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MKSAP: 53-year-old man with recurrent gout attacks

mksap

Conditions and Diseases

May 11, 2019

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

A 53-year-old man is evaluated for a 5-year history of recurrent gout attacks involving the base of the great toes, mid feet, and ankles. Episodes are becoming more frequent and severe. History is also significant for hypertension and stage 3 chronic kidney disease. Medications are lisinopril and metoprolol. The …

The systemic poverty in Navajo Nation is a national travesty

Vincent DeGennaro, Jr., MD, MPH

Physician

May 10, 2019

“I have the CPAP machine. I’ve had it for a year, but I don’t have electricity in my house. I stayed with my aunt who has electricity but things didn’t work out,” said the young Navajo man, his massive belly protruding out from underneath the tray table.

The old Navajo man with Parkinson’s disease, unable to walk fast enough to make it to the outhouse in time, had started taking anti-diarrheal …

If your child is ever prescribed an opioid, read this post first

Michael Milobsky, MD

Medications

May 10, 2019

What if I told you that your adolescent child could contract a disease that can never be cured, but only maintained? That it would be a lifelong struggle that could change their personality, compromise their potential and values, destroy their relationships and have a long-term detrimental effect on their overall and mental health? That this disease can even be fatal, when ineffectively maintained? What if I told you that the …

A new approach to medical student debt

Austin Reifel

Physician Finance

May 10, 2019

As a medical student, I’m no stranger to being stressed out. From passing board exams, to impressing my attendings on the wards, to matching into the best residency, there are plenty of things for me to worry about. But although these concerns are the ones that take up most of my time, there is one worry which hangs over all of them like a cloud, sure to cast its shadow …

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A new approach to medical student debt

Should physicians lie when asked these questions?

Robyn Alley-Hay, MD

Physician

May 10, 2019

Dear colleagues, I know you have seen these questions:

Do you currently have any physical or mental impairment that could limit your clinical practice?
Are you currently taking any medication?
Have you ever been hospitalized for any reason?
Have you ever been hospitalized for, or diagnosed with, a psychiatric disorder to include substance abuse?

Ugh! I hate, hate, HATE these questions! “It is none of their business,” or at least that is what I told …

It’s time we approach heart failure like cancer

Brian Lima, MD

Conditions and Diseases

May 10, 2019

“I’m sorry, Mr. Smith. Your heart is very sick, and your body has irreversible damage. It’s too dangerous to attempt a transplant or implant a heart pump. There’s nothing more we can do.”

I’ve encountered this scenario more often than I care to admit as a cardiac surgeon that treats advanced heart failure. Tragically, many of these patients present long after being followed closely by their referring providers—“I’ve been seeing Mr. …

A relic to help forever remember tragedy

Michael K. Abernethy, MD

Physician

May 10, 2019

“Relic” – an object surviving from an earlier time, especially one of historical or sentimental interest. Relic derives from the Latin “reliquiae,” meaning remains and a form of the Latin verb relinquere, to leave behind or abandon.

Relics include the physical remains as well as other objects that have been “sanctified” by being touched to the body in life or death.

From high over the bluffs of the Mississippi River Valley near …

In a single-payer system, who will be doing the rationing?

Edward Hoffer, MD

Health Policy

May 9, 2019

One of the arguments made against adopting single-payer health care in this country is that it would “lead to rationing.” This assumes that we lucky people in the U.S. have unlimited access to whatever health care we need and are at risk of losing it.

This argument came to mind when I saw a few recent news items. One was that a federal judge, U.S. District Judge Robert Scola, recused himself …

Avoid the stigma: money advice for young doctors

Randall S. Fong, MD

Physician Finance

May 9, 2019

Whenever I discuss matters of money and business with medical students and residents, I‘m surprised by the responses: “Zilch, nothing,” or “Are you kidding?” Sadly, our doctors-in-training still receive little to no education in this arena.

There’s a stigma surrounding physicians and money, based largely on fact, which has become a beacon for all sorts of disingenuous, exploitive people who view doctors as over-stuffed pinatas, belly-full of money, ready to be …

Medicare for all doesn’t look like single payer in the rest of the world

Niran S. Al-Agba, MD

Health Policy

May 9, 2019

Recent polls show a majority of Americans support Medicare for all, but few seem to realize that no other system in the world operates like the current single payer proposals in Congress. Recently, I addressed the concept of single-payer health care, with Cuba’s system as an example. Today I’m writing more about the ideas being discussed now in our country and how those compare to other nations …

Time for grieving is a necessity for medical trainees

Cherilyn Cecchini, MD

Physician

May 9, 2019

It was hour thirty, and I was still at the hospital. My shift had technically ended two hours ago, but I was emotionally invested in this patient She was dying. I didn’t want to leave because I was so worried that she would pass the moment I stepped out of the hospital. My colleagues urged me to go home and practice self-care, as if that was going to make everything …

It’s time to teach the elderly about computer safety

Steven Mussey, MD

Physician

May 9, 2019

Medicare wants doctors to get patients on their computers. Doctors are required to set up computer portals to communicate with patients. These portals use two-factor identification and presume substantial computer literacy from patients in their late 70s or 80s.

Yet, there are limits. For many geriatric patients, a cell phone means a feature phone with gigantic numbers. If they have a computer, it …

Success in medicine does not equate to a successful life

Stephanie Wellington, MD

Physician

May 9, 2019

I sat across the table from my physician client and listened to her story. She asks, “How can it be that after four years of medical school and three years of residency training in my chosen field, I feel so disillusioned and disconnected?”

Instead of seeing the excitement of starting a new chapter in her career or even acknowledging some trepidation about becoming an attending with the increasing pressures of this …

How to manage narcissistic doctors

Leanne Rowe, MD

Physician

May 8, 2019

Anyone can exhibit narcissism or narcissistic personality traits or types from time to time in different forms from mild to severe. When doctors are under stress, they can “act out,” or their behavior can worsen. Greater awareness of damaging behaviors is therefore important. The more we recognize the traits in ourselves and others, the less likely they become a problem. However, unfairly labeling or stereotyping doctors as narcissists is to …

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How to manage narcissistic doctors

What do organized crime and health care have in common?

John H. Wasson, MD

Health Policy

May 8, 2019

During college and medical school, my summer employment acquainted me with members of organized crime families. Now, reflecting on my full career as a primary care clinician, geriatrician, and researcher on health care delivery improvement, I have discovered that several insights from organized crime could guide medical professionals’ responses to our country’s health care crisis.

Organized crime and the U.S. health care industry have more in common than might be immediately …

What volunteering during a crisis taught this medical student

Sudhakar Nuti, MD

Health Policy

May 8, 2019

“Were you on the hurricane emails this weekend?”

This was not the question I expected to start the week.

I came to Raleigh, North Carolina to spend part of my fourth year of medical school as special assistant to Dr. Mandy Cohen, the secretary of the Department of Health and Human Services in North Carolina. I wanted to work in government — to understand what public service meant, gain operational experience and …

The nuances between palliative care vs. physician-assisted suicide

Kevin Tolliver, MD, MBA

Physician

May 8, 2019

Sometimes referred to as “right-to-die,” “physician-assisted suicide” laws make it possible for terminally ill patients to use prescribed medications to end their lives instead of facing a protracted death. The latest state to pass legislation allowing terminally ill patients to end their lives was New Jersey. The law will go into effect on August 1.

The topic of physician-assisted suicide and right-to-die is incredibly complex and emotionally charged. I’m not going …

Physicians and patients must work together to improve health care

Michele Luckenbaugh

Patient

May 8, 2019

According to Wikipedia, a livestock guardian dog is a type of pastoral dog bred for the purpose of protecting livestock from predators. If only our doctors had these noble creatures to protect them from the predators of the world, to alert them when those interested in only the “bottom line” entered the halls of healing, our medical practices. Apparently, a “fox is guarding the hen house,” one who is not …

The journey of being a parent in medical school

Amy Zhang, MD

Medical Education

May 7, 2019

One big life event for me was having my son Matthew during medical school. It has been a fulfilling and interesting journey.

I met my husband Andrew during college, and we were lucky to matriculate together at the University of Minnesota Medical School. I decided to do a dermatology research year between the third and fourth years of medical school, and Andrew did a neurology research year at the same time. …

Political games are destroying our national state of health

Kurt R. Bravata, MD

Health Policy

May 7, 2019

Lately, I have been contemplating the growing political divide in this country. We seem perpetually locked in a state of partisan gridlock. Our nation is stuck in a continuous news cycle dominated by party politics. This perpetuates party divisions and takes us further away from bipartisan consensus on how to achieve and sustain the common good. The gulf between the parties has become so deep, that we can’t even agree …

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