, 2014

While it is unusual for gastroenterologists to see colorectal tumors in patients under the age of 50, and even more uncommon before the age of 40, it does happen, so patients need to be aware of their risks. Colorectal tumors in young people are often detected either through symptom evaluation or because of a colonoscopy performed for an underlying risk factor, most commonly a family history of colorectal cancer (CRC).

During …

This is why doctors practice cover your ass medicine

Shirie Leng, MD

Physician

March 20, 2014

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A small case with big implications almost escaped my notice recently The Boston Globe reported a case in which a family sued after a 23-year-old man died after being diagnosed with a lung infection.

According to the Globe, the young man went to one of the Boston emergency rooms complaining of cough, fever, and chest pains. OK, stop right there all …

Is Match Day outdated?

Allison Bond

Education

March 19, 2014

Match Day: It’s among the most memorable moments of medical school, a time when students, friends, family and faculty gather to open those coveted white envelopes. It’s the symbolic first step out of medical school and into residency, and a tradition that is beloved by many. Yet the matching process is viewed by those outside of the medical profession (and to some within it) as a very odd way to …

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Is Match Day outdated?

People die without love: Why I prescribe the love drug

Pamela Wible, MD

Physician

March 17, 2014

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As a doctor, it’s my job to figure out what patients really need. Some need antibiotics. Some need pain pills. But everyone needs love.

During medical school I cared for burned children. One of my patients was a 3-year-old with severe burns over most of his body. His roommate, an older boy, had just burned one arm. Yet the older child withered in the …

The disturbing confessions of a medical scribe

Anonymous

Physician

March 9, 2014

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As a medical scribe working with a large, well-known scribe company, unnamed to protect my job, it makes me proud reading all the articles published about how much having a scribe benefits a physician, especially in the emergency department. I enjoy my job immensely and I am grateful for the opportunity to learn and engage in patient care. However, as a …

Tips for expats working in health care

Rajka Milanovic Galbraith, MD

Physician

March 9, 2014

How does a working mom and physician keep practicing medicine when her husband’s career brings her halfway around the globe? For me, it was an adventure. While it can be challenging, I encourage other physicians to experience the world with their families while still practicing medicine.

As a 14 year family practitioner from Ohio, I suddenly found myself in Qatar with two young children because of my husband’s job. Qatar is …

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Tips for expats working in health care

Aviation and anesthesiology: The importance of training

James R. Mesrobian, MD

Physician

March 8, 2014

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

Comparisons between the airline industry and anesthesia care are common. One of the most commonly heard analogies is that the takeoff and landing of a jetliner are similar to induction and emergence during a general anesthetic. But there are other equally important analogies between the two …

The request to leave AMA is a signal for an honest conversation

Ishani Ganguli, MD

Physician

March 7, 2014

His nurse paged me at 9pm: Mr. L wants to leave against medical advice (AMA). As the covering doctor, I dreaded the impending standoff even more than usual.

I emerged from the elevator minutes later to find that the gaunt octogenarian had advanced from his isolation room, passed the nurse’s station and the unit doors, and arrived at the elevator bay to greet me. Security guards hovered at a cautious distance …

The societal problem of opioid addiction

Albert Fuchs, MD

Meds

March 6, 2014

Opioids are a family of pain medications chemically related to opium and heroin. They include morphine, fentanyl, codeine, hydromorphone and others. Opioids have unique properties that make them both indispensable for pain management and extremely dangerous.

Unlike virtually any other family of medications, opioids have no maximum effective dose. If any dose, no matter how high, is ineffective at controlling pain, a higher dose can give more pain relief. Most other …

Treating a symptom is not the same as treating a disease

Michael Kirsch, MD

Conditions

March 6, 2014

Physicians and patients collaborate to treat symptoms. This is not newsworthy and even sounds appropriate. Isn’t that what doctors are trained to do? It is but I’m not sure this should be a central focus of our healing mission. Treating a symptom is not the same as treating a disease.

For example, if an individual is having abdominal discomfort, pain medicine should not be the first responder, even if this would …

The myth of the entitled single mother remains as relevant as ever

Rhea Boyd, MD

Physician

February 28, 2014

There is a disconcerting myth about single mothers that has been circulating in our society for some time. It was popularized in the Reagan Era as a denunciation of US social welfare policy and resulted in a pointed caricature of a woman on welfare, forever to be known as the “welfare queen” or the entitled single mother.

The narrative of such a woman goes something like this: Not only is she …

Framing an ethical dilemma: 4 basic concepts of medical ethics

Christopher Johnson, MD

Conditions

February 26, 2014

It seems lately that questions of medical ethics are coming up more and more in the news, things like the rights of patients to make decisions, definitions of futile care, and end of life care. The way to look at these things is not in a vacuum. All of us may have our own opinions about right and wrong, but the field of medical ethics is actually one that has …

Medicare should cover infusion services at patients’ homes

Emma Singh, MD

Physician

February 23, 2014

As I explained his options, my patient’s initial shock turned to disbelief. I told the 84-year-old man that Medicare would pay for treatment of his urinary tract infection if he received infusion therapy at a nursing home, but it would not be covered if he opted to receive the therapy at his own home.

We calculated that the four weeks of therapy at a skilled nursing facility would cost Medicare about …

What’s the difference between speech and voice?

James P. Thomas, MD

Conditions

February 22, 2014

Mr. Heim Stillear, at 70-years-old, seems older and less intelligent to his family, since he was hospitalized for a stroke about two months ago. They come to the appointment with him and help him into the exam chair. When I ask Heim what is going on with him, the long pause before his strained answer begins makes his family uncomfortable.

His daughter interjects, “We are having a very difficult time understanding …

A pediatrician’s survival story: Remembering the children

Natasha Raja, MD

Physician

February 22, 2014

I have just turned on my computer. It is midnight. I should be trying to sleep right now.

My 5-year-old is sick and I am on call for the next few nights. Fortunately, my daughter should get better in a day or two. She needs Tylenol for her fever, mama’s love and time to kick this virus. But as I sat in bed holding her and waiting for her fever to break, …

Is there a downside to open access scheduling?

Lucy Hornstein, MD

Physician

February 20, 2014

The term “open access” in the context of primary care means that patients are able to get an appointment whenever they wish.

The ultimate in open access is 24/7 availability. No, I don’t offer this, although I come pretty close. I’m available by cell phone virtually 24/7 and I’m also almost always willing to come in and see someone if they really need to be seen. This seldom happens. Most of …

Why doctors commit suicide

Pamela Wible, MD

Conditions

February 18, 2014

I’ve been a doctor for twenty years. I’ve not lost a single patient to suicide.

I’ve lost only colleagues, friends, lovers — all male physicians — to suicide.

Why?

Here’s what I know:

A physician’s greatest joy is the patient relationship.

Assembly-line medicine undermines the patient-physician relationship.

Most doctors are burned out, overworked, or exhausted.

Many doctors spend little time with their families.

Workaholics are admired in medicine.

Medicine values …

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Why doctors commit suicide

Why is there a shortage of primary care physicians?

Stephen C. Schimpff, MD

Policy

February 17, 2014

Next in a series.

Primary care physicians (PCPs) are becoming extinct. It’s true. Not many medical students choose primary care as their career path. Older PCPs are retiring early. Many others are closing their practices or seeking employment at the local hospital. And there has always been a shortage of primary care physicians in rural and urban poor areas. Today only 30% of all physicians practice primary care (compared to …

When patients abuse emergency department workers

Jonathon Savage, DO

Conditions

February 16, 2014

There are few professional careers centered around protecting and caring for others that garner so much verbal and physical abuse than a career in emergency medicine. Mental health workers, police, fire, and EMS personnel are the other fields that come to mind when I think of a service that “helps” people yet gets abuse dished upon them on nearly a daily basis.

A 2006 survey of emergency nurses showed that 25% …

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