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Pain control in a patient with rib fractures and a spinal cord transsection

Physician

June 1, 2011

When I was called to see the patient after a motorcycle accident I expected the worst. The patient sustained a thoracic spine injury with cord transsection at T5 level as well as significant chest wall injury on the right side.

Multiple ribs were broken; some with a significant displacement. Managing patients with a significant chest wall trauma could be a nightmare. Pain control is only one of the challenges.

Practical advice for medical students starting clinical rotations

Mary L. Brandt, MD

Education

June 1, 2011

Here’s some advice to think about before starting clinical rotations during the third year of medical school.

Don’t sit in the back of the plane

The basic sciences are important to learn the vocabulary and grammar of medicine. Clinical rotations are different – it’s where you actually learn to be a physician. If you use the analogy of learning to fly, …

The legal issues of doctors and chiropractors working together

Kevin

Physician

June 1, 2011

by Jeffrey L. Cohen and Albert R. Meyer

Chiropractors and medical doctors (or D.O.s) have had a long and somewhat complex relationship.

Though they approach healthcare issues differently, there are many instances where they share care or even work together. Such “M.D./D.C.” relationships are legally complex, but often prove to be rewarding in many respects. Properly constructing the arrangements is critical, especially since government regulators and payers tend …

What happened inside the hospital during the Joplin, MO tornado

Kevin J. Kikta, DO

Physician

May 31, 2011

joplin hospital tornado

Dr. Kevin Kikta was one of two emergency physicians on duty at St. John’s Regional Medical Center in Joplin, MO on Sunday, May 22, 2011, when an EF-5 tornado struck the hospital.

You never know that it will be the most important day of your life until the day is over. The day started like any other day for me: …

Should doctors be addressed by their first name?

Jennifer Middleton, MD

Physician

May 29, 2011

I was sitting next to a resident in the preceptor room yesterday. He was calling a patient to discuss lab results, and introduced himself on the phone by his first name and last name … but not with “Doctor.” (e.g., “Hi, this is John Smith from the Family Health Center.”)

I occasionally see the residents’ patients for urgent visits. When I ask them who their regular PCP is at the office, …

Why doctors can’t screen patients for every disease

Alex Lickerman, MD

Physician

May 26, 2011

I had a patient once who wanted an exercise stress test even though he had neither symptoms nor risk factors to suggest the presence of coronary artery disease (such as chest pain with exertion). I argued vociferously against it. However, extenuating circumstances (not relevant here) prompted our mutual decision to go ahead with it anyway. To our surprise and dismay, it came …

The three most useful words for a doctor

Dr. Martin Young

Physician

May 26, 2011

Here are the three most useful words for a doctor: “I don’t know.”

A close second would be “I’m not sure,” another three that have got me out of trouble more times than I can remember. The older I get, and more experience I have, the more useful it becomes.

Pattern recognition is essential in effective medical practice. So often patient complaints are vague and nondescript, and in the absence of physical …

Doing the physical exam for the first time as a medical student

Jessica Gold

Education

May 26, 2011

Armed with tools I have never used or seen before I entered a physical exam practice room for the first day of learning.

Having finished history-taking practices last semester, we were now beginning a new chapter, learning to take a head-to-toe physical exam. Before class began, we were told to read a book and …

A psychiatrist on the compulsion behind running and exercise

Jeffrey Knuppel, MD

Physician

May 25, 2011

I love running.

I typically run 3-4 miles a day 5 to 6 days per week. It’s only about a half hour of time, and it’s well worth it. I get ‘in the zone’ when I run, and I can tune out the rest of the world and enjoy just being. It feels great physically and mentally each time. It’s helped me immensely to stave off the obesity issues that have …

Why you shouldn’t ignore a swollen knee

Dr. Irwin Lim

Conditions

May 24, 2011

If you develop a swollen knee, please don’t consider it a normal occurrence.

If there was a clear cause, such as a fall to the knee, or some twisting injury to the knee, it’s likely that the cause is due to some mechanical damage. An easily recognized example would be a football or rugby player sustaining such an injury on the playing field. In that case, its typically serious and when …

Read more…

Why you shouldn’t ignore a swollen knee

How managed care caused the mental health care crisis

Kevin

Physician

May 24, 2011

by George H. Northrup, PhD

No one becomes a mental health professional—in my case, a clinical psychologist—for the financial rewards.

With comparable (or less) education, far more lucrative careers exist in law, business, or other health care specialties. Psychotherapy tends to draw practitioners who are fascinated by the mysteries of the mind and who find satisfaction helping others in distress. Money has typically been a …

Pros and cons of private or hospital owned practice

Mary Pat Whaley

Physician

May 24, 2011

Private practices are organized in a corporate model where the physicians are shareholders, or where one or more physicians own the practice and employ other physicians or providers. Private practices are almost exclusively for-profit. Physician practices are organized into corporations for the tax benefits as well as protecting the owners from liability judgments.

Hospitals can be for-profit, not-for-profit …

Why confused, weak elderly patients are subjected to aggressive care

Edwin Leap, MD

Physician

May 23, 2011

Lying on the backboard, a frail little old lady moaned with discomfort.

She had fallen beside her bed in the nursing home and was then tightly bound by straps onto the backboard, a cervical collar pushing her chin up and holding her immobile. A person not familiar with modern medicine might think the ensemble looked like a torture device. Indeed, it can …

Vascular diseases that present as obstructive atherosclerotic arterial disease

Kevin

Conditions

May 23, 2011

by Joe F. Lau, MD and Jeffrey W. Olin, MD

Physicians who perform percutaneous endovascular procedures encounter a multitude of vascular diseases that may masquerade as obstructive atherosclerotic arterial disease. While atherosclerosis is clearly the most common condition seen, complex inflammatory, genetic or structural processes may either not be amenable to an endovascular approach or actually be harmful and thus lead to outcomes that are not …

The difficult road to becoming a doctor

Kevin

Education

May 20, 2011

On May 15, 2011, 147 students embarked on their careers as doctors as they graduated from the University of Pennsylvania School of Medicine.

One student, Jenny Rowland, who will pursue a career in Radiology and continue her training at Penn, shared her personal thoughts and emotions as she prepared to graduate.

by Jenny Rowland, MD

I’m not a typical PennMed student.

I’m 31 years old, and I …

Read more…

The difficult road to becoming a doctor

Pay attention to the color and smell of your urine

Neil Baum, MD

Conditions

May 20, 2011

Most of us are uncomfortable talking about our waste products, urine and feces. However, changes in the color and odor may signify disease that can be treated or prevented. This article will review causes of discoloration of urine and when there is a change in the odor of urine.

For hundreds of years doctors have looked at urine as a barometer of what is happening in the body. The urine can …

Going through Netter’s to teach medical students pelvic anatomy

Nicholas Fogelson, MD

Education

May 20, 2011

I recently had the opportunity to go to the anatomy lab and help the first years go through the pelvic anatomy. What a blast! There is nothing like dissecting a cadaver to tune up one’s surgical anatomy skills, and helping young eager medical students through it is a great experience.

Prior to going into the lab, I spent many hours going through Netter’s atlas to brush up on the anatomy so …

How real life medicine is less glamorous than residency

Jordan Grumet, MD

Physician

May 18, 2011

“Code Blue ICU … Code Blue ICU”

I was greeted by the PA system as I walked into the hospital this morning. A shiver ran down my spine as I quickened my pace . The days of running to codes are long gone. But since I have a patient In the ICU I was curious and just a little bit worried.

As I walked through the sliding doors I passed the room …

Pros and cons of cloud based or web based EMR systems

Peter J. Polack, MD

Tech

May 18, 2011

As if medical practices don’t have enough to worry about with EMR implementation, now they have to decide what kind of EMR system to get: a client-server-based system or a web-based system. The former is the kind that most of us are familiar with. You purchase a computer server, buy a license for the EMR software, install said software on your server, …

Prevent foot fractures while wearing heels

Orly Avitzur, MD

Conditions

May 17, 2011

As 30-year-old New Yorker Carrie Donnelly began her bachelorette party in her new black open-toe five-inch heels, she fell, her foot going one way and her ankle the other.

“When I woke up the next day, my ankle was throbbing and had become extremely swollen,” she said. It was a month before her wedding—the last thing she wanted to do was to walk down the aisle in a cast.

Super-high heels like …

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