Endocrine care

269 articles · Since 2011

Articles, page 7

The hidden curriculum of medical school can be overwhelming and unforgiving

March 10, 2019Mar 10, 20194

I met Mr. B during my week on the endocrine service of my internal medicine rotation. My attending told me we were being consulted for this patient’s high sugars and a foot ulcer, and asked me to take the history.…

I walked into Mr. B’s room and was immediately struck by its stench. Mr. B had undergone a resection of his bladder tumor the day before and as a result was …

Conditions and diseases

MKSAP: 40-year-old man with a new skin rash of 10 days’ duration

mksap

March 9, 2019Mar 9, 2019

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 40-year-old man is evaluated for a new skin rash of 10 days' duration. The rash appeared abruptly and is not tender or pruritic.…

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

A 40-year-old man is evaluated for a new skin rash of 10 days’ duration. The rash appeared abruptly and is not tender or pruritic. The patient has poorly controlled type 2 diabetes mellitus. His current medications include metformin and glyburide. Family history is unremarkable.

On physical examination, vital signs are …

Medical education

Remove your blindfold to your patient’s pain

Christina Abi Faraj

March 8, 2019Mar 8, 20192

“We pass through the present with our eyes blindfolded … Only later when the cloth is untied can we glance at the past and find out what we have experienced and what meaning it has.” – Milan Kundera Two days…

Two days ago, during a clinical skills session on lymph node examination, my classmates insisted that I get what appeared to be an enlarged lymph node in my neck checked by the physician …

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Physician voices

Mainstream medicine needs to play offense

HD, MD

February 7, 2019Feb 7, 20195

Last summer, I published a post called "Alternative Medicine is Kicking Our Ass." In it, I focused on one particularly slick alt-thyroid site that has done a masterful job of sowing doubt regarding the advice mainstream physicians give to our…

Last summer, I published a post called “Alternative Medicine is Kicking Our Ass.” In it, I focused on one particularly slick alt-thyroid site that has done a masterful job of sowing doubt regarding the advice mainstream physicians give to our patients about the thyroid. Not only that, but the site has called into question our competency as doctors, citing “evidence” that supposedly proves (it doesn’t) we …

Conditions and diseases

MKSAP: 60-year-old man with a variable 2-hour postprandial blood glucose

mksap

December 22, 2018Dec 22, 2018

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 60-year-old man variable 2-hour postprandial blood glucose is evaluated during a routine follow-up examination. He has type 2 diabetes mellitus. Review of his…

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

A 60-year-old man variable 2-hour postprandial blood glucose is evaluated during a routine follow-up examination. He has type 2 diabetes mellitus. Review of his blood glucose log demonstrates fasting blood glucose values ranging from 120 to 160 mg/dL (6.7-8.9 mmol/L) and variable 2-hour postprandial blood glucose values ranging from 50 to 190 mg/dL …

Medical education

How to foster and encourage genuine, curious learning in a medical student

Jamie Katuna

December 16, 2018Dec 16, 2018

I just had a conversation with a physician and faculty member at my school. He started the conversation like this: “It’s alright if you disagree with me, and I can disagree with you too. Good academic discourse should allow people…

He then allowed me to question him and explain my perspectives for over an hour as he explained his answers, helped clarify some points, and gave …

Physician voices

What this physician learned after coming back from a medical crisis

Linda Girgis, MD

November 30, 2018Nov 30, 2018

Medical crises come in many forms: from illnesses to sudden injuries. Most often the victims are unsuspecting. They may be gradual in onset or happen in seconds. There are many causes, from faulty drivers to electrolyte disturbances. Mine was caused by a squirrel, a routine yard rodent. In less than three seconds, I went from a practicing physician with a heavy patient load to temporarily disabled.

Returning home from a busy …

Conditions and diseases

How technology removes the pain point from diabetes management

David Ahn, MD

November 17, 2018Nov 17, 20183

There is a wealth of information about your health circulating in your blood. For people with diabetes, accessing that information can be a matter of life or death. For nearly 30 years, the prevailing technology for checking the blood sugars…

There is a wealth of information about your health circulating in your blood. For people with diabetes, accessing that information can be a matter of life or death.

For nearly 30 years, the prevailing technology for checking the blood sugars of someone with diabetes has been the fingerstick. People with diabetes are often asked to stick their fingers and check their blood multiple times a day to assess whether their blood …

Conditions and diseases

Explain hemoglobin A1c in 2 minutes

Adeleke Adesina, DO

November 5, 2018Nov 5, 20183

It was a slow day in the emergency department. I was sitting across the bedside from my patient who came in for a left forearm infection checkup. She was a 73-year-old female with a history of diabetes. She was elegant and soft-spoken. Prior to examining her wound, which had been worsening, I asked her what her A1c number is. She wondered what an A1c number was, and I explained that …

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Explain hemoglobin A1c in 2 minutes

Conditions and diseases

MKSAP: 25-year-old woman with type 1 diabetes mellitus

mksap

September 22, 2018Sep 22, 2018

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 25-year-old woman with type 1 diabetes mellitus is evaluated for recent-onset glycemic fluctuations without symptomatic hypoglycemia. She was diagnosed with diabetes 7 years…

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

A 25-year-old woman with type 1 diabetes mellitus is evaluated for recent-onset glycemic fluctuations without symptomatic hypoglycemia. She was diagnosed with diabetes 7 years ago. Her HbA1c levels since diagnosis have ranged from 6.4% to 7.3%, with the most recent value at 7.3%. She reports eating a carbohydrate-consistent diet at each meal, with …

Conditions and diseases

MKSAP: 57-year-old man with type 2 diabetes mellitus

mksap

August 11, 2018Aug 11, 2018

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 57-year-old man with a 15-year history of type 2 diabetes mellitus is evaluated for bilateral burning sensation in his feet for the last…

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

A 57-year-old man with a 15-year history of type 2 diabetes mellitus is evaluated for bilateral burning sensation in his feet for the last 6 to 12 months. The sensation worsens at night. His HbA1c levels have remained less than 7.0% for the last 2 years but were between 8.0% and 9.0% before …

Conditions and diseases

MKSAP: 55-year-old woman with an eating disorder

mksap

July 23, 2018Jul 23, 2018

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 55-year-old woman is evaluated for a new-patient visit. Medical history is significant for an eating disorder. Although she has maintained a normal weight…

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

A 55-year-old woman is evaluated for a new-patient visit. Medical history is significant for an eating disorder. Although she has maintained a normal weight for the past 20 years, she notes that prior to that time her weight would fluctuate in a range correlating with BMIs of 17 to 19. She has otherwise …

Physician voices

A return to the problem-oriented SOAP note

Robert Centor, MD

July 22, 2018Jul 22, 20186

CMS is changing note requirements, among other changes. Bob Doherty has a wonderful summary: "Medicare's historic proposal to change how it pays physicians." As always, we really will have a difficult time sorting out the unintended consequences of these changes,…

CMS is changing note requirements, among other changes. Bob Doherty has a wonderful summary: “Medicare’s historic proposal to change how it pays physicians.”

As always, we really will have a difficult time sorting out the unintended consequences of these changes, but they certainly seem like a move in the proper direction. To me the most important change is a focus on notes: “Allowing medical decision making to be …

Conditions and diseases

Patients are more than lab results

Johnathan Yao, MD, MPH

July 14, 2018Jul 14, 2018

I loved my endocrinology block in medical school. It was one of my favorite units. One hormone acts on another gland, which either induces a positive feedback releasing its successor hormone or a negative feedback blocking its predecessor. It was…

I loved the material so much that I reached out to an endocrinologist to shadow her. I wanted to see the power of what we were learning …

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Patients are more than lab results

Physician voices

My exit ramp from medicine

Richard Plotzker, MD

July 11, 2018Jul 11, 20184

One day, I was full of moderate despair, overworked, befuddled by the EHR with a tinge of burnout, staring at my computer, I treated myself to something I’ve not done before. It was my 62nd birthday that day, and I gave myself a birthday present. Before rising from that swivel chair, I had written down on a sticky pad the day that would be my retirement date, exactly one year …

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My exit ramp from medicine

Patient voices

A Black Panther for diabetics

Ariel Lawrence

April 27, 2018Apr 27, 2018

In mid-February, thousands flocked to the opening of Black Panther, a highly anticipated film for a multitude of reasons. The most salient of these is its depiction of an African king as Marvel’s and cinematic screen’s first culturally-affirming black superhero. In fact, Black Panther’s success is due to its emergence as a counter-narrative to painful and dysfunctional representations of black life. By normalizing the presence of black royals, diplomats, and …

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A Black Panther for diabetics

Physician voices

Computer algorithms don’t think like doctors

Richard Plotzker, MD

April 23, 2018Apr 23, 2018

Too often, residents want you to address something, so they don't have to — except for infectious problems where they putz around with antibiotics until lunchtime on Friday, then call ID. For me, one example seemed rather routine: a diabetic…

Too often, residents want you to address something, so they don’t have to — except for infectious problems where they putz around with antibiotics until lunchtime on Friday, then call ID.

For me, one example seemed rather routine: a diabetic with another medical illness. It wasn’t terribly well defined in the hospital records, but included atrial fibrillation and congestive failure at presentation. At day nine, with pressure from the DRG lady …

Conditions and diseases

MKSAP: 62-year-old woman with a left adrenal mass

mksap

March 24, 2018Mar 24, 2018

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 62-year-old woman is evaluated for an incidentally discovered left adrenal mass. Two weeks ago, the patient was evaluated in the emergency department for…

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

A 62-year-old woman is evaluated for an incidentally discovered left adrenal mass. Two weeks ago, the patient was evaluated in the emergency department for diffuse abdominal pain and vomiting. A CT scan was obtained that was normal except for the adrenal mass. Three hours after presentation to the emergency department, the pain resolved …

Medical education

In medical school, everything is a zebra

Jake Eggett

February 18, 2018Feb 18, 20183

As a medical student, I have big shoes to fill. I feel that void in my foot-space at all times. These shoes are expensive, and they are monstrously huge. We’re talking circus-clown, Shaquille O’Neal, Andre the Giant shoes. I feel awkward in these size 24s. I’m stumbling and scuffing them, but I’m not even close to calling it quits. These shoes are staying on. I am trying as hard as …

Conditions and diseases

MKSAP 27-year-old woman with type 1 diabetes mellitus

mksap

February 10, 2018Feb 10, 2018

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 27-year-old woman is evaluated for management of her type 1 diabetes mellitus. She was diagnosed 10 years ago. She has no known complications…

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

A 27-year-old woman is evaluated for management of her type 1 diabetes mellitus. She was diagnosed 10 years ago. She has no known complications from her diabetes. She eats a healthy diet and exercises an average of 60 minutes per day in the evening. She takes insulin glargine and insulin aspart. She is …

Endocrine care

Articles, page 7

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