MKSAP: 59-year-old man is evaluated for hypokalemia and hypertension

Conditions
November 3, 2012

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

A 59-year-old man is evaluated for recently discovered spontaneous hypokalemia and hypertension. The patient had normal blood pressure at a visit 1 year ago. He has no symptoms and takes no medications.

On physical examination, temperature is 36.9 °C (98.4 °F), blood pressure is 148/96 mm Hg, pulse rate is 58/min, respiration rate is 18/min, …

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The chef and the surgeon have much in common

Physician
November 2, 2012

From the moment I first stepped into a restaurant kitchen, it felt like home; even though for the past eight years my real home has been an operating room, as I am a surgeon.

Though many on the outside may not realize it, the chef and the surgeon have much in common. Both profess modest beginnings. Cooks were slaves and surgeons were barbers. Those who did the cutting were not even …

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I teach the anchoring error, but I couldn’t avoid it myself

Physician
November 2, 2012

We recently spoke with Nayan Kothari, MD, associate dean for education, chair and program director of the department of medicine at Drexel University College of Medicine/Saint Peter’s University Hospital in New Brunswick, N.J. He is 74 years old with long-standing spinal stenosis. He told us that his condition did not prevent him from biking and hiking regularly, and he was otherwise in good health. His medications included baby aspirin, atorvastatin …

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Oral board exams: A window into how you behave in the operating room

Physician
October 26, 2012

When I clicked on the “View Your Exam Results” link on the American Board of Anesthesiology website, I thought something rashly exuberant would engulf me. I thought that everyone in the lunch room would turn suddenly, throw their reheated pasta and cafeteria sandwiches high aloft with glee and balloons would gush from the cracks between the fluorescent lights on the ceiling as the whole world burst into song.

But instead, there …

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Why doctors shouldn’t treat their family and friends

Physician
October 24, 2012

It is a very odd thing that most doctors, especially ones who really love what they do, provide advice and sometimes treatment to family members and good friends. It is also held to be true that this is a bad practice. How do we reconcile this?

In 1847 the AMA published its first “code of medical ethics” which covered many subjects and, though short, is dense and diatribe-like. It seemed to …

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Why doctors don’t like to go to doctors

Physician
October 24, 2012

Doctors don’t like to go to doctors. I suppose we might see it as a failure or more likely it is pure intellectual arrogance. Whatever the reason, there can be no excuses when you need to get an insurance examination form filled out. One way of taking the edge off it is possibly to try to use your conversational skills to awe the poor general practitioner forced to see a …

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It is both a privilege and an honor to be a primary care physician

Physician
October 21, 2012

With all of its frustrations and challenges, I love my job.  In fact, the very things that make primary care so difficult and often times exhausting are also what make it in my opinion the most awesome field in medicine.

When I was in grade school, I wanted to be a physician.  My parents would take me to the pediatrician for routine check-ups or when I wasn’t feeling so great and I remember …

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How gross anatomy changes you forever

Education
October 21, 2012

After a week of medical school orientation, followed by two weeks in the classroom studying cellular organelles and biochemical pathways, our class was finally going to start the centuries-old rite of passage that is human gross anatomy. For many students, it will be first time seeing a dead body. The anatomy lab is where future surgeons will make their first cut with a scalpel, without the pressure of life and …

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Having our own doctor treat us in the hospital is a thing of the past

Physician
October 19, 2012

Health care reform is a locomotive barreling down America’s tracks. In two years, the Affordable Care Act (ACA) will cover some 30 out of 50 million of us that currently lack health insurance. Political beliefs aside, it would seem that supplying insurance to protect the health of more people is a societal good. Though the costs of reform will be debated for years to come, one major question remains that …

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When can a doctor call in sick?

Physician
October 18, 2012

I struggle every time I’m ill. This week, it’s not so much my own illness that’s been the major problem. It’s the kids. Because they can’t sleep. And if they can’t sleep, we can’t sleep.

It started last week with this upper respiratory bug that’s going around. Cold viruses mutate just enough over time that every few years, I get hit hard. I call it the “three year cold.” This one …

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Why the RVU system gives a false sense of productivity

Physician
October 17, 2012

One of my biggest problems of the RVU system is that it decided by a secret society composed of specialists. Nobody seems to have a problem that a “secret society” decides how much work and how much cost should be allocated to a medical service.

Medical procedures are very dangerous and have a lot of risk, but so is trying to provide healthcare to a complicated 2-year old that can’t tell …

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Are pregnancy and residency compatible?

Education
October 16, 2012

Viewpoint #1.  Training programs might say: we are headed for a major league collision in the training of women physicians.  Soon 50% of all trainees will be women, and in some specialties, such as OB/GYN, they will be 80-90% of the residents in any particular program. Training years coincide with prime child bearing years. Imagine if even only half the residents in a program were pregnant at once.  What would happen …

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To the patients who resent greedy doctors

Physician
October 16, 2012

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Good, it’s about time that these greedy doctors get smacked down for being the financial rapists that they are.  Medicine in this country is the biggest, most destructive SCAM going on today. Doctors think they are entitled to RIDICULOUS amounts of money for simple routine procedures.
– Johnathan Blaze

It is generally agreed upon that the more one values a good or service, the …

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What is the best disease from which to die?

Conditions
October 14, 2012

We can’t, of course, plan the way we’re going to die (with the obvious exception of suicide). We can, however, live in such a way that reduces the likelihood of our dying from certain diseases. Which is why it’s now almost universally accepted that we should exercise regularly, not smoke, drink only in moderation (if at all), avoid too much fat in our diet (and now probably too much carbohydrate), …

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Does Linzess have a role in IBS with constipation?

Meds
October 13, 2012

Linzess is a new drug that received FDA approval by Forest Laboratories for use in irritable bowel syndrome (IBS) with constipation and in chronic idiopathic constipation.  It got my attention because of its biochemistry.

Learning about the mechanism of action of new drugs like Linzess reminds me how much more is understood about the molecular biological level of physiologic function of the human body than when I was in med school.  Linzess …

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Do drugs aid and abet genius or does genius lead to drugs?

Physician
October 13, 2012

Who is your favorite addict? I guess we have to talk about addiction as a preface to that question.

Everybody I know takes psychoactive drugs, except maybe some Mormons, Seventh Day Adventists, and the like.

All drugs are habit-forming, but only a subset of psychoactive drugs can produce psychological and physical dependence, tolerance, and withdrawal symptoms when taken away, the usual definition of addiction.

Most people who become addicted to one drug often …

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Chuck Pagano has leukemia: An oncologist discusses his prognosis

Conditions
October 10, 2012

I’ve been getting a lot of questions about Indianapolis Colts’ Head Coach Chuck Pagano lately, so I thought I would dedicate a blog entry to discussing his disease and prognosis.

Coach Pagano was recently diagnosed with acute myeloid leukemia (AML), a form of blood cancer that typically carries a rather grim long-term prognosis in adults.  While early reports were quite sketchy on the details of Pagano’s presenting symptoms, it seems that …

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How America’s healthcare system will keep you sick

Physician
October 7, 2012

Have you ever worried about how you’re going to get healthy these days? Has your doctor recommended diet and exercise? Well, if you’re like millions who are struggling to find health, you’re going to need a lot more than just diet and exercise. You’re going to have to fight like crazy against a mind-set of disease that’s paradoxically disguised as health care.

America’s healthcare system – health insurance companies, government health …

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Why doctors need to be better social workers

Physician
September 30, 2012

Doctors are already busy, but do they need to do more in a day? If you think a physician’s job is to take the best possible care of patients, then the answer is a resounding yes. But additional responsibilities do not necessarily mean more work—they just require different training.

It doesn’t take unique insight to understand that doctors, in many ways, act as social workers. They help patients schedule follow-up appointments, …

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