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MKSAP: 38-year-old woman with primary membranous glomerulopathy

mksap

Conditions and Diseases

November 16, 2019

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

A 38-year-old woman is evaluated during a follow-up visit for primary membranous glomerulopathy. Diagnosis was made by kidney biopsy 4 months ago, and she was found to be positive for anti–phospholipase A2 receptor (PLA2R) antibodies. Medications are furosemide, losartan, and simvastatin. Recent age- and sex-appropriate cancer screening tests were …

The health effects of structural racism

Niran S. Al-Agba, MD

Health Policy

November 15, 2019

In the United States, the health of African-Americans lags behind most other racial minority groups. Compared to whites, black men and women face higher risks of chronic illness, infection, and injuries. Taken altogether, the average life span for African Americans is six years less compared to whites. If we can begin to acknowledge that health outcomes are often dependent on factors outside of the control of individual patients, their physicians, or their health …

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The health effects of structural racism

The cure to our malignant health system

Deane Waldman, MD, MBA

Health Policy

November 15, 2019

An excerpt from Curing the Cancer in U. S. Healthcare: StatesCare and Market-Based Medicine.

Clinical doctors can readily understand the continuing failure of the U.S. health care system. The attending physicians for Patient Healthcare–Washington, both legislative and executive branches–keep …

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The cure to our malignant health system

A physician reflects on the worth of a decade

Ankita Sagar, MD, MPH

Physician

November 15, 2019

At first, I thought the light was reflecting off the mirror. But no. There It was – my first gray hair. I did not expect to live to see the day. I was ecstatic! At six months old, I was diagnosed with a severe illness called thalassemia major and was incorrectly expecting to have passed by now. (Google told me so!) Yet, this year, I complete ten years beyond my …

Lawyers have figured out what doctors haven’t

Allison Edwards, MD

Physician

November 15, 2019

Dear lawyers:

You got it right. Your operations make sense. I know this is wrong for me to say — doctors and lawyers are often at odds with one another — but I have to tip my cap here. I have this unsettling feeling that — from a professional standpoint — your billing practices make sense. And the way you do your documentation also makes sense. Your delegation and hierarchy make …

Why physicians should start thinking about climate change

Janice Boughton, MD

Health Policy

November 14, 2019

Climate change. Global warming. The greenhouse effect. Devastating wildfires, dangerous air quality. Catastrophic weather events and mass human migration. It all sounds like post-apocalyptic fiction except that it’s real. Inside our air-conditioned offices and homes, it can still be possible to be optimistic. Maybe it’s nothing out of the ordinary. Maybe it isn’t our fault and would have happened without human activity. Maybe we don’t know what will happen and …

Cookie-cutter medical students need decorating

Grant Schroeder

Medical Education

November 14, 2019

“First Aid For The USMLE Step 1 — cost: $45, format: reference book.”

“Pathoma — cost: $99 (1-year subscription), format: video explanations + reference book.”

“SketchyMedical — cost: $150 (1-year subscription), format: cartoon video memory device.”

Our naïve MS2 eyes were glued to the screen as our noble MS3 predecessors clicked through the slideshow, pausing to talk about which third-party study resources were “super high yield” and which were only “moderately high yield” …

Fight burnout with a higher power

Cristina Carballo-Perelman, MD

Physician

November 14, 2019

As physicians, we are constantly faced with a daily barrage of meeting minimum RVUs, while keeping up with EMRs as part of the necessary components to successfully practice medicine. This has resulted in a decrease in personal interactions with patients, which has caused an increase in physician burnout and suicides. Attempts to reverse these negative impacts have resulted in instituting wellness and meditation clinics and debriefing after traumatic clinical events …

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Fight burnout with a higher power

From a neurosurgeon: You need a family doctor

John Spitalieri, DO

Physician

November 14, 2019

One of my favorite scenes in the recent Apollo 11 IMAX film was a dramatic panning shot of mission control moments before lift-off. Row after row of mission specialists, engineers, astronauts, communications technicians — all looking ahead in silent, unbreakable focus. All 100 percent dedicated to the three men about to lift-off into history. It was a truly mesmerizing portrait of teamwork.

While astronaut safety is the focus of every individual …

A physician’s guide to frequent flyer rewards

Cory Fawcett, MD

Physician Finance

November 13, 2019

I recently read an article called “Inefficiency and luxury” in which the author stated that he has never tried to get any frequent flyer rewards, and in fact doesn’t even have a frequent flyer number. This statement left me a bit confused when I first read it. I’m not one who likes to leave money lying on the table. Then he …

I’ve prescribed opioids to patients. And I’m not a villain.

William C. Donlon, DMD, MD

Conditions and Diseases

November 13, 2019

You’ve probably heard this one in one format or another: kid gets wisdom teeth yanked, dentist prescribes a handful of Vicodin, next thing you know, he’s on the street busking for change to pay the man for the big H.

Meanwhile, the dentist is on cruises paid by Big Pharma and taking kickbacks from his local drug dealers.

This author is here to tell you that such yarns have probably been verified, …

A possibly fishy complication of an Alaskan cruise

Deepti Bhandare, MD

Conditions and Diseases

November 13, 2019

A 69-year-old man with a medical history of hypertension, diabetes, and obesity with a body mass index of 33 was admitted with altered mental status. He and his wife were returning from a 14-day Alaskan cruise. On their return, the wife started noticing that her husband was behaving strangely and acting forgetful and had short-term memory loss. This gradually progressed to generalized confusion and altered mental status leading him to …

Here’s why you need to find compassion for yourself

Heather Krantz, MD

Physician

November 13, 2019

Self-compassion. Perhaps this sounds like a contradiction in terms. Compassion is expressed for others, not oneself.

Compassion, as defined by the Merriam-Webster dictionary, is the “sympathetic consciousness of others’ distress with a desire to alleviate it.” Compassion is about allowing oneself to be with the emotional discomfort of someone else’s suffering with the hope of lessening it. Health care personnel do this every day.

It is part of being human to have …

Should speed-eating contests be banned?

Skeptical Scalpel, MD

Conditions and Diseases

November 12, 2019

This eating contest season, there was only one death this year, as far as I can determine. A 41-year-old California man died in August while participating in a taco eating contest at a minor league baseball game. The coroner said he choked to death. In case you were wondering, the Associated Press thoughtfully stated: “It was not immediately known how many tacos the …

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Should speed-eating contests be banned?

What a cardiologist wants you to know about loneliness

Jonathan Fisher, MD

Conditions and Diseases

November 12, 2019

What is the unspoken fatal epidemic of our time? And the greatest predictor of overall health, happiness, job satisfaction, and resiliency? Loneliness.

As a clinical cardiologist, I am committed to the health and well-being of my patients.

As a recovering burned-out physician who suffered in silence for years while hiding this so well from others, I am committed to finding solutions to help my partners suffering so often in silence.

As a husband, …

Why this physician wanted to be a head and neck surgeon

Bruce Campbell, MD

Physician

November 12, 2019

Head and neck cancer surgeons know when “the questions” are coming. A casual conversation eventually turns to, “What do you do for a career?” The pleasant exchange is replaced with talk of disfigurement and life-threatening illness. The person’s brow furrows. “How can you deal with that day after day? Isn’t it depressing? Why didn’t you pick something happier for a career?”

These are legitimate questions. As a medical student many years …

What it really means to support your female colleagues in medicine

Maricela Schnur, MD, MBA

Physician

November 12, 2019

I always knew there were disparities regarding men and women in the field of medicine. However, at the beginning of my training, these inequalities seemed so fictional to me, I could only compare them to dragons and unicorns. The fact that this topic was only occasionally mentioned seemed to solidify my belief that inequalities between female and male physicians were rare. My mind was solely focused on the various aspects …

Healing and heart when recovering from cancer

Pat Wetzel and Sherry-Ann Brown, MD, PhD

Patient

November 12, 2019

As people, we often have multiple stories to tell, from different perspectives. Multiple stories and perspectives can be wed or braided together around the same themes. Here we braid together two separate perspectives of a patient author and a physician author, respectively.

From both perspectives, this is a story about the power of care, cancer, and quality of life.

Following my cancer diagnosis of nodal marginal zone lymphoma, I struggled with my …

The biggest addiction problem in the U.S.? Health insurance.

Jeffrey Gold, MD

Health Policy

November 11, 2019

Whenever I give a talk about health care, I ask the audience, “What is the worst addiction problem we have in the United States?”

The answers are typically the same, and all are good guesses — alcohol, tobacco, opiates, and sugar are most frequently cited. I agree these are all terrible addictions that need to be addressed, but, in my opinion, the worst addiction in America right now is health insurance.

That …

It’s time to stop being skeptical of hospital chaplains

Ilaria Simeone

Medical Education

November 11, 2019

What is your gut reaction when you hear the words “hospital chaplain?” Maybe it’s an eye roll or confused stare about what you believe to be an incoming attempt at religious conversion. As a family member anxious about a loved one in the hospital, maybe it’s a sigh of relief. As a patient, maybe it’s an overwhelming fear of incoming bad news. Health care chaplaincy is chronically misunderstood, beginning with …

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