KevinMD.com

August 8, 2016Aug 8, 2016

It is a master of stealth, stretching less than half an inch long and weighing in at 2.5 milligrams with as estimated air speed of 1 to 1.5 miles per hour. It is virtually soundless in flight, registering zero decibels from ten feet. Its tracking systems hone in on targets by detecting infrared radiation from warm bodies, chemicals such as carbon dioxide and lactic acid, body odors from as far …

Patient

At the end of life, searching for the right word

K. Anne Smith

August 8, 2016Aug 8, 2016

During the first few days that my mother spent in hospice, I silently sat by her bed watching her chest rise and fall, listening to her moan, counting her doses of Ativan, Tylenol, and Morphine, and tallying the days she’d…

On day five of my vigil, I asked her nurse, “How long can Mom live like this? She hasn’t opened her eyes or eaten or had …

Patient

The dilemmas faced by the chronically ill

Toni Bernhard, JD

August 8, 2016Aug 8, 2016

After more than fifteen years of being mostly housebound by chronic illness (which includes chronic pain), here are a few of the dilemmas I’ve faced over and over. I’m confident that I’m not alone in my “should I/shouldn’t I?” world.…

Do I accept an invitation from a friend to get together or do I refuse it?

If I refuse the invitation, depending on who issued it, it may be the last one …

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Physician

Finding the right balance in pain relief: A physician’s story

Rita Agarwal, MD

August 7, 2016Aug 7, 2016

After surgery for my broken tibia, I realized that there were only four points on the pain scale that really mattered to me: I’m OK. This acetaminophen/ibuprofen/whatever is enough. I wouldn’t mind a little something more, preferably something that binds…

After surgery for my broken tibia, I realized that there were only four points on the pain scale that really mattered to me:

I’m OK. This acetaminophen/ibuprofen/whatever is enough.
I wouldn’t mind a little something more, preferably something that binds mu
Um, could you please hurry that up?
NOW! NOW! I need it NOW!

On the 0 to 10 pain scale, who really cares if you are at a 2 or …

Physician

Social determinants matter most to a person’s health. Here’s one story.

Franklin Warsh, MD, MPH

August 7, 2016Aug 7, 2016

To close out my first week of medical school, the class was treated to a talk by a stuffy but soft-spoken lecturer on the relationship between poverty, education, and poor population health. “Social determinants of health,” he labeled them, a clunky and unwieldy term if ever I’d heard one. In those days, audiovisual aids consisted of an overhead projector for black-and-white transparencies. And boy did that talk have transparencies. Chart …

Physician

Sexism in medicine is a public health issue

Lavanya Viswanathan, MD

August 7, 2016Aug 7, 2016

Author. President. Teacher. Doctor. These are all gender-neutral words which happen to relate to a person’s profession. However, I find it particularly interesting that while “doctor” is a gender-neutral word, the field of medicine is riddled with institutional sexism. Let…

Let me begin by explaining that I am a military physician currently training to become a gastroenterologist. If being the only woman in any room bothered me, my journey would imply that …

Physician

Do physicians play God?

Gian-Paul Vidal, MD

August 7, 2016Aug 7, 2016

After rotating in the ICU, I began to wonder about the limitations of modern medicine. In a short time, we have come a long way with the discovery of antibiotics, high-resolution imaging, and the development of advanced surgical procedures. The medical field saves millions of lives. Nowadays, people do not go to a hospital to die; they go to be healed. As physicians, we are very skilled at extending life.

Heart …

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Do physicians play God?

Physician

A love letter to those on the primary care journey

Zubin Damania, MD

August 6, 2016Aug 6, 2016

We are standing at a crossroads in health care. Behind us lies a long-lost, nostalgia-tinged world of unfettered provider autonomy, sacred doctor-patient relationships, and a laser-like focus on the art and humanity of medicine. This was the world of my…

While many still pine for these “good old days” of medicine, we shouldn’t forget that those days weren’t really …

Physician

Even if doctors are demonized, they do make a difference

Linda Girgis, MD

August 6, 2016Aug 6, 2016

As a long-distance truck driver, he did not have time to visit a doctor. In fact, the last time a doctor ever examined him was decades ago. When his leg started hurting, he ignored the pain for months before it got too severe and started interfering with his ability to drive. He showed up in my office in severe pain and limping. And while he tried to joke it off, …

Physician

Who cares about our turf wars? Patients don’t.

Amanda Dean, RN

August 6, 2016Aug 6, 2016

Recently a measure was proposed to allow APRNs full practice authority in the VA health care system. With this measure, the embattled VA hopes to help optimize access to health care for our veterans. A measure to help with the firestorm of problems we witnessed unravel at the Phoenix VA system two years ago. Sounds great, right?

Nothing is ever that simple in American medicine. The professional organizations are, once again, …

Conditions and Diseases

MKSAP: 26-year-old woman with recurrent feelings of fear and anxiety

mksap

August 6, 2016Aug 6, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 26-year-old woman is evaluated for a 10-year history of recurrent episodes of acute-onset feelings of fear and anxiety. These episodes initially occurred approximately…

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

A 26-year-old woman is evaluated for a 10-year history of recurrent episodes of acute-onset feelings of fear and anxiety. These episodes initially occurred approximately 4 times per year but for the past 3 months have been occurring once or twice per month, especially when she is under stress. She describes the episodes as …

Health Policy

Insurance constraints drive shortcomings in health care delivery

Miranda Yaver, PhD

August 5, 2016Aug 5, 2016

It is no secret that mental health conditions are prevalent, and recent years have seen an increase in the dialogue on their causes and consequences. However, we do ourselves a disservice when discussing mental health outside the context of the broader system in which care is provided, and the insurance constraints that drive shortcomings in health care delivery.

SAMHSA estimated that 58 percent of adults have a medical …

Physician

Welcome to the medical profession

Jean Robey, MD

August 5, 2016Aug 5, 2016

Dear medical student, resident, or fellow, You will one day forget something. We are currently in a systematic plot to have everyone forget something important. We are quietly unaware it is happening. We are asked to forget how we got…

Dear medical student, resident, or fellow,

You will one day forget something. We are currently in a systematic plot to have everyone forget something important. We are quietly unaware it is happening. We are asked to forget how we got here. I want to remind you. I want us all to remember.

You undoubtably were more mature than your peers. You undoubtably sacrificed to develop the persona that one day would impress …

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Welcome to the medical profession

Physician

It’s time to stop using the language of war in health care

Brian Stork, MD

August 5, 2016Aug 5, 2016

Summer is heating up, and so is the election rhetoric. In this year's campaign for the White House, when it comes to verbally attacking each other, neither candidate seems to recognize any limits. Personally, I think this behavior reflects poorly…

Summer is heating up, and so is the election rhetoric. In this year’s campaign for the White House, when it comes to verbally attacking each other, neither candidate seems to recognize any limits. Personally, I think this behavior reflects poorly on both candidates.

In heath care, it’s almost impossible to escape this negativity. The media devours and thrives upon it. In our hospitals, televisions in the doctor’s lounge, cafeteria and in …

Physician

This is the only time she will hold her daughter alive

Devin D. Namaky, MD

August 5, 2016Aug 5, 2016

My eyes open. The blackness of the call room envelopes me. Consciousness sets in with a lingering disorientation. A small green light, is speaking … ringing. “Are you standing up?” The resident on the other end knows her attending too…

A woman has arrived laboring at 24 weeks gestation. Records aren’t available, but she reports her fetus has a diaphragmatic hernia. …

Health Policy

MACRA will do to medicine what No Child Left Behind did to education

Niran S. Al-Agba, MD

August 4, 2016Aug 4, 2016

Why must we keep repeating history? NCLB significantly increased the federal role in education by holding schools accountable for the academic progress of all students. NCLB held teachers responsible for education of children; MACRA-proposed changes will hold physicians responsible for…

Why must we keep repeating history?

NCLB significantly increased the federal role in education by holding schools accountable for the academic progress of all students. NCLB held teachers responsible for education of children; MACRA-proposed changes will hold physicians responsible for the medical progress of our patients. The largest problem with this approach is students and patients go home each day to whatever environment in which they live. Neither teachers nor physicians …

Physician

I will not let medicine dehumanize me

Kristina Dakis, MD

August 4, 2016Aug 4, 2016

Dear Dad, I often think about the night you passed away. I was caring for you while you were dying from metastatic colon cancer. Every hour I woke up to give you Dilaudid so you wouldn't feel pain and Ativan…

Dear Dad,

I often think about the night you passed away. I was caring for you while you were dying from metastatic colon cancer. Every hour I woke up to give you Dilaudid so you wouldn’t feel pain and Ativan so you wouldn’t be scared. You had only just been diagnosed eight months before. Despite aggressive chemo, radiation, abdominal surgeries, and all the hope and prayer in the world, the cancer …

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I will not let medicine dehumanize me

Physician

Fixing the breakdown in patient satisfaction

Kevin Haselhorst, MD

August 4, 2016Aug 4, 2016

Ruth was a spry, but frail 98-year-old woman who was stiff and sore following the 6-hour drive from California to Arizona. She had suffered a recent wrist injury and was not recovering well after spending three weeks in a rehabilitation center. She was in the midst of upheaval and discontent — in the throes of relocated to an assisted-living residence closer to her son. The facility’s coordinator had begun to …

Physician

Access to guns is easy. Access to trauma care is becoming more difficult.

Eric Beam, MD

August 4, 2016Aug 4, 2016

Now that the dust has settled in the wake of America’s most recent mass shooting, the odds seem high that history will repeat itself, and our legislature will again fail to enact any meaningful reform. Like it or not, we…

Like it or not, we as a country, through our elected representatives, have decided that we value unfettered access to deadly weapons over an individual’s right to feel safe in public spaces. Why …

Physician

We are all connected to the well-being of LGBTQ youth and their families

Alexis Drutchas, MD

August 3, 2016Aug 3, 2016

The morning my patient Evan tried to end his young life, I woke up early to make banana pancakes. It was a warm spring day, and I pushed up the windows in my kitchen. That same morning, Evan opened his window with a different intent. He had argued with his parents the evening before, not unexpected at 16, yet this was different. Evan is transgender, and his parents were not …

Real physician voices, twice a week

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