Gastroenterology

How should salespeople sell to doctors?

Physician
January 21, 2019

Two device salesmen recently came unannounced to our small private gastroenterology practice. They were hawking a product that could quickly and non-invasively determine how much scar tissue had formed in a patient’s liver, a useful tool for assessing patients with hepatitis and many other liver conditions.

We are physicians, not entrepreneurs. We do not regard the colonoscope as a capitalist tool. Yet, these two salesmen were barraging us with facts and …

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Physician gives in to police pressure to conduct a forced invasive rectal exam

Physician
January 7, 2019

Recently, news broke about a disturbing act of medical battery carried out by doctors at St. Joe’s Medical Center in Syracuse, New York. The case began when police officers conducted a pretext stop and elected to harass their victim about a small amount of marijuana.

As the situation escalated, the cops took the man to St. Joe’s Medical Center for him to be searched for …

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A clinician’s guide to microbiome testing

Conditions
December 17, 2018

The intestinal microbiota, also commonly known as the ‘‘gut microbiome’’ is integral to human physiology and has wide-ranging effects on the development and function of the immune system, energy metabolism and even nervous system activity. There is a lot of excitement around the potential of targeting the microbiome therapeutically to promote health and to prevent or treat medical conditions. Further, as DNA sequencing technologies and computational methods …

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Which of these patients should get a liver transplant?

Conditions
July 7, 2018

People with liver failure and cirrhosis die every year because there are not enough livers available. Who should receive the treasured life-saving organ? There is an organ allocation system in place, which has evolved over time, which ranks patients who need liver transplants. Without such a system, there would be confusion and chaos. How can we fairly determine who should receive the next available liver? What criteria should move a …

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MKSAP: 78-year-old man with symptoms of dysphagia

Conditions
June 9, 2018

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

A 78-year-old man is evaluated for symptoms of dysphagia that began 2 weeks ago. When he eats, he starts coughing after the first bite of food and occasionally has nasal regurgitation.

On physical examination, blood pressure is 135/90 mm Hg, pulse rate is 78/min, and respiration rate is 12/min. Left-sided weakness is noted in both extremities, …

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A surprising cause of rectal bleeding

Conditions
May 2, 2018

“I can’t stand the site of blood!”

We’ve all heard that adage. Blood can provoke emotional reactions from even steely muscle-bound bodybuilders. We gastroenterologists routinely receive fearful phone calls from patients who have observed even minor rectal bleeding. Fortunately, in most of these cases, there is a benign explanation for the sanguinary seepage.

If blood repels you, then gastroenterology should not be on your short, or even long list of professions under …

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MKSAP: 41-year-old woman with burning epigastric and chest pain

Conditions
April 7, 2018

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

A 41-year-old woman is evaluated in follow-up after presenting to the emergency department 1 week ago for burning epigastric and chest pain. In the emergency department, a complete blood count and liver chemistry studies were normal, but a radiograph of the chest and upper abdomen demonstrated calcified gallstones. The pain resolved with administration …

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What you should know about colon polyps

Conditions
March 22, 2018

When it comes to colon cancer prevention, the polyp is the key player to know. Colon polyps, called adenomas, are precancerous growths originating from the inner lining of the colon wall. There are other types of polyps in the colon which are not considered precancerous, but for our purposes in this article, we will consider the terms colon polyp and adenoma to be …

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Fixation error can be deadly in medicine

Conditions
February 26, 2018

John Grover is a nice guy. He’s fifty-five, short, a little chubby, and he has a neatly trimmed red beard. He’s the kind of guy whose eyes light up the moment you walk into the room; The kind of guy who remembers your kids’ names, their ages, and their interests. I’d met him a few times before. He’d come in once to refill his blood pressure medication because he couldn’t …

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It’s time to treat C. diff diarrhea

Conditions
February 20, 2018

For millennia, blood-letting was the standard of care for many diseases; today it is a joke, evoked only to mock our predecessors.  But it is time to dismount our high horse and realize that there is at least one infection that we still primitively try to drain from the body, not from the bloodstream, but from the colon.  This is our friend Clostridium difficile.

According to the CDC, there are about …

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Learn about Clostridium difficile infection with a Medcomic

Conditions
January 8, 2018

Clostridium difficile is a gram-positive anaerobic bacillus which secretes toxins (A and B) that cause diarrhea and pseudomembranous colitis. C. difficile is the most common infectious cause of nosocomial diarrhea. Transmission of C. difficile can occur from contact with contaminated humans and fomites. The organism contains endospores that can survive the acidity of the stomach and reach the large intestine.

C. difficile colonizes the intestinal tract after the normal …

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Burnout during residency? Yep, and here’s what it taught me.

Physician
November 9, 2017

You’ve probably heard this story before: a young physician, who has spent all of his or her life succeeding and building goals, stumbles into a career without meaning or enthusiasm. Indeed, my story about burnout is much like the rest.

Like so many before me, I entered into a career in medicine motivated and eager to change the world through the care of my patients. I grew up in a family …

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Seeds, popcorn, and nuts in diverticulitis: fact and fiction

Conditions
November 2, 2017

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 …

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MKSAP: 32-year-old woman with weight loss, abdominal cramping, and loose stools

Conditions
October 21, 2017

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 …

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Physicians and magicians are not as different as you think

Physician
September 27, 2017

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 …

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MKSAP: 68-year-old man with new-onset ascites

Conditions
April 22, 2017

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

A 68-year-old man is evaluated for new-onset ascites with lower-extremity edema. Symptoms have increased gradually over the past 4 weeks. He has consumed three alcoholic beverages per day for many years. His medical history is notable for coronary artery bypass graft surgery 8 months ago and dyslipidemia. His medications are low-dose aspirin, atorvastatin, …

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Do patients with celiac disease need probiotics?

Conditions
January 28, 2017

One of the most common questions that I receive from patients diagnosed with celiac disease is if they should take a probiotic. The only available treatment for celiac disease, an autoimmune disease characterized by destruction of the absorptive surface of the small intestine which develops in genetically compatible individuals, is a gluten free diet. However, patients and providers often question whether supplementation with probiotics may hasten the healing process.

Probiotics are …

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When should physicians lie for patients?

Physician
August 17, 2016

Even the most honest among us do not tell the truth all of the time.  We are flawed human beings.  We covet, we gossip, we steal, we lie, and we stand idly by. You don’t think you steal?   Have you ever “borrowed” someone else’s idea and represented it as your own?

A few weeks before I penned this, I was presented with two opportunities to lie in order to save a …

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Open access endoscopy raises potential ethical issues

Conditions
July 2, 2016

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 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 …

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How marriage affects men’s colonoscopy rates

Conditions
May 31, 2016

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 …

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