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MKSAP: 65-year-old woman with a cardiac murmur

mksap

Conditions and Diseases

January 26, 2019

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

A 65-year-old woman is evaluated during a routine examination. She was diagnosed with a cardiac murmur in early adulthood. She is active, healthy, and without symptoms. She takes no medications.

On physical examination, vital signs are normal. A grade 3/6 holosystolic murmur preceded by multiple clicks is present at the …

Do huddles really help in primary care?

Hans Duvefelt, MD

Physician

January 25, 2019

I’ve huddled since before we used the word for it: You want to be prepared for the patients coming in that day. “Followup MRI” – did they have it and what did it show? “Ankle pain” – do we have X-ray today? “Eye pain” – be sure to check her acuity and put her in a windowless room, and did the new fluorescein strips come in? All fast-paced, to the …

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Do huddles really help in primary care?

Patients are an integral part of medical student education

Orly Farber

Medical Education

January 25, 2019

A face feels nothing like a frozen pig’s foot, I thought, as I guided a curved needle into the woman’s cheek, drawing the absorbable thread across her still-bleeding wound. Two wraps around the needle driver and I pulled the nearly invisible thread through, bringing the edges of her skin back together, securing my first knot.

“Hey, have you ever sutured?” the ER doctor had asked, just minutes before.

“Only in class,” I replied, …

How customer service breeds bad medicine

Sabina Rebis, MD

Physician

January 25, 2019

“Welcome to our clinic. May we take your order?”

Many patients have Googled, Yahoo’ed or Bing’ed their symptoms way before I even lay eyes on them in an examining room. And they have a schema of what they’ll be getting out of the visit.

If the encounter takes a detour — the diagnosis is not in line with what they believe they have, or they are about to stroke out from unmanaged …

We have a shot at preventing cervical cancer

Lisa N. Abaid, MD, MPH

Medications

January 25, 2019

Many people think eradicating cancer is unattainable. But for cervical cancer, we are well on our way to doing just that.

Cervical cancer was once the leading cause of death in women in the U.S. But we are on the cusp of vanquishing this disease thanks to regular pap screening and a vaccine that protects women and men from developing the human papilloma virus (HPV), the cause of nearly all cervical …

MOC: When you play the game and they change the rules

Xrayvsn, MD

Physician

January 25, 2019

I think one of the biggest frustrations I have as a doctor is being at the mercy of people who either have no medical training or are so detached from medicine that they have lost touch with those on the front line.

The American Board of Radiology (ABR) essentially governs over radiologists who typically need the important board-certified designation to find a place of employment.

I have always played by the rules …

How EMR alert fatigue overwhelms physicians

Scott Keeney, DO

Health Technology

January 25, 2019

As a hospitalist, like most in health care, I am afflicted by the slow march of thousands of mouse clicks on the electronic health record (EHR) every day I work. But after starting a new job and learning a new EHR, I have become painfully aware of the volume of alerts that pop up when I place orders. Don’t get me wrong: I appreciate being informed that a patient has …

V.O.M.I.T. in the ER

Rada Jones, MD

Physician

January 24, 2019

First came the SOAP notes. They’ve nothing to do with cleanliness, just the opposite. SOAP stands for: Subjective, Objective, Assessment and Plan.

S: “Patient states that pain is 16/10, sharp, unremitting. Feeling like a crocodile is eating insides every 10 minutes, after sprinkling them with Frank’s hot sauce.”

O: On entering the room, patient is eating Cheetos and drinking Mountain Dew while texting. Abdomen is soft and nontender.

A: Abdominal pain, probably gastritis.

P: …

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V.O.M.I.T. in the ER

The conflict between pharmacists and their corporate superiors

Vamsi Aribindi, MD

Medications

January 24, 2019

Pharmacists play an essential role in today’s ever-expanding health care system today. They check for drug interactions, watch for signs of opioid overprescribing and try to determine whether a drug for one condition prescribed by one doctor will negatively impact the patient because of another diagnosis the patient has. In hospital units, their roles have become yet more complex — often serving on various quality committees, managing daily dosages of …

10 things patients should know about hospitals

David Slone, NP

Patient

January 24, 2019

When you enter the doors of an emergency department, what you are entering is the realm of the unknown. Needles, blood, blaring alarms and all-nighters with nurses are about to become your new norm. For your whole life, you thought good food, sleep, and TV reruns could fix anything. But those are in short supply in a place you need it the most. Oh, and when else in your adult …

Treat your family like you treat your patients

Doctormom_andmore, MD

Physician

January 24, 2019

Many times during difficult patient interactions — when I am not sure about the right thing to do — I let myself be guided by the question: “What would I do if it was my family member?” This internal dialogue usually cuts the clutter and lets me focus on the most important thing: the well-being of my patient. I can step away from the behavioral chaos and guide them in …

This physician chose not to do a triathlon. Here’s why.

Dora C. Rodriguez, MD

Physician

January 24, 2019

I posted on social media that in 2019, I would compete in Ironman. I wanted to hold myself accountable and was announcing “I could do this.” My primary reason, so I thought, was that “I wanted to grow mentally and physically.”

Since then, I have been training six hours per week on top of my usual daily routine. I have been mentally and physically challenged in ways I didn’t think possible. …

My garden has taught me a lot about health care

Jeffrey A. Oster, DPM

Physician

January 24, 2019

Sustainability is a bit of a buzz word these days. To be sustainable means that you only use what you need, leaving the rest to be used by you or others in the future. Sustainability is a popular topic in environmental sciences and refers to renewable agriculture, good stewardship of natural resources and recycling of waste. What about sustainability in health care?

In health care, we often describe The United States …

What clothing choice says about a patient

Anne Katz, RN, PhD

Conditions and Diseases

January 23, 2019

The woman waiting to see me looked every inch a lawyer or accountant in her black pencil skirt, pink shirt, and a Chanel-style houndstooth jacket. Her ankle boots were reminiscent of those worn by women in Victorian times with a row of small buttons up the side. She had a scarf loosely knotted around her shoulders, and her hair was …

Must-have medical apps for primary care

Douglas Maurer, DO, MPH

Health Technology

January 23, 2019

Earlier this year, we put together a list of what we thought were the best medical apps for health care providers. Now at the end of 2018, we’re augmenting that list to give you a full picture of what we think are must-haves medical apps for those in primary care.

Safe Motherhood Initiative: ACOG DII SMI

Quick reference for common obstetric emergencies

Many of us in family medicine practice full-scope …

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Must-have medical apps for primary care

How hospitals are taking advantage of the 340B Drug Pricing Program

Peter Ubel, MD

Medications

January 23, 2019

Sometimes it is hard for hospitals to provide expensive care to poor patients. When a low-income patient needs $20,000 of chemotherapy, a hospital loses money if that patient cannot pay for the medicine, or pays through Medicaid, with its relatively stingy reimbursement. Fortunately, the federal government created a program for hospitals that care for a disproportionate share of low-income patients, whereby they can purchase those medicines at a discount. The program …

This patient’s regrets were much deeper than money

DocG, MD

Physician Finance

January 23, 2019

You wouldn’t have known it by looking, but Viktor had once been on several modestly successful television shows. He lived for acting. It brought him joy and purpose. So much so that it was the first thing he mentioned to any who happen to pass through his single room next to the nursing station. Viktor was almost famous, definitely broke. His little space in the nursing home …

A stage IV lung cancer survivor story

Jennifer Lycette, MD

Conditions and Diseases

January 23, 2019

I want to share how the era of immunotherapy, specifically immune-checkpoint-inhibitors, has changed the landscape of community oncology practice in metastatic non-small-cell lung cancer, for oncologists and, more importantly, patients.

I want to tell you the story of Joe. A stage IV lung cancer survivor story. (Name and details changed to protect anonymity.)

In 2015, Joe was diagnosed with stage IV non-small-cell lung cancer (NSCLC), adenocarcinoma. He had multiple metastases to other organs. …

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A stage IV lung cancer survivor story

To my mentor: Thank you. I didn’t know how much I needed you.

Elizabeth Rubin Ribak, MD

Physician

January 23, 2019

I never really had a true mentor. Or role model. I wasn’t sure if they were the same thing, or what the difference was, so I gave up. Sometime in middle school, I remember a teacher encouraging us to find someone we looked up to and develop a mentor relationship. I was 12, looked at my teachers who I thought were old, and ignored that advice.

In high school, I thought …

Getting old ain’t for sissies

Therese Zink, MD, MPH

Physician

January 22, 2019

These days we are talking more about advanced directives and living wills in health care. This is progress, but as a member of the sandwich generation, I am focused on the aging process. I don’t have kids, but I have parents and have the honor of watching patients struggle with aging and helping loved ones grow old — walking the long, winding and thorny road.

Patients have asked me, “Where are …

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Getting old ain’t for sissies