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 …
I will not let medicine dehumanize me
Like nearly every gastroenterologist, we have an open access endoscopy system. This means that patients can be referred, or refer themselves, directly to our office for a procedure without an office visit in advance.
Why do we do this? We offer it as a convenience, so patients do not need to make two visits to see us when it is clear that a procedure is necessary. For example, a referring physician …
Open access endoscopy raises potential ethical issues
“I need help with my colitis.”
“Really? I thought we had things pretty well controlled.”
I hadn’t seen her in the better part of a year. I remembered how hard it had been to get her ulcerative colitis into remission. How sick she had been, how miserable her life was. There was a bit of trial and error in the office, followed by a hospitalization for intravenous steroids, then a tapering dose …
People are going broke because they can’t afford care. It needs to end.
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 68-year-old woman undergoes upper endoscopy for evaluation of dyspepsia. She has a history of pernicious anemia. She has no other medical problems and her only medication is oral vitamin B12.
On physical examination, vital signs are normal, as is the remainder of the physical examination.
Upper endoscopy discloses a 6-mm polyp in the body of the …
MKSAP: 68-year-old woman with dyspepsia
A good friend of mine recently found herself between jobs, with a gap in her health insurance and a recurrence of her kidney stones. What she needed were fluids and pain relief, fast. I’m a gastroenterologist, and hoping to minimize the financial impact, I went with her to our local ER and had a conversation with the attending physician. Maybe we could pass on the CT scan and extraneous lab …
When it comes to your health care, buyer beware
Did you know that married men have a lower colorectal cancer mortality when compared to unmarried men? What about the fact that married men have higher rates of colorectal cancer screening? Interesting, right? In fact, studies showing the association between marriage and favorable behavior regarding colon cancer screening have been published as early as 2010.
More recently, a study published in the journal Preventive Medicine found that married men are …
How marriage affects men’s colonoscopy rates
I recognized a glitch in my electronic medical record’s decision support software when it prompted me to consider prostate and colorectal cancer screening in a 93-year-old man, who, though remarkably vigorous for his age, was unlikely to live for the additional 10 years needed to benefit from either test. Although deciding not to screen this patient was easy, determining when to stop cancer screening in older patients is often more …
How to discourage overuse of cancer screening in older adults
Of course, patients are entitled to medical care around the clock. You would not expect to show up at 2 a.m. at an emergency room to find a “closed” sign. If you are having chest pain on a weekend, and you call your doctor’s office, you should expect a prompt response from a living and breathing medical doctor. Patients are aware that when they call the doctor at night, that …
How can we take care of patients we have never seen?
An excerpt from What It’s Like to Become a Doctor: The Year-by-Year Journey From Medical Student to Practicing Physician, Greenbranch Publishing, 2016.
I passed the board exam in November 2011 to become a gastroenterologist. This is the last exam I have to take until I recertify in internal medicine in 7 …
This is what life is like for a gastroenterologist
Over the past week, while covering the inpatient gastroenterology service, we cared for three patients who were hospitalized with gastrointestinal bleeding who were found to have large, potentially life-threating, stomach ulcers. All three of the patients had abruptly stopped their acid-suppressing proton pump inhibitor (PPI) medication in the preceding 1 to 2 weeks. With PPIs being a primary therapy for gastroesophageal reflux and ulcer treatment, why would these patients have …
Dementia from PPIs: A hypothesis that may have led to gastrointestinal bleeding
An excerpt from What It’s Like to Become a Doctor: The Year-by-Year Journey From Medical Student to Practicing Physician, Greenbranch Publishing, 2016.
My third year of fellowship: June 2010 — July 2011
In July 2010, I began my third and final year of fellowship. This year was focused on honing all the skills we …
A gastroenterologist looks for his first job. Here’s his story.
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 55-year-old man is evaluated in follow-up after a recent routine screening for antibody to hepatitis C virus (HCV) was positive. His medical history is unremarkable; he has not used illicit drugs or had any history of blood transfusions. He currently feels well and takes no medications.
Vital signs and physical examination are normal.
Laboratory studies reveal …
MKSAP: 55-year-old man with hepatitis C virus (HCV)
The microbiome is among the hottest topics in medical and scientific research. The National Institutes of Health and private foundations have invested hundreds of millions of dollars in research to define and characterize the human microbiome. In the next decade, billions more will be devoted to deciphering how microbes influence human health in a positive manner. The White House even issued a national call to action for …
A gastroenterologist shares practical advice on probiotics
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Although it is still early, 2016 is already shaping up to be a year to remember in science: Long-postulated gravitational waves were finally discovered, the CDC scrambles to battle Zika virus on multiple continents, and long-awaited clinical testing begins for a new HIV vaccine.
But these accomplishments all pale in comparison to the monumental study published in the American Journal of Gastroenterology titled “Read more…
What you don’t know about anal sex. A gastroenterologist explains.
Your primary care doctor has been nagging you for years. Your wife and brother seem to be in on the scheme too. Every once and a while one of your coworkers even says (with a chuckle) “C’mon Bob, you’re fifty-seven, you really need to get it done!”
“OK, enough,” you finally say, “I’ll go for a colonoscopy!” So at your next visit you ask your primary doctor how to set it …
Should you have a precolonoscopy visit? The answers may surprise you.
Years ago, I was having dinner with two members of the Cleveland Orchestra, one of the finest orchestras in the world. I asked them, with my kids present, how much time they devoted to their craft. As many parents know, getting kids to commit to practicing a musical instrument is about as easy as splitting the atom. The musicians told us how much time they practiced, which was mind boggling, …
Do physicians who go on long vacations lose their skills?
You see your gastroenterologist with long-standing stomach pain. You have undergone a reasonable evaluation and all the endoscopic bodily invasions, and imaging studies of your abdomen have been normal. Repeated lab work provides no clue explaining your distress. You have been twice to the emergency room and were sent home with prescriptions that didn’t work. You are frustrated and so is your gastro guy. You are convinced that there is …
Don’t rely on Google for medical judgment
A patient came to the office and refused to see me, although I was quite willing to see him. I’ll present the scenario followed by the patient’s reason he took an abrupt U-turn. Then, if you are inclined, you may offer your own advice and comment.
I performed a colonoscopy on this patient and found a large polyp in the upper part of the large intestine, or colon. The upper part …
Is it the doctor’s fault if a patient doesn’t want to come in?
Everywhere you go, you can see people from all walks of life sporting some pretty cool tattoos. Tattoos are so popular nowadays that they’re almost conformist. I consider myself really hip since I don’t have any tattoos; how avant-garde! However, that doesn’t mean I don’t appreciate good ink when I see it. As a matter of fact, I even dabble as a tattooist sometimes.
It is common practice to leave a permanent tattoo at …
Gastroenterologists are the tattoo artists of medicine
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 50-year-old man is evaluated in follow-up after hospitalization 6 months ago for a large bleeding gastric ulcer. Tests performed for Helicobacter pylori infection at that time were negative. However, for the 3 months before hospitalization he had been taking ibuprofen for chronic back pain. He was discharged from the hospital on omeprazole, and his ibuprofen …
MKSAP: 50-year-old man with a large bleeding gastric ulcer
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