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MKSAP: 32-year-old man is disoriented, combative, and agitated

mksap

Conditions

March 25, 2012

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

A 32-year-old man is brought to the emergency department after becoming disoriented, combative, and agitated earlier that day. He is accompanied by a friend, who states that the patient has a history of alcohol and drug abuse, including inhalants.

On physical examination, the patient is uncooperative and …

Mexico needs more pediatricians

Cesar Lucio, MD

Physician

March 21, 2012

Being a child in 21st century Mexico utterly differs from any other era. The last decade has been a constant whirlpool for Mexico. Political, cultural and economical changes have shaken the country to its core. Primary care physicians, particularly pediatricians, have a burdensome challenge at hand.

Problems like obesity have quickly emerged in all age groups. Obese children, childhood type 2 diabetes and sedentary lifestyles have invaded Mexican homes. Nutrition related customs …

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Mexico needs more pediatricians

10 strategic questions to ask yourself about the future of health care

Joe Flower

Policy

March 19, 2012

Today and for the next few years the weather of this industry will be dominated by pervasive, discontinuous change. Structures, revenue streams, relationships of every level: All are shifting in fundamental ways. Specifically, the weather will be driven by:

i) invention and propagation of new business models;
ii) shifting risk onto both the provider and the patient, accompanied by building of new risk-based relationships, contracts and alliances;
iii) smart primary care coming to …

Why this pediatrician quit medicine

Lumi St. Claire, MD

Policy

March 17, 2012

There are an awful lot of reasons that led up to my eventual resignation from a career in primary care medicine. I don’t know that any one of them is more important than the other (it really just depends on which day you ask me). One that stands out for me though as a universal problem shared by millions is Managed Health Care, and the imposition it has posed on …

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Why this pediatrician quit medicine

Heed the 4th year medical student spoils

Nonmaleficence

Education

March 16, 2012

Looking back on the first three years of medical school, it’s hard to imagine living through the endless days of studying again. Weekends were spent cooped up in the library and there were countless holidays that I wasn’t able to spend with my family. Instead, they were spent memorizing indecent aspects of the human anatomy and performing DREs on strangers. There are better ways to get to know a person …

Will Peyton Manning ever fully recover from his spinal nerve injury?

Edward Pullen, MD

Conditions

March 15, 2012

Does muscle weakness improve after disc surgery?

For an NFL fan arguably the best thing that could happen to your team is to sign Peyton Manning and have him perform at or near his pre-injury level. The corollary is that one of the worst things to happen to your team would be to take a huge salary cap hit to get a Peyton Manning with such weak throwing arm that even …

How to prep for a successful colonoscopy

Gottumukkala S. Raju, MD

Conditions

March 9, 2012

If you really want to know what’s going on inside your colon, don’t show-up for a colonoscopy without a clean colon.

Many say that preparing for the colonoscopy is the worst part of the entire exam. But, it just so happens that it’s also the most important part.

If the prep is done right, it’s easier for your doctor to see not only big polyps but also flat polyps, which can be …

Does leaving against medical advice stick patients with a bill?

John Schumann, MD

Physician

March 8, 2012

(All names and identifying features of characters in this story have been changed.)

Nora, a third year medical student, came to me in moral distress.

Ms. DiFazio, one of the hospitalized patients on her internal medicine rotation, was frightened to undergo an invasive (and expensive) medical procedure: cardiac catheterization.

The first year doctor with whom Nora was paired, Dr. White, vented to her:

“These patients come to us seeking our help and then refuse …

How working as a scribe prepared me for medical school

Steven Krager

Education

March 7, 2012

After undergrad, and before starting medical school, I worked for two years as scribe in the emergency department. I followed emergency physicians and completed their charts as they saw patients. I would also remind the physicians of various tasks to complete, alert them of abnormal lab values and pull up x-rays to be interpreted.

One of the reasons I wanted the job was to gain experience in medicine, first as a …

Denying payment for unnecessary emergency room visits

Douglas Perednia, MD

Policy

March 5, 2012

Just when American healthcare system seems so dysfunctional that it seems impossible to imagine how it could be screwed up further, a decision is made that restores one’s faith in the creativity of Man. But before you run out of guesses as to which particular decision we’re talking about today, we’ll just blurt it out. We are referring to a recent decision by Washington State Medicaid to deny payment for …

Is it necessary for a doctor to examine you on each visit?

John Schumann, MD

Physician

March 5, 2012

A tug-of-war is going on in medicine right now between the past and the future. The present is confused and very unsure of itself.

Though I could be writing about health care in the U.S and the looming Supreme Court battle over the new health care law, I’m actually raising a much more intimate issue: Whether your doctor touches (examines) you or not.

Many pundits have weighed in on whether the …

Are anesthesiologists the last true generalists?

Karen S. Sibert, MD

Physician

March 3, 2012

There’s been a great divide between the medical and surgical specialties ever since I can remember. Surgeons believe internists perseverate too much when decisions need to be made. Internists consider themselves the true intellectuals of medicine. I suppose anesthesiologists like me fall somewhere in the middle–we work in surgery, but have to take care of all the medical problems the patient brings to the OR table. Does that make us …

Residency interview tips from a Chief Resident

Gopi J. Astik, MD

Education

March 2, 2012

I never realized before how much work goes on behind the scenes to prepare and conduct these interview days, but I sure do now. As a Chief Resident, I schedule residents to attend the applicant dinners, lunches, and tours, and to spend time with the applicants our lounge. This makes the actual interview days go by much smoother, because two of us are present at all times to speak to applicants and answer any …

A sick care system instead of a health care system

Stephen C. Schimpff, MD

Policy

March 1, 2012

An excerpt from The Future of Health Care Delivery.

We Americans like to pride ourselves on having the best health care system in the world, but unfortunately that is not the case. We have a medical (that is, sick) care system—a system that waits until we become ill before it kicks into action—instead of a health care system focused on helping us stay healthy. We give lip service to prevention and, …

6 reasons why applicants fail to get into medical school

Jessica Freedman, MD

Education

February 28, 2012

shutterstock_133751096

Every year medical school applicants feel confused and in the dark about why they have been rejected by medical schools. They do not understand what they did wrong or what they need to do differently when they reapply. Whether you are a premedical student trying to make sure to “do everything right” or a medical school applicant who has not yet …

Taking care of patients is a great honor

Elizabeth Breuer, MD

Physician

February 26, 2012

As my husband and I try and make a long term financial plan for paying off my almost $200,000 in loans from medical school, I sit here wondering, why did I pay 200 grand so that I can get peed on, pooped on, bled on, screamed at and sworn at? I’ve delivered a baby without gloves on (it was an emergency). I’ve been kicked so hard I almost fell off …

Doctors need to stop being so complacent

Anonymous

Physician

February 24, 2012

Four brutally honest declarations:

1. I can perfectly decide what is best for myself, my family, my patients, and my practice. I don’t need outside guidance telling me how to lead.

2. I decide what works best on my terms to practice the best medicine.

3. I will succeed and lead because I am focused on my goals just as much (if not more) than my patient’s goals.

4. My goal is to make …

Why maintaining a distance is necessary for doctors

Michelle Au, MD, MPH

Physician

February 24, 2012

You would think that for doctors, who work with life and death issues every day, the issues of our own frailties or the tenuous line between health and sickness for our own families would be, if not accentuated, then at least more immediate than to those who, say, do investment banking for a living. But the strange thing is that despite our easy familiarity with human mortality, it is not …

Impersonal communication on the Internet fuels cyberbullying

Dominic A. Carone, PhD

Tech

February 22, 2012

In the old days, bullying used to consist of name calling or physical aggression from someone in a position of power over another, typically from a roughly similarly aged peer group. The bullying could be mild such as occasional name calling and having one’s books knocked down when walking in the hallway. This does not mean the effects of the bullying were mild but comparatively speaking, this is generally not …

Why are labor and deliveries closing?

Vivian E. von Gruenigen, MD

Policy

February 18, 2012

Labor and deliveries are slowly closing across the United States: California, Pennsylvania, and Ohio. In regional areas where there have been no closures, conversations in hospital boardrooms are probably questioning whether they should be. But why? Because of health care reform, increasing medical expenditures, hospitals are making less money due to reduced reimbursement, and because of the financial margin of obstetrics. To explain the complex answer further, we need to …

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Why are labor and deliveries closing?

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