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How long do I have? The question of prognosis has no simple answer

Physician

August 28, 2012

“The question” comes in several forms: “Doc, what stage is my cancer?” “What is my prognosis?” “Can it be cured?” “Am I going to die?” “Have long have I got?” These tough honest words require courage. “The question” superficially asks for a simple answer. Time to live. However, in the real world of life and death, these questions and therefore the answers are far more complex and subtle.

Years ago we …

Choose your doctor: Astute diagnostician or empathic practitioner?

Michael Kirsch, MD

Physician

August 27, 2012

Would you rather your physician be an astute diagnostician or a compassionate and empathic practitioner? Of course, we want our physicians to be blends of these qualities. We want it all. We want them to be chimeras of Drs. House and Welby. But, is this possible?

I can’t say. I suspect that it is easier to cultivate soft bedside manners than it is to teach medical acumen, although the latter was …

6 tips for choosing the right water drink

Mary Ellen Herndon, MPH, RD

Conditions

August 25, 2012

Flavored water. Water with electrolytes. Tonic water. Sparkling water. Seltzer.

Grocery shelves are packed with so-called water options. But not every drink that bills itself as water is the real deal.

Many drinks labeled as water are loaded with sugar and empty calories. Even though these drinks have ‘water’ in their name, drinking them regularly may cause weight gain and may increase your risk of obesity.

And, that’s bad news because maintaining a …

Artificial death extension: It means that I actually care

Monica Williams-Murphy, MD

Physician

August 25, 2012

The names of things often greatly affect our perception. In end of life lexicon, there is a movement underway to change the name of the medical order DNR (do not resuscitate) to AND (allow natural death). No change in the medical reality of what occurs, but a radical change in our emotional reaction to the each term.

DNR: “They withholding a medical intervention” (evoking negative feelings).

AND: “They are giving care that …

Test results without physician guidance will cause patient anxiety

Kevin Pho, MD

KevinMD

August 23, 2012

The following column was published on August 5th, 2012 in USA Today.

A patient once blamed me for causing him considerable anxiety because he had to wait several weeks before receiving the results of a lab test, which I had ordered. Many patients commonly have to wait days, if not weeks, before getting lab results from their doctor. The delay can affect patients’ health negatively.

For instance, one study looked at women who underwent …

3 simple games to lower doctor stress and prevent burnout

Dike Drummond, MD

Physician

August 19, 2012

Burnout is a constant threat for physicians. Research consistently shows an average of 1 in 3 doctors suffering from symptomatic burnout on any given office day. In my work with over stressed and burned out doctors, I have found that most of us work way too hard being the superhero to our staff, patients and families — and don’t have any fun at all. It doesn’t have to be …

How to think like a doctor: Start with differential diagnosis

Suzanne Koven, MD

Conditions

August 17, 2012

“What would you do if you were your doctor?” Mary asked me. Mary is my physical therapist and she was trying to figure out why the rehab after my shoulder surgery was progressing so slowly. A month after my operation I was still in pain and still not moving the joint well.

Without hesitation I replied: “I’d come up with a differential diagnosis.”

Differential diagnosis is a two word summary of how …

Work-life balance in medicine: Is it possible?

Karen S. Sibert, MD

Physician

August 13, 2012

Unless you’ve lately returned from a retreat at a remote Cistercian abbey, if you’re interested at all in women’s issues you’ve probably read Anne-Marie Slaughter’s recent article in the Atlantic, “Why Women Still Can’t Have It All.” The author eloquently tells how she left her dream job in the State Department as the first woman director of policy planning in order to return to her husband, her two …

Why are so many doctors complete jerks?

Eric Van De Graaff, MD

Physician

August 12, 2012

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As odd as this might sound, my mother was upset when I declared my intention to go to medical school.

It wasn’t the mountain of debt I was sure to incur since I’d already figured out how to get Uncle Sam to pick up the bill (a small deal that put me in a military uniform for a decade). It wasn’t the …

Read more…

Why are so many doctors complete jerks?

Should I get a spray tan? A doctor discusses whether it’s safe

Bobby Ghaheri, MD

Conditions

August 12, 2012

We all know that the use of baby oils and baking in the sun for hours on end is probably not a good idea. We know that increased sun exposure correlates with increasing skin cancer rates. We know that it can cause accelerated skin damage in the form of pigmentation changes, wrinkles, and increased skin laxity. Don’t believe me? Check out this picture! Truck drivers tend to get increased sun …

Computers in the exam room: Good and bad setups

WarmSocks

Tech

August 10, 2012

Does your doctor use a computer in the exam room? Some people think that computers are a great way to keep track of patient information. Others see some advantage, but problems in the implementation. There are also a few Luddites who oppose this change simply on principle. I’ve had good experiences, and bad experiences, and believe we have a long way to go before computers are as helpful as they could be.

There …

You’re seeing the wrong gynecologist: 6 red flags

Jennifer Gunter, MD

Physician

August 9, 2012

As a doctor, I appreciate that I am at an advantage when I seek medical care. Knowing terminology and basic medical principles helps a lot. In addition, when you’ve been practicing medicine for a while you get a feeling from how a doctor discusses options if the care seems valid or if a second opinion is in order. Other things I look for are board certification and a doctor …

Is the death of Rory Staunton really the result of a simple mistake?

Skeptical Scalpel, MD

Physician

August 8, 2012

If you pay attention at all to news about medicine, you must have heard about the tragic death of a 12-year old boy who was seen and discharged from the emergency department of the prestigious New York University Medical Center. He had developed sepsis from what appears to have been a small cut and the diagnosis was missed. When he eventually returned to the ED and was admitted, it …

How to avoid Zumba injuries: 10 physician tips

Orly Avitzur, MD

Conditions

July 29, 2012

Zumba, the Latin dance-inspired fitness craze, is a great way to burn calories, up to 500 per hour. It also gives you a good cardiovascular workout without making you feel like you’re exercising. This increasingly popular workout attracts a diverse crowd at dance studios and health clubs, including a sizable number of those 50 and up.

But for people who are out of shape, taking the first classes can be like …

EKG reading: It’s shocking what medical residents don’t know

Wes Fisher, MD

Education

July 26, 2012

“Dr. Fisher, can you teach our residents EKG lecture series?”

Naively, I said “Sure!”

What I didn’t realize is how hard this is to do today.

Much of this is not residents’ fault. They only have so many hours in so many days to attend lectures while caring for patients. Thanks to residency work-hour restrictions, those hours have become even fewer. To make matters much worse, through the year residents are torn to …

Why I would never go to a non-board certified physician

Jennifer Gunter, MD

Physician

July 25, 2012

Full disclosure. I have 4 board certifications and dutifully do all of the required reading, continuing medical education (CME) and recertification exams to maintain my status (I am board certified in OB/GYN in both the US and Canada as well as board certified in pain medicine by both the American Board of Pain Medicine, ABPM, and the American Board of Physical Medicine and Rehabilitation).

I would never go to a non-board …

The role of IVs and central lines in critical care

Mark E. Nunnally

Conditions

July 22, 2012

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

As a critical care anesthesiologist, I care for patients when they are most vulnerable. Critical care patients require intravenous (I.V.) fluids and medications, frequently through central venous access. These are catheters inserted into larger veins with a special procedure. I believe managing I.V. lines requires procedural skills, …

Do people need to suffer the consequences of their bad behavior?

Greg Smith, MD

Physician

July 19, 2012

You know the headlines. You read them and hear them and see them every day.

Someone gets angry at the system and shoots someone or several someones in cold blood, often having planned the act, gathered the necessary firepower and ammunition ahead of time, stalked the victims, checked the schedules and shown up at the right time to do maximum damage.

A family including mother and young children in a van are …

How much does surgery cost? About $147 a minute

Nate Johnson

Physician

July 17, 2012

The patient had a large abscess surrounding his spleen. On a large screen in the middle of the operating room, I watched a surgeon drain the fluid collection and remove the organ with small metal tools.

I remember the surgeon navigating the complex anatomy with alacrity, handling the laparoscopic equipment with expert finesse, and quickly and confidently answering the battery of questions from the assisting medical student. To a young and …

9 essential tips for new medical students

WhiteCoat, MD

Education

July 17, 2012

Whether you’re starting medical school or beginning your second year, this post is for you. Will probably work just as well for PAs, NPs and any other health professional student who hasn’t started clinical rotations.

Our former babysitter just graduated from medical school and the WhiteCoats are just as proud as her parents are. Then I started thinking, what advice would I give to students starting medical school?

Our first day of …

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