KevinMD.com

June 11, 2016Jun 11, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 54-year-old man is evaluated because of fatigue. He also notes constipation and cold intolerance. Medical history is significant for tonsillar squamous cell carcinoma…

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

A 54-year-old man is evaluated because of fatigue. He also notes constipation and cold intolerance. Medical history is significant for tonsillar squamous cell carcinoma treated with radiation 3 years ago. There is no family history of thyroid disorders.

On physical examination, the skin is dry. Mild periorbital edema is present. The thyroid is of …

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MKSAP: 54-year-old man with fatigue

Physician

Living the oath requires physicians to set boundaries

Kathy Stepien, MD

June 10, 2016Jun 10, 2016

“I solemnly pledge to consecrate my life to the service of humanity.” Standing with my medical school colleagues, we continue: “I will respect and hold the secrets that are confided in me. I will exercise moral integrity.” I easily agree.…

I easily agree. But then, “The health of my patient will be my first consideration.” I’m 40 weeks pregnant, with swollen feet and raging heartburn. My baby kicks wildly. With certainty, I know that …

Physician Finance

When this doctor retires early, here are 4 things he’ll miss

Physician on FIRE, MD

June 10, 2016Jun 10, 2016

As a physician who is planning an early retirement, and is writing about the topic often, I find that retirement is frequently on my mind. It’s not difficult to articulate my desire for an early retirement. I crave the freedom and time with my family. I look forward to restful nights free from the threat of the loathsome pager. Another round of MOC is not for me, and I’m ready …

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Medications

What I learned about prescription drug abuse from San Diego

Roneet Lev, MD

June 10, 2016Jun 10, 2016

The news media is hooked on the opioid prescription drug abuse story. Every day, it seems, I read a new announcement: The CDC has issued guidelines for prescribing opioids for chronic pain. The FDA has announced immediate-release pain medications will…

The news media is hooked on the opioid prescription drug abuse story. Every day, it seems, I read a new announcement:

The CDC has issued guidelines for prescribing opioids for chronic pain.
The FDA has announced immediate-release pain medications will need to have “black box” warning labels about the risk of addiction, abuse, overdosing and even death.
The White House has requested $1.1 billion in its 2017 budget to combat …
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What I learned about prescription drug abuse from San Diego

Physician

How pain scores escalated the opioid crisis

Mark Vierra, MD

June 10, 2016Jun 10, 2016

“It’s an 8,” I heard him say from behind the curtain as I walked into the room. The nurse’s aide dutifully recorded the number while the automated blood pressure cuff searched for his pulse, and the plastic clip on the…

“It’s an 8,” I heard him say from behind the curtain as I walked into the room.

The nurse’s aide dutifully recorded the number while the automated blood pressure cuff searched for his pulse, and the plastic clip on the tip of his index finger measured his oxygen saturation.

“What does an 8 mean?” I asked.

“Oxycodone!” he chirped cheerfully, without a moment’s hesitation. “An 8 means oxycodone. Five milligrams!”

“Ah, but you’re wrong,” …

Patient

I didn’t get to say goodbye

Debbie Moore-Black, RN

June 9, 2016Jun 9, 2016

I slipped and fell. My hip fractured, surgery would make it better. But it didn't. My body was too weak to fight. I couldn't cough and deep breathe; I stayed in bed. I had nausea and vomiting. I couldn't breathe.…

I slipped and fell. My hip fractured, surgery would make it better. But it didn’t. My body was too weak to fight. I couldn’t cough and deep breathe; I stayed in bed. I had nausea and vomiting. I couldn’t breathe. I became weaker and weaker, until my family noticed. The medics rushed me into the ER. My blood pressure was 62/34. For how long? The ER nurses and doctors tried …

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I didn’t get to say goodbye

Physician

The hospital’s homeless at night

Ahmed Zaafran, MD

June 9, 2016Jun 9, 2016

Sometimes when I’m working at the hospital overnight, I go for walks. Every now and then, things calm down in the operating room, and you can get some time to relax. Life moves at such a break-neck pace, especially within…

Walking around a hospital at night is very different than during the day. During the day, it feels like …

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The hospital’s homeless at night

Medical Education

The donors were our first patients

Alicia DiGiammarino

June 9, 2016Jun 9, 2016

I handed her the humungous gardening shears and watched as she snapped through each rib providing access to the silent heart of our cadaver. Abruptly, the fire alarm rang out cutting short the most physically taxing day of our yearlong anatomy lab course. Once we had evacuated, firemen streamed into the building, and I wondered if my lab-mates were also thinking about the horrific scene these men would encounter as …

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The donors were our first patients

Physician

The story of a man who did not feel well

Mark E. Williams, MD

June 9, 2016Jun 9, 2016

Once upon a time, not that long ago, there was man who lived an uncomplicated life. One morning he awoke and did not feel well. He could not really describe his malaise, but he definitely was not his usual self. Nothing particularly noteworthy had happened to him except that his dog had recently died of old age. William, a scruffy little terrier, was 17 years old, and the man knew …

Health Policy

Sooner or later, you will need the ER. Will it be there?

Myles Riner, MD

June 8, 2016Jun 8, 2016

Sooner or later, you will need the ER. I don’t care how healthy you are, how much you hate going to the hospital for care, how much you distrust doctors or modern medicine, how rich you are, or how deep in the woods you live, the odds are almost 100 percent that in your lifetime you will end up in the ER.

You may get lucky, and find …

Physician

Doctors don’t have to wear a white coat to look professional

Neha Sharma, DO

June 8, 2016Jun 8, 2016

The first time I wore a white coat was during the white coat ceremony in medical school. It was a beautiful day in New York City. Scores of young, bright-eyed medical students and their proud family members were all congregated…

It was particularly warm inside the building, and we were being served hot coffee while …

Physician

The question doctors should ask before ordering a test

James C. Salwitz, MD

June 8, 2016Jun 8, 2016

Doctors have several bad habits. They order piles of tests just to get a vague, unfocused view of a patient’s health. They order expensive and invasive tests to rule out the unlikely or extraordinarily rare. The worst “bad test habit” is when doctors order a test, which, no matter what the result, will not change what they are planning to do.

Why do doctors over order? These same people thought a …

Medical Education

Sign this petition to prevent medical student and resident suicides

Ashley Maltz, MD, MPH and Pamela Wible, MD

June 8, 2016Jun 8, 2016

On May 11, 2016, we lost another bright, young soul to suicide. Sean Petro was in his third year at the USC Keck School of Medicine and is the third tragedy at his school in the last two years. On…

On May 11, 2016, we lost another bright, young soul to suicide. Sean Petro was in his third year at the USC Keck School of Medicine and is the third tragedy at his school in the last two years.

On April 23, 2015, we lost Kevin Dietl to suicide just weeks before he was to graduate medical school. Kevin’s parents were so excited to attend their son’s graduation. Instead, they attended …

Medical Education

A surgeon is humbled by unexpected feedback

Heena P. Santry, MD

June 8, 2016Jun 8, 2016

“Hey, Doc!” I heard the patient say as I blazed by bed A. Bed A is the "door" bed. My patient was in bed B, the "window" bed. I had just met him; it was a new inpatient consult. For…

“Hey, Doc!” I heard the patient say as I blazed by bed A.

Bed A is the “door” bed. My patient was in bed B, the “window” bed. I had just met him; it was a new inpatient consult. For all the rules and regulations surrounding patient confidentiality, the curtains between beds do little to protect privacy since inevitably there will be audible conversations about symptoms, diagnosis, and management between patients and …

Physician

Are you the physician who yells?

Edwin Leap, MD

June 7, 2016Jun 7, 2016

I’ve never been the doctor who yells. However, if you work in medicine, you’ve met him or her. I’ll call this physician "Dr. Barkus Yellby." Dr. Yellby is angry. A lot. In the old days (and not so old days),…

I’ve never been the doctor who yells. However, if you work in medicine, you’ve met him or her. I’ll call this physician “Dr. Barkus Yellby.” Dr. Yellby is angry. A lot. In the old days (and not so old days), he threw instruments in the OR when they weren’t what he wanted. Or if the charts and labs weren’t ready for rounds, he slammed things on the desk and berated …

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Are you the physician who yells?

Medical Education

Nothing can cultivate humility like medicine

Hamsika Chandrasekar

June 7, 2016Jun 7, 2016

There was a morning where I felt like the smallest human being on earth. It was a morning spent in the OR, where it seemed like I could do nothing right. I placed the Foley incorrectly on my first attempt, and then ended up removing it incorrectly as well. I nonchalantly brushed past the robot we were using for the case, which was already draped and prepped, and whose sterility I …

Physician

As physicians, we learn much from our patients

Robert Pearl, MD

June 7, 2016Jun 7, 2016

When I first met Mary, already in her forties, she had suffered throughout her life from an arteriovenous malformation of the face. As a result, from early childhood, she had endured the discomfort and humiliation that accompanies the stares of…

The abnormal connection between the arterial and venous halves of her circulatory system caused her cheek, jaw, and neck to …

Patient

The first shower after surgery

Kristen Knott

June 7, 2016Jun 7, 2016

"Do you need help getting undressed?" Jon asks from the doorway of our bedroom, one hand holding his BlackBerry, the other tucked into the front pocket of his baggy jeans. His head is slightly tilted, his eyebrows arched, highlighting his…

“Do you need help getting undressed?” Jon asks from the doorway of our bedroom, one hand holding his BlackBerry, the other tucked into the front pocket of his baggy jeans. His head is slightly tilted, his eyebrows arched, highlighting his forehead wrinkles.

His phone vibrates, drawing his eyes from me to the incoming message. I wait.

Jon reads, ponders and then looks up, half-absorbed in what he’s just read, and registers that …

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The first shower after surgery

Physician

Physicians as innovators: 6 ways we help and hurt ourselves

Nicole Van Groningen, MD

June 6, 2016Jun 6, 2016

The U.S. health care system is the world's top in health care spending per capita, but in terms of performance, we're dead last among developed countries. As a young physician embarking on a career in this landscape, it's glaringly obvious…

The U.S. health care system is the world’s top in health care spending per capita, but in terms of performance, we’re dead last among developed countries. As a young physician embarking on a career in this landscape, it’s glaringly obvious that we need disruptive innovation to create better health at a lower cost. Physicians are uniquely positioned to make critical contributions to medical innovation, but even among …

Health Policy

Freestanding emergency departments: The model we need to study

Joshua Elder, MD, MPH

June 6, 2016Jun 6, 2016

I recently took care of a woman in her 50s that came to our emergency department (ED) complaining of chest pain. The pain had started shortly before arriving in the ED but within minutes, we performed a battery of tests, treated her pain, and gave her an aspirin. Still concerned about heart disease being the cause of her pain, I observed her overnight in our EDs observation unit and completed …

Real physician voices, twice a week

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