Gastroenterologists and physicians writing on KevinMD about digestive disease: colonoscopy and when to stop screening, celiac disease and gluten, the liver, pancreatic enzyme insufficiency, the tests marketed for leaky gut, and what patients are fed in hospitals. Board-review cases make up part of this archive. One maintained record draws on this archive: Cancer: what physicians say, in their own words.
Research radiologists at the Massachusetts General Hospital in Boston evaluated the accuracy and detail of imaging the colon (a virtual colonoscopy or colonography) with no laxatives as preparation and comparing it with traditional colonoscopy. There are clear evidence based guidelines suggesting that all low-risk men and women have a screening for colon cancer with a colonoscopy at age 50. If that study is normal they are directed to repeat it …
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Is there a role for the laxative free virtual colonoscopy?
When I see patients in the office, I try to guess their occupations from their demeanor and mannerisms. Salesmen are the easiest to ID. In general, they are gregarious males with manly handshakes. They laugh loudly and like to tell jokes. Teachers are more reserved and often give their narrative in a logical and chronological order, as would be expected. Another clue that the patient is an educator is that …
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How should physicians give bad news to patients?
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 25-year-old woman is evaluated for a 2-year history of almost daily bloating and lower abdominal cramping; the symptoms are associated with constipation, relieved with bowel movements, and seem worse when she is under stress. She has one or two small bowel movements a week and often has a feeling of incomplete evacuation. She …
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MKSAP: 25-year-old woman with bloating and abdominal cramping
Some time ago, I endured a medical staff meeting, where attendance is taken and 50% attendance of all meetings is required. I learned that they are serious about this rule when, a few years ago, I was demoted from active staff when I failed to attend enough meetings. This demotion did not demoralize me, as I was only losing my right to vote, which I did not regard as a …
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Contaminating medicine with mercenary incentives
My mom passed away last December to Stage V breast cancer metastasized to her liver. During this battle she developed ascites (an accumulation of fluid in the peritoneal cavity) as her liver failure progressed. This accumulation of fluid was not only extremely uncomfortable but painful as well. In an attempt to find symptomatic relief for the last months of my mom’s life, the oncologist presented us two options: we could …
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The tragic outcome of a decision to minimize costs
Patient satisfaction is an important element of medical care. It was always important, but it has taken on a new significance since hospitals and physicians will be graded on their bedside manners. And, these grades count for cash. Money motivates. Who believes that a leopard can’t change its spots? Throw a leopard into the pay-for -performance arena, define spots as inferior quality, and watch what happens. We would all witness …
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Finding the right model for patient satisfaction
It always has broken my heart to see a person bankrupted by the costs of their healthcare. I remember my outrage when I first learned the only people who pay full price for their medical procedures are the ones paying cash. Insurance companies use their market muscle and patient volumes to negotiate discounts for their patients that have always been unavailable to the uninsured, individual healthcare consumer.
If you have been …
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Hide your health insurance status and pay cash instead
There’s nothing better than sitting down with a patient, going though an entire visit, and collaborating on a well thought out plan that meets everyone’s expectations.
Shared decision making is a wonderful and necessary concept in modern patient care. Paternalistic attitudes are fading away in the medical community as the next generations of doctors continue to get educated on how to manage patients who are very knowledgeable and yearn to be …
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Shared decision making is a necessary concept in modern patient care
The ability to critically assess the validity of a clinical trial is one of many important skills that a physician strives to develop. This skill helps guide clinical decision-making, and there are a number of things that we are trained to look for to help determine the validity of any given study. Right at the top of the list of factors that go into this appraisal is that of study …
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How placebo treatment may be helpful
There are some patients we doctors never forget. They linger in our memories for various reasons. Often, it is their serious or unusual medical condition that stays with us. On other occasions, it is a zany or unique personality that we recall, even years later. Rarely, when the doctor-patient relationship becomes injured, then the patient may become unforgettable.
I remember a particular patient from 20 years ago for a very different …
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Patients are our best teachers
Can you say “reactance”? Don’t feel bad, I wasn’t familiar with the term either until recently. But as you will see, anyone that has ever been a patient will catch on pretty quickly as to what reactance is and how it works.
Reactance is how we respond to something that threatens to limit or eliminate our behavioral freedom. I recently experienced reactance in the course of “prepping” for a colonoscopy. The …
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Minimize reactance in your health organization
Using data from Medicare and private insurers, analysts at the RAND Corporation found that the rate of involvement of anesthesiologists for upper GI endoscopy and colonoscopy in low-risk patients had risen steadily over the last few years and is estimated to add $1.1 billion in what may be unnecessary health care costs. There was wide regional variation in the use of anesthesiologists which suggests that some or most of the …
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Why more colonoscopies need anesthesiologists
“It is getting worse everyday.” “Medicare fix at the last moment.” “Too much paperwork not enough time with patients.” “ACO’s and bundling.” The headlines scream at us everyday.
If we have one word that underlies the medical community it is fear.
The looming uncertainties of reimbursement, insurance changes, electronic medical records and new regulations form the main topic of doctor worry talk. The country’s health system remains in perpetual flux and catching …
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Doctors need to find meaning in their work
If you really want to know what’s going on inside your colon, don’t show-up for a colonoscopy without a clean colon.
Many say that preparing for the colonoscopy is the worst part of the entire exam. But, it just so happens that it’s also the most important part.
If the prep is done right, it’s easier for your doctor to see not only big polyps but also flat polyps, which can be …
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How to prep for a successful colonoscopy
I was jogging one day while on a business trip in LA and collapsed during the run. Within hours, I was at the hospital at UCLA Medical Center on a gurney headed for a CT scan of my abdominal cavity. I remember telling the ER physicians that I was a doctor and recommending my own course of action. As my advice to the ER doctors went largely ignored, I realized, …
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A diagnosis of stomach cancer profoundly changes an oncologist
Losing weight can help lower your chances for cancer if you’re overweight or obese.
But not just any weight-loss plan will give your body the nutrients it needs to fight off diseases like cancer.
Below, I’ve separated out the good from the bad among popular diets.
Good nutrition is not a fast fix
Diets that make the “good list” encourage long-term change. They also give you a variety of options from all …
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What you need to know about popular diets
Test your medicine knowledge with the MKSAP challenge, in partnership with the 
