Let me post a question that neither I nor readers can answer: How much of what I do during the course of a day directly benefits patients?
Perhaps, I don’t want to really know as I would be dismayed at how much of my effort benefits no one. Ask a nurse who works on a hospital ward, how much of his or her effort is directly applied to patient care. I would …
Most of the documentation physicians perform don’t help patients
Diverticulitis is a common and sometimes serious problem that affects several hundred thousand people each year. Diverticulitis is the condition where small outpouchings or “pockets” in the wall of the large intestine called diverticula become inflamed and infected, and typically presents as a constant lower abdominal pain, associated with fever or chills, and often bloating or constipation symptoms. Despite becoming even more common in recent years, not much is understood …
Seeds, popcorn, and nuts in diverticulitis: fact and fiction
If any reader has heard of C. difficile, affectionately known as C. diff, then I presume you have had closer contact with this germ than you would have liked. It’s an infection of the colon that can be serious, or even fatal. There isn’t a hospital in the country that isn’t battling against the infection.
We are not winning the war against this crafty and cunning adversary.
While the infection is not …
C. difficile: We are not winning the war against this cunning adversary
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 32-year-old woman is evaluated for a 2-month history of weight loss, abdominal cramping, and loose stools. Her stools are malodorous, but she has not noted any blood associated with her bowel movements. Although her appetite is good, she has lost 3.2 kg (7.0 lb). She has an 8-year history of diffuse …
MKSAP: 32-year-old woman with weight loss, abdominal cramping, and loose stools
Gastroenterologists, as specialists, are called upon by other doctors to address digestive issues in their patients. For example, our daily office schedule is filled with patients sent by primary care physicians who want our advice or our technical testing skills to evaluate individuals with abdominal pain, bowel issues, heartburn, rectal bleeding and various other symptoms. The same process occurs when we are called to see hospital patients. If a hospital …
Why are you seeing the gastroenterologist?
When asked to describe my career, I consider myself primarily a clinician educator. Recently I have reflected on the influences that allowed me to have a successful career doing what I love. This post is not meant to mention all those influencers, but just some that I recall often. As I have thought about this post, I quickly realized that all the “heroes” that I recall focused on clinical education. …
An ode to great clinician-educators
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 58-year-old man is evaluated in follow-up for hepatitis C-related cirrhosis that is complicated by nonbleeding small esophageal varices and ascites. His ascites has recently worsened and has required large-volume paracentesis three times per month. He has been on a low-salt diet, spironolactone, and furosemide.
On physical examination, temperature is 36.8 °C (98.2 …
MKSAP: 58-year-old man with hepatitis C-related cirrhosis
We all know what, in 1888, Rudyard Kipling pronounced to be the world’s oldest profession. But what’s the world’s second oldest? Hunter-gatherer? Nah, everybody did that. Primitive politician? That’s a tautology. Neolithic attorney? Nope. Too similar to the oldest.
I strongly suspect that the second oldest profession was healer/magician. Fire up Mr. Peabody’s Wayback time machine, and you’d probably find that the first healers were regarded as magicians, and the first …
Physicians and magicians are not as different as you think
Most of us do not know the basics of economics, although we should. It impacts every one of us every day that we are alive. Yet, for most of us, once we get beyond the law of supply and demand, our knowledge of the subject starts to vaporize. I can’t explain fiscal or monetary policy. While I regard economics as a science, it seems that experts routinely interpret data differently, …
The cost of drugs confounds this gastroenterologist
As an oncologist, I have spent my career learning how to break bad news. I am still not entirely sure how to tell my children about the tumor in my pancreas, why I will be gone from our home next week for a Whipple operation, or my excuse for abstaining from wrestling matches for the foreseeable future.
I am blessed with two kids, temperamentally diametric: a careful, sagacious nine-year-old daughter and …
Cancer doesn’t take away from the beauty of life
I’ve known that I’ve had tumors in my pancreas since 2009. Until now I’ve done nothing about them.
This might sound like a counter-intuitive, even foolhardy strategy, especially for an oncologist, who should surely know better than to let his disease gain an advantage through his own inaction. But I don’t have the “usual” type of pancreatic cancer, the kind that claimed the life of Patrick Swayze and has sentenced many …
After 8 years, this doctor is finally treating his pancreatic tumors
I bought a pocket ultrasound in 2011, determined to learn how to perform and interpret ultrasound at the bedside and thus transform my internal medicine practice. I bought it new, and it cost over $8,000. That was a staggering amount of money to spend on something I knew very little about. In 2015 after having performed many thousand ultrasound exams with my little GE Vscan with the phased array transducer, …
4 times a bedside ultrasound made a difference this week
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 58-year-old man undergoes follow-up evaluation for cancer of the ascending colon diagnosed 3 weeks ago. Colonoscopy at that time revealed a fungating mass in the ascending colon. Biopsy revealed adenocarcinoma, and additional studies showed no evidence of metastatic disease. Right hemicolectomy was performed. The pathology report showed a 4-cm primary adenocarcinoma …
MKSAP: 58-year-old man with cancer of the ascending colon
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At 3 1/2 years old, my son was the picture of health. I have an actual picture. He is in jammies, wearing my sunglasses, laughing and chalk coloring the driveway while the sun is shining on his blond hair. That picture frequently flashes in my mind. I posted it on Facebook, my happy, healthy boy. There was no warning and nothing to prepare me for the months ahead.
First, it was …
How Frozen saved my son in a way medicine couldn’t
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 54-year-old man is evaluated for a 4-month history of intermittent, nonprogressive solid-food dysphagia. He has a long-standing history of heartburn that has been well controlled with once-daily proton-pump inhibitor (PPI) therapy for the past 5 years. Results of a screening colonoscopy 4 years ago were normal. There is no family history …
MKSAP: 54-year-old man with dysphagia
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 67-year-old woman is evaluated during a routine examination. She has a history of hip and knee pain related to degenerative joint disease. The joint pain is now well controlled with diclofenac, which was started 3 months ago. A previous trial of high-dose acetaminophen was not effective. She does not have any …
MKSAP: 67-year-old woman who takes diclofenac
An excerpt from Looking Out for Number Two: A Slightly Irreverent Guide to Poo, Gas, and Other Things That Come Out of Your Baby.
Early bowel patterns | What’s normal
As we learned, the poo patterns of new babies don’t settle in until a week or two after birth.
And …
How to prepare your baby for the perfect poo
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 57-year-old woman is evaluated after a recent screening colonoscopy. The colonoscopy disclosed a 12-mm polyp in the ascending colon, which was removed. No other lesions were noted. On pathology, the lesion was found to be a sessile serrated polyp.
Physical examination findings are unremarkable.
Which of the following is the most appropriate time …
MKSAP: 57-year-old woman is evaluated after a recent screening colonoscopy
I was covering for my partner over the weekend and saw his patient with end-stage liver disease, a consequence of decades of alcohol abuse.|
He was one of the most deeply jaundiced individuals I have ever seen. His mental status was still preserved. He could converse and responded appropriately to my routine inquiries, although he was somewhat sluggish in his thinking. It’s amazing that even after the majority of a liver …
Physicians are under no professional obligation to provide care that is futile
What should a medical consultant do when the referring physician wants a procedure that the consultant does not favor?
Of course, this sounds like a layup. The consultant, readers would surmise, should have a conversation with the referring colleague to explain why the procedure is not in the patient’s interest. The colleague then thanks the consultant for his thoughtful input, and for sparing the patient from the risks and expense of …
The sad reality that medical consultants face
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