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MKSAP: 60-year-old man with exertional chest discomfort

mksap

Conditions and Diseases

December 21, 2019

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

A 60-year-old man is evaluated for a 5-month history of exertional chest discomfort that improves with rest. His symptoms have progressively worsened such that he has reduced his activity to a minimum. Medical history is significant for hypertension and hyperlipidemia. Medications are low-dose aspirin, losartan, hydrochlorothiazide, and atorvastatin.

On physical …

The erroneous belief that the elderly have the healing power of younger individuals

Steven Reznick, MD

Conditions and Diseases

December 20, 2019

A wise professor of medicine always told me as a young physician, “Eighty-year olds are to be revered and not messed with.” This is especially true for those 90 or older. Here in South Florida, there is always some senior citizen telling us today’s 80 is yesterday’s 60, and today’s 70 is yesterday’s 50. It just isn’t so. I see this erroneous belief of the elderly having the healing power …

Chronic illness? Have faith in medicine.

Katie Teller, PA-C

Conditions and Diseases

December 20, 2019

I am healthy, a mom of two boys, a wife, and an emergency medicine PA for the past 12 years. I don’t just say I’m healthy to say it, but I really am. I’ve never taken medications, until now. It’s New Year’s Eve, and I’m scheduled for my injection. I grab my sharpie and write injection on the 31st. I suddenly didn’t know whether to laugh, cry, or be angry. …

A paradoxical fix to physician burnout: more patients, less supervision

William O. Collins, MD

Physician

December 20, 2019

Most physicians recall the rigors of their residency training through a mixed lens. In prior generations, a single-duty shift could stretch to 36 or more consecutive hours, but the exhaustion was buoyed by the camaraderie of sleepless on-call nights in the hospital. Despite the exhaustion, resident well-being received scant attention. Beginning with the 1984 Libby Zion case, and later the Accreditation Council on Graduate Medical Education (ACGME) duty hour restrictions …

How special interests won big and consumers lost big

Robert Laszewski

Health Policy

December 20, 2019

As the year winds down and must-pass year-end spending bills are completed — and with that, any chance of attaching and approving health care legislation — the special interests have won big, and consumers have lost big.

Employers, unions, and insurance companies won big with the repeal of the “Cadillac” tax on high cost-benefit plans at a cost of $200 billion over ten years as well as the repeal of the …

Doctors: Always be prepared to suture wounds

Nathan Whittaker, MD

Physician

December 20, 2019

Ninety minutes before my Sunday night shift, my two-year-old, Titan, comes screaming up the stairs looking like a scene out of a slasher horror movie. His older sister sheepishly admitted to chasing him into the edge of a door frame. We created an ED bed on our kitchen counter and slipped a pillowcase up his arms, behind him, with him laying …

The progressive increase in adult obesity is more complicated than we think

Christopher Johnson, MD

Conditions and Diseases

December 19, 2019

All of us are aware of what has been termed our “obesity epidemic.” The current prevalence of obesity among adults in the U.S. is around 40 percent, a dramatic increase over the past 50 years; it was about 15 percent in 1970. Rates are also increasing across first world countries, so we are not alone in this.

Obesity is defined as a body mass index (BMI) greater than 30. Values of …

Tales of an emergency physician, recertifying for the third time

Michael Burg, MD

Physician

December 19, 2019

Year 2000. I’m sitting in a semi-fancy hotel ballroom near LAX along with several hundred slightly edgy emergency physicians. We’re all awaiting the start of our ABEM written re-certification examination. This was in the old-school days of live exams. We had an MD master of ceremonies, a famous EM leader; and I can still remember his message to the assemblage. “If you’re re-certing for the first time, welcome, relax, good …

Beyond the EpiPen: Irrational drug prices are now pervasive

Stephen C. Schimpff, MD

Medications

December 19, 2019

There was outrage over the sudden rise in the price of the EpiPen. But the rise in many other pharmaceutical prices gets less attention but is just as concerning. It can be easy to forget issues like this until they affect us personally. My two encounters with irrational drug price increases for dermatologic conditions are a reminder of how pervasive this problem is today.

I have rosacea, a …

An orthopedic surgeon goes to a bar. Here’s what happened next.

Mara L. Schenker, MD

Physician

December 19, 2019

I went to a bar last night — and I looked good: red coat, black dress, knee-high suede boots. I was feeling pretty good.

I met my best friend at this bar — he lives elsewhere now — but this is his favorite spot in the world. Like Norm in Cheers, he is also their favorite customer.

We ordered dinner, and my best friend stepped away to talk to the bartender. I …

Patient demand doesn’t justify medical excess

Michael Kirsch, MD

Physician

December 18, 2019

We live in an era where plastic surgery is routine. Indeed, in many parts of the country, plastic surgery is an expected rite of passage. Years ago, facelifts and “tummy tucks” were done on those in middle age who were trying to experience a surgical time machine. Now, folks in their 20s are having all kinds of work done, not to recreate a prior image, but to create a new …

The thought cancers that almost took my life

Maiysha Clairborne, MD

Physician

December 18, 2019

The night I almost swallowed a bottle of Percocet post-call in residency is still clear in my mind, as is the hours leading up to it; the thoughts going through my head, the swirl of emotions seemingly pulling me like an ocean undertow. I can only attribute my pause to a power greater than myself. The truth is when I look back on that night, I can see that those …

What can a famous actress teach us about curing addiction?

Mark Leeds, DO

Physician

December 18, 2019

I recently had the pleasure of interviewing famous television and film actress, Claudia Christian. She has played significant roles in many notable movies and shows, including lead roles in the long-running sci-fi series Babylon 5 and the Disney film, Atlantis: The Lost Empire. In our podcast interview, we discussed treating alcoholism using the FDA-approved drug, naltrexone.

Why listen to an actress about medical treatment for addiction? First of all, doctors generally …

Burnout is death by a thousand cuts

Anonymous

Physician

December 18, 2019

I think I’m finally burned out. And it’s been a long time coming.

It likely started when my private physician-owned emergency group got bought out by one of the big corporate groups. The changes were small at first. Turning us into hourly paid employees instead of an RVU-based salary. Shiny new VPs and directors sending us emails. Things seemed fine for a while. Then came the many, many emails about better …

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Burnout is death by a thousand cuts

Experience and in-depth knowledge can empower you with an appreciation for nuances

Hans Duvefelt, MD

Physician

December 17, 2019

In medicine, contrary to common belief, it is not usually enough to know the diagnosis and its best treatment or procedure. Guidelines, checklists, and protocols only go so far when you are treating real people with diverse constitutions for multiple problems under a variety of circumstances.

The more you know about unusual presentations of common diseases, the more likely you are to make the correct diagnosis, I think everyone would agree. …

Our optimal future U.S. health care system

Taylor J. Christensen, MD

Health Policy

December 17, 2019

Next in a series.

The Healthcare Incentives Framework helps show how to fix incentives in health care systems. It starts by enumerating the five jobs we expect a health care system to do for us and then identifies which parties in the health care system (providers or insurers) have a natural incentive to fulfill each of those jobs. Those incentives arise naturally, but the big challenge is shaping …

Combat burnout one bite at a time

Xrayvsn, MD

Physician

December 17, 2019

I can’t speak on behalf of all in my specialty, but I wager that there is a good percentage of radiologists out there who essentially work nonstop from the moment they walk in the door to the moment they leave, working through lunch hours, etc.

Throw in a mandatory meeting every now and then and “the list” of studies to be read can explode, and it can truly be demoralizing.

I have …

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Combat burnout one bite at a time

Experienced-based medicine has value

Cristina Carballo-Perelman, MD

Physician

December 17, 2019

There was a time, before treatment algorithms, when physicians would rely on the detailed bedside and/or office observations of their patients in conjunction with the most recent published peer-reviewed studies.

Time spent with each patient was considered essential and appropriate to reach a proper diagnosis and treatment plan. Now, due to corporate mandates to produce higher RVUs, time is regarded as an unnecessary luxury, to be controlled and curtailed. Yet recent …

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Experienced-based medicine has value

5 improvements needed to modernize the American hospital landscape

Robert Pearl, MD

Health Policy

December 16, 2019

Over the past 40 years, the number of U.S. hospitals declined by 12 percent, from more than 7,100 in 1975 to 6,200 in 2017, according to the latest American Hospital Association survey. And, yet, despite shuttering nearly 1,000 facilities, hospitals remain the nation’s largest source of health care spending, accounting for $1.1 trillion annually (or 33% of all national health care expenditures). Much of that money goes …

Medicare for all is dead because Democratic voters aren’t buying it

Robert Laszewski

Health Policy

December 16, 2019

Fixing Obamacare and adding a public option is the health care policy territory first staked out by Democratic Presidential candidate Joe Biden.

Writing about Biden’s plan recently on my blog, I said:

If the Democrats capture the White House, keep the House, and take over the Senate, no matter who they elect as President, this Biden health care outline, not Medicare for all, will likely be the plan Democrats …

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Medicare for all is dead because Democratic voters aren’t buying it