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MKSAP: 44-year-old man with HIV, hypertension, and hyperlipidemia

mksap

Conditions and Diseases

May 18, 2019

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

A 44-year-old man is evaluated in the office during a routine visit. Medical history is significant for HIV diagnosed at age 25 years, hypertension, and hyperlipidemia. He is a current smoker. Medications are chlorthalidone, tenofovir-emtricitabine, and raltegravir.

On physical examination, the patient is afebrile, and blood pressure is 126/74 mm …

Should we write that patients are “pleasant” in medical notes?

Paul Sax, MD

Physician

May 17, 2019

When writing medical notes, some clinicians include an appreciation of their patient’s personality and disposition in their opening line (the “chief complaint”), or when they’re wrapping up (in the “assessment and plan”), or in both locations.

You know — it goes like this:

“CC: Ms. Smith is a very pleasant 62-year-old woman admitted with …”

or:

“A/P: To summarize, Mr. Jones is a delightful 89-year-old man presenting with …”

or:

“CC: This lovely 74-year-old retired school teacher was in her usual state of health …

This story happens every week in clinics like mine and it’s got to stop

Hans Duvefelt, MD

Physician

May 17, 2019

Jeanette Brown had lost twenty pounds, and she was worried.

“I’m not trying,” she told me at her regular diabetes visit as I pored over her lab results. What I saw sent a chill down my spine:

A normal weight, diet controlled diabetic for many years, her glycosylated hemoglobin had jumped from 6.9 to 9.3 in three months while losing that much weight.

That is exactly what happened to my mother some years …

Doctors, stay human

Lizbeth Hingst, DO

Physician

May 17, 2019

She was a middle-aged female who was life-flighted from an outlying facility to the tertiary care hospital in which I worked. As she quickly rolled out of the elevator, I ran toward her and saw her blood pressure was tanking with her mentation fluctuating. My hair mindlessly placed in a ponytail, my blue scrubs wrinkled, and my nerves a jumbled mess, EMS briefly gave me an account of her history: …

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Doctors, stay human

Why academic doctors might be less informed about finances

Smart Money, MD

Physician Finance

May 17, 2019

Apart from a minority number of academic physicians, nearly all of the physicians openly discussing finance matters online are either retired or in private practice. The data might be skewed since most practicing physicians don’t work in academia anyway. What might be interesting is to compare the percentage of financially literate academic physicians to that of those outside of academia. I would venture to surmise that academic physicians might be more financially …

Woman physicians: Make informed decisions early on planning a future family

Anu Kathiresan, MD

Conditions and Diseases

May 17, 2019

As women in medicine, we are always focused on the next goal we need to achieve to advance our career. Though undergraduate education, medical school, residency, and fellowship, we are constantly striving to get the highest score, to maintain a high GPA, to publish papers, to get excellent letters of recommendation. The challenge that women physicians face is balancing these demands in the midst of our passing prime reproductive years. …

A medical educator’s poignant epiphany

Robert Marion, MD

Medical Education

May 17, 2019

For a long time, I didn’t feel as if I were getting any older. Because I’ve been at my institution since 1975, I’ve always been surrounded by the people who educated me. Though my teachers and mentors have undoubtedly aged, to me, none of them seems much older than they were when I first met them. And since for most of those years our student-teacher relationship has remained unchanged, when …

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A medical educator’s poignant epiphany

How music changed this physician’s life

Cory Fawcett, MD

Physician

May 16, 2019

We have all received many gifts throughout our lifetime. Most are long gone and forgotten, but a few gifts stand out as favorites. As kids, we are given so many toys that we don’t even remember most of them. As we get older, practical gifts like ties and socks are given. Sometimes people don’t know what to give us, so we get gifts we don’t even want or need. There …

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How music changed this physician’s life

An experiment in removing the heart from medicine

Janice Boughton, MD

Physician

May 16, 2019

I delight in learning my patients’ stories and giving them exactly what they need when I take care of them in the hospital. Who they are and what is the best approach to their problem is the primary mystery to be solved, my Sherlock Holmes moment. This is why, if somebody asks me, I will tell them that doctoring is the best job in the world. The opportunity to connect …

The simplest and most important question to ask in the exam room

Michael L. Millenson

Conditions and Diseases

May 16, 2019

It was the first time the young woman had come to the health center in a suburb just north of Chicago. When the 26 year old walked into the exam room back in 2008. There was no paper chart or electronic health record (EHR) accompanying her, no background information — nothing to indicate anything but a routine annual gynecological exam.

She and her husband were about to try to have their …

The problem with burning health insurance down

Margalit Gur-Arie

Health Policy

May 16, 2019

Let’s burn health insurance down. Greedy corporate bastards should burn. Big Pharma and big hospitals should probably burn too. You know who else is really, really, bad? Wall Street. Let’s burn the banks. And let’s burn Big Tech and the entire Silicon Valley cartel. Let’s also burn Big Agribusiness that’s making us fat and sick. And let’s burn the Oil companies that are destroying the planet, and let’s burn the …

What’s wrong with health care, and do we have the will to change?

Davis Liu, MD

Health Policy

May 16, 2019

Our health care system is in crisis and needs significant change. So, I was excited to read Dr. Lisa Rosenbaum’s great February 2019 three-part series in the New England Journal of Medicine and accompanied round table about teamwork in health care. Rosenbaum kicks off each piece with a story: How the Brigham’s and Women’s Hospital’s “shock team,” doctors of different specialties, worked seamlessly in a “remarkable …

The inspiring story of how a physician fought MOC against all odds

Meg Edison, MD

Physician

May 16, 2019

Well, I won. Six years after I started down the very slow process to end forced MOC in my state, it happened. On December 27, 2018 Michigan governor Rick Snyder signed HB 4134 and 4135 into law. The harm BCBS caused me and my patients will never happen to another pediatrician in Michigan.

I know. Crazy. I’m still in shock. It’s taken a while to process it enough to …

How a Minnesota Supreme Court decision could affect curbside consults

Christopher Johnson, MD

Physician

May 16, 2019

“In a case that could have wide-reaching implications for medical practice in Minnesota, the Minnesota Supreme Court issued a ruling on April 17 in the case of Warren v. Dinter holding that the existence of a physician-patient relationship is not a prerequisite for a medical malpractice action. Rather, a person may sue a physician for malpractice – even if that person was not a patient of the physician – if the harm …

Second victim syndrome: a doctor’s hidden struggle

Harry Karydes, DO

Physician

May 15, 2019

As physicians, we have embraced a calling where we help others. A commitment many of us fully relish. We are grateful for our patients and the families who put their trust in us as we diagnose and treat their sometimes incredibly complex illnesses. I have been genuinely inspired by the stories I have heard from patients and my colleagues on the work we do.

Yet, in spite of the incredible advancements …

The truth about Caribbean medical schools

Jessica K. Willett, MD

Medical Education

May 15, 2019

I graduated from St. George’s University School of Medicine in Grenada and now work as an emergency medicine physician at a trauma center in Northern California. To some, that may seem like an extreme jump or a rare success story. The stigma of a Caribbean medical school education is built on rumors — and they’ve run their course. Let’s address some.

1. Students only go to Caribbean medical schools if they …

Sexually discriminatory language used against our trainees: There is no grey area

Kate Wonneberger Gardner, MD

Physician

May 15, 2019

“Thanks baby, I mean doctor … Doctor baby …” he finished uncertainly.

I washed my hands, gave him a quick nod, and walked out of the emergency department exam room with my smirking attending following behind me.

Speaking to a group of my female colleagues, it seems everyone has a story or two like this. Starting as medical students and continuing through our practice today, for female physicians there seems to be …

Lawmakers should stop trash-talking health care professionals

Niran S. Al-Agba, MD

Physician

May 15, 2019

Washington state Sen. Maureen Walsh (R-Walla Walla) became a national headline for alleging that “[nurses] probably play cards for a considerable amount of the day” during debate on legislation mandating break periods. Many nurses have mailed decks of cards to Walsh and posted pictures of blood-spattered emergency department walls in order to call attention to “last night’s card game,” driving home the point that they aren’t “playing” anything …

How non-video telehealth can be a cure for overprescribing antibiotics

Ray Costantini, MD

Health Technology

May 15, 2019

When Dr. Fleming found penicillin mold in his Petri dishes in 1928, he had no idea of the impact he — and it — would have on global health. Penicillin and the antibiotic revolution that it triggered have saved countless lives and change world history.

Less than a century later, though, antibiotics occupy a space between savior and sinner. This complicated reputation is mostly due to how …

Share your stories and experiences, in written, visual, or media form. Stories matter.

Alya Ahmad, MD

Physician

May 15, 2019

Narrative medicine: I have heard of that, but what is it? I often get asked this question. As a master’s student of narrative medicine, I am still trying to hone in on the best response to that question.

For many, narrative medicine (NM) is not a novel concept. We have watched movies or read books of doctors helping, listening or learning from patients as they wrestle with their illness. Many writers …

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